COUNSELLING, TESTING AND CARE STRATEGIES FOR MSM/SEXUAL MINORITIES IN UGANDA (NATIONALSKIN/ STD UNIT)

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Key Words

 MSM; Men who have sex with men
WSW; Women who have sex with women
TG; Transgender (someone biologically male or female but feels another sex).
MARPI: Most At Risk Populations Initiative

Overall Goal:
To contribute towards the prevention and control of HIV and STIs in the Ugandan population through putting intervention among the vulnerable and Most At Risk Populations specifically targeting  MSMs and other sexual minorities.

INTRODUCTION

MARPI (Most At Risk Populations Initiative) project is located at the national STD/Skin clinic at 12, Mulago National Referral Hospital. It is an affiliate of National STD unit in prevention and control of STIs/HIV and supports intervention programs for the Most At Risk Populations. Several sub-programs are supported under this arrangement including;
1.      MSM/Sexual Minorities’ program
2.      CSWs(Commercial Sex Workers) program
3.      Tertiary Institutions program
4.      Couples program
5.      Community  program

Interventions are target specific and the package includes:
·         Sensitization and Education specifically for HIV and STI
·         Peer Education
·         HIV counseling and testing plus referral
·         STI screening and treatment
·         RH and Family Planning services
·         Referral

Target populations:
  1. Commercial Sex Workers
  2. MSMs, WSW and TGs
  3. Students in tertiary institutions
  4. Couples
  5. Communities around target populations

MSMs and other sexual minorities program
This program aims at reaching MSMs and other sexual minorities with HIV/STI interventions.
It targets all people who fall under this category both self identifying and those reported either by partners or through other channels.
A health action desk for these groups has been established at the National STD unit. The desk is involved in planning, implementation and monitoring of intervention activities for these populations.
The activities include sensitizations, training, peer led activities, HIV counselling and testing and other as mentioned above in the package of interventions offered.

Intervention or response/ Methodology

They are reached through peer net works using safe space venues.
Interventions so far include:
·         Sensitization and Education about STD/HIV and other health issues
·         Voluntary counseling and testing for HIV
·         Screening and treatment of STIs
·         Psychosocial support

Results & lessons /Key findings

Key outputs (MSM and other sexual minority programme results)
  1. Number reached to date with sensitization and education, 3835 (April 2008-April 2009).
  2. No of peers leaders/educators trained, 771 (April 2008-April 2009).
  3. No reached with VCT, 10863 (April 2008-April 2009).
  4. Actual No tested, 10815 (April 2008-April 2009).
  5. No testing negative, 10267 (April 2008-April 2009).
  6. No testing positive, 548 (April 2008-April 2009).
  7. Prevalence of HIV positivity rate, 5.1%.

Lessons/ key findings;

  1. There are many people with different sexual orientations in Uganda as evidenced by people identifying themselves under different categories
  2. Stigmatization and discrimination of other sexual orientations is highly prevalent and this makes it difficult to reach these populations with interventions
  3. The demand for health intervention (HIV counseling and testing, STI screening and treatment etc) in these groups is very high but the interventions are extremely scanty.
  4. There is significant sexual mixing among MSM, WSW, Transgenders and other Most at Risk Populations like female sex workers and the general populations.
  5. HIV and STI are highly prevalent in these populations.
  6. These populations are friendly and can be reached despite the unfavorable legal, social and cultural environments however they are very sensitive.


 

Challenges to implementation/Background

 

  1. Limited resources hindering scale up
  2. Criminalization, stigma and discrimination faced by same sex orientation normative community. This places Health service providers and other services providers in a delicate position.
  3. Disregard of the health needs of same sex orientation community. This places health services providers in a situation where they cannot provide requisite consumables.
  4. The hate drive from various institutions and Individuals makes access to these populations for health interventions hard.
  5. Absence of IEC materials specific to MSM/Sexual Minorities.
  6. Lack of funding to support research in these population limits understanding of these populations and hinders decision making. As a result  intervention policies are lacking

 Recommendations

    1. Mobilize and direct resources towards prevention  and control among the Most At Risk Populations
    2. Scale up prevention activities such as peer education, counseling, testing and guidance
    3. Consider procurement of  pre-exposure consumables and IEC materials specific to the target populations
    4. Provide support mechanisms for those who feel like quitting a same sex orientation.
    5. Provide sexuality education to the community in order to understand this aspect of life.
    6. Engage communities in dialogue on same sex orientation and tolerance as a strategy to reach them with HIV/AIDS/STDs intervention
    7. Engage the beneficiaries through providing training to leaders in counselling and guidance skills.
    8. Involve MSM/Sexual Minorities in anti-STDs/HIV/AIDS interventions and safer health practices.


Acknowledgement:


  1. CDC/PEPFAR, which provides majority of the funds for the program
  2. MJAP to which we are sub-partners
  3. UNFPA which supports some programs
  4. ACLAIM which manages our finances
  5. MoH for technical and other support
  6. STD Unit MIS

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