"Missing Voices From The Field" is a collection of over 120 abstracts focused on the health and human rights of MSM and transgender people that were submitted for oral/poster presentation at the 2012 International AIDS Conference (AIDS 2012) in Washington D.C. and subsequently rejected after review by the conference organizers. This publication aims to provide an added venue to showcase valuable advances made by researchers, public health officials, and community members across all world regions to promote the health and human rights of MSM and transgender people.
Full-text versions of high-scoring abstracts and a description of the project are contained in the "Missing Voices" publication. Full-text versions of moderate-scoring abstracts are available on this page.
Download "Missing Voices" by clicking here.
14 Engaging US communities of color and sexual minorities in biomedical HIV prevention research and implementation advocacy: AVAC's PxROAR Program (Prevention Research, Outreach, Advocacy, Representation)
29 HIV-Related Sexual Risk Behaviour in Gay, Bisexual, and other Men who have Sex with Men (GB-MSM) in London, Ontario: Preliminary Findings from the Health in Middlesex Men Matters (HiMMM) Project Survey
61 Electronic medical records and short messaging service (SMS) in anti-retroviral therapy: Mobile health/electronic health (mhealth/ehealth) recommendations from a qualitative study among men who have sex with men and sex workers in Swaziland
By Wilson Zulu
Background: The response to HIV/AIDS in Zambia has often marginalized vulnerable groups like lesbians, gay, bisexual, Transgender and Intersex (LGBTI). A rights based approach necessitates that there is protection of the rights of those who are particularly vulnerable. Much ground in the area of HIV/AIDS in recent years can be said to have covered the country, this effort unfortunately, has not been all-inclusive. The work has been directed at heterosexuals, nothing has been done to address the specific needs of LGBT. Often, specific prevention & treatment needs of LGBT’s are lost in the bigger picture of the AIDS response.
Methods: In 2010, ZAPHIT undertook a study on LGBTI’s rights to access HIV related treatment and services in Lusaka, Zambia. The study included:- A literature review that looked at legislation, policy and other information related to this area.- A survey to identify specific training for personnel caring for HIV positive LGBTIs, types of treatment, testing and general health services available.
Results: There are many barriers that face LGBTIs in accessing HIV related services which include:- LGBT behaviour, continues to be illegal in most African nations, including Zambia- Absence of an appropriate legal and policy environment - Legislation that criminalizes same sex relationships between two consenting adults -Adherence challenges due to the fact LGBT people are in the closet and refuse to be associated with the LGBTI movement for fear of victimization.- Limited knowledge of health personnel regarding how to deal with LGBTs’ accessing services from their facilities- Non availability of rectal microbicides.
Conclusion: Based on the study, ZAPHIT will engage civil society in developing an advocacy strategy for LGBTI access to health services. It is also hoped that similar research can be done in Zambian prisons where inmates have more obstacles to access some condoms.
By Steve Goodrich; Dane Richardson; Kandasi Levermore
Background: Deaf MSM in Jamaica bear the double burden of being marginalized based on their disability and stigmatized based on their sexual orientation. Existing public health facilities do not provide interpreters to facilitate communication between the deaf and health care professionals. Confidentiality is compromised as deaf clients rely on friends/family members as interpreters when seeking health advice/services.
Methods: JASL through its Deaf MSM programme seeks to build awareness and provide psychological services to the population in order to understand and address issues related to risk of HIV infection. Beginning May2011, support groups are conducted in five areas across the country with the assistance of the only psychologist in Jamaica serving the deaf community. Staff also refer clients to JASL clinics and other MSM friendly health services. Meeting attendance and agendas are documented.
Results: • 51 deaf attendees are served through support group meetings monthly. • 82 % of deaf support group attendees have consistently attended 4 and 8 meetings • 21 deaf MSM attending meetings • 29 non- MSM deaf were also engaged in the meetings (14 Sex Workers, 2 Women who have sex with women,11 heterosexual males and 4 heterosexual females) • 9 MSM, 2 MSM SWs and 5 deaf PLHIV were referred to the JASL clinics. • 22 deaf support group attendees accessed VCT • 1230 male condoms, 52 female condoms and 94 lubricants were disseminated support group attendees
Conclusions: JASL has seen an almost 50% increase in the number deaf individuals that have received HIV and STI information, safer sex commodities and those tested for HIV. There is a higher demand for in rural areas based on the lack of interventions with the population. Importantly, the advent of the support group for deaf MSM has created in-roads to other subsets of the deaf population such as SWs and heterosexuals.
By Sean Cahill; Robert Valadez
Background: HIV prevention with MSM has focused on individual risk behavior and less on antigay prejudice, a key structural driver of HIV vulnerability.
Methods: Research on the impact of antigay stigma on HIV vulnerability among MSM was reviewed. Research-based social marketing campaigns conducted by Gay Men’s Health Crisis (GMHC) were reviewed.
Results: Family rejection and social isolation increase vulnerability to HIV infection among MSM. Anti-gay bullying creates hostile and unsafe environments, and correlates with sexual risk behavior among young MSM. School-based interventions such as gay-straight alliances (GSAs) help young people cultivate a healthy gay identity, and improve their sense of physical safety and belonging at school. Gay and bisexual youth who are rejected by their families are much more likely to report HIV risk behavior; family acceptance is a resiliency factor. GMHC implemented a series of social marketing campaigns to combat anti-gay bias as an HIV prevention strategy. Strength-based campaigns show great efficacy in changing individuals’ behavior. One 2008 campaign, titled “My Son is My Life,” ran on bus shelters, and modeled behavior in which a black father supports his gay son. A 2010 campaign, which ran in New York City’s subway, promoted positive, strength-based images of black and Latino gay men. The campaign, titled “I Love My Boo,” depicted young men in loving embraces in public settings, and encouraged gay men to aspire to committed, long-term relationships.
Conclusions: Antigay prejudice is a public health threat. Community-based prevention programs that affirm the healthy formation of gay and bisexual identities are needed. School-based initiatives that affirm gay and bisexual youth, and social marketing campaigns that challenge family rejection and cultural invisibility of racial minority gay men, are needed to reduce antigay prejudice and HIV vulnerability.
By Nicklas Dennermalm
Background: Until now, The Sexperts has only referred Stockholm's MSM to Venhälsan, the gay clinic of Stockholm for the simple reason that they are the only clinic we can trust doing their job. Our goal is to make sure that MSM are welcome at all clinics both from a rights based perspective as well as way of increasing testing regularity by lowering the thresholds.
Methods: In Nov/Dec of 2011, we engaged our peer workers as well as members of the community as Mystery Testers. Three Mystery Testers were send out to each selected clinics, in total approx. 30 people. After the visit they filled in a protocol with hard questions like “were you offered free Hep B vaccine” and softer questions like “What was your gut feeling after the visit”. The protocols was evaluated in February and The Golden Stars of The Sexperts 2012 was presented to the clinics that passed the test. The goldstar diploma will be on display in the waiting rooms throughout the year. Other marketing channels incl web sites, traditional media and blogs. The clinics, which did not pass the test, will get recommendations on how to improve their work. The Golden Stars of The Sexperts will be valid through 2012. The intervention was not done in secret; it was presented for the clinics and the community through banners and Facebook.
Results: Five HIV/STI clinics was awarded the Golden Stars of The Sexperts in Feb 2012.
Conclusions: The method will be developed further and executed a second time in Dec 2012 and the goal is to increase the amount of Golden Stars presented each year.
By Rose Françoise Tchwenko; Isaac Babila Macauley; Fanny Petitbon; Aisatou Ngong
Background: The HIV/AIDS Prevention Program (HAPP) funded by the United States Agency for International Development is the major project addressing HIV/AIDS needs for marginalized populations in Cameroon. It aims to reduce new HIV infections among most-at-risk populations (MARP) including MSM, increase risk perception among MARP and their access to good quality HIV prevention services. This program aligns behind the Government of Cameroon’s objective to address HIV infection in MSM, as outlined in the HIV/AIDS National Strategic Plan 2011-2015. This study examines the prospects and challenges of implementing a project targeting MSM within a context where same-sex sexual relationships are punishable by law.
Methods: An external qualitative assessment was conducted in 2011 on the project strategy. The methodology included field visits, interviews with HAPP beneficiaries and staff of five local partner organizations; analysis of strengths, weaknesses, threats and opportunities; review of HAPP documents and key external documents on standards for MARP programming.
Results: The HAPP has built a firm foundation by promoting rights-based approaches among its staff, partner organizations and health centres, focusing on the right to health for all, thereby contributing to positive changes in attitudes towards MARP. Through the inclusion of target populations and national institutions in program implementation and oversight, the HAPP has secured key actors’ involvement in activities, among which the 2011 Integrated Biological and Behavioral Surveillance survey within the MSM community. However, given the high level of stigmatization against MSM, the HAPP has difficulty providing access to information and services to hidden sub-groups (older men and MSM who identify themselves as heterosexual males).
Conclusions: The HAPP successfully undertakes prevention and care activities for MSM, despite legal dispositions criminalizing homosexual practices. However, the impact of the HAPP is hindered by challenges faced in reaching most hidden MSM sub-groups (“clandestines”), this in addition to stigma and legal issues.
By Tooru Nemoto; Mariko Iwamoto; Usaneya Perngparn; Chitlada Areesantichai; Maria Sakata; Elnaz Eilkhani
Background: This study sought to understand the sociocultural context of HIV risk behaviors among Thai FSW and KSW in Bangkok.
Methods: Based on purposive sampling, 86 FSWs and 67 KSWs were recruited from bars/clubs, massage parlors, and street spots, and interviewed using a short survey and a qualitative interview guide.
Results: FSWs were older (M=32years), engaged in sex work longer (M=7years), and had more customers (M=9customers/week) compared with KSWs (M=25years, M=3years, M=3 customers, respectively). Alcohol use was commonly reported among participants (75%). FSWs were likely to report being current alcohol users (84%) and drinking 4 or more drinks every day (35%) than KSWs (64% and 26%, respectively). About one third of both groups had used illicit drugs in the past 12 months. Yaba (methamphetamines) was most popular: 54% FSWs and 59% KSWs had used 2-3 days a week, in the past 6 months. A FSW reported: “I used [yaba] 2-3 times a day, one tablet a time. I used it before working every day. It made [me] feel less embarrassed to go out with customers.” Another FSW reported: “[I drink] every day. My customers asked me to drink to keep him company. I used to get so drunk that I forgot to use condoms.” A KSW reported: “I drink every day. I think [that] it's part of the job because customers ask me to drink with them.” Another KSW reported: “I won't use a condom when I meet good-looking customers, and also when I sleep with regular customers.”
Conclusions: Alcohol and substance use was highly prevalent among FSWs and KSWs. In collaboration with owners/managers of sex work venues, HIV prevention programs must be implemented to educate sex workers about possible consequences of alcohol and drug use and effective techniques to turn down alcohol and drug use offered by customers.
By Dylan Galos; Derek Smolenski; Anne Cain-Nielsen; B.R. Simon Rosser
Background: Though HIV cases among men who have sex with men (MSM) are generally well-documented, MSM remain at disproportionately high risk for other STIs. These can indicate a risk for HIV transmission and worsen prognoses among those living with HIV. In a recent study, we sought MSA-specific rates of gonorrhea, syphilis and HIV for MSM in 16 MSAs but encountered uneven surveillance and definitions. We present data of MSM-specific reporting of gonorrhea, syphilis and HIV and reasons why some health officials report they did not collect these data.
Methods: As part of the Structural Interventions to Lower Alcohol-related STI/HIV Risk (SILAS) study, we sought MSM-specific gonorrhea, syphilis and HIV rates for 16 metropolitan statistical areas (MSAs) with populations between 250,000 and 2.7 million. We requested surveillance data from STI/HIV divisions within state and city health departments in these MSAs from the years 2003 to 2008. Data received were a combination of county-level data and totals for MSAs. This analysis focuses on the prevalence of surveillance for the specified outcomes, specific to MSM, within each MSA.
Results: In 2003, 6% of health departments within surveyed MSAs collected MSM-specific information on gonorrhea, syphilis and HIV. At most, 19% (2004-2006) collected MSM-specific information on gonorrhea, 56% (2004-2007) documented MSM-specific syphilis cases and 81% (2004-2007) collected MSM-specific HIV cases. The most common reasons given for not reporting risk information at the MSA level were small numbers of cases and concerns about privacy.
Conclusions: Given the co-morbidity of HIV and other STIs, thorough surveillance is critical for lowering the burden of these pathogens. There are possible barriers on several levels to accurate documentation (e.g., differing standards of reporting from region to region), and future work could assess their impact and the effectiveness of alternate methods of report (e.g. location of gonorrheal infection as a proxy measure).
By Antonio Alberto Solis Rodriguez; Juan Carlos Rodriguez Espinoza; Rafael Villanueva; Yahir Zavaleta Rocha; Roberto Perez Baeza
Background: The HIV epidemic response involves several scopes to take into account and requires a comprehensive strategy focused on reconsider social conditions influencing beliefs and most at risk populations behaviors. Therefore, homophobia should be considered and addressed from scientific approaches free from stigma within social spaces where reproduces and reinforces itself, since it is a main obstacle for the provision of prevention services. Regarding to this, the project is a pedagogical model consistent with the national education plan and aims to positively change beliefs and attitudes towards human sexual diversity with a main focus onteachers.
Methods: "Life Lessons" projectinvolved an examination of both current curricula and educational plans in elementary education. It was validated by teachers ofdifferent levelsof elementary education in Mexico City and State of Mexico, regardless of the subject and attending homophobia as a crosscutting approach that can guide specific contents and strengthen skills for social dynamics. Current primary education teachers at different primary education levels validated this proposal.
Results: Audiovisual material and teaching strategieswere produced according to the raised contents and skills regarding the four levels respectively, into which elementary education in Mexico is divided. Moreover, we reached a great involvement of teachers around awareness mechanisms responding to a comprehensive empowerment of both students and educational sector.
Conclusions: Addressing on sensitive issues such as homophobia,demands for any educational system to seeks a strengthen into social coexistence respectfulon human rights as well as impact the social determinants that hinder a comprehensive strategy to confront the HIV epidemic. The main challenge to face considers resistance (overt and tacit) of teachers sharing this strategy, due to their own beliefs and prejudices, but we consider that fulfill the outcomes from this project will consolidate a meaningful sequence in Mexico regarding the Millenium Development Goals.
By Laurent Kapesa; Christian Fung; Sheila Mensah
Background: The HIV/AIDS epidemic is complex and heterogeneous, with prevalence ranging from less than 1percent to 5percent in this sub-region. In reality HIV prevalence is much lower in the general population compared to Most At-Risk Populations (MARP): female sex workers (FSW) and MSM, with odds ratio of MARP being HIV+ at least ten times greater. HIV programs targeting MARP are poorly documented, inadequately funded and still in their nascent stages. USAID/West Africa (WA) has responded to these challenges with a research and implementation of MARP HIV strategy.
Methods: USAID/ WA commissioned a series of qualitative and quantitative baseline studies in 2011 and 2012: 1. Peer-reviewed and gray literature analysis of HIV epidemiology, policy and MARP programming in West and Central Africa; 2. Epidemiological and Behavioral Sentinel Surveillance surveys of HIV prevalence among CSW and MSM, plus size estimations in Cameroon, Burkina Faso and Togo; 3. Mapping of prevention and care interventions in selected countries; 4. Analysis of opportunities to scale-up existing models and replicate similar interventions in a different context. In addition USAID/WA compares current MARP focused programs in Ghana, Mali, and Cameroon.
Results: Findings highlight: (1) MARP important role in the epidemic, yet consistently underserved; (2) Consistent funding and enabling policy environment ensure sustainable access to services and reduce HIV impact among MARP; (3) MSM groups´ early involvement and long-term commitment to service delivery reduces their HIV vulnerability; (4) Research is a platform that increases policy makers´ interest in MARP programming, and improves access to HIV prevention, care and treatment for MARP.
Conclusions: Potential for scaling up MARP programs exists. Evidence-based programming is essential for developing appropriate strategies that increase MARP access to services. While continuing to fund these much needed programs, donors should both anticipate backlash among religious and civil leaders and clearly articulate rights-based principles to reduce HIV burden among MARP.
By Rafael Villanueva; Juan Carlos Rodríguez; Yahír Zavaleta; David Carballo; Antonio Solís
Background: People living with HIV (PLHIV) in confinement situation have frequently argued not having friendly health services, which represents the main barrier to access them, likewise the guards and technical staff in penitentiary centers do not have enough information about HIV and sexual diversity, which also leads to constant acts of discrimination against this population when interacting with them. This project funded by the National Programme for HIV / AIDS, aims to improve the life quality of PLHIV deprived of their liberty.
Methods: The process was carried out through the delivery of workshops and constant training prison personnel responding to the problems detected.
Results: In order to assess the impact of the project, we came back to the inmates who reported being less infringed upon their rights by the guards, also declared having friendly medical care and advice, while noticing a notorious willingness from the staff to improve communication mechanisms.
