1. Aimed at Key Affected Population Groups

2.  Clinical social franchising is a model for organizing networks of private providers  to deliver a range of standards-based health services under a common brand.  The goals of social franchising are to improve results in health, equity, quality of services, cost-effectiveness, and new usership.  In the case of KAPs new usership is linked to improved health seeking behaviour

4.  MSM  PWID ( we prefer PWUD)  Sex Workers  Transgender people  Prisoners etc  All these Groups use various substances for various reasons

5.  Epidemiology  The 2012 UNAIDS report on the global AIDS epidemic states that people who inject drugs (PWID) are at least 22 times more likely to be living with an HIV infection than the general population of 49 countries with available data. In some countries, the HIV prevalence of PWID is up to 50 times higher than that of the general population. Recent reports show that China, Russia and the USA have the largest populations of PWID living with HIV. 1

6.  The prevalence of injecting drug use (IDU) varies considerably around the world, both between and within countries. An estimated 15,9 million people worldwide are injecting drugs and up to 3 million of them are infected with HIV (noted in 2010 by the regional office for Southern Africa of the United Nations Office on Drugs and Crime).  Until recently IDU was thought to be a problem in Asia, America and Europe only, but the data indicate that it is increasing in Africa.  Although South Africa has one of the highest levels of HIV and AIDS infection in the world, the extent of IDU and its relationship to the epidemic have not been researched adequately.  The CDA in collaboration with the UNODC is preparing to determine the extent of the link between HIV and IDU in South Africa.

7.  It is also important to note that although heroin is mostly smoked, SACENDU data (Dada et al., 2011) suggest that injection of this drug is not uncommon. For example, and with regard to the period January to June 2011, respectively 6%, 16% and 11% of those patients who were in treatment centres in the Western Cape, Gauteng and in the Mpumalanga-Limpopo region for primarily heroin use reported that they injected this drug (Dada et al., 2011).)

9.  New research published in The Lancet HIV shows that polydrug use is common among HIV-positive men who have sex with men (MSM) and is strongly linked to sex without a condom  This is the largest questionnaire study of people living with HIV in the UK, accounting for about 5% of all HIV- diagnosed MSM in the UK. The findings show that half of MSM surveyed had used recreational drugs at least once in the previous 3 months. About half of those who used drugs took three or more different types of drugs, while roughly 20% said they had used five or more different drugs in the past 3 months. Condom use was markedly lower with increasing polydrug use. For example, over 75% of participants who said they had used five drugs or more in the past 3 months also reported condomless sex, compared with less than 25% of those who reported no recent drug use.

10.  "The majority of these men would not consider or self-refer to traditional harm reduction services. Our findings highlight the need for cross-agency collaboration between HIV treatment and drug support organisations to provide tailored services for HIV-positive MSM who use recreational drugs, and with national HIV and STI prevention programmes to address recreational drug use." - Lancet HIV

11.  Drug and alcohol use is common; injecting drug use not common.  Drug and alcohol use among MSM is high and is associated with sexual risk behaviours.  Interventions for MSM should address risks associated with both sexual behaviours and recreational drug and alcohol use.  MSM-friendly clinics can be an effective way to reach a high number of MSM and provide risk reduction services.

12.  Sex work and injecting drug use often tend to be interconnected. Individuals who fall into both groups become increasingly vulnerable to HIV infection. 7 Sexual partners of injecting drug users constitute a channel of HIV transmission between PWID and the general population.

14.  Harm reduction is a comprehensive package of interventions widely recognized around the world as an evidence-based approach to HIV prevention, treatment and care for PWID. (PWUD) It includes opioid substitution therapy (OST). As of 2010, data reveals that OST coverage has only reached 6-12% of PWID on a global scale with a wide gap between regions depending on wealth distribution. Harm reduction methods have been proven to respect human rights of PWID, decrease the spread of HIV and encourage more people to receive treatment.

15.  Most discussion on men’s help-seeking positions them as reluctant consumers or “behaving badly” with respect to their health. Few studies have explored whether health service providers are equipped to deal with men’s health issues appropriately. The current health system appears not to be tailored to meet the health needs of men especially those in KAPs. Better collaboration is required across disciplines, to further investigate men’s health using both qualitative and quantitative research methods.

16.  2 year project to measure impact of SF4 Health  Impact on health seeking behaviour both sexual health and substance abuse  Impact on Health outcomes

17.  Measurements such as impact, cost effectiveness, equity and quality of service to determine if SF4Health contribute to improved health seeking behavior and whether such a model is sustainable and could be scaled up nationally to have a real impact on health outcomes.

18.  Client Surveys and Feedback – questions such as  Talked with a doctor or health professional about HIV  Talked with a doctor or health professional about having sex with men  Attended a safer sex workshop or other HIV-prevention program On-line Sources  Sought out information using a search engine  Sought out information using a GLBT website  Sought out information using a health website  Sought out information using a bulletin board  Sought advice from an online HIV expert  Sought out information using a federal government website  Sought out information using a national radio and television website  Sought out information using a health insurance website  Emailed a health provider

19.  Measurements of Social Franchise effectiveness  Quality of services - Metric: client feedback, internal audits  Health Impact - Metric – DALY averted  Cost effectiveness - Metric – cost per DALY averted  Equity - Percentage/number of clients in lowest 2 quintiles of wealth index.