Delivering HIV-related community, structural and service development interventions for men who have sex with men in Kenya, Tanzania, Uganda & Zimbabwe; an appraisal of the SHARP programme
21st International AIDS Conference (AIDS 2016), Durban, South Africa, July 18-22, 2016
Speakers: Adam Bourne; Elizabeth Fearon; Will Nutland; Caroline Dorval Defferary; Gavin Reid
Background: In Kenya, Tanzania, Uganda and Zimbabwe, homosexuality is illegal, subject to severe social stigma and discrimination, and often coupled with state-sponsored violence. This environment hampers HIV prevention efforts among men who have sex with men (MSM), who are at a heightened risk of acquiring HIV. The Sexual Health & Rights Programme (SHARP) comprised a number of interventions that aimed to improve the social and political environment within which MSM live, and sensitise clinical services to the specific health and social care needs of MSM. This paper reports on a detailed appraisal of such interventions.
Methods: Adopting a rapid feedback approach, the study assessed each discrete intervention in relation to effectiveness, coverage, need, acceptability, feasibility, acceptability and cost. Data was collected via interviews and focus groups with staff and volunteers from seven SHARP-supported MSM-led community based organisations (CBOs) who deliver HIV prevention and care interventions to MSM and analysis of routine monitoring data. Triangulation was facilitated by interviewing other local stakeholders familiar with the interventions delivered and their integration with other health and social care systems.
Results: Recognising the need for credible allies, all CBOs in SHARP had, following in-depth sensitisation training, partnered with state sanctioned clinical care providers to allow safe referral pathways to MSM in their localities. This had improved accessibility of sexual health services, although the nature of syndromic-only screening still posed a risk of missed STI diagnoses. Many CBOs have also achieved success in their engagement activities by starting from a position of facilitating holistic well-being; providing safe spaces for socialising and resilience building among MSM. While some success in policy and lobbying efforts to improve the legal environment has been achieved, significant challenges still remain in safely gaining access and maintaining relationships to key decision makers in shifting political climates.
Conclusions: MSM led organisations have earned the trust of large sections of the community and are well-placed to facilitate access to health and social services essential to the well-being of MSM. While essential to the HIV response, both the successes and shortcomings of policy and lobbying interventions should be considered within the broader, largely hostile, political environment for MSM.