Conclusion: Inmates can now directly express their needs and these are resolved as well. Mexico City Penitentiary undersecretary’s office has made a public acknowledgment of this work and has requested the project to be replicated in prisons with similar needs. Moreover, it obeys to a meaningful achievement of the "Ministerial Declaration, prevention through education" and the provisions covered in the gender equality and sexual diversity diagnosis of Mexico’s City Human Rights Commission.
By Dolly Sonia Antunez
Background: The HIV epidemic in Bolivia is poorly known and concentrated in MSM and TG. This study aims to investigate by qualitative methods, their vulnerability in Santa Cruz, spontaneous and paid sexual practices, work activity, experiences of discrimination within the family, school, social and the health system, to guide more effective interventions.
Methods: Activities were organized with sexually divers associations in Santa Cruz, Standardization of criteria was established between the principal investigator and interviewing psychologists and pilot interviews were conducted. In depth interviews to 18 MSM and TG between the ages of 18 and 29 were conducted , income and sexual identities were identified. The analysis was done inductively. Non-participatory observations were also made in 8 meeting places for MSM and TG (chicha bars, karaoke places and whiskey clubs) of low, medium and high economic status.
Results: Strong discrimination within the family, school, social environment and work factors influencing vulnerability. Transgender are particularly vulnerable because of their greater visibility and lack education; they have few alternatives for work and social inclusion, leading to their entry into prostitution. Drugs, frequent alcohol use and highest pay for unsafe sex all increase risk for HIV. There are no safe spaces in Santa Cruz for MSM and TG. They maintain frequent occasional sexual encounters, many take place in bathrooms, sometimes in-group and unprotected.
Conclusions and Recommendations: The lack of hope for having a family, having space and job influence the sexual and emotional behavior of MSM and TG. Interventions to improve social inclusion for sexual diversity that influence acceptance of sexual orientation by their families and other institutions could impact vulnerability to HIV. It is vital to encourage full participation of MSM and TG members in the design, monitoring and evaluation of interventions, to identify in epidemiological studies TG sex workers from other groups and to develop specific projects for their needs.
By Susanne Strömdahl; Ian Phiri; Gift Trapence; Vincent Jumbe; Chris Beyrer; Stefan Baral; Andrea Wirtz
Background: HIV prevalence is estimated to be 9% among men and 21% among MSM in Malawi, suggesting that MSM are disproportionately affected by the HIV epidemic. Barriers to HIV prevention and care for MSM in Malawi include lack of targeted efforts, stigma and criminalization. One component of Malawi's first combination HIV intervention for MSM, are volunteer peer educators (PE) providing counseling, condoms, lube, referrals for STI/HIV testing and treatment.
Methods: Nine in-depth interviews were conducted in December 2011 in Blantyre Malawi with trained PEs. Interviews explored motivation, experiences, and resources associated with PE responsibilities with the purpose to improve this part of the intervention. Recordings were transcribed, translated into English, and coded using the grounded theory methodology.
Results: Themes included strong motivation and feelings of empowerment associated with being a PE “I think I will change to the better because as a peer educator I'm standing as a role model.” PE's described high levels of HIV risk behaviour among MSM participants and low awareness of risk regarding STIs/HIV and protection. PEs reported anxiety related to and strategies to avoid unintentional disclosure of themselves as a MSM and PE. Barriers to reaching MSM participants were also related to disclosure: “they fear being arrested when it comes out that they are MSM”. In spite of this, PEs reported being able to provide services to clients in a safe, confidential manner. PEs demonstrated immense community resilience and faith in their work.
Conclusions: Understanding the challenges and strategies to overcome these for PE's in low- income settings with large structural barriers are important for ongoing improvement of prevention programs and informative to other PEs volunteering in similar contexts. Peer educator programs that are incorporated into HIV prevention programs for MSM, may allow structural barriers to be overcome to enhance HIV prevention for MSM.
By Neil Bird
Click here to see the figure associated with this abstract.
Background: This presentation will focus on the peer support project for HIV + gay and bisexual men in Scotland. Referrals are made into the project, individual assessments carried out and personal support plans put into place. Peer support is then planned, delivered and reviewed. Two years into the project an in depth evaluation has been carried out to measure the impact of the service.
Methods: The men have been consulted and involved with the development of an assessment tool. This comprises a series of ten scoring questions composed of distinct characteristics ranging from mental health to sex/positive prevention. An initial baseline assessment is made followed by regular 3 monthly impact assessments. Service users are asked to score themselves on a scale of 1 to 4 to measure the difference the interactions have made.
Results: A life wheel will evidence baseline and impact assessments for 30 individuals in the project, over a 6 month period, marking the distance travelled. Two individual case studies will be presented in detail, including initial presenting issues, changes, outcomes and personal statements. The results evidence the significant change/distance travelled for individuals as a result of receiving the service. Overall the assessments have shown an improvement in most areas; for example. ’social isolation’ has shown an improvement of 22.7% and ’lack of direction’ in life a 13.6% improvement.
Conclusions: In particular the data has provided an opportunity to understand and change discussions about sexual health so that they are more open and honest in addressing risky behavior. An additional outcome has been that men have established their own support networks that help them to become less reliant on services. The project is now being delivered to 60 men including men in rural areas and men affected by HIV, i.e. negative partners of HIV + men.
14. Engaging US communities of color and sexual minorities in biomedical HIV prevention research and implementation advocacy: AVAC's PxROAR Program (Prevention Research, Outreach, Advocacy, Representation)
By Osamudiame Uzzi; Cindra Feuer; Julie Patterson; Deirdre Grant
Background: HIV in the US disproportionately affects communities of color, transgender women and gay men. Recently, the biomedical HIV prevention research field has exhibited positive results. Certain new prevention strategies such as PrEP and treatment as prevention are likely to be used in concert with current social and behavioral interventions in the near future. It is essential that these populations are aware of and engaged with biomedical HIV prevention advocacy to ensure optimal implementation of these new interventions.
Methods: The PxROAR program supports 15 US-based community advocates engaging with affected populations around prevention research and implementation locally and nationally in a variety of innovative ways. Specifically, PxROAR members educate their particular constituencies in developments around PrEP, microbicides, treatment as prevention, male circumcision, and vaccine research. In turn, PxROAR provides a forum for their constituents to discuss and voice their opinions and concerns about the research. ROAR members are representative of the very populations that shoulder the domestic AIDS epidemics. They include people of color, transgender and gay men.
Results: Participants in PxROAR community forums have reported an increased knowledge of biomedical HIV prevention research and general positive opinions around the research and potential implementation. Varied concerns around potential cost and access issues have been documented. Other common concerns include the lack of black MSM enrolled in research studies and the mixed results for PrEP in women. The PxROAR program engages research teams and implementers around these concerns. Additionally, PxROAR members have become representatives on a number of Community Advisory Boards and other research oversight mechanisms.
Conclusions: Through the PxROAR program, communities of color and sexual minorities have the opportunity to shape HIV prevention research and implementation agendas. This process will ultimately improve the future acceptance, uptake, and eventual success of biomedical HIV prevention methods in the very communities that need them.
By Nathan J. Lachowsky; Peter J. Saxton; Nigel P. Dickson; Anthony J. Hughes; Cate E. Dewey; Alastair J. Summerlee
Background: International HIV research indicates concern for younger men who have sex with men (YMSM). Condoms are a verifiable prevention tool and New Zealand's primary sexual health promotion strategy. The objective of this research was to identify factors associated with condom use among YMSM by partner type and anal sex modality.
Methods: A pooled sample of 3387 YMSM (aged 16-29) was created from the 2006-2011 samples of New Zealand's second-generation surveillance. Participants were recruited in Auckland from a gay community fair, gay bars, or sex-on-site venues, then subsequently from national dating websites. Four multivariate models were developed for condom use: when receptive or when insertive with a casual partner, and when receptive or when insertive with a regular partner. The dependent variable was a three-level categorical variable: (1) always or almost always, (2) about half the time or sometimes, (3) never. This condom use variable was regressed on putative factors using multinomial regression. Initially, variables were selected using stepwise backward elimination in three blocks: sociodemographics, testing and sexual behavior, and knowledge and attitudes. These separate models were then merged and backward elimination was repeated until all variables were significant at p< 0.05.
Results: Recruitment site, sexual identity, number of regular partners, type of regular partner, condom use with other partners, and three attitude measures were associated with condom use regardless of partner type or modality. Age and having had sex with a woman were associated with condom use during receptive sex. Recent STI diagnosis and relationship duration were only associated with condom use with regular partners.
Conclusions: Condom use among YMSM is multifaceted and varies by partner type and anal sex modality; in addition to sociodemographics and behavior, knowledge and attitudes remain important. Condoms remain the most effective prevention tool available, and this complexity should be embraced in future research, surveillance, and health promotion.
By Jama Shelton; Angela Aidala; Tali Ziv
Background: Homeless LGBTQ youth are at high risk for STI infections including HIV. Many of these young people are alienated from their natal environments because of their LGBTQ identity and have endured extreme levels of trauma. These individuals are a hard to reach population and consequently have limited access to appropriate services, scant social support and an increasing prevalence of HIV/AIDS. This study aimed to explore this population further, seeking to discern the specific social factors that motivated these individuals to find social service assistance. We examined their HIV risk behaviors, trauma histories and self-reported needs at time of program intake.
Methods: We conducted a secondary data analysis of intake data collected at a homeless service organization. Data was collected using the Homeless Management Information System database, then exported into SPSS for descriptive statistical analysis.
Results: We found high rates of childhood trauma, including 60% (n=140) of participants reporting physical abuse, 52% reporting childhood sexual abuse and 64% experienced domestic violence. Participants were disconnected from their families - 85% stated that family reunification was not an option. Participants reported infrequent condom use and low HIV testing rates. 54% reported never using a latex barrier for oral sex. For anal or vaginal sex, 34% reported inconsistent condom use and 14% reported never using condoms.
Conclusions: Homeless LGBTQ youth experience high rates of trauma. They lack social connectedness and seek services primarily for housing and employment assistance, though identified needs included identification, showers, and love. They engage in multiple HIV risk behaviors. They are a diverse group with numerous unmet needs.
By Ben Tunstall; Sir Nick Partridge
Background: London has the highest HIV prevalence among MSM in the UK (ca.15% of men using the city's gay bars, clubs and saunas. Half of London MSM were born outside the UK, many without English as their first language, The challenge facing THT was to produce campaigns targeting and engaging London MSM when British cultural references in campaigns fail with foreign-born nationals unless they have global recognition.
Methods: Two mass media campaigns were delivered in 2010 and 2012 using imagery and messages with specific appeal and relevance to MSM in London. Iconography of the city's public transport system was used. In one campaign ('1 in 7') the famous red London bus was the vehicle for messages about HIV prevalence, risk and disclosure of status. In another ('Mind the Gap'), the Underground network ('Tube') was the theme for a campaign promoting regular testing. Supporting material included Mind the Gap travel card wallets and online advertising and humorous Youtube clips (featuring opening Tube doors revealing a variety of messages).
Results: Focus groups during the campaign's development and post-launch evaluation identified that using London icons was especially popular with the target audience. Men saw linking HIV with transport as novel and refreshing, with high 'stand out' in gay settings (press and bars) and relevant to all ages. Bold colours anchored the campaign more firmly in men's memory. The lettering (echoing London Transport's) appealed especially to younger men. To men of all ages the campaigns signposted what they identified as particular London issues.
Conclusions: Further pan-London campaigns can expand the theme to include other icons of the city. Additional research will identify other iconography which is suited to carrying HIV messages and can offer common reference points to a diverse target group.
By Matthew Avery; Philippe Girault; Rangsima Airawanwat
Background: Men who have sex with men (MSM) in Yunnan province have low levels of HIV testing and STI screening. A 6-month community-driven campaign to increase uptake of STI screening and HIV testing among MSM in Kunming was implemented in response. An evaluation was conducted as a part of a USAID/PEPFAR-supported Routine Behavioral Tracking survey, in which 451 MSM in Kunming were recruited using respondent-driven sampling. Previous descriptive analysis identified a significant dose-effect on uptake of STI screening and HIV testing, respectively, for exposure to campaign intensity.
Methods: Additional analyses included a multivariate analysis to further examine associations between recalling the campaign and HIV testing and STI screening in the past 12 months, respectively. Covariates entered into the models included socio-demographic characteristics, HIV-risk behaviors, recalling the campaign, and exposure to other interventions in the past 12 months. Collinearity among the selected covariates was tested before beginning a backward logistic regression.
Results: In the first model, key factors associated with HIV testing were exposure to peer education (OR 1.57, 95%CI 1.01-2.44), to drop-in center activities (OR 1.91, 95%CI 1.19-3.06), and receiving an STI check-up (OR 4.97, 95%CI 3.07-8.04). However, recalling the campaign was not associated with HIV testing. In the second model, MSM who recalled the campaign and resided in Kunming for more than 12 months (OR 1.97, 95%CI 1.18-3.30), to peer education (OR 1.97, 95%CI 1.25-3.10) and to activities at the drop-in center (OR 2.4, 95%CI 1.40-4.11), and who had undergone an HIV test (OR 4.89, 95%CI 3.00-7.96) were more likely to have had a STI check-up.
Conclusions: Recalling the campaign was associated with STI screening but not with HIV testing. This lack of association may be due to the short lifespan of this campaign and its low coverage, as opposed to other interventions reaching MSM. Long-term campaign implementation may be more effective.
By Juan Carlos Rodríguez Espinosa; Yahir Zavaleta; Rafael Villanueva; Antonio Solis
Background: The lack of awareness and education on rights, sexuality, HIV and STIs in Mexico, is a major problem in health care and education setvice providers, wich reinforce discrimination on the impact of services provision and HIV prevention strategies . Homophobia, discrimination and gender violence toward homosexuals and transsexuals, represent the greateast obstacle for an appropiate health services providance and for preventive strategies to be effective in the context of promoting behavior change and new positive models of coexistence free from prejudices that affect a comprehensive development and health care of HIV Most at risk Popultations.
Methods: Throughout media and outreach strategies we consolidated working groups of gay mothers, parents and educational staff with particular interest on the process of living together. They participated in discussion sessions and materials development aimed to gnenrate social changes regarding homophobia and HIV issues. Positive models considered in the project were screened on TV and Internet. Moreover, we designed and produced materials with HIV, homophobia and rights contents, in order to encourage participation of affected populations, to promote changes in social norms as well as an inclusive culture, respectful and free of discrimination on homophobia and transphobia, which are the main obstacles in providing health services and strategic prevention.
Results: Involving social participation of PLHIV into prevention programs and promotional campaigns focused on preventing HIV transmission, wich are also adressed to reduce stigma, discrimination and homophobia in key populations, gay and transgender people.
Conclusions: The lack of positive models of social interaction among diversity-related groups reinforces stigma, discrimination and homophobia in particular. It also strengthen HIV and new infection preventing barriers and so it is important to wok within families and teachers enviroments in order to promote the development of these models in the context of HIV prevention.
By Arif Jafar
Background: Religion, social norms and traditional values are dominant cultural factors in India and therefore have the potential to greatly influence the lives of many men who have sex with men. This seems to be of significant importance in the lives of practicing Hindu men who have sex with men.
Methods: A desk review of literature on Hinduism related to same sex behaviour was done. In addition to this 20 in-depth interviews were conducted. Sexual histories were of the respondents were also explored. Respondent were practicing Hindu MSMs with clear identities based on their sexual orientation such as gay, kothi, giriya and double-decker. The desk review and study was conducted to understand the impact of religious belief on safer sex behaviour.
Results: The sacred texts in Hinduism clearly show diverse views on same sex behaviours, where homosexuality is one of the possible expressions of human desire. The Kama-Sutra and the temples in Khajuraho clearly indicate same sex sexual behaviour has not only been historically present in India. The desire to have a same sex partner produces a great deal of guilt, anguish, fear and stigma among MSM for not conforming to the hetro-normative values. The social pressure to be normative is enforced by family, friends and neighbour which in turn results in unsafe sexual practices. About forty percent of participants had faith in their religion and due to sin consciousness, their safer sex practice and consistence condom usage got affected. Mouth is seen, as sacred and anal sex is predominant in people with faith.
Conclusions: While Hinduism in terms of its sacred texts has a tolerant view of homosexuality, the cultural and anti-colonial history has taken precedent. A range of resources need to be developed for Hindu MSM to have a better understanding and knowledge of their faith in regard to same sex sexualities.
By Ainura Moldokmatova; Shana Aufenkamp; Janet Kim
Background: Central Asia has one of the fastest growing HIV epidemics in the world, with growing transmission among men who have sex with men (MSM). While HIV prevalence among the general population ranges between 0.1-0.3%, 2010 Sentinel Surveillance estimated HIV prevalence among MSM to be at 1% in Kazakhstan and 1.2% in Kyrgyzstan.“USAID Dialogue on HIV and TB Project” in Central Asia launched HIV prevention outreach activities targeting MSM in 2010. At the outset of the project, PSI conducted research on behavioral factors for seeking VCT services and used the results to inform the design of behavioral change communications (BCC).
