TAKING STOCK: Facilitating and Impeding Factors in HIV Prevention, Treatment, and Care among Southern African Sexual Minorities OSI/OSISA/OXFAM/UNDP PHP MEETING, 24 March, Cape Town Vasu Reddy (HSRC) & Theo Sandfort (HIV Center, Columbia University)

AIMS To identify common and country specific needs for support regarding HIV prevention, treatment, and care aimed at sexual minorities To develop a rationale for (a) a cross-national proposal and (b) the countries and organisations that should be involved To start building an inventory of the specific backgrounds in the various countries

CURRENT CONTEXT IN REGION: SOME FACTORS  African sexual minorities live in contexts where same-sex practices are criminalised (with the exception of South Africa) and where heterosexism, homophobia and prejudice is rampant  Little information about HIV prevalence among sexual minorities  Lack of understanding of how homosexual transmission plays a role in the overall HIV/AIDS epidemic  No coherent understanding of the prevalence of unsafe sexual practices among sexual minorities and the psychosocial and contextual determinants of HIV risk behaviours  Lack of political support and resources for prevention targeted at sexual minorities  Current limited prevention efforts are not evidence-based  Effectiveness of current prevention efforts is unknown

CURRENT CONTEXT IN REGION: SOME FACTORS (continued)  Sexual minorities are not “one” population: there is diversity in expression and organisation of sexual minorities. In order to develop effective prevention efforts, there is a strong need for understanding the diversity in expression and organisation of sexual minorities  HIV risk cannot be understood (and also not effectively addressed) without taking other issues into account (stigma, discrimination and violence, alcohol and drug use, socio-economic and cultural circumstances)  Effective research requires involvement of affected communities, together with appropriate advocacy tools

There are currently many studies underway in SA and elsewhere in region: strongly focused on men  Johannesburg Ethekwini Men’s Study (JEMS): nearing end (HSRC/Wits/MRC)  AMFAR-funded: Tshwane Men’s Study (Minority Stress) (Columbia, HSRC, OUT)  PRISM Initiatives (Regional, Schorer)  Work by Tim Lane (Soweto, CAPS)  Work by MRC/Desmond Tutu HIV Center (Cape Town)  MSM within HIV & AIDS Development Policy & Programming in Southern & Eastern Africa (HSRC)  HIV and Sexual Risk Among MSM in Tshwane (NIH Funded: Columbia University & HSRC with OUT LGBT)  New Work on WSW (Southern Africa) (HSRC with OSISA)

POSSIBLE VALUE TO A REGIONAL PROPOSAL FOR WORK ON SEXUAL MINORITIES IN REGION Build solidarity through research and advocacy Build capacity of resources in region Utilise research and advocacy for greater political effort Work toward combating prevention and strengthening prevention, treatment and care of sexual minorities with HIV/AIDS But we need to have some groundwork covered with answers to questions? What are some of these?

How diverse are sexual minority individuals in terms of sexual and gender identity, outness, connection to sexual minority communities, etc.? To what extent are there sexual minority communities and an LGBT-infrastructure?

What are the major health issues facing sexual minority individuals and communities and what is the place of HIV/AIDS in this?

How are sexual minority communities affected by AIDS and HIV in comparison to the “general” population; in what way is the impact qualitatively different? Do sexual minorities have specific needs in terms of HIV/AIDS prevention, care and treatment?

To what extent are organisations able to comprehensively address the HIV/AIDS prevention, care and treatment needs of sexual minorities? What are the major barriers that impede the delivery of HIV/AIDS prevention, care and treatment and uptake by sexual minority individuals?

What is most needed to more effectively address the HIV/AIDS related prevention, care and treatment needs of sexual minorities? What would be needed to strengthen the capacity of communities to manage and address an effective response?

WRAPPING UP OUR CONVERSATION? Where to from here? Next Steps?

Thank You