Men who have sex with men (MSM) in Africa are twice as likely as the general population to be HIV positive – partly because their health needs are not being met.
Although, South Africa has made great strides in the provision of HIV-related healthcare services, the health needs of MSM are often misunderstood by healthcare practitioners and neglected in HIV service programmes, according to the Anova Health Institute.
Sensitising health facilities
Gordon Khoza, Anova’s outreach ambassador, said that the MSM community is stigmatised and discriminated against in health facilities.
“The MSM community is stigmatised in a way that they cannot access the health services fully like other populations, but we have started sensitising the health facilities so they can be MSM friendly,” Khoza told an MSM forum in Johannesburg attended by representatives from southern and eastern African countries.
Nine years ago, Anova established a model called Health4Men (H4M) to lead South Africa’s response to HIV among gay, bisexual and other men who have sex with men (MSM).
This model provides direct health care services at two centres of excellence in MSM sexual health care, and also by building support networks of MSM competent sites.
H4M’s David Motsoagae said that they are training public health facilities to become MSM friendly and provide services that ensure people’s dignity. “We are actually a bridge between H4M and the public health facilities,” said Motsoagae.
Not very competent
Anova’s Dr Kevin Rebe said that even when clinics were friendly towards MSM they were usually not asked about anal sex, and, as a result, they were not screened for their health care needs.
“You find that the clinic can be very friendly to the MSM but it is not very competent to meet their health care needs,” said Rebe.
In contrast, the H4M centres offered health interventions aimed at protecting men who have sex with men, such as offering antiretroviral drugs as pre-exposure prophylaxis (PreP).
“It is absolutely clear from multiple clinical trials that PreP will prevent HIV in MSM if used correctly even if they have high risks of sexual exposure to the virus,” said Rebe.
PrEP, for HIV prevention, involves the use of ARVs by HIV-negative people to reduce the risk of becoming infected. Daily TDF/FTC (a combination ARV marketed as Truvada) has been approved for use in populations at high risk of HIV by a number of national regulatory agencies. In late-2015, the World Health Organization recommended PrEP as an additional prevention option for HIV- negative people at substantial risk of HIV. According to a previous Health24 article, PrEP should not be viewed as the first line of defence against HIV, but in conjunction with other preventative measures, and should be taken daily.
According to Rebe H4M currently has two sites that are providing PreP for MSM, one in Cape Town and one in Johannesburg. He added that the Department of Health will also be increasing access of PreP to MSM as they will be opening new sites starting from April 2017.
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