Methods: A cross-sectional study among MSM (18 years or older) across Kazakhstan, Kyrgyzstan and Tajikistan was conducted in the spring of 2010. Chain-referral sampling was used to interview 783 MSM. Logistic regression was conducted to determine significant factors for using VCT services (p<=.05). Results were used to design targeted BCC.
Results: 26.1% of MSM were tested for HIV and received their results in the last 12 months. Logistic regression determined that encouraging friends and partners to be tested and knowing where to go for testing (odds ratio of 2.39 and 1.26, respectively) were significantly associated with being tested for HIV and receiving results.
Conclusions: Based on the key factors associated with HIV testing, the project created a comprehensive strategy for MSM focused on building community, encouraging MSM to share knowledge and opinions, and increasing awareness of testing services. The percentage of MSM tested for HIV is higher among those reached by the project (during the 12-month period of October 2010 to September 2011) compared to the general population of MSM surveyed in the initial study. 845 of 2246 MSM (37.6%) reached by the project were tested and received their results through the project’s referral system - a 44.1% increase.
By Steven Gibson; Shane Collins; Kimberly Koester; Omar Sahak; Geoffrey Kellogg; Gabriel Galindo; Wayne Steward
Background: Magnet, a sexual health services (SHS) clinic in San Francisco, is a community-initiated response to the ongoing needs of gay men. Instead of maintaining a discreet profile away from the center of city life, Magnet seeks to normalize sexual health by operating out of an inviting, highly visible storefront in San Francisco’s largest gay neighborhood. We present an explanation of how Magnet meets clients’ needs and examine the factors that predicted Magnet usage among gay men and other men who have sex with men (MSM).
Methods: Between January, 2010 and January, 2012, we conducted interviews (n=35) and surveys (n=195) with men aged 18 or over; identified as gay, bisexual, or as having had sex with another man; reporting prior use of SHS; and currently living, working, or socializing regularly in San Francisco. We conducted a Framework Analysis of the qualitative data and used multivariate logistic regression to identify the factors strongly associated with the use of Magnet’s services.
Results: Interviews: MSM described Magnet as conveniently located and gay-friendly, the environment as non-threatening, and non-stigmatizing. In contrast, they described experiencing a “sense of shame” when accessing institutional and “impersonal” SHS clinics. Surveys: Use of Magnet was high. Almost 40% of MSM (n=77) received services, primarily for HIV testing (n=63) and/or STD screening (n=69). Men were more likely to have used Magnet if their decisions to receive SHS were based on convenience of location (OR=1.51, p<.02) or the availability of services beyond HIV testing (OR=1.53, p<.04).
Conclusion: Sexual health clinics for MSM can be successful when located in prominent and centralized locations. By operating out of a neighborhood facility, Magnet has created an environment that fosters visibility, accessibility and ultimately, high uptake of SHS.
By Stanley Sesugh Chull; Kadiri Audu; Ifeanyi Orazulike; Remy Emodi
Background: The general belief that anal sexual intercourse has no risk of transmitting any kind of disease has fueled the practice of unprotected anal sexual intercourse among men who have sex with men in Abuja Nigeria, increasing the risk of contracting HIV and other sexually transmitted infections for them and their partners, MSM have no or low access to HIV/AIDS and STIs prevention mitigation and clinical services.
Methods: International Center for Advocacy on Right to Health (ICARH) with the support and supervision from Family Health International (FHI) and Heartland Alliance (HA) carried out HIV/AIDS and STI Comprehensive Minimum Prevention Package Intervention (CMPPI) with the MSM community in Abuja Nigeria through the selection and training of 20 and 30 respectively key influential community members as Peer Educators to pass across prevention information as well as condom and lubricant distribution. Outreach was conducted to reach community members with HIV/AIDS and STI talks, Rapid HIV Testing and Counseling. Conduct Community dialogue to reach community members with prevention services.
Results: About 50 MSM come into the community center monthly to access information on HIV/AIDS and STIs, the uptake of condoms and lubricant has increase to 812 and 506 respectively as against 484 and 484 per month which indicate that MSM are practicing safer anal sexual intercourse. Communication amongst MSM is greatly improved as community members report a drastic reduction in sexual partners.
Conclusion: An intensive training on service provision and implication of health issues as it relate to stigma and discrimination should be conducted for MSM and Health Care workers to improve service provision to the MSM community. Conduct periodic community base outreach to sensitize MSM on the importance of enhancing behavior change. Development and implementation of IEC materials to build the knowledge of MSM on HIV/AIDS and STIs issues.
By Sen Chieh Hsu; Mei C.M. Tsai; Deng Min Chuang; Yin Chi Chuang; Chih Hao Chiu
Background: It is the global trend to advocate from a PLWHA position. However, the Chinese culture society as a whole remains to have negative points of view toward MSM and PLWHA. In order to avoid the threats against life because of the exposures of self identities, they seldom stand or speak out to fight for their rights, which lead them to an even more vulnerable situation. This study was designed to focus on methods and how to inspire PLWHA self empowerment capacities.
Methods: This study is through the action research and based on the social diffusion theory, recruited 13 HIV infected MSM who possess leadership qualities, using the empowering enhancement as action strategy. The first part of action plan involved 5 focus group meetings, and collecting of the intervention difference from each participant. Part 2 includes three meetings of life stories, where they would collect the focus of what each participant wants to have as a breakthrough of their internal stigma. From the data collected, we produced the quantitative documentation and established the PLWHA leaders’ intervention model.
Results: Through the action analysis, we found there are 4 types of PLWHA leaders’ intervention approaches. They are fire (social movement), water (social education), air (companionship and support) and earth (signifying code). The targets of intervention are the public and PLWHA. The intervention strategies are aggressive and passive. Concerning the barrier of internal stigma, these leaders adapted into the most suitable platforms and contribute their capacities to achieve realistic social impact and diffusion.
Conclusions: The influences of PLWHA are strong, dynamic and not just for the public. Each leader can exert his best influence on the basis of social positions and living situations. This study follows the unique social context of MSM and PLWHA in Chinese society to establish a model that is suitable for every PLWHA. The results indeed have significant contributions on the practical, academics and policy level.
By Maria José Campos; Eugénio Teófilo; João Brito; Ricardo Fuertes; Hugo Machado; Tiago Rodrigues; Júlio Esteves; Ricardo Abrantes; Nuno Pinto; Luís Mendão
Background: According to the National Health Institute the number of new HIV cases on MSM has been rising since 2004. CheckpointLX started in April 2011, as the first Portuguese community based HIV testing centre for MSM, located in Lisbon's gay district and is actively promoted in bars, saunas, outdoor cruising areas and online. This abstracts analyses the results of the first 10 months of activity focusing on MSM and men who have sex with men and women (MSM/W).
Methods: Trained peers perform counselling and testing providing information on HIV, sexually transmitted infections (STIs) and harm reduction strategies. MSM who request testing complete a questionnaire that includes socio-demographics items, reasons for testing and sexual behaviour. Rapid test (Retrocheck HIV®) is performed according to the best practices. An active referral is offered to all MSM with a reactive result. A member of the team is available to accompany to the first medical appointment.
Results: From April 2011 to January 2012, 1056 HIV tests were performed, 923 (87,4%) in MSM and MSM/W. Median age was 30 (SD 9,3). 86% of men have already been tested, 63,5% in the previous 12 months. Median age of MSM with previous testing was 31 and for those being tested for the first time was 30. There were 49 (5,3%) reactive results. 42 MSM accepted a referral to the Infectious Disease Clinic (IDC). 18 men accepted to be accompanied to the first medical appointment. Data from the first immunological evaluation of MSM showed a median CD4 cell count 492/mm3 (n= 26) and a median viral load 4,86 log10 (n=22).
Conclusions: CheckpointLX shows to be a pioneer initiative regarding early detection of HIV infection in MSM. The number of tests performed and the number of reactive cases referred to IDC shows a high degree of acceptability of the peer methodology.
By Alisa Pedrana; Mark Stoove; Jason Asselin; Colin Batrouney; Shanton Chang; Steve Howard; Olivia Ilic; Margaret Hellard
Background: The popularity, interactivity and potential to create and engage communities makes social networking sites (SNS) an ideal platform for health promotion. However few health promotion interventions using SNS have either been trialled or rigorously evaluated. 'Queer as F**k' began as pilot project (2010) to deliver sexual health promotion through short webisodes on SNS to gay/bisexual men. Now in its 5th season, it is among the most successful attempts internationally to exploit the enormous health promotion potential of social media. We present two years of evaluation data from this project.
Methods: In the absence of published evaluation approaches to SNS health promotion, we adapted evaluation methods from the health promotion, information systems and creative spheres. Process evaluation incorporated a) computer laboratory testing and b) insight Facebook statistics to assess reach and acceptability. Impact evaluation involved a) insight Facebook statistics, b) focus groups with users, and c) qualitative content analysis of online dialogue between users.
Results: Since April 2010, over 70 Queer as F**k webisodes delivered on Facebook and YouTube have attracted over 4,000 predominantly male fans from 15 countries. Queer as F**k now reaches almost 5,000 people each week, with ~200 unique users engaging online on a weekly basis and over 450,000 post views and 90,000 video views accumulated. Evaluation participants accurately recalled sexual health themes from the videos, indicated that Queer as F**k offered on going sexual health reminders and reported that the SNS initiative delivered sexual health messages in an engaging, informative and accessible manner.
Conclusions: While many groups are using SNS for health promotion, an overwhelming majority are not effectively exploiting SNS functions to engage target audiences. 'Queer as F**K' has emerged as a successful example of exploiting the reach and engagement potential of SNS, and provides a model for delivering and evaluating health promotion interventions on SNS.
By Alex Duke; Duangta Pawa
Background: HIV prevalence among transgender peoples (TG) is reported at 8.9% in Chonburi province, Thailand (IBBS, 2010). Pattaya city in Chonburi attracts a large TG population, offering TG greater freedom to express their identity more openly. However, commercial sex provides the only employment option for many. Research shows consistent condom use is low, despite high knowledge of HIV transmission (PSI, 2009) and interventions to increase condom use. We sought to understand factors influencing consistent condom use to design appropriate targeted intervention.
Methods:Qualitative research was conducted in 2011 in three districts in Chonburi using in-depth interviews with fourteen TGs aged 18-35 years old, followed with an interpretative workshop comprising eight TG to analyse key findings. The research explored issues beyond well understand barriers to condom use such as trust and reduced pleasure, to learn how self-perception, aspirations, and the presence or absence of factors that give stability in the lives of TG, may influence condom use.
Results: Regarding condom use, TGs who perceive themselves as less attractive than their peers and TG who were younger or newer to sex work, had lower self-esteem and confidence, and were less able to negotiate condom use with clients. Meanwhile TGs with dreams about their future, and sense of responsibility for their family expressed intention to use condoms regularly. More broadly we found that a combination of factors – instability through seasonal mobility, self-stigma regarding gender identity, uncertainty about future, ability to determine future – influence the outlook of TGs. This can have negative impact on general health seeking behaviours.
Conclusion: Future activities must emphasise providing a more comprehensive set of services that address more holistically the health and social needs of TG. Meanwhile communications delivered through outreach activities will emphasise building pride among TG about their identity and working to establish long term aspirations.
By John Adeniyi; Kehinde Okanlawon; Kadiri Audu
Background: Response to HIV policy making and implementation in Nigeria suffers human rights protection due to lack of enforcement of policies that prohibit HIV based discrimination in government and private organizations. PLWHA in Nigeria still lose job opportunities due to HIV status. Nigeria is a signatory to many international conventions and treaties that prohibits discrimination and as well guarantees the protection of fundamental human rights of indigenous and foreign citizens living in Nigeria, Thus there are few gaps in policy making and implementation in relation to HIV status based discrimination in Nigeria. This is partly possible due to the failure of the Nigerian national assembly to locally pass The Anti Discriminatory Bill into Law.
Methods: In-depth interview and experience sharing was utilized to explore the experiences of HIV positive people who lost employment opportunities because of their HIV status.
Results: Existence of HIV based discriminatory policy in the Nigeria Aviation sector. 23 persons were sampled in the research, 2 persons (8.7%) were identified to have experience Flight License Denial (Cabin-crew) due to HIV status, one male and one female.
Conclusions: Nigeria is a signatory to most of the International Human Rights Instruments beginning from the International Bill of Rights down to the recently ratified CEDAW, but lack of domestication and implementation of these treaties allows for HIVBD. Recommendations: Media organization should intensify efforts in reporting policies that promote discriminations on the grounds of HIV status. The Nigerian government and other developing countries around the world should domesticate international laws that prohibit Discrimination within their territories. International organizations should provide for accessible funding and technical support services for victims of HIV based Job discrimination. Human rights defenders should educate PLWHA on ways to fight back on HIVBD.
29. HIV-Related Sexual Risk Behaviour in Gay, Bisexual, and other Men who have Sex with Men (GB-MSM) in London, Ontario: Preliminary Findings from the Health in Middlesex Men Matters (HiMMM) Project Survey
By Daniel Pugh; Todd Coleman; Greta Bauer; Gloria Aykroyd; Rob Newman; Lyn Pierre Pitman; Leanne Powell; Meredith Fraser; Kevin Murphy
Background: The Health in Middlesex Men Matters (HiMMM) Project is a community-based study of factors (homophobia, social exclusion, and communication) identified within the LGBT2SQ community of London-Middlesex, Ontario and their impact on HIV-related risk, HIV testing, and health services access. Canadian information on the health of GB-MSM and information on HIV are lacking outside of major metropolitan areas such as Vancouver, Toronto and Montreal. A city of approximately 350,000 situated amidst smaller rural communities and farmland, London is similar to other mid-sized Canadian cities in its limit of resources specifically for LGBT2SQ communities, incidences of homophobia, and meeting of HIV-related needs through a slight number of organizations and one AIDS service organization.
Methods: An online survey containing original variables and variables adapted from the Public Health Agency of Canada’s M-Track surveillance questionnaire on sexual experiences and HIV-related risk was distributed to local GB-MSM, 18 years or older, via respondent-driven sampling in November 2011.
Results: We are presenting preliminary unweighted statistics from respondents as of June 30, 2012, depicting demographic characteristics, HIV prevalence, past six-month sexual behaviour (including condom use), and HIV testing.
Conclusion: Combined with a previously-conducted qualitative phase, results from the HiMMM Project will: 1) provide observations regarding sexual risk-taking; 2) compare these levels in a mid-size Canadian city with those in major urban centres; 3) describe processes through which homophobia, social exclusion and communication impact the health of GB-MSM, and; 4) quantify the effects of these factors on sexual risk, HIV testing, and access to (GB-MSM supportive) health services. Knowledge exchange will occur through local town hall meetings, open-access peer-reviewed publications, fact sheets, and videos.
By Steeve Laguerre; Vladimyr J. Valcin; Reginald Dupont
Background: Haiti is a point of origin for human trafficking, often times resulting in forced labor and sometimes sexual exploitation. Data suggests that 2,000-2,500 Haitian boys mostly from the North of Haiti are trafficked to the Dominican Republic annually. Most of these boys are involved in a host of informal activities including street vending, agricultural work, domestic service and prostitution. Meanwhile, HIV rates in Haiti hover around 2.1% nationally, with youth severely vulnerable. Approximately 300,000 children have been orphaned by AIDS, many of who are HIV-positive. The estimated infection rate of pregnant women stands at about 5%, with an estimated 4,000 HIV+ babies born annually.
Methods: In 2008, SEROvie began a project in Northern Haiti to reduce the incidence of HIV and AIDS and ultimately human trafficking. The project, funded by amfAR and the Global Fund, has used innovative approaches to combine the two sectors of HIV and AIDS and trafficking. SEROvie has implemented intensive training and sensitization surrounding human rights, HIV and AIDS education, and community mobilization in order to address the interaction between HIV and AIDS and human trafficking.
Results: • Human trafficking is a contributing factor to the HIV prevalence rates in Northern Haiti• The prevalence rates in the project areas is 8% (of those coming forward for VCT)• Education activities, both formal and informal, are essential for engaging communities• Linking local community forums to national human rights’ organizations increases community sensitization • Engaging the young boys themselves in community sensitization sessions is particularly beneficial• Providing alternative sources of income and options for the community as a whole is essential
Conclusions: Border towns in Haiti, and other similar countries, should implement joint programming that focuses not only on typical HIV and AIDS programs, but that also addresses the underlying human rights issues that contribute to the spread of the epidemic.
By Sodara Chan; Chivorn Var; Chhorvann Chhea; Daniel McCartney
Background: Reproductive Health Association Cambodia (RHAC) is one of the leading NGOs providing SRH and HIV-related services in eighteen clinics in Cambodia. In an attempt to increase the number of men who have sex with men (MSM) and transgender accessing reproductive health services, RHAC offered free Primary Health Care (PHC) at some clinics as an entry point to increase uptake of STI and HIV testing services between Nov 2010 to June 2011.
