STRENGTHENING/CONSOLIDATE ACTIVITIES AT 50 IDENTIFIED MSM SAFE SPACES AS A BEST PRACTICE FOR ACCESS TO HEALTH SERVICES AND REDUCE HIV AMONG MSM IN UGANDA, EAST-AFRICA (2009)

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 CONCEPT

KEY WORDS: 3
BACKGROUND: 3
SITUATIONAL STATUS IN UGANDA: 3
PROBLEM STATEMENT: 4
JUSTIFICATION: 4
METHODOLOGY: 4
DELIVERABLES: 5
BUDGET: 5
SUSTAINABILITY PLAN: 5

 

KEY WORDS:

GBT……………….Gay, Bisexual, Transgender
HIV………………..Human Immuno Deficiency Virus
IDU………………..Injecting drug Users
KYE……………….Know Your Epidemic
KYR……………….Know Your Responses
MARPs…………….Most at Risk Populations
MSM……………….Men who have sex with men
MARPI…………….Most at Risk Populations’ Initiative
MODPRETCAS…...Mobilising for Dialogue, Prevention, Treatment, Counselling and Care
WSW……………….Women who have sex with women
TG………………….Transgender/Intersex

BACKGROUND:


Uganda still criminalises commercial sex work and same sex relations. This has created a restricting environment for service providers and seekers. However, in embracing many strategies for reducing HIV transmission cycle Uganda has had to provide an environment for innovations that identify exposure risks and address them. One such approach was to establish in 2008, MARPs network an Umbrella Organisation targeting MARPs. All forms of MARPs; Long distance Truckers, Commercial sex workers, Youths, Persons in relationships, Fisher folks, Uniformed personnel, MSM and Substance/drug users are targeted. The mission: to provide health services to all MARPs without discrimination. All MARPs are targeted by specific organisations which make the MARPs Network. MSM and Substance/Drug Users are targeted by Most at Risk Populations’ Initiative (MARPI). MARPI is involved in direct health services (e.g., prevention, treatment, and care) for sexual minorities; MSM, WSW and Transgendered. The MARPs Network Secretariat is involved in research and providing information to inform policy about MARPs trends in order to support effective policies and increased public funding for HIV prevention and treatment efforts among all MARPs including MSM; and supporting research to build understanding of HIV epidemics and interventions among all MARPs.

SITUATIONAL STATUS IN UGANDA:


MARPs Network is an umbrella of many organisations one of which is MARPI which has provided Health services to Sexual Minorities {MSM, WSW and TG} since September 2008. Presently, 5.000 sexual minorities have benefited from being provided with health education for best practices, sexuality and sexual health counselling for self actualisation, trainings in peer to peer counselling and guidance and self esteem counselling using 50 safe spaces identified. The purpose was to enable sexual minorities interface with health provider staff trained in unconditional positive regard. The HIV prevalence for sexual minorities is 5.4% (MARPI, July 2009). Incidence modelling reveals that of all new HIV infections in adults (15-49 years) in 2008, 43% were among people in discordant monogamous relationships in the past 12 months while 46% were among persons reporting multiple partnerships and their partners. Commercial sex workers, their clients and partners of clients contributed 10% of new infections. MSM and IDU contribute less than 1% {MOT, March 2009}.

PROBLEM STATEMENT:


There is insufficient understanding of the current modes of transmission of HIV in Uganda. This lack of clear understanding of where new infections are occurring may imply that national HIV prevention plans are not driven by evidence and may result in a mismatch between services provision and service demand by MSM{MOT, March 2009}.

JUSTIFICATION:


MARPs Network is the official coalition under which is MARPI a health services provider extends direct health services for MSM in Uganda through community outreach and establishing health action groups incorporating prevention, treatment, and care, policy-oriented projects, and/or research projects. So far more than 50 safe spaces targeting Sexual minorities have been conducted especially for programming targeted towards reaching hidden MSM communities or MSM who do not identify as gay, working with more open GBT communities, and/or engaging allies. An innovation such as the Public Dialogue Projects has provided a platform for Sexual Minorities including MSM to express themselves and there by generate much information. By mobilising and creating safe spaces for health services provision more MSMs are reached. MARPs Network is linked to Uganda’s Ministry Of Health and projects that include (or have the potential to inform) regional or international advocacy activities. Demonstrated involvement of MSM in project processes, development of practical measures, implementation of activities through formed groups, and evaluation is possible using established groups and safe spaces.

METHODOLOGY:


MSM are pivotal stakeholders in designing programmes that address their issues. They can be reached through peers and using safe spaces. The safe spaces/drop-by venues dubbed RAINBOW SPACES will be used as mobilisation platforms for conducting meetings and dialogue, promote prevention, treatment, care and support group strengthening from March 2010- February 2011. This best practice is dubbed the ‘MODPRETCAS’ an acronym for all the strategies to be used which will also provide opportunity for MSM to generate risk factors and contextual factors that lead to exposure risks among MSM (KYE/KYR), MSM health seeking behaviour, nature and characteristics of MSM in Uganda, where MSM receive social services, what kinds of social safe spaces appeal to MSM and issues pertaining to Human Rights.




DELIVERABLES:


  1. Number of outreach programmes for MARPs and vulnerable populations will be established.
  2. Kind of messages that make MSM aware of protecting risky sex acts.
  3. Number of MSM involved in protecting risky sex acts.
  4. Identify which service safe spaces provide quality services and appropriately diagnose and manage STIs among MSM.
  5.  Knowledge on kind of services demanded by MSM.
  6. Strategic information on coverage of most HIV prevention services among MSM to inform periodic national outcome and impact evaluation.
  7. Knowledge of the size of population groups, strategies that work for MSM and corresponding coverage of key prevention services.
  8. Identify process and output level indicators essential for monitoring coverage of programmes in order to provide appropriate biomedical interventions and behavioural interventions. This strategic information is necessary to guide performance and identify persistent problems.
  9. Linking the Epidemic to the Response (KYE-KYR) Synthesis to address a mismatch between the epidemiology, policies, programmes and resource allocation targeting MARPs, risk and contextual factors.
  10. Provide information disaggregated by MSM indicators.

BUDGET:


Number
Activity
Unit
Amount (USD)
Total (USD)
Remark
1.
Arranging and conducting
Safe space activities for MSM
Access to participatory planning, Health services and support life skills in Uganda
48
600
28,800

2.
Administrative-work/ Documenting best practices
1
1200
1200

3.
GRAND TOTAL


30.000


SUSTAINABILITY PLAN:


Number
Particular
Unit
Action Point
1.
Identify needs and conduct trainings in team building
50 groups
Improved organisation structures.
2.
Register all groups under MARPs Network
50
Formally registered MSM groups.
3.
Design work plans for all groups
50
Effectively functional support groups.
4.
Identifying and formation of volunteer facilitators/resource persons.
50
Involve volunteers in encouraging work ethics.


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