HIV Prevention, Care and Treatment For MSM:

A Review of Evidence-Based Findings and Best Practices

14-16 February, 2012 Africa

Johannesburg, South

Regional Workshop on HIV Prevention among MSM

Improving Community Outreach and access to commodities and service among MSM in Ethiopia. Dereje Teferi, Director of MSM programs
Rainbow Ethiopia Initiative for MSM, Ethiopia

Febreuary,2012

1.

MSM and HIV in Ethiopia

Adult HIV prevalence in Ethiopia was estimated to be 2.4 percent in 2010, which corresponded to more than 1.2 million people living with HIV. Although prevalence is lower than in many other countries, the absolute number of cases 1.HIV/AIDS IN ETHIOPIAmeans Ethiopia has one of the largest HIV-infected populations in the world. Available data and evidence indicate that the epidemic is generalized and more heterogeneous with marked variations across regions. However, there is significant variation in the epidemic among geographic areas and population groups. Prevalence is higher among women than men (2.8 percent and 1.8 percent, respectively). And though rural prevalence is increasing of late, at 0.9 percent it is still much lower than in major urban areas (7.7 percent).

ACKNOWLEDGMENT

We would like to extend our gratitude to our comrades and partners who gave us their helping hands during the difficult times following the AMSHER MSM pre conference and ICASA.

No reliable data are available as to the size and characteristics of key populations in Ethiopia. In addition, the Ethiopia 2010 UNGASS country progress report includes no information on any key populations;MSM are not included as a key population in the countrys strategic plan. Although there are some recent small scale efforts by CDC and USAID,so far there is well established MSM-targeted HIV prevention, treatment and care programming funded by the government, the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) or the U.S. Presidents Emergency Plan for AIDS Relief (PEPFAR).

Although there have been no documented research studies of MSM in Ethiopia, some anecdotal reportsincluding NGOs working on MARPssuggest that high risk sexual practices among MSM are common and the levels of knowledge associated with HIV and STIs-related risks are low. This indicates that prevalence among MSM is likely to be higher than among the general population. Studies from other countries in the region with similar epidemics have shown that MSM are disproportionately affected by HIV, and there is no reason to believe Ethiopia is much different.

2.Profile

Rainbow-Ethiopia Initiative for MSM is a CBO working to develop an integrated and holistic approach in advancing the sexual health and psycho social well being of MSM who are one of the key populations in relation to HIV/AIDS and STI Vulnerability.

Our target groups include different subcategories of MSM including youth, male sex workers, married men and others who need our support. Vision Attain full sexual health and rights of Men who have sex with men (MSM) in Ethiopia. Work towards an empowered and healthy life for MSM in Ethiopia. Mission To advance the sexual health rights of MSM and reduce stigma and discrimination aliened with them by creating general awareness with the aim of empowering the MSM community and the society at large, advocating for the rights to good health, access to STI/HIV and AIDS related care and treatment in Ethiopia.

3.Objectives Rainbow-Ethiopias objectives, in broad terms, are:

Advocate for equal access of healthcare for MSM in Ethiopia. To identify and develop a referral system for health and health related needs of MSM. To create, raise and promote Public awareness about MSM including youth, MSM living with HIV, male sex workers, married men,etc. To use different medium and events e.g. fliers brochures, newsletters & social events to pass messages regarding sexual health and safer sexual practices for the MSM community. Capacity building of members and our networks in all parts of the country. To offer community out reach and peer education services to our target groups. To create, plan and manage different support groups for our target groups. To emphasize life skills, and development of positive attitudes and values. To create and raise security awareness among MSM community and MSM and HIV activists.

4.Programs and Services

Rainbow-Ethiopias programs include: Offering MSM Psychosocial counseling and support . Referrals to MSM-friendly HCT and STI screening and treatment services. Promotion and distribution of male and female condoms and condom compatible water-based lubricants. Wellness workshops that include safer sex awareness and life skill development One to one ,one to many and group peer education. Open forum discussions. Post Test Clubs [PTC] for those who know their sero status. Community mobilization through various outreach activities. Providing technical assistance to other local MSM networks or individuals in all parts of the country . Engaging and supporting with researchers to conduct population size estimation, behavioral,bio medical and structural researches on MSM.

