PROMOTING THE HEALTH OF MEN WHO HAVE SEX WITH MEN WORLDWIDE A training curriculum for providers

The MSMGF-JHU Curriculum for Providers To arm local community groups with the ability to independently implement training programs to build cultural and clinical competency among healthcare providers

Guiding Framework Sexual Health Framework Move away from a disease model Focus on strengths-based approaches and sexual harm reduction Designed for easy adaptation Modular facilitating use of specific modules; Offers flexible training options Complements local training efforts and tools

KNOWLEDGE ATTITUDESKILLS

What are the nine modules? Understanding Gay Men and Other MSM Sexuality and Health Barriers to Health Creating a Friendlier Environment Promoting Mental Health Taking a Sexual History Supporting Gay Men and other MSM Who Use Drugs and Alcohol Interventions for HIV and STI Prevention Clinical Care for HIV and other STIs

Are there any accompanying materials? Participant’s guide and deck of PowerPoint slides to accompany each module are available for download from Instruments to evaluate the process and outcomes of the training are also provided. The evaluation tools are designed to assess: Learning needs assessment. Pre- and Post- Assessment Process Evaluation (Overall Satisfaction) Follow-up Surveys Providers Clients

Pilot Test with GALZ, Zimbabwe

Evaluation Results ITEMPRE-TESTPOST-TESTCHANGEP-VALUE Knowledge of MSM issues (mean score) <0.01 Participants would feel comfortable discussing anal sex with clients 36.8%61.9%25.1%0.1 Participants would feel comfortable providing friendly sexual health services to MSM 31.6%81.0%49.4%0.02 Participants believe they are ethically obliged to maintain confidentiality regarding same-sex behavior, even where it is criminalized 95.2%90.5%4.7%>0.1 Participants believe it is important to develop relationships with LGBT organizations 94.7%90.5%4.2%>0.1 Participants disagree that homosexuals are more likely to commit deviant sexual acts than are heterosexuals 57.9%71.4%13.5%>0.1 Participants disagree that acceptance of homosexuality aids in the deterioration of morals 28.6%76.2%47.6%<0.01 Participants believe it is impossible for a provider who morally objects to homosexuality to provide appropriate services to gay men 52.6%23.8%28.8%0.02

Evaluation Results ITEMPRE-TESTPOST-TESTCHANGEP-VALUE Knowledge of MSM issues (mean score) <0.01 Participants would feel comfortable discussing anal sex with clients 36.8%61.9%25.1%0.1 Participants would feel comfortable providing friendly sexual health services to MSM 31.6%81.0%49.4%0.02 Participants believe they are ethically obliged to maintain confidentiality regarding same-sex behavior, even where it is criminalized 95.2%90.5%4.7%>0.1 Participants believe it is important to develop relationships with LGBT organizations 94.7%90.5%4.2%>0.1 Participants disagree that homosexuals are more likely to commit deviant sexual acts than are heterosexuals 57.9%71.4%13.5%>0.1 Participants disagree that acceptance of homosexuality aids in the deterioration of morals 28.6%76.2%47.6%<0.01 Participants believe it is impossible for a provider who morally objects to homosexuality to provide appropriate services to gay men 52.6%23.8%28.8%0.02

Evaluation Results ITEMPRE-TESTPOST-TESTCHANGEP-VALUE Knowledge of MSM issues (mean score) <0.01 Participants would feel comfortable discussing anal sex with clients 36.8%61.9%25.1%0.1 Participants would feel comfortable providing friendly sexual health services to MSM 31.6%81.0%49.4%0.02 Participants believe they are ethically obliged to maintain confidentiality regarding same-sex behavior, even where it is criminalized 95.2%90.5%4.7%>0.1 Participants believe it is important to develop relationships with LGBT organizations 94.7%90.5%4.2%>0.1 Participants disagree that homosexuals are more likely to commit deviant sexual acts than are heterosexuals 57.9%71.4%13.5%>0.1 Participants disagree that acceptance of homosexuality aids in the deterioration of morals 28.6%76.2%47.6%<0.01 Participants believe it is impossible for a provider who morally objects to homosexuality to provide appropriate services to gay men 52.6%23.8%28.8%0.02

Evaluation Results ITEMPRE-TESTPOST-TESTCHANGEP-VALUE Knowledge of MSM issues (mean score) <0.01 Participants would feel comfortable discussing anal sex with clients 36.8%61.9%25.1%0.1 Participants would feel comfortable providing friendly sexual health services to MSM 31.6%81.0%49.4%0.02 Participants believe they are ethically obliged to maintain confidentiality regarding same-sex behavior, even where it is criminalized 95.2%90.5%4.7%>0.1 Participants believe it is important to develop relationships with LGBT organizations 94.7%90.5%4.2%>0.1 Participants disagree that homosexuals are more likely to commit deviant sexual acts than are heterosexuals 57.9%71.4%13.5%>0.1 Participants disagree that acceptance of homosexuality aids in the deterioration of morals 28.6%76.2%47.6%<0.01 Participants believe it is impossible for a provider who morally objects to homosexuality to provide appropriate services to gay men 52.6%23.8%28.8%0.02

PROMOTING THE HEALTH OF MEN WHO HAVE SEX WITH MEN WORLDWIDE A training curriculum for providers

Module 1: Understanding Gay Men and Other MSM 19

Learning Objectives Define MSM and common sexual practices Identify unique health issues faced by gay men and other MSM Discuss provider roles in addressing the health needs of gay men and other MSM

Who are MSM? Not all MSM identify as ‘gay,’ or bisexual There is great diversity within gay- identifying and non gay-identifying MSM, socially and culturally defined sub-groups and sub-cultures MSM may be married, have children, and have sex with women MSM are often hidden within their communities MSM cannot be identified by clothing, mannerisms, or social roles 21 MSM are men who have sex with other men

Same-sex behavior exists globally Evidence of Male-to-male Sex 22 In a recent study in the United States, 3.8% of Americans identified as lesbian, gay, bisexual, or transgender (LGBT), and 8.2% engaged in same-sex behavior Other studies show varied prevalence of MSM in E Asia, S and SE Asia, E Europe, Latin America, and Africa Most study findings are underestimates because of underreporting: o Fear of stigma and discrimination o Criminalization of same-sex behaviors (77 countries) Subsequently, gay men and other MSM can remain invisible in the healthcare system, hindering their healthcare provision

Technical Advisory Board Eduard Sanders – Kenya (Kenya Medical Research Institute) Kevin Rebe – South Africa (Anova Institute) Paul Semugoma – Uganda (Frank and Candy, AMSHeR, MSMGF) Venkatesan Chakrapani – India (Center for Sexual Health Research and Policy) Frits Van Griensven – Thailand (University of California, San Francisco) Martin Choo – Malaysia (University of Malaya) Igor Toskin – Switzerland (WHO) Carlos Caceres – Peru (Universidad Peruana) Rafael Mazin – USA (PAHO) Billy Pick – USA (USAID) Ken Mayer – USA (Fenway Institute) George Ayala – USA (MSMGF) Chris Beyrer – USA (Johns Hopkins) Rodney Vanderwarker – USA (Fenway Institute) James Robertson – India (Alliance India)

Conclusion Partnerships Technical Support Sustainability

Acknowledgements Technical Advisory Board Krystal Mason Ryan Zahn Liesl Messerschmidt Ivy Climacosa Clarence Low GALZ Stefan Baral George Ayala