More research is required to effectively respond to the high prevalence of HIV among men who have sex with men (MSM) in South Africa.

This was the call of numerous speakers at the second day of the Top2Btm symposium in Cape Town where researchers, medical professionals and policy makers met to discuss treatment, prevention and care of HIV for MSM.

According to Dr. Stefan Baral of the Center for Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health, HIV prevalence among MSM in a number of African countries (including South Africa) is markedly higher than the general population. Yet spending on research, prevention and treatment among MSM remains minimal.

“We see HIV incidence rates for MSM continue to increase in all studied countries,” Prof. Linda-Gail Bekker, Deputy Director of the Desmond Tutu HIV Center confirmed, adding: “We must advocate for more research.”

According to Bekker part of this research would need to include more studies on the efficacy of a rectal microbicide; products – in the form of gels or lubricants – that aim to reduce HIV infection during anal sex.

Creating ‘packages of prevention’

Bekker also called for the introduction of a series of specific HIV packages that are tailored to the needs of particular groups, including a package designed specifically for MSM.

But, Baral cautioned, “biomedical strategies can only have a limited impact if MSM live in fear, live hidden or have limited access to safe and effective clinical care.”

One way to increase access to information without fear of persecution may be the use of communication technology that allows MSM to access HIV information on their phones or personal computers.

According to Dr. Patrick Sullivan, Associate Professor of Epidemiology at Emory University’s Rollins School of Public Health, there are a range options for employing technology in the provision of sexual healthcare for MSM. This can include the use of electronic surveys to collect data or questionnaires administered before patients see doctors.

Typing information into an electronic form on their phone or PC thus allows MSM to be more open about their sexual practices, he explained.

Embracing this concept, last week Health4Men introduced a mobi site where MSM in South Africa can access HIV information and ask questions from their cellphones.

Training healthcare professionals

Not all interaction can be digitised and so much emphasis during the day was also on sensitivity training for counsellors, nurses and doctors. “Talking comfortably with your patient and getting a thorough sexual history is critical to providing good care,” emphasised Glenn de Swart, of the Anova Health Institute’s Health4Men project.

But providing comprehensive services for MSM requires more than an attitude shift and the elimination of prejudice in the healthcare system.

“As a patient, what you want even more than someone who is compassionate, is to be in the hands of a truly competent caregiver”, said Dr. Kevin Rebe, Medical Director at the Anova Health Institute’s Health4Men project.

As it stands, healthcare providers are not sufficiently skilled or experienced to identify MSM, know which medical issues to look for and how to treat them effectively.

For Prof. Vasu Reddy of the Human and Social Development Research Programme at the Human Sciences Research Council (HSRC), correctly addressing this would require the inclusion of MSM-related components and related biomedical issues in the medical curriculum for medical and nursing students.

Mainstreaming MSM

This would present a kind of “mainstreaming” of MSM services to create an environment in which MSM would not need to seek out a specialist doctor or nurse and instead can access treatment from any clinic.

“We like to go back to the biology with our training,” said Glenn de Swart of Anova’s Health4Men. “It’s not about identifying whether your patient is gay or straight, it’s about correctly addressing the risks of anal sex and talking about those risks it in a way that the patient will truly understand what you mean.”

Anal sex, after all is not something that is exclusively practiced by MSM and learning about the risks and correctly communicating those is critical for prevention efforts as a whole.

Talking openly about sex

Introducing MSM issues to clinics that traditionally provide a service to exclusively heterosexual patients may have positive effects for all patients.

During a discussion, one of the delegates Dr. Nelis Grobbelaar from Anova’s West Coast Winelands Project described his experience: “When we started some of the MSM sensitivity training, the clinic staff were very clearly not comfortable talking openly with their patients about their sexual practices. Through MSM training we are changing people’s minds – not just about homosexual sex but about sex in general.”

The Top2Btm symposium is hosted by the Anova Health Institute with support from PEPFAR.

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