Out reach community initiative to night clubs, other out door meeting places and to other MSM social events to stimulate discussions on how to practice safer sex. Talking sex, feeling safe program to discuss about STI and HIV/AIDS issues (e.g., condom demonstration),personal, social and risk reduction experiences. Professional psychosocial counseling in a safe space that gives emotional support and self worth (with their anonymity and privacy respected) for the male sex worker and other MSM. Building and maintaining MSM friendly web-based online forums and other enetworks to disseminate sexual health information, education and communication to provide MSM friendly and judgment free information about their chance of contracting and spreading the virus. It will also help as a platform to enable them to develop coping skills to withstand the prejudice, discrimination, stigmatization and denial that are inflicted upon them. In the future, if conditions & our capacities allowed we have a plan to work on toll free help phone lines.

5.Challenges/constraints
Lack of enabling and MSM inclusive national HIV prevention and control strategies in Ethiopia. Challenges Associated with Legal Status (criminalization),social Stigma and Discrimination negatively affecting the programming. The government refuses several times to recognize, track or provide services to MSM; the our few partner organizations that work with MSM remain silent for fear of official persecution; and many MSM forego seeking medical care because of discrimination. We are ejected by the Ethiopian Charities and Civil Societies Agency to register as a resident nongovernmental organization working in Ethiopia because of the new civil societys law and the criminalization of the same sex practice in Ethiopia. Water-based lubricants are hardly available for distribution in Ethiopia; therefore, most MSM use saliva and oil-based lubricants like Vaseline and lotions, which are riskier in terms of HIV transmission.

6.Development and success stories

We have adapted and developed the first MSM training manual and peer learning guide in partnership with Engender Health Inc. ,USAID MARPs project and amfAR,The foundation for AIDS research. We have finalized BCC/IEC/behavioural communication materials for MSM in Ethiopian context. We are planning to conduct a training of trainers (TOT) and step down community outreach workers training which will help us to supervise and cascade our community outreach program effectively and strategically. We have participated in the global powerful report Achieving an AIDS free Generation to Gay Men and other MSM,Financing and Implementation of HIV Programs targeting MSM by amfAR and JHU,Bloomberg School of Public Health and Human rights as a country consultant. We are finalizing a formal partnership agreement with some private health facilities for MSM friendly HCT and STI screening and Treatment services. We are also supporting two national MSM behavioural assessments by USAIDEngender Health and CDC-Ethiopian Public Health Association which will bring a strong and solid evidence to our advocacy and prevention campaign with government and other stakeholders.

7.Technical and capacity building partners United States Agency for International Development. amfAR,The foundation for AIDS research Engender Health Inc. ,MARPs project American Jewish World Service John Hopkins University, School of Public Health and Human rights. Heartland Alliance for human right and humans need. The AIDS foundation of Chicago and others.

8.Strategic plan2012/2017/the way forward

Build an enabling environment through empowering communities at risk so that their vulnerability is reduced.
Increase access to condoms at intervention sites Increase condom use with non-paying/regular partners and increase/maintain the current levels of high condom use with paying partners. Improve access to STI services for sex workers and MSM.

Increase the utilization of STI/HIV/AIDS related services by sex workers, MSM and their partners in project intervention sites.
Generally our main objective is to use the best interactive sexual health education techniques & communication skills to enhance our target groups coping skills to bring a behavioral change which will enable them to make a health choice & take a rational action/responsibility for their own health

9.Recommendations
Create an MSM-specific strategic fund to provide resources for supporting in-depth, reliable research on the MSM population in Ethiopia. The results could help guide key programming decisions based on the size of the population, its access to health and social services, and the impact of legal, social and economic stigma and discrimination.

Increase financial and technical support for operations research that can identify interventions capable of reaching diverse MSM communities in all regions, and disseminate results to inform national and regional policies.
Work with civil society coalitionsand with bilateral and multilateral partners including European governments, UN agencies, the World Bank, and othersto increase national resources for HIV/AIDS and related programmes targeting MSM.

Above all the policies and laws that impede effective HIV programming must be reframed and th should include the repeal of laws that criminalize consensual adult same-sex practice and the implementation of policies that seek to aggressively combat stigma and discrimination aimed at sexual minorities and PLHIV.

Develop programmes and structures to assess the degree to which government-run health facilitie are able to meet the needs of MSM and other vulnerable populations.