Methods: A study was conducted to compare the service usage at clinics with free PHC and clinics without free PHC. Data on the uptake of STI and HIV testing were retrieved from the clinic database. In-depth interviews with 4 self identify MSM, 4 health workers and 4 MSM counselors were also performed to further investigate the use of free PHC as an entry point.
Results: It found that the proportion having STI screening and HIV test among those who came for free PHC ranged from 55% to 90% at the intervention clinics, while this percentage was less than 33% in the clinics without free PHC. Majority of new MSM to the clinic utilized testing services in combination with free PHC services, including hepatitis B vaccinations, general check-ups or skin consultations. However, providing free PHC services alone did not guarantee increased service usage, as other factors, such as provision of travel support, strong referral systems, and supportive environments within clinics, were equally important in bringing MSM to clinics.
Conclusions: Essential package of free PHC services should be offered in combination with STI and HIV testing services. RHAC clinics should also make their clinic appearance more suitable for MSM, build the capacity of their counsellors to provide services for MSM. Maximize the current referral system to strengthen the link between MSM communities and health care providers.
By Sheryar Anwar Kazi; Bushra Rani
Background: Naz Male Health Alliance (NMHA) is implementing GFATM's Regional Grant R-9 to empower MSM/TG communities in Pakistan to prevent HIV. Community strengthening activities and participatory research methods are being used to reach MSM/TGs and understand community needs to effectively design prevention-programs. Same process was carried out in Larkana where MSM are engaged in high risk behaviors to an alarmingly high level which makes them highly vulnerable to HIV/AIDS and other bio-psycho-social hazards.
Methods: An ethnographic study was conducted in 03 brothels of male-sex-workers. Data was collected through In-depth interviews, participants observation and data verification was done through FGDs. NMHA's ethical standards were followed and data was collected after informed consent by each of the participant. The researchers were themselves self-identified MSM accustomed to the local/community dynamics. While planning, data-analysis and reporting was assisted by a clinical psychologist.
Results: Age range of male-sex-workers in Larkana in 13-18 years and mostly they are un-educated, with low/no HIV/STIs knowledge and with no concept of condom/lubricant use. Drug-use is more prevalent among brothel based boys. Daily frequency of clients is very high while income rates are very low. Brothels are managed by munchees (Brothel Manager) and their assistants. Overall health status and hygienic conditions were not good and participants reported violence from community, brothel administration, and clients. Current HIV/AIDS interventions cover only a very small number of MSM.
Conclusions: An urgent need for adolescents-focused programming including socioeconomic rehabilitation/empowerment, HIV prevention, and life skills. Further qualitative and quantitative evidence is required to effectively design programs. Involving key stakeholders in program designing and implementation is highly recommended.
By Serongkea Deng; Sodara Chan; Chivorn Var; Vic. Salas
Background: Key Populations are disproportionately affected by HIV and greatly marginalized in society, facing barriers to access many services including HIV prevention and health services. There are National Strategic Framework, Operational Plan, standard operational procedures, and policy-making bodies for HIV prevention for MSM. The study aims to understand and use information for advocacy to improve policy, programming and funding actions for MSM.
Methods: The study was conducted in Phnom Penh using standard series of 45 questions and discussion questions, which are used in other 26 countries with similar study. Information was collected through desk research, FGD and interviewing key informants from UN agencies, CSO, government institutions, network of people living with HIV, MSM network, HIV(+) MSM, transgender, peer educators, clients and masseurs.
Results: VCT and STI services are available in all provinces. Condoms are accessible at health centres and clinics. Government health services are in theory equally open to MSM/Transgender regardless of HIV status. Some specialist clinics for MSM located in Phnom Penh and a few in other population centers. MSM’s health issues, stigma and discrimination are not included in training curriculum of health providers. Clinic hours tend to be inconvenient with long waiting times. No reports of HIV prevention in prisons and in other all-male settings. No current estimates of numbers of HIV positive MSM, or those may need ARV. No media campaigns address HIV prevention among MSM and female partners, although 40% of MSM have female partners.
Conclusions: Strengthen friendly and non- discrimination health services provision: training allied and clinic staff with a national curriculum of gender sensitivity, non-discrimination, client relations, MSM health issues. Increase access to HIV prevention intervention for MSM in closed and all-male settings. Make condoms and lubricants more freely available in hot spot areas. Promote national HIV prevention approaches targeted MSM and female partners.
By Jhalak Jerajani; Ankur Srivastava; Murugesh Sivasubramanian; Sandeep Mane; Steven Safren; Carey Jonson; Matthew Mimiaga; Kenneth Mayer; Raman Gangakhedkar; Vivek Anand
Background: Men who have sex with men (MSM) are an important group in the HIV epidemic in India (prevalence >5%). Many are married to women due to social pressure; thus, they represent an important bridge population. The present study aims to understand factors that influence condom use among married and unmarried MSM.
Methods: We conducted in-depth interviews with 40 participants (20 self-reported married MSM and 20 self-reported unmarried MSM) at the Humsafar Trust, Mumbai, India. The interviews collected detailed information on sexual behaviours, sexual preferences, condom use, substance use, and demographic data. The data were analysed using content analysis guided by principles of grounded theory using NVivo 8 software
Results: About half the married participants had married by choice and most of married MSM reported inconsistent condom use with wives. Fear of social embarrassment was the major reason for lack of consistent condom use with them.. Participants who had their sexual debut later in life were more likely to use condoms irrespective of their marital status. The main reasons for using condoms with male partners were: fear of HIV and other STIs. However, many indicated that they were less likely to use condoms if the male partner looked clean, trustworthy, or the partner refused to use condoms. Other themes related to less condom use included : concerns about the quality of condoms & problems during use such as slippage, tears, and smell. These responses were common among both married and unmarried MSM
Conclusions: Themes did not differ greatly across marital relating to the use of condoms with male sexual partners. However, married MSM reported inconsistent condom use with their wives. Thus, interventions should include comprehensive and skills building information about condom use and negotiation. Married MSM should be an important focus group for improving condom use.
By Romane Knight; Lois Hue; Sally Moore; Kerry-Ann Willis
Click here to see the figure associated with this abstract.
Background: Men who have sex with men in Jamaica represent a diverse mixture of groups and sub-cultures, each with a particular set of norms, practices and varying degrees of “outness”. Traditional peer education approaches allows targeting to some visible groups, but is ineffective in reaching the more “closeted” subgroups such as “professional” and bi-sexual MSM. To overcome this barrier, the Jamaica Red Cross funded by American Red Cross, developed various social media platforms with the aim of providing these hidden groups with safer sex information and creating a safe space for confidential conversations and supportive interaction.
Methods : Using social media platforms to target these "closeted" subgroups, a blog, Facebook secret group, Facebook fan-page and a Twitter stream were developed and launched. Each tool was branded and marketed under the name "Real Flexx”; The Jamaican vernacular for relaxation or socialization, and provided the targeted subgroup with information relating to safer sex practices, basic facts on HIV and Stigma & Discrimination, all within a safe and confidential environment.
Results: From September - December 2011, Real Flexx has seen steady increases in web traffic, subscribers and group followers (see table). The blog to date has received over 3200 hits; where visitors have left upwards of 90 comments. Real Flexx’s Facebook platforms have a shared audience of over 1,150 MSMs; generating on average, a total of 18 conversations on a weekly basis.
Conclusion: The gains that the “Real Flexx” social media platforms have been able to experience, underscores the significant accomplishments that can be made within countries where the MSM community is highly stigmatized and discriminated against. By leveraging the use of social media and other web 2.0 technologies, additional avenues through which to provide safer sex information to populations at higher risk can be created; resulting in the creation of safe spaces for marginalized populations.
By Tena Jehovani; Velasco Víctor
Background: The population of the transgender community are those with higher rates of human rights violations and more prone to HIV infection. Of this population, those most vulnerable to these conditions are the youth population Trans. This population seems not to exist, because of new onset, there is no written material to strengthen one´s thinking about making the move undertaken to desired gender identity. The intervention presented was aimed at creating a Sexual Wellness Guide for Young Trans, which was easy to distribute, reading comprendible and issues relevant to them and themselves.
Methods: We conducted interviews with key people who are related to the transgender population in Mexico City: Center for Transgender People Care, Civil Organizations, mental health professionals, doctors who specialize in sexual health, transsexual men, women transgender, men transvestites, Trans community activists. Interviews were conducted individually, explaining to the participants the purpose of their intervention. Electronically documented for a qualitative analysis of information obtained: Trans 20 women, 3 men Trans, 4 mental health professionals, 2sexual health physicians and 2 Civil Society Organizations. This gave us information on the major issues facing the transgender population.
Results: We developed a 52-page educational material, which covers the following topics: resilience; trans movement´s history in Mexico: definitions of sexuality: sexual orientation, gender identity, sexual diversity; Homo / Transphobia; psychological exercises for strengthening emotional; childhood youth and transgender; and three chapters devoted to the transvestite, transgender and transsexual to. This guide also contains what we call "Pleasant and Protected Erotic Life," elements of a human rights advocacy, legal aspects, several references to web sites, books, self-help groups, art work, and a list of professionals who specialize in population sensitized Trans.
Conclusions: The material presented provides Trans populations: elements of self care, legal, and emotional capacity for a better experience of their gender identity, and better quality in your sex life.
By Caroline van Gemert; Kongchay Vongsaiya; Chad Hughes; Rebecca Jenkinson; Amphoy Sihavong; Chansy Phimphachanh; Niramonh Chanlivong; Mark Stoové; Mike Toole; Margaret Hellard
Background: Men who have sex with both men and women are a diverse and important population group for the control of HIV and other sexually transmitted infections (STIs) in Southeast Asia. This study explores the sexual networks of these men to inform our understanding of HIV transmission between heterosexual, homosexual and bisexual networks in Lao PDR.
Methods: Using snowball sampling we recruited a sexual network of male, female and transgender (“kathoey”) participants in Vientiane, Lao PDR in 2010. Participants completed a sexual behavioral questionnaire and referred up to 5 sexual partners. Men were classified as behaviorally heterosexual, homosexual or bisexual. We compared sexual orientation and behavior, median partners and consistent condom use (CCU).
Results: A total of 298 people were recruited, including 63 behaviorally bisexual men. Few behaviourally bisexual men (10%) reported pure bisexual sexual orientation. Behaviorally bisexual men reported greater number of sexual partners during their lifetime (median=19) than behaviourally heterosexual (median=6) or behaviorally homosexual men (median=6). Behaviorally heterosexual men reported the highest CCU (43%) compared with behaviorally homosexual (14%) or behaviorally bisexual (27%) men. Using social network diagrammatic representation, heterosexual, homosexual and bisexual networks are shown to be interlinked.
Conclusions: This research provides evidence that homosexual and heterosexual sexual networks are linked via behaviorally bisexually men. Sexual orientation is not homogenous among behaviourally bisexually men, and overall these men were highly sexually active and had low rates of consistent condom use. These men require a multi-strategic and targeted approach to provide sexual health promotion given the evidence that they engage in risky sexual behaviors.
By Kossi Yves Justin Kugbe
Background: Since 2008, Espoir Vie-Togo, a center for people living with HIV, has introduced an HIV prevention and care program for MSM / TG. The criminalization of homosexuality presents many barriers to achieve access to health care services for MSM throughout the Togolese territory. According to the Homosexuality analysis report in Togo, 67.5% of MSM also have sex with women and only 33.3% used condoms with their last encounter. It is therefore urgent to target MSM in Togo whom have difficulties accessing health services and information. Using internet to find sexual partners and friends is frequent among MSM in Togo with more than 360 profiles on www.gayroméo.com.
Methods: A team of two people were trained to do online outreach. Two of the most popular sites were chosen for prevention efforts. Peak hours and days were determined in order to reach the highest number of men on the websites. The team created an online profile and all conversations were recorded for evaluation and analysis.
Results: Over the course of three months, 201 MSM were reached. 65 MSM had the opportunity to hear about our services for MSM for the first time. There was an increase by 148% of MSM visiting the EVT center. And we have record 19 testing by using internet services compared to 9 before. There was an increase in 111% of MSM accessing the center for testing.
Conclusions: Internet outreach efforts have proven to be an effective tool to reaching a greater number of MSM, especially those whom would not attend conventional prevention events. The next steps will enable us to overcome some difficulties associated with this activity such as keeping focused some users on discussion topic and access to some sites is charged. A text message campaign is also being planned as another opportunity to reach MSM.
By Kehinde Okanlawon; Opeyemi Agbaje; Uche Ani; Ayo Adebowale
Background: Evidence shows that MSM and sex workers bear a high burden of HIV/AIDS in Nigeria. Yet, the health needs of economically disadvantaged MSM, who engage in sex work for economic survival, remain unmet. While MSM sex work can increase vulnerability to HIV and human rights violations, the HIV prevention and human rights needs of MSM sex workers in Nigeria remain under-researched and poorly addressed. This paper examined HIV vulnerability, sexual risks and human rights violations experienced by MSM sex workers in Nigeria.
Methods: Snow-ball sampling was used to select 16 MSM sex workers in Ibadan, Lagos and Abuja to participate in the study. Their informed consent was sought and In-depth interviews were utilized.
Results: They were all ages 17-33 years. 56% were gay, 25% bisexual and 19% transgender. Unemployment and poverty drove everyone to the sex industry. They all experienced violations as clients and policemen took advantage of the criminalization of sex work and homosexuality to abuse them. This increased their HIV vulnerability as many were forced to do risky sex against their wish, physically beaten and sexually violated. Others had no say regarding safer sex with multiple clients and partners whom they depended on for survival. Many reportedly experienced discrimination from doctors and resorted to self-medication and visiting traditional healers for treatment of anal STIs. Everyone reported being tired of sex work as it had increased their HIV vulnerability. 44% were HIV positive, 12% HIV negative while 44% didn’t know their HIV status.
Conclusion: The study highlights the role that poverty, sex work and a hostile environment towards MSM sex workers can play in increasing their HIV vulnerability. Organizing financial empowerment programs, safer sex education and human rights training for MSM sex workers and providing friendly healthcare services can reduce their vulnerability to HIV and human rights violations.
By Kipling Beardsley; Sandra Duvall
Background: Policy analysis and advocacy for services for Sex Workers, Transgender, and Men who have Sex with Men tends to focus on major issues of criminalization. Yet, there are numerous nuanced policies that impact access to, and quality and sustainability of services.
Methods: International human rights frameworks and global best practices for SW/TG/MSM services were used to design a structure for qualitative and quantitative analysis of country level policy language and implementation.
Results: Tools in the Policy Analysis and Advocacy Decision Model for Services for SW/TG/MSM identify restrictive, poorly written, and absent policies that impact the access to and sustainability of key services including HIV Counseling and Testing, Antiretroviral Therapy, Sexually Transmitted Infection services, Condoms and Lubrication, Information, Education and Communication, Outreach, Alcohol Harm Reduction, and Reproductive Health and Family Planning. These services are analyzed in the environments of community-based and prison programs. Policy areas include service coordination; data use and decision making; participation of SW/TG/MSM in decision making, service delivery and evaluation; consent; personal data protections; stigma and discrimination; criminal sanctions; gender-based violence; human rights; procurement and supply management; eligibility; funding; and service delivery protocols. Findings from the implementation of the model in Burkina Faso found that even in policy environments that didn't officially criminalize behavior, there were opportunities for policy advocacy to improve access to and quality of service delivery.
Conclusions: The Decision Model provides a comprehensive, systematic structure for policy analysis. The Decision Model expands the scope of policies that impact services for SW/TG/MSM beyond general criminalization dichotomies; makes the connection between advocating for service-specific policies and a human rights-based approach; and identifies the value of targeted, incremental policy change within a long-term human rights policy agenda.
By Emilia Lombardi; Anthony Silvestre
Background: Men who have sex with men (MSM), regardless of race, continue to be the risk group most severely impacted by HIV. In the jurisdiction covered by the Pennsylvania Department of Health the HIV/AIDS epidemic continues to pose a significant and disproportionate threat to MSM. The strategic plan outlines recommendations regarding the delivery of HIV prevention interventions and resources to MSM communities.
Methods: The Pennsylvania Department of Health partnered with the Pennsylvania Prevention Project at the University of Pittsburgh to explore and describe the prevention needs of HIV negative and HIV positive MSM and injection drug using MSM (MSM-IDU) and the prevention activities/interventions currently being implemented to address these needs. The assessment activities included 1) a community services assessment, 2) the identification of prioritized target subpopulations among HIV positive and HIV negative MSM and 3) the identification of appropriate evidence-based prevention activities/interventions.
