Exciting news for gay, bisexual and straight men who have sex with men (MSM) in South Africa: Competent health services for MSM are being expanded in five provinces. This has been made possible by a significant five-year grant awarded to the Anova Health Institute by the United States President’s Emergency Plan for Aids Relief (PEPFAR), through USAID.
Health4Men, a project of the Anova Health Institute, was established in 2008 in response to the Department of Health’s (DOH) request for greater emphasis on MSM-competent health care and the development of a local model for providing such care. This request was in accordance with growing recognition of MSM as a key population for sexual healthcare in South Africa’s previous National Strategic Plan on HIV, Aids and STIs (2007 – 2011).
Over the next year Health4Men established two centres of excellence on MSM sexual health, in Cape Town and Soweto respectively, where we developed and refined a model for addressing HIV, sexually transmitted infections (STIs) and general sexual health among MSM.
Health4Men then piloted various aspects of this model in different settings, including a free-standing clinical site in Soweto; a site embedded in an existing Department of Health structure in the Western Cape; and the provision of services through an independent non-government gay and lesbian organisation in Pretoria.
All services rendered by Health4Men’s highly competent medical team were provided free of charge, including ARV treatment for HIV positive men. After the pilot period, only services embedded within existing DOH clinical sites were found to be sustainable.
At the same time Health4Men explored various means of attracting men into our sites. This entailed carefully monitoring which adverts and other media products brought men from different geographical areas to our clinics, allowing us to refine carefully nuanced messaging for diverse sub-groupings of men.
We complemented this approach by using focus groups of gay, bi and straight-identifying men to ‘test’ our messaging, a practice that is integral to the Health4Men model. This has allowed us to develop significant expertise with regard to both preventive and treatment-related messaging, culminating in a model for HIV and STI prevention and treatment that has been widely recognised for its innovative sex-positive approach.
Health4Men also dentified a need to promote a novel form of training for health workers. Instead of merely sensitising health workers to male-on-male sexual dynamics and addressing related prejudices and stigma, as other organisations were doing, we developed a facility-targeted approach that promoted medical competence. In effect, health workers trained by Health4Men are able to talk to men about their sexual preferences and behaviours, and can identify and treat anal sexually transmitted infections, including gonorrhoea and syphilis.
To date, the project has trained hundreds of health workers in Limpopo, Mpumalanga, Soweto and Johannesburg as well as in the Western Cape, and was invited to train medical personnel in Uganda earlier this year. We are flattered that other organisations in South Africa have taken cognisance of, and adopted, various aspects of the Health4Men model including the concept of facility-based training and an emphasis on competent medical services as opposed to mere non-prejudiced services.
Health4Men has augmented our training by including an emphasis on mentoring of health workers by Health4Men doctors and nurses to ensure a transfer of medical skill. In addition, we provide ongoing technical support and consultation to trained medical personnel, which includes the use of technology.
The project also established a robust research unit, undertaking both biomedical and psychosocial research into various aspects of men’s sexual health. The biomedical research team is led by our infectious diseases specialist, Dr Kevin Rebe who is based in Cape Town.
Over the past few months we conducted the first annual Health4Men Online Survey, with approximately 1 500 gay and bisexual men from throughout South Africa participating by answering questions about their relationship status, preferred sexual behaviours, online cruising, recreational substance abuse, on-line cruising and health-seeking behaviour.
Our psychosocial researchers are currently analysing data that will inform our ongoing preventive interventions. Previous psychosocial research has been undertaken in collaboration with Dr Andy Tucker, Acting Director of the Centre for Gender Studies at the University of Cambridge. Our collaborative research on MSM-targeted community outreach programmes has indicated, inter alia, an HIV prevalence rate of 35% among a sample of MSM residing in township areas surrounding Cape Town.
Health4Men currently provides free services in Cape Town, Yeoville (in central Johannesburg), Bellville, Khayelitsha and at Zola and Chiawelo, both in Soweto. These sites attract men from a wide geographical area. For example, men from Pretoria and other cities who travel to Johannesburg to visit the Yeoville site.
The new grant will allow Health4Men services to be extended in Gauteng and the Western Cape, in addition to a rollout of MSM competent sites into Limpopo, Mpumalanga and North West Province.
The five-year grant will culminate in South Africa having over one hundred MSM-competent sites where gay, bisexual and straight men who have sex with men will be able to receive quality health services without fear of homoprejudice or stigma. This extension of services will be implemented in close cooperation with the Department of Health on a national and well as on provincial and regional levels, enabling the five provinces to meet the objectives expressed in the current National Strategic Plan on HIV, STIs and TB (2012 – 2017), to address the sexual health of this key population.
The Health4Men team is excited about this very significant development which will allow us to provide greater access to care for vulnerable men and we look forward to engaging and sharing our expertise with various organisations and community groups as we move ahead.