People DO NOT have labels

Key Affected Populations PWUD PWID Sex Worker MSM MSM/W Transgender

HIM HEALTH A Social Franchise for Key Affected Populations in low to middle income countries Gauteng – South Africa

WHY A MODEL AIMED AT MEN? ASTRA STUDY: UK "The majority of these men would not consider or self-refer to traditional harm reduction services. Our findings highlight the need for cross-agency collaboration between HIV treatment and drug support organizations to provide tailored services for HIV-positive MSM who use recreational drugs, and with national HIV and STI prevention programs to address recreational drug use."  - Lancet HIV Population Fund/PEPFAR Study in Kaduna, Nigeria Interventions for MSM should address risks associated with both sexual behaviors and recreational drug and alcohol use. MSM-friendly clinics can be an effective way to reach a high number of MSM and provide risk reduction services. Soweto Study 50% of MSM also sleeps with women. Thailand study 61% of transgender (male to female) received money or gifts in exchange for sex PWUD High proportion of young recreational drug users engage in transactional sex to obtain drugs – especially young straight (heterosexual) men. Poor Health Seeking Behavior Among men in General and specifically men in Key Affected Population Groups The poorer you are the more likely you are to engage in high risk behavior and less likely you are to seek help from health services

Male Health Seeking Behavior Reasons for Poor Health Seeking Behaviour Stigma and Discrimination – MSM, Transgender women, “addicts”, PLWHIV etc Embarrassment, distress, and/or fear related to using health services - ideas about masculinity that imply men are ‘weak’ for seeking help. Privacy and Confidentiality Inconvenient Service Hours COST Shortcomings in scope of services provided Poor communication/rapport with health professionals: Men were uncomfortable with health professionals who were not polite, rushed without explaining important information, used medical jargon, and lacked sensitivity to their needs. Viewing symptoms as minor and insignificant: This often resulted from men’s lack of knowledge about symptoms and low interest in their body and health. Need for emotional control: Some men felt that by worrying about their symptoms they were ‘losing control’ of their emotions (SAMJ) “Many studies have documented low rates of medical help-seeking among men. This has been associated with poorer health outcomes in men such as diagnosis delay, higher mortality rates, and increased burden on the healthcare system.” SAMJ

CARE EDUCATION RESEARCH HIM Health Program – to address poor HSB Focus on MEN – to reach male members of key populations Branding – NB not to brand as Drug or HIV Clinic Brand as Sexual Health Clinic for MEN One Stop Service Bias Free Zone Competent health care workers Privacy and Confidentiality Involve peers in education, counseling, information dissemination, risk reduction strategies and harm reduction programs Cost effective Talk Openly about Sex

One Stop IEC – Info, Education and Communications Outreach Counseling Diagnostics – Rapid tests, GeneXpert Risk Reduction – HIV/STIs Biomedical Interventions – condoms, Water based lube (also female condoms for anal sex) PrEP & PEP & TasP Harm Reduction - PWUD NSP (needle & Syringe Programs) MAT (medically assisted Treatment) OST (Opiod Substitution Therapy) Treatment – STIs and HIV and Addiction Meds Vaccinations – HPV, HBV

EXPRESS MOBILE OUTREACH Peer involvement After Hours Reach “hard to reach” populations and the poor Contains : Information Diagnostics/Screening Counseling Treatment Harm Reduction Risk Reduction

Diagnostics STI Screening HIV Testing VL Monitoring CD4 Monitoring Istat – biochemistry & Hematology Short waiting times Same day results – mins to hours No need to come back for results Results sms-ed to client Follow up advice sms-ed to client Save money – less transport fees, less time away from work etc.

Mobi Health Tech GHI Partnership Data Collection Surveys Web & Mobile app based information Web and mobile based Help from HCW and medical professionals HCW Training and Education : HCW Empowerment USSD Apps for men in rural areas – e.g. USSD games and questionnaires Incentives: Free airtime, SMS bundles and vouchers for medicine Assisting the poor with MHealth medicine vouchers and free advice “Please Call Me” service

MONITORING AND EVALUATION By including community members and other stakeholders in the monitoring and evaluation (M&E) of prevention programs, the findings - as well as any corrective actions - should be more reflective of and more responsive to the people most affected by the HIV epidemic and the prevention response. According to the World Bank, four core principles of participatory M&E are: Primary stakeholders are active participants, not just sources of information; Building capacity of local people to analyze, reflect and take action; Joint learning of stakeholders at various levels; and Catalyze commitment to take corrective actions.