Results: Current MSM and MSM-IDU HIV prevention and intervention activities used by HIV subcontractors in the state of Pennsylvania (excluding Philadelphia) are extremely limited. HIV prevention contractors are not reaching the MSM population in Pennsylvania. Qualitative research results identified many barriers and facilitators experienced in recruiting and retaining MSM in prevention interventions and the resources needed to implement effective HIV prevention interview to local MSM. Suggestions were identified for establishing an effective HIV prevention and intervention programs tailored to fit the needs of the MSM population in Pennsylvania.
Conclusions: Multiple levels of influencing factors require that the corresponding prevention and intervention programs be implemented at the appropriate level. New and innovative approaches need to be developed, implemented and evaluated. The recommendations to improve HIV prevention among MSM populations are focused on education, skills building and behavior change, The setting of HIV prevention activities, how to recruit and identify participants, guidance for organizations and funding agencies, and future areas regarding HIV prevention.
By Chi-Chung Lau
Click here to see the figure associated with this abstract.
Background: Responding to the MSM's HIV epidemic, funders invest most grants and practitioners prioritize efforts towards changing MSM's individual attitudes, knowledge and behaviours related to condom use and HIV testing. However, globally, MSM's HIV infection is continuously on the rise. A critical examination of this intervention focus on individuals is required.
Methods: Situating his previous years of frontline experiences in HIV prevention, a veteran practitioner reflected on the intervention focus on individual changes with reference to his latest application of a theoretical framework (i.e. the Socio-ecological model, Table 1) in studying risk factors for HIV infection among MSM in Malaysia through consultations with stakeholders
Results: In Malaysia, four focus groups and three interviews were conducted with 5 program staff, 6 volunteers, 2 business owners, 6 MSM, and 11 multi-lateral agency practitioners. Other than the individual level, risk factors existed at other levels which underpinned HIV infection (Map 1): at the interpersonal level, MSM in regular relationships assumed partners' negative HIV status for unprotected sex; at the community level, MSM were exposed to more sexually-charged cultures and became more sexually active; at the organizational level, AIDS agencies could not deliver responsive programs due to conflicts with mainstream values and policies; at the societal level, religious beliefs and heterosexism deprived MSM of their sexual rights; at the supranational level, MSM in Malaysia have established sexual networking circuits with neighbouring countries.
Conclusions: Shown in the Malaysian context, critical reviews on community practice in communicating HIV status, examinations on sexual cultures' influences on MSM's sexuality and sexual behaviours, challenges to dominant discourses and beliefs that affect MSM's sexual rights, and an adoption of a global response to the MSM's mobility for regional sexual networking are necessary lenses to understand and respond to MSM HIV transmission. Interventions must extend beyond changing individual MSM.
By Wisdom Joseph Inyang; Oliver O. Anene; Victor George; Valor Bassey Atte; Ifeanyichukwu Obike
Background: Most young people in southern Nigeria are vulnerable to the HIV epidemic due to low level of HIV/AIDS knowledge. Worldwide, over half of all new infections are occurring among youths due to multiple and vulnerable sexuality. This study examines HIV/AIDS education, prevention knowledge and the sexual behaviors of young men in Calabar.
Methods: The survey was conducted through a self-administered questionnaire on 30 young men who for the first time visited the IMH-Initiative community center, a youth development center that focuses on HIV/AIDS prevention programs especially among MSM (Men who have sex with Men). Participants were randomly selected between the ages of 18-25, in the Calabar metropolis, in the month of December 2011. The questionnaire was used to get data regarding HIV knowledge, sexual health and condom use.
Results: All 30 respondents were sexually active and about one-fourth had had sex with multiple partners, while a half of the respondents identified as MSM. Among the sexually active respondents, the rates of condom use in the first and last sexual intercourse were 14% and 10% respectively. The knowledge regarding HIV/AIDS transmission and its prevention methods among respondents were low, while HIV related stigma, discrimination and misconception was on the high. Respondents reported high numbers of sexual activities with multiple concurrent partners among in-school and never married youths. Level of exposure in education, location, media exposure, sexual experience and financial status appeared as the important determinants of HIV/AIDS related knowledge and prevention behaviors.
Conclusion: Youths continually practice risky behaviors that could lead to contacting HIV/AIDS or other STIs. Comprehensive Information, Education and Communication (IEC) and sex education programs should be developed to improve sexual and HIV/AIDS related knowledge among in-school youths.
By Kevin Rebe; Glenn De Swardt; Geoff Jobson; Helen Struthers; James McIntyre
Background: In August 2011, the South African government (SAG) revised state-sponsored anti-retroviral HIV treatment (ART) program to include state-funded ART initiation for HIV-infected adults from a CD4 count of 200cells/l to 350. Attracting newly-qualifying clients back for ART was only partially successful.
Methods: A collaborative project between the SAG and Anova Health Institute, supported by PEPFAR/USAID, the Ivan Toms Centre for Men’s Health is a community-based, primary-healthcare clinic in Cape Town ,providing free services to MSM including SAG-supplied ART. 62 clients were identified from clinic folders as eligible for treatment according to the new guidelines. Efforts were made to contact these clients for ART initiation, including telephoning all available contact numbers at least twice, leaving voicemail messages and sending an email where possible.
Results: Of 62 newly qualifying clients 13 (20.1%) initiated ART at our clinic, 17 (27.4%) were contacted for ART initiation but have yet to start. 13 (20.1%) clients transferred to other institutions and 19 clients (30.6%) were un-contactable and lost to follow up. In this analysis, delaying ART resulted in only 30/62 clients (48.4%) remaining in HIV/ ART care when all should have been on ART.
Conclusion: Delaying ART initiation among MSM until later than WHO and CDC recommendations resulted in a high loss to follow up rate of MSM attending our clinic and many could not be returned into care using reasonable administrative methods after local guidelines changed. An important opportunity to improve the health of these clients as well as prevent possible forward HIV transmission was thus lost. African MSM are often hidden and difficult to attract for sexual healthcare. ART clinics need robust and regularly-updated demographic data collection systems. Clinics providing MSM-targeted HIV-care need to focus on retention in care to ensure that treatment opportunities are not missed. Key words: MSM, South Africa, ART, early treatment.
By Riaz Sheikh Moin
Background: HIV epidemic in Punjab, from an epidemiological perspective, need to be controlled. There are few MARPs which have concentrated HIV epidemic, despite earlier provision of services. The health department is cognizant of this impeding threat and has taken an initiate to control the propagation of HIV in more efficient manner. Initiate of 8 months was under taken by the Punjab AIDS Control Program with the close collaboration of Pak Plus Society to work with MSMs and HIJRAS in DERAS regarding awareness and prevention of STIs, HIV & AIDS and education about SRH.
Method: Total numbers of 1120 MSMs and HIJRAs were targeted in Lahore. Through mapping 50 groups each comprising of 50-60 members were formed, in selected project targeted areas. We identified one community member from each group to act as the peer educator and trained them by trainings on the same issues. Outreach workers conducted sessions with the groups on various components of SRH, STIs, HIV & AIDS and about safe sex practices. STIs clinic and VCCT services were developed in the drop-in-center for the easy and friendly access to targeted community. Advocacy meetings were conducted with law enforcement agencies, religious leaders, general practitioners, political leaders and other stakeholders for the enabling environment. HSWs 447 Zananas(MSMs) 312 Giriyas(Partner of HSW or MSM) 213 Chawas (MSMs) 148
Results: End line survey results 60% of targeted community is using condom during last penetrative sex. VCCT was done of 650 beneficiaries in which 7 diagnosed as HIV positive. 16.5 HSWs and 10.5 MSMs were diagnosed as syphilis positive
Conclusion: 80% of beneficiaries surveyed in project area can spontaneously, without prompting, correctly identify: Three ways that HIV infection is transmitted Three ways to prevent transmission of HIV infection Use of condom can prevent the occurrence of other STIs Location of center for the treatment of HIV.
By Ramesh Jagtap; Vivek Raj Anand
Background: HIV prevalence among transgenders (TG) in India is around 49%. Efforts have focused on reducing the HIV prevalence among TGs through peer outreach strategy and setting up of TG CBOs in several states. These responses through government, civil society and funders has focused only on health and addressing the structural factors like livelihood, human rights and other social security aspects that drives HIV among these groups are left unaddressed.
Methods: In order to address the key structural factors, four capacity building workshops and training programmes were conducted by the Transgender peers for the TG CBO members. These workshops were done from 2009 to 2011 with the help of SIDA-RFSU project through Integrated Network for Sexual Minorities (INFOSEM),a national network for sexual minorities to ensure equality for themselves in all spheres of life, free from discrimination.
Results: The involvement of TG resource persons helped the TG participants to get involved in the workshop and willingness to learn. TG preferred to get trained through exercise based sessions than classroom method learning. The workshops were planned where the participants could relate the sessions to their work, they were able to strategize the plan during the workshops which could be implemented in their organizations from the workshops. Preliminary analysis of the feedback sessions reflected the satisfaction of the TG participant that provided them with an opportunity of self-learning and environment of empowerment through capacity building.
Conclusion:Along with health, successful implementation of HIV interventions through TG CBOs should focus on structural and social factors that would not only empower the community members but also enable the CBOs to provide a holistic approach to the target population. These series of trainings would also make the TG participants to become more competent to coordinate with others and build their capacity.
By Thomas Joseph; Shruta Mengle; Hemangi Mhaprolkar; Pallav Patankar; Vivek Anand
Background: The GFTAM Round 9 project aims to support National AIDS Control Program of India in reaching out to MSM, TG and Hijra communities in a first of its kind grant given to support 200 Community based organizations (CBOs) of MSM and Transgender in 17 states and 184 districts. Community Capacities to run interventions are limited and needed urgent attention for these most at risk populations.
Methods: The Humsafar Trust, Mumbai, India the only Community based sub recipient in this national level project works in 5 states, 48 districts and provides support to 58 partners. A conscious effort was made to use the technique of ‘community train communities’. Community experts were invited and areas of Capacity building identified through community consultations. 18 topics were finalized and modules covered areas such as finance, monitoring and evaluation, Mental Health Counseling, Female Partners, Positive Living and Trauma and Violence. Community experts developed final training modules after exhaustive consultations. Community members with training expertise were trained as ‘Master Trainers’ to build capacities of the CBOs. The trainings imparted are regularly monitored on the ground to ensure that the learning’s have been translated into action.
Results: The inclusion of community members in this process created a favorable environment for increased community commitment. The training topics complemented the National AIDS Control Program and help new organizations manage interventions. The capacity building program is being managed by the community with the help of community friendly resources.
Conclusions: Communities are the best judge of their needs and Involving communities in the capacity building process creates ownership. On ground monitoring ensures high quality of implementation. The community addresses not just the symptoms but also the cause, effect and remedial measures for controlling high-risk behavior and minimizing risk of STIs and HIV through sustained and effective community based interventions.
By Maxim Kasianczuk
Background: Nikolaev is the big city in the south of Ukraine. From 1994, there works NGO «Lesbian and Gay Association» (LiGA). This study, supported by COC Netherlands, was conducted to collect data about sexual behavior and risk factors of MSM in Nikolaev.
Methods: A crossectional RDS-study was conducted with 350 MSM. With informed consent, all participants were interviewed and tested for HIV, syphilis and hepatites. All interviews were anonymous, with participants testing positive for HIV being referred for follow-up at the local AIDS-center. Cases are people, which answered «NO», and controls — which answered «YES» to question «Do you use a condom during last anal intercourse with male partner?». Analysis was done with chi-square (p≤0.05) and logistic regression (p≤0.001).
Results: Using the data, the main factors of non-using condoms (NUC) in last anal same-sex intercource are: number of male partners during last 6 months (if respondent had 2 or more partners, AOR of NUC were 0.1 with 95%CI 0.1–0.3), average income per month (respondents of low-income, less than $125, often use condoms AOR 0.2 (0.1–0.6)), real family status (men having standing same-sex partners neglect of using condoms, AOR 3.9 (1.6–9.5)). Discussion: Accociation low-income with using of condoms seems to be a paradox, because of condom's high prices, low-level of life and high taxes in Ukraine. Perhaps the stable operation of the LGBT-NGO allows MSM of low-income to get free condoms and motivates them to use the safer sex to reduce the economic risks associated with infection.
Conclusions: The results can help for designing more effective programs for MSM in Ukraine: working with gay-partnerships to stimulate them to use condoms, continuing distribution of free condoms.
By Jochen Drewes; Joachim Kuck; Matthias Kuske; Dirk Sander; Dieter Kleiber
Background: In order to react to the rise in numbers of newly diagnosed HIV-infections in MSM a nationwide HIV prevention campaign directed to MSM was launched in 2008 by the NGO“Deutsche AIDS-Hilfe”. The campaign is characterized by multiple goals, the combination of different strategies, a role-model approach and the integration of HIV-positive MSM. To assure quality an accompanying evaluation was conducted comprising process and outcome evaluation. This abstract focuses on the results of the outcome evaluation regarding coverage, acceptance and effectiveness of this campaign.
Methods: Effectiveness, coverage and acceptance were analyzed via two internet-based surveys. Participants were recruited on several online platforms addressing gay and bisexual men in Germany. The pre-post-design to determine effectiveness employed trend analyses and an ex-post-facto control group (non-campaign-users). To eliminate biases in the two samples and in the intervention/control group due to study design, statistical procedures were applied including post stratification and propensity score matching. 6.339 MSM participated in the first survey, 21.928 in the second.
Results: More than half of all participants (51 %) reported knowledge of the campaign. Coverage of the campaign was higher in MSM with higher education, gay-identified MSM and HIV-positive MSM. Acceptance of the campaign was high. 31 % of the sample was identified as active users of the campaign (intervention group). After correcting procedures analyses reveal strong evidence for a change in HIV testing behavior and intentions among MSM in Germany due to the campaign. The evidence for changes in condom use, STI test intentions and HIV stigma is more weak.
Conclusions: After two years the campaign shows satisfying coverage and acceptance in the target population. Disadvantaged groups of MSM show lower than average participation rates, though acceptance in these groups is higher than average. The campaign's focus on HIV testing turned out to be successful in the target population.
By Okechukwu Effoduh
Background: HIV prevalence among MSM in Nigeria is estimated at 13.5% which is higher than the national prevalence of 4.6%. With approximately 75 programmes on radio tackling issues of HIV/AIDS in Nigeria, alarmingly, none of these programmes focus on the relationship between HIV and the MSM population. The objective of this study is to expose a major barrier to HIV intervention with media programmes on HIV/AIDS in Nigeria completely excluding the MSM population.
Methods: With In-Depth Interviews (IDI), I questioned 50 Producers/Presenters on HIV/AIDS intervention programmes on radio in Nigeria either in person, by interactive emails or by phone.The survey was guided by a series of open-ended questions directed to the programme makers about the content and projection of their HIV programmes. This survey was conducted between February 2011 and January 2012.
Results: 0% (i.e. none of the respondents) has involved sexual health issues relating to the MSM population in planning and creating HIV/AIDS programmes on television and radio and 12% is unaware of the existence of an active MSM population in Nigeria. 58% of the respondents expressed knowledge of the MSM population being identified asmost-at-risk group but have excluded making programmes on the sexual health needs of the MSM population for reasons founded on audience sensitivity to MSM(30%), moral, cultural and religious reasons (32%), knowledge impediment (12%), and organizational limitations (12%).
Conclusions: Taboos against same-sex relations drive the practice underground. With stigma and discrimination on MSM, educating the MSM population is best achievable through the media since that will accord no physical participation. Media intervention in the field of HIV is lopsided with the exclusion of the MSM population and failure to address their sexual behaviorendangers not just the MSM population but the public at large since in the Nigerian environment many MSM also engage in opposite sex relationships.
By Md. Mamunur Rashid
Background: Bangladesh is a conservative Muslim country. MSM, hijras and other sexual minorities are neglected in all aspects of society due to high level of stigmatization and social exclusion. Thus, basic human rights like access to treatment and access to education are still dream for these sexual minorities. Bandhu Social Welfare Society (BSWS), as a leading MSM community led organization in Bangladesh has been implementing a sexual health programme for MSM and hijras since 1997 with limited resources. With the availability of GFATM funds through the South Asia regional project, it has been able to expand its resource centre to become largest in the country focusing on needs of MSM and hijras.
Methods: BSWS is one of the implementer of South Asia Regional Global Fund Round-9. Funds available from the grant enabled BSWS to develop a specific accessible Resource Centre which provides knowledge products, training and technical support to MSM groups and networks, as well as other stakeholders providing HIV services in the country. Funding allowed the development of a library, a media room, a training centre, and space for community meetings and social activities. And archive centre is also being developed.
Results: While historically, BSWS has been providing knowledge, training and technical support, this has been approached in an ad-hoc way. GFATM fund enabled BSWS to bring together these aspects under one roof, and thus strengthen and scale up its capacity to deliver these key programmes. Further, this has been a participatory process, where MSM community members have been engaged in developing, designing and donating resources to this centre.
