Service Delivery for Vulnerable Groups

Health4Men

Helen Struthers, PHRU

Death Rates by age per 100,000 by sex: 1997 and 2004

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

Female 2004

Female 1997

Male 2004

Male 1997

Source: Statistics SA: Adult Mortality (age 15-64) based on death notification data in South Africa: 1997-2004

•South African Constitution – Bill of RightsThe equality clause states: “The state may not unfairly discriminate directly or indirectly against anyone on one or more grounds, including race, gender, sex, pregnancy marital status, ethnic or social origin, colour, sexual orientation, age, disability, religion,

conscience, belief, culture, language and birth” Chapter 2, Clause 9(3)).

•Operational Plan for Comprehensive HIV and AIDS Care and Treatment for South Africa - 2003

Universal care and equitable access regardless of “race, colour, gender and economic status

•National Strategic Plan for HIV/AIDS and STI’s (2007 – 2011)expands on the 2003 plan with guiding principles including promoting social change and cohesion, talking inequality and poverty, promoting equality for women and girls, recognising diversity, ensuring equality and non-discrimination and personal responsibility. Through these principles the vulnerability of women and girls, gender violence, male sexual health and high-risk groups are addressed.

Constitution and HIV/AIDS Strategic Plan

0

5

10

15

20

25

30

35

Prevalence (%)

Source: 1] PHRU, 2] SA Dept. of Health, 2008

100 fold increase: from 1 in 300 to 1 in 3 over 20 years

0

5

10

15

20

25

30

35

Prevalence (%)

South Africa National Survey, 1990 to 2007

HIV prevalence among ANC attendees

PHRU Soweto PMTCT service, 1987 - 2008

MSM Prevalence studies in Soweto

Source: Lane, Dladla, Struthers & McIntyre, AIDS Priorities Conference, 2008

Soweto MSM Study: Respondent driven sampling design

368 Soweto resident MSM

• HIV prevalence 25.3% overall – 49% in MSM 20 - 49

• 33.1% of men who reported women among their last 5 partners report unprotected anal intercourse (UAI) with other men (54/163)

• >90% of UAI among MSM+W is reported as insertive, but 39.6% reported unlubricated UAI

HIV among Youth in South Africa

3.2

9.4 8.5 9.86.0

23.9

38.5

49.0

0

5

10

15

20

25

30

35

40

45

50

Age 15-19 Age 20-24

Men Women All MSM Gay identified

Source: 1] HIV Prevalence, Incidence, Behaviour and Communication Survey 2005, HSRC, Nelson Mandela Foundation. 2] Soweto Men’s Study, Lane, T. et al, ICASA 2008

Prevention and treatment initiatives for MSM

An innovative, multimedia campaign promoting safe sex, health sexuality,

HIV counselling and testing and care and treatment to MSM of all races and ages in South Africa

playnice Health 4 Men

A comprehensive HIV and STI testing, and HIV/AIDS care and treatment

clinical service, predominantly aimed at MSM, in male friendly dedicated

public sector facilities.

Community prevention strategies

Community prevention strategies VCTVCT

Medical care and

monitoring

Medical care and

monitoring

Individual prevention strategies

Individual prevention strategies

Psychosocial care and support: PLWA and familiesPsychosocial care and support: PLWA and families

OI prevention & treatment

OI prevention & treatment

Antiretroviral treatment

Antiretroviral treatment

PMTCTPMTCT

The range of PHRU activities

Impact of HIV & national and international policy and advocacyImpact of HIV & national and international policy and advocacy

PREVENTIONPREVENTION TREATMENTTREATMENTCARECARE

Health4Men Services• Risk assessment

• Sexual behaviour• Drug use• Specific at-risk MSM (Sex workers, discordant couples)

• Sexual health assessment• Clinical STI screening including assessment of anal and prostatic

health• VDRL• Hepatitis A antibodies• Hepatitis B antibodies (and antigen if HIV positive)• VCT (with CD4 and appropriate linkage to care)

Health4Men Services

• Mental health assessment• Double stigma and discrimination due to MSM and

HIV status• High depression rates (gay teenage suicide rates...)• Relationship and support issues

• Risk reduction measures• Counselling and referral (drug and alcohol)• Hepatitis A and B vaccination• Condoms and lube for Africa

Health4Men Services

• HIV assessment• Huge variation in knowledge• Huge variation in expectations of treatment

• Specific HIV treatment issues among MSM• D4T is often not acceptable• Recreational drugs• Anabolics

Thanks!