1. Bheki Sithole 30 Nov 2011 @ Sibayeni Lodge Most at Risk Behavior Populations (MSM): Feedback, Challenges and Experiences

2. Presentation Structure Definition Background Information Challenges Feedback Recommendations Recommendations for Interacting with MSM

3. Definition Who is MSM?Who is not?

4. Definition MSM defines by behavior rather than identity, and thus intended to be inclusive of all adult males who engage in consensual male to male sex, including those self-identifying as gay, bisexual, or heterosexual in their sexual orientation, and including individuals who are biologically male regardless of gender identity.

5. Background Info Same-sex behaviour are part of every culture and society around the world – acknowledgement can vary. Majority of new infections with HIV in sub-Saharan Africa are acquired through heterosexual sex?  lack of studies on same-sex and accrual is a challenge.  The rate of infection among sub-Saharan Africa is estimated to be 4 to 5 times higher than the rate to other men (Baral et al., 2002) MSM risky behavior seem to influence HIV epidemic among the general population. MSM has also not been considered to any great extent in national HIV and AIDS interventions in the country. MSM practices are also likely to occur in particular institutional settings MSM is not a culture Any male client can be potentially be an MSM.

6. Some MSM Challenges (Vulnerabilities)  Lack of knowledge of the risks of MSM sexual practices.  Fewer options for MSM clients  Couple –based HTC  Some effective strategies are not available.  female condoms and lubes  Some strategies are not effective.  Poor treatment of STIs, esp. rectal STIs.  Judgmental or abusive reactions to MSM from health care workers/counsellors  Stigma and discrimination  Poor self-esteem (fear)

7. Feedback from MSM population HTC does not tackle the specific needs of MSM Counseling received is irrelevant MSM are deprived of discussion because of hetero- normativity Service providers’ attitudes, esp. to certain dress codes is a barrier to rapport Lack of room for couple-based HTC Fear of sexuality disclosure esp. if health care provider is known

8. Recommendations  Sensitization of health care providers on MSM related issues  Training of health care providers on MSM should included at college level  IEC material should be inclusive of MSM information  Include MSM in decision making  MSM-appropriate sexual health material should be made available (FC2, condoms, lubes)  Create public awareness on MSM (embedded in public health education)  Approach health needs holistically (esp. mental needs)  Equal treatment; non-judgmental attitude

9. Recommendations for Interacting with MSM Consider that MSM is not a homogenous group: some single; committed relationships; married to women; don’t identify as ‘gay’. Be sensitive of sexual identity and/or gender identity  Consider transgender clients  Rather ask client how they prefer to be addressed Develop rapport by moving from the general to specific issues Learn about the local MSM terms and words

10. End of presentation…. Thank you Remember …. Stigma kills