DESIRED OUTCOMES Improved Health Seeking Behavior of Key Populations and men in general in low and middle income countries Reduction in HIV acquisition and high risk behavior among key population groups and subsequently the general population Harm Reduction for PWUD or PWID Reduction in stigma and discrimination experienced by key pops from especially HCW Measure success based on SF4Health metrics – cost effectiveness, quality of services, equity, impact and user uptake. Sustainable program that is scalable to be rolled out Nationally and across borders

PROGRAMS HIM HEALTH – men in key population groups Our HIM program focuses specifically on male members of key populations. Men historically find it difficult to seek health advice and care. Our aim is to improve health seeking behaviour and health outcomes of men through research, outreach, information dissemination and social franchising MAT - aimed at PWUD and PWID MAT is our Harm Reduction spokesperson that represents harm reduction as best available option for dependence on drugs. Drug use contributes greatly to increased risk behaviour among all populations groups. Needle and syringe programs (NSPs) Medically Assisted Treatment/Opioid substitution therapy (OST) and other drug dependence treatment HIV testing and counselling Antiretroviral therapy Prevention and treatment of sexually transmitted infections Condom distribution programs for people who inject drugs and their sexual partners Targeted information, education and communication for people who inject drugs and their sexual partners Vaccination, diagnosis and treatment of viral hepatitis and HPV Prevention, diagnosis and treatment of tuberculosis

PROGRAMS mHealth – MobiTech Gateway With the support of our technology partners we create innovative technology to bring health information to hard to reach populations and people in remote, resource limited settings. We also develop mobile technology to ensure community healthcare workers are empowered with knowledge at their fingertips. Research We aim to improve services rendered to PLWHA by involving ourselves in research focussed on health seeking behaviour and social franchising of health. Gateway health aims to develop a new model of social franchising for health aimed at men – male sexual health centre and mobile clinics. To have an effective social franchising we need more research on quality of services rendered, cost effectiveness of services, equity and the impact we have on health outcomes. More research is needed on the effect of social franchising on expansion of health services.

PROGRAMS Key POPs – Home Testing Home Testing for members of key pops with clear instructions, online or telephone counselling. IEC on follow ups. “Please Call Me” Service. Advice to attened Express Labs for further screening, and clinics for treatment and care.

Company Profile

Vision Mission GHI reaches out to people affected by HIV or at risk of acquiring HIV, especially key affected populations. We aim to have a positive impact on the health-seeking behaviour and health outcomes of hard to reach populations through education, research, innovative technology and integrated healthcare services To become a regional force in delivering comprehensive health care solutions to hard to reach populations and those in low resource settings by working with our partners to ensure access to information, the latest technologies and integrated healthcare services. Gateway is committed to improve health outcomes for communities we serve and the delivery of community-oriented, culturally sensitive, and affordable health care solutions throughout South Africa and the region.

Values Quality We strive for excellence in everything that we do and measure the quality of our programs and services to enable us to learn and improve. Cost Effectiveness We ensure our services and programs are cost effective to enable the poorest of the poor to benefit. Zero stigma and Discrimination We empathize with the needs of our clients and aim for a world free of any form of stigma and discrimination. Our Health centres will be bias free zones Innovation To use the latest technologies available for the benefit of hard to reach and key affected populations and to contribute to beating the global HIV pandemic. Respect We build honest and ethical relationships with each other, clients, their families and the community by preserving individual dignity, supporting choices and valuing diversity. Ethics We ensure our services and programs are rendered in an ethical way, respecting privacy and confidentiality and putting the patients right to autonomy first. Equity We will ensure that our services reach the poorest of the poor

Our Team Dr Coenie Louw – Medical Director With an MBChB and Dip HIV Management SA, Coenie has a passion for HIV and TB and sexual health in general. He has 20 years experience as medical practitioner, worked in the NGO field for more than 5 years, first as Global Program Director and then as Country Director in SA for LittleBigSouls International Charitable Foundation. Coenie focuses on key affected populations especially MSM and People Who Use Drugs. He is currently running the MAT drug awareness campaign, is the founder of SANPUD (The South African Network of People who Use Drugs) and is a member of the South African Addiction Medicine Society, the HIV Clinicians Society and the International AIDS Society ,as well as committee member for Africa at the Global Breastfeeding Initiative of the UN.

OUR TEAM Maggie Mogale – Program Director As National Project Co-ordinator of the National Professional Teachers Organisation of South Africa for the Prevention, Care and Treatment Access (PCTA) Project and Project Director of the Education Labour Relations Council (ELRC) Maggie has established herself as achiever in the field of program management. Maggie conducted HIV research, both quantitative and qualitative, as per organisational needs. She was responsible for policy development and executive decision-making and conducted the union’s Human Rights-HIV/AIDS national and provincial workshops. She also actively researched the latest developments in health and HIV/AIDS management. She developed and implemented the organization’s public relations, marketing and stakeholder management strategies.

Our Team Pieter Fourie – Financial Director With a BCom Financial Management, Pieter has 12 years’ experience in the financial field. He has been involved with the ELRC-PCTA project that was funded by PEPFAR from 2007 – 2011. He also worked as finance officer on several South African Government Projects rolled out by the Department of Education. He is currently the executive officer of NAPTOSA.

© 2014 Gateway Health Institute NPC 2014/191675/08 CONTACT US www.gatewayhealthinstitute.org Programs programs@gatewayhealthinstitute.org MAT Campaign MAT@gatewayhealthinstitute.org @HIMHealth © 2014 Gateway Health Institute NPC 2014/191675/08

THANK YOU to our PARTNERS and SUPPORTERS Reckitt Benckiser SA SA Medical Research Council – Drug and Alcohol abuse program Cepheid Mobi Health Tech INPUD via SANPUD Rorotika Technologies Mashadane Research Center Drug Surveillance SA