Conclusions: Community-led organizations providing health services to MSM in resource constrained and stigmatizing environments, should have as an integral part of their programme such Resource and Knowledge Centre as part of the process of developing enabling environment for MSM towards strengthening community mobilizing strategies.
By Bryan Chee Hong Choong; Dharesheni d/o Nedumaran
Background: In Singapore, many mature men who have sex with men (MMSM), who are 40 years or older, were victim to intense homophobia during their youth. And without internet access to sexual health resources, many have internalised those negative experiences, affecting their socialisation as well as their help-seeking behaviour. Till recently, HIV education and prevention in Singapore also caters mainly for MSM aged 18 to 39. Data from Singapore's Health Ministry shows that half of male HIV infections are men aged 40 and above. Although these data do not reveal exact numbers of MSM, we estimate that approximately 35% to be MMSM. OC own MMSM poll shows that half of 255 respondents have not done HIV testing at all or done more than one year ago. There is an urgent need to address this service gap and upward trend of infection rates for MMSM.
Methods: The Mature Men Project (MMP) by OC had one workshop, four social events and two support groups attended by 200 MMSM. At the workshop attended by 60 MMSM, we covered aging MSM issues such as sexual, physical health, same sex relationship and relationship issues.
Results: In the 38 valid pre and post workshop feedback. 92% of respondents stated that they are more aware of MSM supportive resources available. 84% stated they are more aware of the importance of maintaining sexual health. 86% stated that they are confident of seeking help or information on HIV and STIs resources. 92% are more prepared to participate in MMSM related activities.
Conclusions: MMSM face unique challenges and thus have different needs than younger MSM which age-specific programs can better address. MMP builds MMSM's resilience relative to aging and empowers them to adopt safer sex practices by using an approach and language suitable for MMSM.
By Jaco Greeff Brink
Background: To determine the extent to which the theory of planned behaviour (TPB) is applicable in explaining condom use intention among a sample of student men who have sex with men (MSM).
Method: A sample of fifty sexually active student MSM were recruited through convenience sampling to take part in an online (baseline and follow-up) survey, three months apart.
Results: Only attitude and perceived group norms could significantly predict intention to use condoms. Attitudes regarding condom use were found to have an inverse relationship with intention to use condoms. The results from the hierarchical multiple regression analyses revealed that the linear combination of the TPB variables could significantly account for 68% of the variance in intention to use condoms when the predictors were considered together.
Conclusions: The present study questions the applicability of the TPB in understanding and predicting intention to use condoms among a sample of student MSM attending a South African higher education institution (HEI). The findings advocate for additional research to be undertaken on the applicability of the TPB in informing sexual health interventions that aim to reduce HIV transmission risk among student MSM at South African HEI. A need to further investigate the following was identified:• the inversely significant relationship between attitudes and intention to use condoms; • the predictive utility of the perceived behavioural control construct; and • the relationship between intention and actual condom use.
By Thomas Muyunga
Background: This study of two groups randomized 109 human immunodeficiency virus (HIV)-infected patients with CD4+ cell counts >350 cells/microL to intermittent antiretroviral therapy (ART; the drug conservation [DC] group) versus continuous ART (the viral suppression [VS] group). A drug conservative (DC) group, for participants starting ART when the CD4+ cell count was < 250 cells/microL. The DC group is for those identified after vigorous outreach programmes. The VS is for those who initiated own HIV Counselling and Testing (HCT). Clinical outcomes in participants not receiving ART at entry inform the early use of ART.
Methods: Patients who were either ART naive (n=29) or who had not been receiving ART (n=28) were analyzed. The following clinical outcomes were assessed: (i) opportunistic disease (OD); (ii) OD (fatal or nonfatal); (iii) serious non-AIDS events ( SRH-commodities, malaria, TB, nutrition issues, lack of taxi-fares, battering, physical bruises, anal inflammation, STIs, cardiovascular, renal, and hepatic disease plus non-AIDS-defining cancers); (iv) discrimination and stigma (v) the composite of outcomes (i), (iii) and (iv) and (vi) the composite of outcomes (ii) and (iii)
Results: A total of 57 participants (28 in the DC group and 29 in the VS group) were followed (mean, 18 months). For outcome (v) 52 events occurred in DC and 13 events in VS. For outcome (vi), 23 events occurred in the DC (3 in ART-naive participants and 20 in those who had not received ART) and VS (1 in ART-naive participants and 2 events in those who had not received ART) groups, respectively.
Conclusion: Early reporting for health care by MSM informs on Initiation of and appropriateness of STI/HIV-related services may reduce both OD and serious non-AIDS events.
By Ajai Kumar S; Joseph Francis Munjattu
Background: India has the world's second largest number of mobile phone users, and Bangalore is known as the hub of the Information Technology sector in India. The introduction of multimedia handsets and the increased usage of social networking sites in Bangalore has radically changed the way men who have sex with men (MSM) and transgender people, hijra, and others network and communicate. This study evaluated how social networking sites have influenced the ways that young MSM of Bangalore Metro City network and their awareness of health-related issues, including HIV and sexually-transmitted infections (STI).
Methods: The study was conducted among young MSMs, who have mobile phones, in Bangalore, Karnataka State, India (n=224) during October - December 2011. A questionnaire has been administered regarding various aspects of their access to internet, their gadgets, patterns of networking, their memberships in social networks and their level of health awareness especially about STIs, HIV and AIDS.
Results: 73% of MSMs having mobile phones use multimedia handsets. 84% of the MSMs using multimedia handsets are members of social networking sites. Membership in social networking sites: 90%. Connected with more than 5 community members previous month: 86%. Social networking sites preferred for interaction: 96%. Received messages on HIV and STI vulnerability: 65%. At least one meeting attended after joining social networking sites: 96%. Reasons for preference: Anonymity: 93%. Enables group communication: 76%. Cost effectiveness: 85%.
Conclusions: The study shows the potential of social networking sites as a medium to engage the young MSM population in urban settings. Policy makers and programme implementing agencies should include social networking sites as a tool to interact with young MSMs based in urban settings, helping to strengthen MSM networks and add muscle to HIV prevention programmes.
By Lyndal Cairns; Chris Clementson
Background: Healthy Communities works to limit HIV amongst Queensland gay men. In 2011 we employed a Social Media Coordinator to solidify growth into online networks. This not only increased HIV outreach but also increased discussion creating a more supportive environment for HIV prevention.
Methods: Reaching a dispersed population with changing habits towards online communications and hook-ups meant we embraced social media to engage gay men and other men who have sex with men (MSM). Diverse social media networks and tools engage, educate and activate gay men about HIV prevention. Evaluation means Healthy Communities internet outreach is tweaked often to improve it.
Results: Facebook is a fantastic tool for community action as evidenced by the Rip & Roll condom reinforcement campaign. Included a photo booth and branded albums on Facebook that users could tag, this campaign has 2093 "likes" and 717 people are "talking about" it. Also we have Facebook groups for regional and diverse interest groups; pages for campaigns; and we use professional profiles to have health conversations. Connections are built through word-of-mouth and low-cost, targeted social advertising. GrindR is the peak hook-up app for gay men and MSM. Health workers outreach GrindR daily. Profiles are personable but obviously professional and are refreshed every few weeks. Workers' names and descriptions identify them as health workers. Our Sunshine Coast team reports greatly increased engagement and only positive contact with GrindR users keen to know about sexual health. Other hook-up apps, like Scruff (for bears) and Recon (for BDSM fans) are also outreached. Healthy Communities also has corporate accounts on Twitter, LinkedIn and Google+.
Conclusions: Social media is a sophisticated tool for targeted HIV Prevention amongst gay men wherever they are sexually connecting. Evaluation ensures we are using the correct tools for the job at hand.
By Van Tung Nguyen; Thanh Tung Chu; Ngoc Tuan Dao; Thang Vu; Dang Khanh Nguyen
Background: MSM under 18 years old were very in risk of HIV infection due to their poor knowledge and inferior position. Condoms were often not used because their partners often believed that they were not at risk. However, they were not included in any current HIV and MSM support programs. In Vietnam, there is no project to MSM minor group. They are not approached with safety sexual information, psychology supports. The rejection is still popular so they cannot tell their problems to families, friends or in education areas. The peer educators are not equipped enough skills for psychology assistant in MSM minor.
Methods: Due to high level of stigma and shyness of the group, Echo approach was used to identify and reach them. Contacts were first made in internet forums before offline meetings. Broader sexuality education was provided to make them comfortable with their sexual identity and practices before more specific education on HIV prevention. This also helped the sharing of sensitive issues such as sexual abuse. Media materials including pictures, films, videos and online discussions were used to facilitate the discussions. The program also provided counselling and psychological support.
Results: Nearly 800 under 18 years old MSM were reached. After joining the program, they not only showed significant improvement in knowledge and practices regarding HIV prevention but also their self-esteem and self-confidence. 5 groups of MSM minor are established and operated weekly with the participation of more than 500 MSM.
Conclusion: Targeting under 18 years old MSM have long-term positive impact as this is very important time of psychological development. Echo was very effective to reach this often hidden and timid group. Diversify the outreach by direct outreach, friend network, internet system such as online forum, social network (Facebook, Twitter, Zing me...), Yahoo messenger will increase the efficiency of program.
By John A. Schneider; Keith Green; Charles Nelson; Montre Westbrook; Nanette Benbow; Yaa Simpson; Nik Prachand; Stuart Michaels
Background: YBMSM ages 16-29 have the highest rates of HIV infection in the United States. HIV prevention in this population would have considerable impact on future health-care resources given the need for lifelong antiretrovirals Estimating the numbers of YBMSM complicates HIV prevention program planning.
Methods: We focus on South Chicago (SC), a 95 mi² region and is one of the largest contiguous Black urban communities in the US: Census data reports 54,420 young black men (16-29). To estimate the number of YBMSM in SC we utilized three methods. First, a modified Delphi approach averaged community expert estimates. Second, data from the most recent National Survey of Family Growth (NSFG) estimated the proportion of black men who report sex with a man. The third method used an indirect approach following the formula: P=C/F, where P is the estimated number of YBMSM; C is the average YBMSM prevalence estimate (# HIV+ YBMSM/young Black male population)x100,000; and F is the YBMSM HIV seropositivity rate (#YBMSM HIV+/#YBMSM). F is sensitive to study design and was obtained from two sources: the CDC’s Chicago Behavioral Surveillance System (BSS) and the Social Risk and Network Assessment (SRN).
Results: The modified Delphi approach yielded rates of 3.0% (2.3-3.6), 16.8% (14.5-19.1) and 25% (22.0-27.0); average of 14.9%. The NSFG estimates 3.2% (95% CI: 1.41-4.99). Using BSS yielded 12.4%; SRN with 10.5%; average of 11.5%. Crude average of the three methods yields an average of 9.9%. Applied to SC, the combined estimates result in 5,388 YBMSM.
Conclusions: The number of YBMSM in one of the largest contiguous Black urban communities is relatively small offering potential for elimination of new HIV cases. While this population is relatively small, the younger age category, the high rates of infection as well as challenges with identifying and effectively reaching this population remain.
By Minh Thanh Le; Quan An Ho; Hong Quan Tran
Background: To make parts of people understand that homosexuality is not a disease, homosexuals can not choose their sex orientation but they can live, work and study very well.
Method: Made up a drama about the tragedy of a MSM ( hiding the real sex orientation, being forced to marry a woman by his family, can not remain love with his boyfriend... ) and then performed publicly about 4-5 times in some theatres in Ho Chi Minh City, Vietnam- Produced a scientific docmentary film with the title : "Homosexuality - An issue to be concerned". It talks about the story of a MSM who has got over difficulties and come out with his family, friends and colleages. He is now succeeding in his career and eveyday life. Moreover, some doctors, social masters and members of CSOs spoke up to prove that homosexuality is a normal fact. The film was first broadcasted on VTV9 channel and then widely on about 12 other channel in Vietnam from November, 2011 to the end of December, 2011.
Results: Over 1200 audiences, especially who is not a homosexual, went to the theatre to enjoy the drama, but there´s about 2/5 the amount of audiences continue keeping stigma of homosexuality and the rest ones changed their thought about homosexuals - About 2000 view turns on television and 400 view turns on internet for the documentary film. A half of viewers say good things about the homosexuals.
Conclusion: After enjoying the drama and viewing the documentary film, lots of Vietnamese has changed their thoughts, behaviours to homosexuals. This will give generally the homosexuals and particularly the MSM community in Vietnam, a chance to feel better and more confident. As a result, they can access to HIV/ STIs services easier.
By Brett Stevens; Joseph Debattista
Background: In 2010 Queensland recorded the highest number of people newly acquiring HIV since it became notifiable in 1984. With the current National HIV Strategy 2010-2013 placing a strong emphasis on promoting sexual health testing, the Queensland Association for Healthy Communities in conjunction with the Sex On Premises Venue (SOPV) Operators Group and Qld Health developed a six month project trailing the efficacy of a STI testing promotion within SOPV’s.
Methods: The project’s formation was influenced by a range of factors including a decline in gay men’s sexual health testing (QGCPS 2010); the suspension of government initiated SOPV Outreach Clinics, as well as a range of research papers such as “An Ordinary Night Out” (Grierson, Smith, Doussa) highlighting traditional methods of resource display & distribution were having limited success in venues such as SOPV’s. Key approaches include the implementation of a HIV/STI testing promotion targeting test-naïve or infrequent testing SOPV patrons with an aim of increasing access to mainstream clinical services. Running concurrently to the project was a state-wide survey recruiting men online and at gay venues to gather behavioural data around motivators and barriers to gay men’s testing.
Results: While the SOPV Testing Project is due to conclude at the end of March, initial findings from the project & survey results indicate that the strongest motivation to testing remains engaging in a risky event. Further findings will be presented at the Conference.
Conclusion: In order to increase STI testing among gay and other MSM, and to slow the rates of new cases of HIV & other STI’s, new interventions such as incentivised testing need to be explored to overcome impediments to testing. The presentation will cover the results of the Project, as well as the linkages to current research on personal, community and health service barriers to gay men's testing.
61. Electronic medical records and short messaging service (SMS) in anti-retroviral therapy: Mobile health/electronic health (mhealth/ehealth) recommendations from a qualitative study among men who have sex with men and sex workers in Swaziland
By Darrin Adams; Zandile Mnisi; Nhlahla Nhlabatsi; Rebecca Fielding-Miller; Stefan Baral; Caitlin Kennedy
Background: The Swaziland antiretroviral therapy (ART) delivery system is straining to provide care for a population with the highest adult HIV prevalence rate in the world (26%), with 160,000 infected people and 60,000 receiving ART. Swaziland's first qualitative study among HIV-positive sex workers (SWs) and men who have sex with men (MSM) explored their experiences with healthcare and ART delivery for these hard-to-reach populations.
Methods: 20 MSM and 20 SWs were recruited using snowball sampling. Respondents self-identified both as MSM/SW and as HIV-positive. Semi-structured, in-depth interviews took place across the country. Transcripts were analyzed using emergent codes with co-analysis discussions.
Results: The majority of both SW and MSM respondents reported long wait times to see health care providers, short visits with hospital staff, medical files being lost by hospital administration, overcrowded reception areas, and being turned away due to drug stock outs. Many respondents reported using their cell phone alarms or having a friend send messages or call them for medication reminders. In the Swaziland ART counseling policy, counselors make such recommendations to patients. Though high-risk populations like MSM and SWs raised these issues, they reported going to the ART dispensary “like everyone else” and described a shared experience with the general HIV-positive population.
Conclusions: To further support HIV-positive patients at both health system and behavioral levels, Swaziland could pilot e-health/m-health interventions in chronic disease patient management like 1) electronic medical records and 2) using SMS to communicate with patients on topics from drug stocks to counseling. Swaziland has shown promise in implementing mobile and electronic health interventions with successful cell phone reminder systems, and is positioned to implement additional e-health/m-health programs that could benefit a wide variety of HIV-positive populations, including MSM and SWs.
By Macarena C. Garcia; Quyen L. Duong; Paul Ward; Samantha Meyer
Background: In Vietnam, MSM are disproportionately affected by HIV infection compared to the general population. The objective of this study is to estimate the prevalence of multiple sexual partnerships and other behaviors that put MSM at an elevated risk of HIV infection in Vietnam.
Methods: A web-based cross-sectional survey of self-reported HIV sero-prevalence and sexual attitudes and behaviors was conducted nationwide among 2,077 Vietnamese MSM (40.5% response rate) living in Vietnam and over 18 years of age between 8 August – 9 October 2011. Descriptive analyses were conducted using screened and validated data.
Results: 67.4% of MSM self identified as homosexual and 63.2% self identified as ‘bong kin’ (a masculine MSM who hides his homosexual activities). A total of 85.7% of respondents reported having sex with any type of male partner in the last 6 months and 59.9% reported anal sex with a male. 8.9% reported having sex with both male and female partners in the last 6 months. MSM were more likely to report multiple sexual partners (56.7%) than monogamous partners (24.8%) in the last 6 months. 57.1% reported never having a voluntary HIV test, with only 17.6% reporting being voluntarily tested for HIV. Only 36.2% of MSM reported protecting themselves from HIV in the last 6 months. A low percentage of respondents (0.4%) reported ever injecting drugs, which is a promising finding.
