The sexual health needs of men who have sex with men (MSM), particularly men who identify as straight but engage in same-sex sexual practices, are notoriously neglected, making them a most-at-risk population (MARP), or key group in the HIV epidemic.

Anova’s Health4Men initiative is one of the first projects on the continent to draw considerable attention to and address the sexual health needs of men who have sex with men in the context of HIV.

Anova's Health4Men clinics have developed innovative services and programmes to address the ‘gap’ in HIV prevention and care by providing sexual health services for MSM.

The project, which started its work among the gay community in Cape Town’s city centre, is increasingly expanding its work addressing the wider needs of MSM, finding innovative means of reaching out to this often hidden group, addressing their behaviour and improving their access to health care.

Sensitivity training for healthcare workers

Recognising that one of the key barriers to addressing HIV among MSM in South Africa is stigmatisation of MSM by healthcare workers, Health4Men runs MSM sensitivity training workshops in both Johanneburg and Cape Town, aimed at healthcare workers.

In a bid to support MSM and clinic staff,  These workshops tackle the basics of gender, sex, sexual identity and sexual practices by illustrating that these four components do not always intersect as society expects them to.
The workshop also aims to make healthcare workers more comfortable with dealing with MSM by familiarising them with the specific risk factors that MSM face in relation to HIV.

Health4Men’s goal of establishing MSM friendly facilities throughout the country has brought about the development of a manual for healthcare workers on sexual healthcare for MSM, aptly named From 'Top2Bottom: A sex-positive approach for men who have sex with men. A manual for healthcare providers'.

Staying connected

Aside from various campaigns which boast colourful and attention-grabbing media, Health4Men also has its own website packed with resources, news and events.

In an innovative effort to reach out to and inform MSM, Health4Men also has a mobi site which allows users to access safer sex information instantly using their cellphones.

Health4Men Cape Town

Known for their cheeky, to-the-point campaigns and posters, Health4Men has embarked on a new initiative aimed at MSM in the townships surrounding Cape Town. Recognising that the campaign had to be approached sensitively, and needed to move beyond slogans, Health4Men partnered with University of Cambridge researcher Dr. Andrew Tucker, Deputy Director of Gender Studies, to ensure the campaign’s impact would be effectively gauged.

An initial survey of 300 men showed that approximately 33% of the participants were HIV-positive. Tucker has subsequently associated the high prevalence of HIV among MSM in townships with their “ecology of risk”. In other words, their hostile environments discourage the men from taking precautions and seeking the necessary medical care.
Health4Men’s campaign is focused not only at MSM in townships but also their wider communities.

Named “Ukwazana”, a Xhosa expression meaning “getting to know each other”, the campaign is clearly focused on inclusivity and is defined by its informality.
It relies heavily on “ambassadors” – men who are recruited to address and diffuse homophobia in their communities using informal tactics. These tactics include hosting community sports days or get-togethers at the local tavern where the community can get to know MSM.

Like the ambassadors, peer educators also form an integral part of Health4Men’s outreach team. These peer educators perform volunteer work in their communities and, during the course of these duties, spread the word on HIV prevention and treatment and attempt to address the discrimination experienced by MSM.

In August Health4Men guided 55 more men through the seven-module peer education course. Topics covered in the training include the biomedical aspects of HIV and STIs, sensitivity training for dealing with men who have sex with men and communication and counselling skills.

In the city bowl, where many men are openly gay, Health4Men and Emory University are piloting couples’ counselling and testing for gay men. Based on a model initially designed for heterosexual couples, the effectiveness of this approach for gay couples is being tested. “For too long HIV services in South Africa have failed to recognize that gay men form significant long-term relationships and that these relationships are a vital part of their lives,” says study leader Dr. Rob Stephenson from Emory University in Atlanta, USA.

As part of Health4Men’s vision of providing an MSM-competent clinic in every district, the organisation has partnered with the provincial Department of Health. At two public clinics in Khayelitsha and Belville Anova provided training, technical support, logistics and improved infrastructure.

MSM-competent clinics will improve access for many men who otherwise would have had to travel roughly 30 kilometres to Health4Men’s clinic in Woodstock to access basic sexual health services in a comfortable and stigma-free environment.

Health4Men Soweto

Based at Chris Hani Baragwanath Hospital, Health4Men’s Soweto-based Simon Nkoli Centre for Men’s Health and its team of doctors, nurses, lay counsellors and outreach staff strive to provide comprehensive services to MSM in the area. This year the centre has continued to supplement its free medical and psychosocial services with outreach services such as HCT, thereby extending its reach beyond the clinic’s walls.

HIV counselling and screening has become an integral part of MSM outreach internationally and Health4Men has recognised the importance of the activity as a key method of improving HIV prevention and treatment among this group. This year the Gauteng branch of Health4Men brought HCT to revellers at Johannesburg and Soweto Pride events. The number of people counselled and tested for HIV at Johannesburg Pride more than doubled this year, showing the growing demand for such event-based HCT.

Health4Men Treatment sites:

CAPE TOWN:
Ivan Toms Center for Men's Health 
Top Gate, Woodstock Hospital, Victoria Walk Road, Woodstock 
Tel +27 (0)21 447 2844

SOWETO:
Simon Nkoli Centre for Men’s Health
First Floor, New Nurses Home, Chris Hani Baragwanath Hospital, Soweto
Tel +27 (0)11 989 9756/9865