Repairing HIV service cascades that leak: Key population communities taking the lead Johan Hugo 18 July 2016

Health4Men - an Anova Health Institute initiative Health4Men is the largest MSM service organisation in South Africa, also now increasingly working with other KPs including SW and TG. Direct medical services to MSM (and other Key Populations) via its Centres of Excellence in Cape Town and Johannesburg PrEP, PEP and TasP Clinic training of over 250 public healthcare clinics in MSM Competency, in collaboration with the South Africa Department of Health Outreach and peer education (Ukwazana / Zwakalani) Community-based HCT Biomedical and Psycho-Social research Communications programmes and campaigns Number of clinical health care workers trained = 2440 Number of non clinical health care workers trained = 2800 Number of competent sites = 261 Global fund stats

Health4Men Supply Demand Centres of Excellence More than 6000 trained clinic workers at over 250 public clinics Private sector work PrEP demonstration projects, PEP and TasP Biomedical and Psycho-Social Research Demand Communication strategies and programmes Outreach and peer education programmes Tailored IEC materials Psycho-Social Research More than 6000: includes clinical and non clinical

Health4Men AFRICA Drawing on experiences in South Africa, now also offering services across Africa. For example: Technical Consulting on supply and demand creation for services (peer educators, CSOs, clinical competency) KP appropriate training Monitoring and Evaluation Working with partners including Linkages, MSF and the International HIV/AIDS Alliance. One of the five EQUIP partners working to address 90-90-90 in USAID-supported countries (primarily in Africa). Anova and Health4Men are the leads of KP and PrEP within EQUIP.

In an ideal world… Condom, lube, needle exchange Adherent on ART HIV positive Initiate ART Differentiated HCT inc. community-based Locate KP populations Encourage HIV testing Facility based HIV testing Condoms, lube, needle exchange HIV negative PrEP Credit: Dr. Andrew Tucker, Health4Men AFRICA

In the real world… Need for supportive policies Discrimination and lack of competency at public health facilities Condom, lube, needle exchange Adherent on ART Fear of losing KP social grouping/clients if HIV positive HIV positive Initiate ART Differentiated HCT inc. community-based KPs clandestine due to social discrimination Loss to follow up especially acute due to KPs being clandestine and lack of health facility competency Locate KP populations Encourage HIV testing Operational /policy barriers to harm reduction and lube KP not self-identified Loss at referral due to fear of discrimination at clinics Operational/ policy barriers to PrEP Facility based HIV testing Condoms, lube, needle exchange HIV negative PrEP Loss to follow up especially acute due to KPs being clandestine and lack of health facility competency

In South Africa… KPs clandestine due to social discrimination KP not self-identified Fear of losing KP social grouping/clients if HIV positive Discrimination and lack of competency at public health facilities Loss to follow up / referral especially acute due to KPs being clandestine and lack of health facility competency Operational / policy Policy, operational PrEP support and implementation

In South Africa... Health4Men has: KPs clandestine due to social discrimination Community-based outreach models (Ukwazana / Zwakalani) making programmes place-specific Cohorts of ‘ambassadors’, peer educators and outreach staff Community-based HCT Large-scale communication campaigns WeTheBrave MHealth initiatives KP not self-identified Fear of losing KP social grouping/clients if HIV positive Discrimination and lack of competency at public health facilities KP competency training, mentoring and on-going TA at identified and suitable health clinics Loss to follow up / referral especially acute due to KPs being clandestine and lack of health facility competency Support clinical services via outreach teams Support groups for MSM and other KPs dealing with issues such as HIV stigma, discrimination, community fears and adherence. M&E systems to highlight loss to follow up Operational / policy Working closely with Department of Health in training and support for clinical services Contributed to the development of PrEP guidelines Ensure that implementation of ART guidelines is appropriate for MSM Policy, operational PrEP support and implementation

Lessons Learned: Health4Men’s model is based on the need to : Be inclusive and understanding of diverse KP needs (there is no ‘one-size fits all model’) Affirm the lived realities of different KP groups (our ‘sex positive approach’ and ‘Brave enough’) Link together psycho-social and biomedical concerns, necessary to achieve 90-90-90. Health4Men and Health4Men AFRICA offer solutions to health concerns Health4Men and Health4Men AFRICA are constantly learning and adapting to remain on the forefront of technical expertise

Thank you Anova Health Institute PEPFAR USAID Dr. Andrew Tucker Dr. Johan Hugo hugo@anovahealth.co.za +2721 447 2844