Conclusions: Multiple sexual partnerships are a common pattern among MSM in Vietnam, especially MSM in long-term sexual relationships with a female. Effective HIV protective measures such as HIV testing and condom use are dangerously low among MSM surveyed. Given the prevalence and significance of lack of consistent condom use, multiple sexual partnerships and low levels of HIV testing among MSM in Vietnam, our findings underscore the urgent need for segmented and focused prevention efforts targeting this high-risk group.
By Dr. Kathleen Anne Triffitt; Mr. David S Novak
Background: With the advent of technologies such as viral load monitoring (on which to base an assessment of sexual risk) gay men may have adapted their sexual behaviours. Positive Life NSW (Australia) designed a web-based campaign that looks at the choices made by HIV-positive men about using condoms in sero-concordant relationships. Drawing on formative research (1:1, group interviews) and campaign development (website, video stories) Positive Life NSW, in collaboration with Online Buddies, Inc.’s OLB Research Institute, launched “Wrapped or Raw – POS-POS Sex” (WoR). After an 8 month promotion a formal evaluation was performed.
Methods: A coordinated email broadcast, banners and blog/video launched “WoR” across Manhunt, Manhunt Daily, and Manhunt Cares. An email broadcast campaign evaluation consisting of 23 multiple choice and one open-ended question was sent to all active (past year) Manhunt NSW members. Analyses consisted of health campaign distribution metrics and evaluation responses with a focus on type of media consumed, message type, and perceived effectiveness across men with and without HIV.
Results: From 11/2010-7/2011 campaign promotion results revealed a total of 10,418 unique visits to the WoR website: 7,345(70.5%) from Manhunt, 2,120(20.3%) from Manhunt Daily, 953(9.2%) from Manhunt Cares and nearly 13,500 views of the video 13,095(97%) from Manhunt Cares. Campaign evaluation revealed 1,533 unique visits to the online survey and 1,326(85%) completed responses.
Conclusions: Significant reductions in HIV-transmission may be achieved by combining existing prevention approaches (condom reinforcement campaigns) along side targeted education (non-condom based risk reduction strategies such as viral load monitoring) with emerging biomedical and technological innovation. New partnerships including sexual/social networking sites are integral to this work.
By Ryan Paul Nuyles Cortes
Background: Sex work in the Philippines has expanded from female streetwalkers and brothel-based to male and even transgender (TG) escorts and online-based sex workers (SWs). Given the nature of their occupation, sex workers are exposed to health risks such as STIs, HIV/AIDS. Recent Philippine IHBSS 2011 showed Cebu City having the second highest HIV prevalence among MSM (i.e. 4.7 percent); which the TG women population are included. Due to the lack of social recognition of TG women, combined with the stigmatization of sex workers, this leads to discrimination, violence and health risks among TG women SWs. Hence, it is important to look at their gender identity and self-description; context and nature of sex work involvement; and their perceived and experienced occupational risks.
Methods: The Method used was face-to-face in-depth interviews with fifteen (15) TG women SWs in Cebu City as categorized by the researcher. Content analysis was used for qualitative analysis of transcribed interviews.
Results: The findings revealed that TG women SWs do not necessarily identify themselves as TG but see themselves as women expressed in different modalities, but commonly undergoing body modifications (i.e. hormone pills). Economic benefits and sexual enjoyment gained from sex work are the main motivations for sex work involvement. Escorting has the most economic benefits, followed by online chatting, online harvat, and harvat in cruising sites. Greater preference for foreigner clients and the “versatile” sexual role because of greater economic benefits and sexual satisfaction. Lastly, there were lesser experiences of occupational risks than what they perceived.
Conclusions: The study concludes that perceived and experienced risks associated with sex work are not merely occupational, but are also behavioral and gender-based. As such, the risk to STIs, HIV/AIDS is more behavioral than occupational. Hence, BCC strategies for HIV prevention should be client-specific to address health needs of the general TG women population.
By Sean Cahill
Background: Pre-exposure prophylaxis (PrEP) for HIV prevention has shown efficacy with MSM and heterosexual women and men. Demonstration projects are underway in several countries. U.S. and global regulatory bodies are considering approval of FTC-TDF for PrEP or issuing guidance in 2012. Millions living with HIV don’t have access to antiretrovirals. While MSM are 19 times more likely to become HIV-infected, most MSM still do not have access to HIV prevention services.
Methods: Clinical trials PrEP research, implementation modelling, and research on attitudes toward PrEP among MSM was analyzed. Policymakers and stakeholders were interviewed.
Results: PrEP could cost-effectively reduce HIV incidence if targeted toward most vulnerable populations in combination with scaled-up treatment. Sustained care and behavioral interventions must accompany PrEP to ensure adherence and maintain condom use. Most MSM in the U.S. and globally have limited knowledge of PrEP; when PrEP is explained, there is widespread interest in using PrEP. Cost is the most significant obstacle to widespread scale-up. Brand-name daily FTC-TDF would cost about $8,000 a year per person in the U.S. In lowest-income countries tenofovir is available for $66 a year and FTC-TDF for $108 per year. Private insurers and Medicaid departments in the U.S. are open to coverage. National leaders should consult the latest research to strike the right balance between funding treatment and PrEP. Existing treatment infrastructures could assist PrEP scale-up.
Conclusions: The provision of PrEP to MSM should occur in a broader context of ensuring clinically competent health care to LGBT people. While cost of PrEP in the U.S. would be substantial, elements of the Affordable Care Act could facilitate coverage. Low-cost generic medications could enable access in low-income countries. Striking a balance between resources for treatment and PrEP, and ensuring access for MSM and other most vulnerable populations, is critical to the successful implementation of PrEP.
By Nicklas Dennermalm
Background: Between December 2010 and January 2011 RFSL Stockholm ran an Online campaign targeting MSM with sexual relationships with other person(s) than their steady partner. The aim with the campaign was to encourage clear communication between (sexual) partners regarding safer sex, honesty, mistakes and rules concerning the openness of their relationship. From studies made we know that sexual relationships with others than steady partner is common among Swedish MSM. It is also well established that concurrent sexual partnerships increase the risk for HIV/STI transmission.
Methods: The Key element of the campaign was a micro site with an interactive platform where users created a Sex Contract between them selves and one or more partners, either by using prewritten 'rules' or creating their own rules. The microsite generated a cumstom made contract to be e-mailed to one or several partners to be discussed or edited. The campaign also used a well-known Swedish gay blogger who recorded four short films about the campaign, about deals, negotiated safety and failing the deals. By the use of iPads, peer educators did outreach with the campaign at MSM meeting spots. The campaign also had a twitter account tweeting all new 'rules' added to the Sex Contract by users. By presenting this campaign, RFSL Stockholm would like to share our experiences on how an interactive campaign involving several Online elements can be created and also linked to more traditional outreach work by peer educators.
Results: 153 contracts have been e-mailed to unknown amount of partners. The YouTube videos have been watched over 5 000 times. The campaign was listed as one of the top sexual health campaigns of 2010 and the campaign may be exported to the USA.
Conclusions: No scientifical Conclusions were made even though the campaign was inspired by recent Swedish reserach.
By Keshab Deuba; Rachana Shrestha; Laxmi Bhatta
Background: Nepalese government has recognised men who have sex with men (MSM) as marginalised and most at risk of becoming infected with HIV and has begun to address HIV among them through different prevention, care and support interventions including rapid expansion of voluntary counseling and HIV testing, the promotion of condom use and HIV education. However, little is known about demographics, behavioral and family support characteristics of MSM participating in the interventions. We examined the association between MSM demographics and family support, behavioral, and, participation in HIV prevention interventions.
Methods: A cross-sectional survey was done among 339 Nepalese MSM, at least 15 years of age, recruited in a convenience sample between September-November of 2010. The outcome variable was participation in any HIV prevention interventions in the past year (i.e. been to MSM outreach/drop-in centres and participated in individual counselling, HIV education session, and condom distribution). Logistic regression analysis was used to examine possible associations between outcome and independent variables. The confidence interval (CI) was set at 95%, and significance level set at 0.05.
Results: Among total MSM, 78% participated in any HIV prevention interventions in the past year. In a multivariate model, MSM who reported not using condom in last three anal sex encounters with men (adjusted odds ratio (AOR): 0.35, 95% CI: 0.13-0.93, p-value: 0.036), sexual orientation reported as tas(masculine appearing men and perform an insertive role during sexual intercourse, AOR: 0.29, 95% CI: 0.12-0.74, p-value: 0.009) and MSM with no family support (AOR: 0.44, 0.21-0.93, p-value: 0.032) were less likely to have participated in HIV prevention interventions in the past year.
Conclusions: Study findings suggest that interventions are not reaching all MSM sub-population (tas) with high risk behaviour. To be more successful, interventions targeting MSM in Nepal should cover all MSM sub-populations with high risk behaviour and no family support.
By Tooru Nemoto; Doug Polcin; Mariko Iwamoto; Ben Cabangun; Maria Sakata; Elnaz Eilkhani; Akemi Takagi; Jay Camegla; Jonathan Magat
Background: HIV incidence and prevalence among APIMSM in the U.S. are steadily increasing. TEPOT-II is a community-based participatory HIV prevention project targeting high risk APIMSM in San Francisco and Alameda County.
Methods: As of January 2012, 179 clients were recruited through community outreach and online venues. A curriculum was developed to address culturally relevant issues among APIMSM (e.g., coming out and relationship with family). APIMSM Health Educators were trained for the motivational interviewing techniques to reduce substance use and HIV risk behaviors based on the stages of change. Clients could either enroll in the Brief Intervention (two 1.5-hour individual sessions) or the Motivational Enhancement Intervention (four 1.5-hour individual sessions). At the baseline, exit, and 6-month follow-up, clients were interviewed for a risk assessment. Clients who abuse substances are referred to treatment programs.
Results: Internet-based recruitment is the most efficient way to reach and recruit the targeted APIMSM. Participants were Chinese (32%), Filipino (31%), Multiracial (17%), and another Asian ethnicity (20%). Over half were born in the U.S. (55%). Participants reported sexual risk behaviors: 34% had unprotected anal sex during their last encounter; and 55% had had sex under the influence of alcohol or drugs in the last 3 months. During the past 30 days, 76% had gotten drunk or very high from alcohol; 34% used marijuana; 7% methamphetamines; 6% crack. To increase retention, continuous contact was made with clients through social media. Health Educators' intervention sessions was closely monitored by a clinical supervisor to ensure fidelity. Through participating in TEPOT-II, clients were referred to HIV testing and other services and connected to APIMSM community.
Conclusions: Alcohol and drug use among APIMSM must be addressed in relation to risky sexual behaviors. Further, we need to disseminate evidence-based efficacious intervention programs for APIMSM (e.g., Brief Intervention).
By Arif Jafar
Background: Sexual identities and same-sex behaviours in India are strongly linked to socially prescribed gender roles. People who engage in receptive anal intercourse may prefer to identify themselves as “females”, and identify themselves as “kothi”. Their penetrative partners are known to identify themselves as “real men” and do not have any sexual identity. However, people who self-identify as “kothis” label their penetrative partners as “panthis”. Kothis are vulnerable to gender-based violence because of their preferred gender identity and gender expression.
Methods: 100 questionnaires were administered on the kothis associated with 3 MSM CBOs in Uttar Pradesh. Among these 10 respondents were contacted for in-depth interviews to further explore about the multiple rapes, sexual violence.
Results: 42% of the respondents reported that they have been raped. The kothis who have experienced sexual violence by groups of men stated that this was because of their identity and sexual roles. An outcome of sexual violence is the increase low self esteem and self-worth of the victims which resulted in low condom usage and unsafe sexual practices, as they do not see any worth in their lives.
Conclusions: In India, feminised males (who have sex with males) sexual violence and coercive sex starts at a very early age as reported by the respondents. Most of sexual violence incidents have been reported at schools, colleges and workplace therefore a range of education programmes need to be developed. We need to sensitize, In addition this rights based advocacy to mitigate sexual violence against individuals who do not conform to socially prescribed gender roles is very much needed. At the same time rape/trauma counselling for kothis/ transgender/ other sexual minorities needs to be readily available.
By Júlio Esteves; Jesus Cornejo; Hugo Machado; João Brito; Tiago Rodrigues; Ricardo Fuertes; Ricardo Abrantes; Maria José Campos; Luís Mendão
Background: CheckpointLX offers anonymous, confidential and free rapid HIV testing for men who have sex with men (MSM). Counseling is offered by trained MSM promoting access to prevention and sexual health in an effective and integrated way in the reality of the MSM community. In Portugal MSM are disproportionally infected by HIV according to EMIS survey and PREVIH project. Men who have sex with both men and women (MSM/W) are a hard to reach hidden population. This study aims to characterize the HIV testing experience among MSM/W.
Methods: Trained peers proposed a structured questionnaire to the clients that included socio-demographics data and sexual behaviour characterization. Retrocheck HIV® was used to screen for HIV. Men with a reactive result were referred to the Infectious Diseases Clinic and a member of the staff offered to accompany to the first appointment.
Results: From April 2011 to January 2012, 1056 HIV rapid tests were performed, 10% (106) in MSM/W with a median age 30,5 years (SD 12,06); 45 (39%) reported a steady partner (64% male, 29% female and 7% MTF transgender). 73,3 % have ever been tested for HIV, 53,4% in the previous 12 months (median age 30,5). Two MSM/W (1,7%) had an HIV reactive test. Among MSM and MSM/W tested (n=922), median age was 30 (SD 9,3), 86% have ever been tested for HIV, 63,5% in the previous year (median age 30), 5,8% had an HIV reactive test.
Conclusions: According to our evaluation, the socio-demographic differences found between the tested MSM and MSM/W populations are not significant. Comparing to total sample, MSM/W were less tested in the past (86% vs 73,3%) and also in the previous 12 months (63,5% vs 53,4%). Advertising CheckpointLX at open air cruising areas, parks and beaches, as a new strategy to reach this population has been developed by a group of volunteers.
By Ricardo Pulido; Angelica Ospina; Rodrigo Parrini
Background: Female-Transgender-Sex-Workers (FTSW) are one of the most vulnerable populations for acquisition HIV in Mexico, though there are no data about HIV prevalence and little is known about their attitudes toward HIV testing or Antiretroviral-Therapy (ART). This study aims to identify barriers and facilitators of HIV testing and ART adherence.
Methods: Eleven FTSW, residing in Mexico City and aged 20-50 years old, were recruited by health promoters and trained as peer researchers. During the 5-day training, they designed interview guides for interviews they conducted among their friends during August 2011. Forty-five in-depth interviews were conducted. Topics included daily life, transformation from male-to-female process and health worries and needs.
Results: Respondents expressed negative attitudes towards HIV. They had lack of knowledge about living with HIV and ART, myths about HIV and ART, lack of ability to deal with a positive diagnosis, and lack of social-support-networks. All participants reported an AIDS-related death among their closest friends. Self-report HIV status indicated a high prevalence in this community: 33% (n=5/15) of 20-30 year olds were positive, 69% (n=9/13) of 30-40 year olds were positive; however, no participants over 40 years reported being HIV-positive (n=0/17). The primary facilitator for promoting healthy habits among FTSW was their capacity to invent themselves day-by-day. In projective exercises the image of a warrior who fights to achieve her personal objectives was the most recurrent image used to represent themselves.
Conclusions: Although these are qualitative data, they show trends of high HIV prevalence in 20-40 year olds that should be further explored by quantitative studies. It is urgent to promote HIV testing and ART adherence to increase health among FTSW. Accompaniment to health services by health promoters can bring FTSW closer to those services. Peer researchers recommended that peers share successful personal overcoming stories as strategy for spreading knowledge about HIV and ART.
By Daniel Rodriguez; Sherry Estabrook; Jacoby Johnson; Tamika Howell
Background: YMSM are frequently turning to online dating sites to meet new sexual partners. This practice poses unique risks for a population with climbing rates of HIV diagnoses, particularly for black YMSM , who experienced the highest increase in new HIV diagnoses of any racial or ethnic group from 2005-2008.
Methods: To address this need, the Black Men’s Initiative at Harlem United Community AIDS Center adapted the Popular Opinion Leader (POL) program to modify perceptions and practices related to social norms in Black and Latino YMSM who seek sex online. POL is a community-level HIV prevention intervention to equip influential members in the YMSM community to initiate informal risk-reduction conversations to modify practices and perceptions of safe sex among their peers. We adapted POL to provide online, sex-positive, harm reduction messaging for young MSMs, ages 18-29 on the website Black Gay Chat (BGCLive.com).
