Integrated Biological and Behavioural Surveillance (IBBS) Survey among MSM in South Sudan 24 July 2018

Presentation Outline Background Methodology Results Recommendations

Background FSW and their clients account for at least 63% of new adult infections (MoT, 2014) FSW: Prevalence is at least 5x higher than the general population (SS GF CN, 2015) Other KPs: HIV and AIDS data is limited e.g. for MSM No previous data around MSM in SS KPs necessary in programming targets to achieve 90-90-90

Homosexuality in South Sudan Homosexuality and sodomy is illegal in South Sudan 2008 SS Penal Code criminalises sodomy and Section 248, ‘law of unnatural offences’, states that persons found to violate this law could be liable to a fine and face imprisonment of up to ten years. Socio-cultural conservatism: MSM sexual behaviour is viewed as culturally unacceptable, immoral and highly stigmatised Security situation: Affects environment for conducting research, especially with KPs in the country

Objectives Understand the MSM community and factors that predispose the population to a greater risk for HIV Obtain baseline prevalence data for HIV and Syphilis Provide recommendations to address gaps in access to critical HIV prevention, treatment, care and support services for MSM and their partners Not for the whole country but suggested sites – for 6 sites

Methodology Non probability purposive sampling and snowball sampling to recruit respondents Standard behavioural questionnaire (N=165) HIV and Syphilis testing (N=152) FGDs (N=5) with MSM KIIs (N=19) with MSM network leaders, government Data collected from in 6 sites, during 3 weeks, in Nov/Dec 2017 Ethical approval granted by the ERC (GoSS-MOH) Quality control measures were observed throughout the study

Respondents’ Nationalities (N=165)

Age of Respondents (N=165) page 8

Sexual History in Past 18 Months Characteristic Frequency (n) Percentage (%) Types of Casual Partners   Male only 152 92.1 Male and Female 13 7.9 Sex with type of Partners Sex with regular male partners 61 37.0 Sex with casual male partners 104 63.0 page 9

Condoms and Lubricants Access* *Note: N=165 unless otherwise stated

Condom Use During Anal Sex (N=165) Reasons for not using using: “Condoms were not available at the time and they take away pleasure” (Yambio FGD participant) “Sometimes I forget to use condoms when in a hurry” (Torit FGD Participant) “It depends on whether you trust your partner, some partners refuse to use condoms” (Juba FGD Participant). “Sometimes one can be busy and does not go to collect the condoms” (Torit FGD Participant) “Perceive condoms as being for female sex workers” (Yambio FGD Participant)

Sexually Transmitted Infections (N=165)

GAM Indicators* *Note: N=165 unless otherwise stated

Conclusions Develop and implement national MSM policy framework Strengthen advocacy and awareness sessions about MSM health issues among all stakeholders Improve targeted BCC among MSM to reduce risk and promote safe sexual behaviours Address observed stigma and discrimination against MSM among some health practitioners

This study was funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria through UNDP as the Principal Recipient of the project, Investing Towards Impact for HIV and AIDS in South Sudan For further information and enquiries, please contact Marian Solangon at msolangon@iom.int