Jamra primary scholl for children affected by HIV/AIDS, drugs or poverty, Senegal (c) Nell Freeman/Alliance Participants in the Photovioce project, Ecuador © Marcela Nievas for the Alliance
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Responding to the needs of MSM


Aids Alliance

Even in the most criminalised and stigmatised environments action can be taken to respond to the sexual health needs of men who have sex with men (MSM) and to address their vulnerability to HIV. This was one of the key messages that emerged from the recent Alliance Africa Regional Programme (ARP) workshop held in Pretoria, South Africa on 11-15 May.

The workshop brought together twenty-three people from ARP partner organisations, government representatives from Senegal, Kenya, C'te d’Ivoire and South Sudan and members of Alliance Best Practice, Policy and Field Programmes Teams.

The objectives were to improve understanding of the HIV-related needs of MSM; to increase knowledge of effective responses; and to identify key country level priorities, actions and appropriate partners in the response.

Research shows that HIV prevalence is higher among MSM than the general population across the world, including Africa. Increased vulnerability can be attributed to a number of interwoven factors including individual behaviour, stigma and discrimination at a community level and criminalisation at a structural level.

For many of these reasons there is little or no data on MSM and HIV in Africa. High levels of criminalisation, stigma and discrimination have meant that the sexual health needs of MSM have been largely ignored or denied, and research in this area has been almost impossible.

A lack of concrete evidence to support advocacy, policies and funding has further compounded a situation where the needs of MSM are not being responded to by governments, health service providers and non-governmental or community-based organisations involved in HIV prevention, care and support.

The ARP Workshop explored the barriers to responding to these challenges and enabled participants to share learning on effective responses even within a hostile environment.

The discussions addressed the importance of including MSM at all stages of the project cycle; building partnerships with other organisations; and sensitising religious leaders, policy makers, the media and service providers.

There were also discussions about how to work with MSM groups despite the threat of hostility towards them, including that of deregistration, and without appearing to be promoting homosexuality.

Attendees said they valued the opportunity to share and learn from the experiences of colleagues in partner organisations, and to be able to have open and honest discussions about a topic which is often hard to address within their country contexts.

Participants worked in groups to plan MSM programmes for hypothetical country scenarios before spending the last day consolidating experiences and learning in the preparation of action plans to respond to their own individual country situations.

A summary of key joint learning

The need to:

  • base programme design on participatory situational/needs analysis triangulated with other sources of information/data.
  • base interventions on a hypothesis about how the intervention will effect/produce change and, where possible, use evidence-based interventions to effect that change.
  • identify opportunities to involve MSM in strategies at both the internal and national levels without compromising safety.
  • build partnerships with other organisations which have a common vision.
  • be realistic and set achievable targets given the context.
  • identify potential unintended consequences of interventions at the start and be vigilant in order that they do not harm.

As well as a full Workshop Report, the Alliance Best Practice Unit is developing a Facilitator’s Guide to enable participants to conduct similar meetings at a national level in their own countries.