Results: As of October 2011 POL trained over 286 YMSM of color to act as POLs. Through informal conversations, POLs have engaged over 6117 community members. Training results from n=50 POLs in 2011 indicated a significant shift in attitudes about HIV and sexual risk from pre- to post-test at the p<.01 level. A May-June 2011 community assessment of n=118 BGCLive members indicated that 51% had come in contact with the program as measured by their recognition of the CRAVE logo. There were statistically significant differences associated with logo recognition; more frequent HIV testing [F(1,116)=4.24, p=.042], and fewer overall sexual encounters, [F(1,116)=7.35, p=.008] and with individuals they met online [F(1,115)=5.43, p=.022].
Conclusions: This innovative POL model has crossed into the virtual world, engaging high-risk men who are difficult to reach through traditional street-based outreach methods. Results from evaluations indicate that the program is successful in educating POL participants and BGCLive.com community members on healthy sexual practices and attitudes.
By Drashko Kostovski; Ninoslav Mladenovik; Elizabeta Bozinoska; Zoran Jordanov
Background: Macedonia is among the countries with the lowest HIV prevalence in south-east Europe, yet HIV has a disproportionate impact on gay men and other MSM. Homophobia among the general population is high and MSM remain hidden with a number of recent cases of violence towards MSM. Is this homophobic environment having a negative effect on accessibility or are their other structural factors?
Methods: A study was conducted to assess the availability and accessibility of SRH and HIVrelated services for gay men and other MSM through desk review of published data, two focus group discussions with MSM, and seven interviews with key informants from UN agencies, government institutions, LGBT organization, network of PLHIV, and community-based organizations. Qualitative analysis was utilized to determine the major barriers to accessibility.
Results: While condoms, lubricant, and HIV testing are routinely provided free of charge through outreach work by community-based organizations, these same services are not routinely available from government services. Apart from one youth-friendly clinic in partnership with the national LGBT network, there are no specific clinics adapted to the needs of MSM. The main barriers to accessibility of services are: fear that confidentiality will be breached; homophobic attitudes of parents or friends; homophobic attitudes of health care workers in clinics; location of services, especially outside of capital city; and cost of services.
Conclusions: To improve the availability and accessibility of SRH and HIV-related services for MSM, there is a need to scale up services outside of the capital city. With a number of existing government clinics throughout country, it is essential to build the capacities of medical staff in these clinics to provide MSM-friendly services. It is also recommended that the government conduct a national anti-homophobia campaign in partnership with MSM/LGBT organizations
By Bhuiyan ASM Rahmat Ullah; P.S. Sarkar
Background: In Bangladesh social attitudes towards sexual minorities to be particular towards feminized males leads them as the prior victim of abuse, assault, harassment and violence, rape, murder, stigmatization and poverty, disempowerment which consequences the persons a range of physical, psychological, social, economical and emotional problems which increases social exclusion. There is law country which bearing some ancient laws and presence as especially Section 377 of the BPC to criminalize the sexual minorities. This is compounded by the fact that Bangladesh to be deeply influenced by religion, social and cultural norms. Thus increasing concerns of harassment and violation of sexual minorities addressed by BSWS with due importance and continues with intense concentration.
Methods: BSWS formed District Level Lawyers Group, Journalist Forum, Religious Leaders, Law Enforcement Agencies, Local Elected Bodies and Civil Society members. DLLG is providing legal aid support, sensitizing fellow lawyers in respective Bar Councils and creating enabling environment in favor of sexual minorities. BSWS maintains a strong referral linkage with Human Rights and Legal Aid providing organizations. The primary data regarding the Violence, Abuse, Discrimination or Human Rights Violation collected through a format and after reported the cases investigated. Then the reported cases are resolved locally, case filed at Police Station/ Court, dealt.
Results: In 2011, 109 (one hundred nine) cases reported to BSWS against sexual minorities. Among the cases 48 collected from working areas of BSWS and the rest 61 cases from legal helpline service. And 12 cases resolved locally, 1 Case Filed at Police Station, 64 case directly dealt by Legal Officer and 29 cases addressed in continues advocacy/ sensitization/ awareness meetings and workshops.
Conclusions: BSWS hopes if rights violation issues strictly addressed by the law enforcing agency, sensitization in mass level and the policy maker the number of rights violation & harassment will reduce.
By Victor Ekon George; Oliver O. Anene; Wisdom Joseph Inyang; Valor Bassey Atte; Ifeanyichukwu Obike
Background: In the context of the global AIDS epidemic, sex between two men is significant because it involves anal sex – a practice that, when no protection is used, carries a higher risk of HIV transmission than unprotected vaginal sex.
Methods: Small Group Discussions with 50 Men who have Sex with Men (MSM) discussing the sexual health and rights situation in Akwa Ibom State; and in depth interviews with 15 MSM who were victims of homophobic violence by homophobic people within the state. Findings from these discussions were documented using tape recorders and notes, and compiled by a research consultant. Written consent was provided by all participants.
Results: During the SGD, 10% of MSM respondents have families and friends who know and accepted their sexuality, and 90% percent will hide their sexuality due to fear of maltreatment. Most participants agreed that HIV/AIDS and STIs could be transmitted through anal sex, but weren’t aware of all the available prevention options. Fewer respondents had personal doctors who they could share any health challenge with, while a larger proportion of the group preferred to carry out self medication without seeking for medical help, when challenged with anal sexual health issues. Homophobic violence has predominantly been perpetrated in two forms; by gang-raping the victims, or by continuously blackmailing the victim financially.
Conclusion: In Akwa Ibom, MSM are less visible. Sex between men is stigmatized and criminalized. This adds to their vulnerability to health risks and violence, and makes it near impossible to carry out relevant health campaigns in the State. All Nigerians have the right to health and freedom from oppression. All government and non government stakeholders must work together to improve the lives of all Nigerians.
By Kevin Rebe; Glenn De Swardt; Helen Struthers; Geoff Jobson; James McInyre
Background: HIV-prevalence among men-who-have-sex-with-men is high in Cape Town. Anti-retroviral adherence (ART) among MSM and subsequent treatment failure, is affected by stigma and discrimination, depression, other mental health challenges and alcohol and drug use. The Ivan Toms Centre for Men’s Health (ITCMH), a collaborative project of the Department of Health and Anova Health Institute supported by USAID / PEPFAR, provides primary-care sexual-health and HIV services for MSM in Cape Town .
Methods: A retrospective review of clinic data of HIV-positive MSM clients (August 2008 - December 2011) who developed virological failure (VF) (defined as a viral load above 1000 copies/ml) and were switched to second-line, protease inhibitor-containing ART.
Results: 508 MSM received ART during this period. N % Total virological failures 26 100 Self identified MSM 14 54 Self identified MSM/W 2 8 Self identified MSW 10 39 Referred to psychologist/psychiatrist 11 42 Regular alcohol use 8 31 Regular recreational drug use 7 27 Self reported ART adherence problems 14 54 Treatment interruption due to lactic acidosis 1 4 Suspected primary HIV resistance 3 12 No identifiable cause for VF 1 4 Considering these risk factors, 1 client had 4 identifiable risk factors for failure, 2 had three risks factors, 5 had two risks factors and 13 clients had 1. 5 failed without any of these risk factors present..
Conclusions: Adherence support can be complex for MSM clients in Africa. Homoprejudice, stigma and discrimination remain pervasive. Internalised homophobia could negatively affect pill-taking behaviour. MSM are at risk of social isolation and may self-medicate with alcohol and drugs. Poor self-reported pill taking, mental health challenges and substance abuse were identified as problems in 21 out of 26 clients requiring second line ART at our MSM-targeted sexual health clinic and should addressed as part of adherence assessment and support for HIV positive MSM on ART. Keywords: South Africa, MSM, ART, Adherence.
By Jaco Greeff Brink
Background: The objective was to determine self-reported sexual risk behaviour and alcohol-and-drug use among student MSM at a South African higher education institution.
Methods: A sample of fifty sexually active student MSM were recruited through convenience sampling to take part in an online survey.
Results: Ten percent of the student MSM reported sexual debut at or before the age of 12, with a mean of 8.13 lifetime sexual partners and 14% reported previously being in a multiple concurrent partnership. Thirty six percent reported having male and female sexual partners, while another six percent reported sexual preference for female partners. 4% reported having made a female sexual partner pregnant in their past. 56% had used alcohol or drugs during sexual intercourse in the past. Six percent reported having been forced to have sexual intercourse against their will. Thirty six percent experienced abuse, and/or violence, on campus due to their sexual preference. A chi-square test on the relationship between gay-identifying participants and participants who have experienced some form of violence or abuse on campus produced significant results χ²(1, N = 42) = 7.98, p < .01. One third reported no or inconsistent condom use in the past. Most of the MSM (80%) had been tested for HIV in their lifetime, and of those who had been tested for HIV, 4.4% reported that they were HIV positive. In the twelve months prior to data collection, 70% of the sample was tested for HIV. Other STIs were reported by 6% of the sample.
Conclusion: South African student MSM are at risk of contracting HIV. Risky sexual behaviours identified include: unprotected anal sex, multiple sexual partners, concurrent sexual partners, the presence of STIs, early sexual debut, unknown HIV sero-status, being HIV positive, social homophobia, the presence of female sexual partners and substance use before or during sexual intercourse.
By Thomas Muyunga; Gerald Sebulime
Background: Sexual minorities identifying as WSW, MSM and TG are categorised as same sex, a behaviour which is penalised in Uganda according to 3 sections of the Penal Code of Uganda: Section 145, Section 146 and Section 148. This restrictive context influences support activities targeting sexual minorities ranging from access to health services and healthy lifestyle information.
Methods: 13 funded organisations from 2009-2011 reached out to 300 members. 2 organisations targeting MSM, 2 targeting LBT, 2 university based targeting LG, 3 targeting trans-persons, 1 targeting MSM/TG, 1 targeting intersex, 1 internet based social network and 1 targeting bisexual filled a questionnaire and during outreaches initiated question and answer sessions whose responses were used as means of generating information for this report.
Results: The 300 clients of these outreach services requested and were provided with IEC on issues related to sexuality, gender orientation, health, and relationships. Accessing these services allowed the clients to acknowledge their self-defined gender identities. The services also provided a safe environment in which clients were able to discuss pressing health and social issues including physical abuse, assault, battering, stigma, discrimination, STIs, illness, nutrition support, refuge and legal redress.
Conclusion: Regular and planned activities of organisations targeting WSW, MSM and TG are a means of realising met and un-met health-social needs. This influences appropriateness of services to address legal, social to health issues.
By K.Z.H. Wee
Background: SGRainbow is a social group for young gay and bisexual men,aged 25 years and below, in Singapore. One of the aims is to pioneer the advancement of knowledge regarding YMSM and their sexual health. By organizing social events, we create a safe environment for young gay and bisexual men to explore their sexuality and gain more awareness about HIV/AIDS and sexual knowledge. This is important as we perceive this to be lacking in Singapore´s mainstream sexuality education.
Methods: Through an event, Check-In 3, 14 registered participants aged between 18 to 23 years old were provided with knowledge regarding the gay community as well as accompanying issues like HIV awareness. Check-in is an event where participants visit gay-friendly places. One of the places visited was Action For Aids, a NGO working in the field of HIV/AIDS, raising awareness, and providing assistance to PLHIV. The event was promoted through online channels and word-of-mouth. Feedback was collected from participants through a survey to investigate the effectiveness and to evaluate their learning outcomes.
Results: From the survey results, all participants (100%) agreed that the event allowed them a deeper understanding of the gay community and its pioneers. Issues such as HIV/ AIDS awareness were highlighted when participants reflected a greater understanding of them. Examples would be the differences between HIV and AIDS as well as learning about CD4 count. For instance, a participant reflected that he now knows that HIV is the virus that causes AIDS, which is an acquired condition.
Conclusions: Our event and subsequent survey revealed that participants were largely ignorant or hold misunderstandings about the gay community and their sexual health. However, from the encouraging feedback given, we will continue to organize more Check-in events to continue educating and plugging what we perceive to be a crucial information gap among YMSM in Singapore. Country of research: Singapore
By Steeve Laguerre; Reginald Dupont; Daverne Stephen; Marjory Lafontant
Background: Fondation SEROvie conducted a study to explore issues of stigma, discrimination, health and HIV risk among Haitian men who have sex with men (MSM), and to increase informed and inclusive HIV public policy debates. MSM in Haiti are at high risk of HIV for various reasons, including multiple sexual partnerships, and reduced access to HIV services due to fear of stigmatization and discrimination. A moral and legal environment compounds the HIV vulnerability of MSM. The Haitian media plays an important role in disseminating accurate information on HIV and related issues and is a powerful ally in increasing public awareness around MSM issues.
Methods: - Focus group discussion in four major cities in Haiti - Interview with key organizations working with MSMs - Individual interviews with MSMs, decision makers and health personnel
Results: "Results indicated MSM were highly vulnerable, with most reporting multiple sexual partnerships and many not recalling the number; - Lack of access to HIV services based on stigma/discrimination; - lack of MSM-specific treatment services; - treatment and perception of MSM vary depending on social status - Awareness on radio on MSM issues - Vulnerability is reinforced high level of stigma and discrimination - MSM needs are not addressed by most stakeholders involved in the response to HIV
Conclusions: - Hostility toward MSM represents a danger for the collective well-being of the community - More open discussion on MSM issues will lead to a better response to HIV - Publication and dissemination of media brief on MSMs and HIV - Additional dissemination is needed - MSM issues need to be placed on the forefront of HIV programming in Haiti. - MSMs need to advocate and lobby to be a strong component of the National Strategic Plan - MSMs need (through associations) to develop better strategies to influence policies and to promote respect for Human rights.
By Angelica Ospina; Ricardo Román; Juan Carlos Mendoza
Background: In Mexico 10% of Men-who-have-Sex-with-Men (MSM) live with HIV. Opportune HIV detection guarantees better survival and combined with adherence to treatment, diminishes the likelihood of HIV transmission. This study aims to understand factors that inhibit/enable HIV-testing among MSM.
Methods: 345 men aged 18-50 years, who reported having had anal-sex with other men in the past 6-months, were recruited for a behavioral survey from August to November 2011, using respondent-driven sampling. Logistic-regression-analysis was conducted to identify factors associated with having an HIV-test during last 12-months. 6-focus groups were conducted to gain more in-depth understanding on barriers against regular HIV-testing; participants were men aged 18-50 years randomly selected by health-promoters at MSM gathering-places.
Results: 56% of respondents reported having been tested for HIV during last year. Main reasons for not having an HIV-test included; considering HIV-testing unnecessary (57%) and fear of knowing the test result (26%). Controlling for socio-demographic characteristics, results from logistic-regression-analysis showed that individuals who had participated in HIV-prevention activities (OR=2.96; p<0.05 CI: 1.40-6.23), received an offering for HIV-testing (OR=2.64; p<0.05 CI: 1.45-4.81), know where to go for HIV-testing (OR=4.93; p<0.001 CI: 2.16-11.27) and who are open about homosexual-practices (OR=1.11; p<0.05 CI: 1.00-1.23) were more likely to have had an HIV-testing during last 12-months. Qualitative results from focus-groups confirmed that stigma associated with homosexual-practices and HIV, mis-information about HIV and AIDS related death are key barriers to HIV-testing; Knowing successful stories of people-who-live-with-HIV and pleasant experiences with health promoters are main motivators for HIV-testing.
Conclusions: Qualitative and quantitative results revealed that having contact with prevention activities and other MSM contribute to promote HIV-testing. Creating an accompaniment system for getting tested with outreach promoters could encourage MSM to get tested. Emotional, generalized mass media campaigns are recommended, using successful personal-overcoming-stories to diminish myths about getting tested, living-with-HIV and taking treatment.
By Ajai Kumar
Click here to see the figure associated with this abstract.
Background: The Global Fund R-9 South Asia regional HIV programme was designed to strengthen MSM and transgender community systems in a multi-country approach. This regional technical assistance programme was based on increasing efficiency, effectiveness and economy. A central part of the project is the development of a regional technical assistance and knowledge hub that would support country partners through technical support and shared communication resources. There is also a need of a mechanism which will understand good practices happening within the system, grab those and disseminate effectively.
Methods: A system study of the communication process was conducted in the Global Fund R-9 South Asia regional HIV programme. Interviews and interactions were conducted with stake holders at various levels to understand the elements of communication process and the trends in flow of messages.
Results: The study reveals the existence of a communication process within the programme. The study further analysed the communication process and identified a communication model which was suiting to the current process (Figure 1). A two way communication process was identified. Due to the two way communication process, the community members and the regional programme implementing agencies are identified as changing their roles as senders and receivers when flow of communication reverses from time to time.
Conclusions: The study recommends setting up a multiple level documentation system to capture the learnings and good practices of the programme implemented in South Asia. The communication model derived as part of this study can be used for implementing the documentation system. Such a system will not only share good practices, new knowledge and learning, but also smoothens all communications transfers at all levels, particularly within a framework of populations that are highly stigmatized, and at significant risk and vulnerability. This system can effectively be replicated in other programmes where regional initiatives are being implemented.