1. Repairing HIV service cascades that leak: Key population communities taking the lead
Johan Hugo
18 July 2016

2. Health4Men - an Anova Health Institute initiative
Health4Men is the largest MSM service organisation in South Africa, also now increasingly working with other KPs including SW and TG.
Direct medical services to MSM (and other Key Populations) via its Centres of Excellence in Cape Town and Johannesburg
PrEP, PEP and TasP
Clinic training of over 250 public healthcare clinics in MSM Competency, in collaboration with the South Africa Department of Health
Outreach and peer education (Ukwazana / Zwakalani)
Community-based HCT
Biomedical and Psycho-Social research
Communications programmes and campaigns
Number of clinical health care workers trained = 2440
Number of non clinical health care workers trained = 2800
Number of competent sites = 261
Global fund stats

3. Health4Men Supply Demand Centres of Excellence
More than 6000 trained clinic workers at over 250 public clinics
Private sector work
PrEP demonstration projects, PEP and TasP
Biomedical and Psycho-Social Research
Demand
Communication strategies and programmes
Outreach and peer education programmes
Tailored IEC materials
Psycho-Social Research
More than 6000: includes clinical and non clinical

4. Health4Men AFRICA
Drawing on experiences in South Africa, now also offering services across Africa. For example:
Technical Consulting on supply and demand creation for services (peer educators, CSOs, clinical competency)
KP appropriate training
Monitoring and Evaluation
Working with partners including Linkages, MSF and the International HIV/AIDS Alliance.
One of the five EQUIP partners working to address in USAID-supported countries (primarily in Africa). Anova and Health4Men are the leads of KP and PrEP within EQUIP.

5. In an ideal world… Condom, lube, needle exchange Adherent on ART
HIV positive
Initiate ART
Differentiated HCT inc. community-based
Locate KP populations
Encourage HIV testing
Facility based HIV testing
Condoms, lube, needle exchange
HIV negative
PrEP
Credit: Dr. Andrew Tucker, Health4Men AFRICA

6. In the real world… Need for supportive policies
Discrimination and lack of competency at public health facilities
Condom, lube, needle exchange
Adherent on ART
Fear of losing KP social grouping/clients if HIV positive
HIV positive
Initiate ART
Differentiated HCT inc. community-based
KPs clandestine due to social discrimination
Loss to follow up especially acute due to KPs being clandestine and lack of health facility competency
Locate KP populations
Encourage HIV testing
Operational /policy barriers to harm reduction and lube
KP not self-identified
Loss at referral due to fear of discrimination at clinics
Operational/ policy barriers to PrEP
Facility based HIV testing
Condoms, lube, needle exchange
HIV negative
PrEP
Loss to follow up especially acute due to KPs being clandestine and lack of health facility competency

7. In South Africa… KPs clandestine due to social discrimination
KP not self-identified
Fear of losing KP social grouping/clients if HIV positive
Discrimination and lack of competency at public health facilities
Loss to follow up / referral especially acute due to KPs being clandestine and lack of health facility competency
Operational / policy
Policy, operational PrEP support and implementation

8. In South Africa... Health4Men has:
KPs clandestine due to social discrimination
Community-based outreach models (Ukwazana / Zwakalani) making programmes place-specific
Cohorts of ‘ambassadors’, peer educators and outreach staff
Community-based HCT
Large-scale communication campaigns WeTheBrave
MHealth initiatives
KP not self-identified
Fear of losing KP social grouping/clients if HIV positive
Discrimination and lack of competency at public health facilities
KP competency training, mentoring and on-going TA at identified and suitable health clinics
Loss to follow up / referral especially acute due to KPs being clandestine and lack of health facility competency
Support clinical services via outreach teams
Support groups for MSM and other KPs dealing with issues such as HIV stigma, discrimination, community fears and adherence.
M&E systems to highlight loss to follow up
Operational / policy
Working closely with Department of Health in training and support for clinical services
Contributed to the development of PrEP guidelines
Ensure that implementation of ART guidelines is appropriate for MSM
Policy, operational PrEP support and implementation

9. Lessons Learned: Health4Men’s model is based on the need to :
Be inclusive and understanding of diverse KP needs (there is no ‘one-size fits all model’)
Affirm the lived realities of different KP groups (our ‘sex positive approach’ and ‘Brave enough’)
Link together psycho-social and biomedical concerns, necessary to achieve
Health4Men and Health4Men AFRICA offer solutions to health concerns
Health4Men and Health4Men AFRICA are constantly learning and adapting to remain on the forefront of technical expertise

10. Thank you Anova Health Institute PEPFAR USAID Dr. Andrew Tucker
Dr. Johan Hugo