This manual draws on the experience of the Anova Health Institute’s Health4Men project that provides sexual health services for men who have sex with men (MSM) in South Africa. The manual is a resource to assist healthcare workers to provide appropriate and accessible psychosocial and medical care for MSM.

The Health4Men project was initiated in 2008 when the South African Department of Health started to focus on providing HIV- related services for MSM in accordance with the National Strategic Plan (NSP).

The Anova Health Institute supported this initiative by developing the sex-positive model for addressing MSM sexual health – with an emphasis on HIV – for implementation throughout South Africa. Health4Men provides a comprehensive package that includes combination HIV prevention linked to competent MSM sexual health and HIV services.

Health4Men now has services throughout the country. Two clinics have been awarded the title of Centres Of Excellence (COE) for their specialised HIV-related care and treatment – the Ivan Toms Centre for Men’s Health in Woodstock, Cape Town and the Yeoville clinic in Johannesburg.

MSM, competent services are integrated into public health facilities to maximise reach and sustainability. In addition to MSM services, Health4Men focuses on the health needs of other high-risk male populations, including displaced persons and refugees, prison populations, commercial sex workers and intravenous drug users.

The Anova Health Institute undertakes research and specialises in innovative projects that extend to hard-to-reach populations. The Health4Men project has significant expertise in preventative interventions specifically with diverse groupings of MSM.

Download the Top to Bottom Manual

In the light of an emphasis on extending access to competent sexual health services for two Key Population groupings, namely men who have sex with men (MSM) and sex workers (SW), the transgender population has generally been overlooked within the public health sector. This applies equally to sexual health-related research on Key Populations where transgender people have often been ignored; where they have been included, they have frequently been incorporated as being either MSM or SWs.

Importantly, transgender people experience their own set of unique barriers to accessing essential health services. These include transphobia and trans-prejudice, stigma and discrimination, and a pervasive lack of understanding and insight into their health needs among health professionals.

It is within this context that we welcome you to this training material.

This training content is intended to be preceded by another training course developed by the Anova Health Institute, Key Populations Diversity Training. Being exposed to this combined content has been designed, firstly, to facilitate the development of insight into various stereotypes and prejudices regarding members of Key Populations, including transgender people. Secondly, this current course will develop health workers’ knowledge regarding the rendering of competent health services specifically for transgender people.

We acknowledge the dedicated hard work of Dr Anastasia Tomson who developed this content on our behalf. It was a pleasure working with her throughout the process and we benefited greatly from her significant insights. We also acknowledge and thank Professor Roy Shires of the Endocrinology Department of the University of the Witwatersrand, and psychiatrist Dr Greg Jonnson for undertaking a review of elements of this training manual. We extend appreciation to Jill Schlachter who edited and structured this course content, and Anthony Dalton for the layout. The entire process was driven and coordinated by Glenn de Swardt.

Finally, we thank our donors for their support and confidence in us to undertake training of health workers on the provision of services to transgender people, and we express our sincere appreciation to the Department of Health for their generous partnership.

To download the Transgender Health Training manuals click on the links below:

The Southern African HIV Clinicians Society published its first set of oral pre-exposure prophylaxis (PrEP) guidelines in June 2012 for men who have sex with men (MSM) who are at risk of HIV infection. The Society's updated PrEP guidelines can be found on their website here.

With the flurry of data that has been generated in PrEP clinical research since the first guidelines, it became evident that there was a need to revise and expand the PrEP guidelines with new evidence of safety and efficacy of PrEP in several populations, including MSM, transgender persons, heterosexual men and women, HIV-serodiscordant couples and people who inject drugs. This need is particularly relevant following the World Health Organization (WHO) Consolidated Treatment Guidelines released in September 2015.

These guidelines advise that PrEP is a highly effective, safe, biomedical option for HIV prevention that can be incorporated with other combination prevention strategies in Southern Africa, given the high prevalence of HIV in the region. PrEP should be tailored to populations at highest risk of HIV acquisition.

Dr. Kevin Rebe, Specialist Medical Consultant of Anova Health Institute:
"I am extremely happy that the society has released updated and expanded PrEP guidelines.  These guidelines consider and include the latest evidence regarding the use of PrEP and will be a valuable educational and clinical tool for health providers.  I hope that publication and dissemination of these guidelines will promote the use of PrEP in South Africa.  PrEP has the potential to make a dramatic contribution to our fight against HIV/AIDS and will assist the country in meeting it’s 90/90/90 targets.  The Anova Health Institute is currently running PrEP demonstration projects for men who have sex with men which align with these newly published guidelines.  We are also working with the National Department of Health, providing technical assistance to promote the scale up of PrEP in the state health sector."  

Click here to download the guidelines.

Anova's Dr Moyahabo Mabitsi shares her insight on the implementation of NIMART training that has led to an increase in access to HIV treatment in Johannesburg since more PHC facilities are providing HIV treatment services. "In our experiences, the biggest success in implementation was based on training followed by facility-based clinical mentorship, continuous medical education and co-ordination with the District team."
Read full article in HIV Matters Journal, page 20, below...

 HIV Matters March 2015 small-934.pdf

Adolescents are expected to negotiate increasingly difficult situations as they mature. This includes discovering and expressing their sexuality. Without the correct advice and care these young adults may take decisions that put their sexual health at risk.
In the South African context, where HIV prevalence is exceptionally high, effective counselling for teenagers is especially important. Despite this urgent need, many people working with adolescents are not equipped to provide the guidance that could help adolescents to properly negotiate these challenges and effectively manage their sexual health. Without training or reliable resources, imparting life skills and sharing information in a sensitive and age-appropriate manner can be extremely challenging.
Anova Health Institute developed this manual, which offers a solution and is an essential resource for all people working with adolescents. It provides trainers and facilitators with the necessary insight to work effectively with young adults. Using participatory learning methodology, the manual serves as a tool for facilitators, helping them to set up clubs where adolescents can explore their sexuality in a judgement-free space. The manual includes various other training methodologies like role-playing, case studies and small group work, which encourage maximum participation from the adolescent club members.
See full manual below:

 Sexual and Reproductive Health for teens

Remco Peters, a clinical programme specialist at Anova Health Institute, presented findings from a cohort study on tuberculosis (TB) testing at the TB conference held in Durban last week. The study was conducted at 5 primary healthcare (PHC) facilities in Mopani District, comparing clinic versus remote laboratory basedXpert® MTB/RIF for diagnosis of tuberculosis (TB) in rural South Africa.
This TB test provides accurate data within two hours so that patients can be offered proper treatment on the same day.
See the full presentation together with its findings below:


 A cohort study of clinic versus laboratory based Xpert
A presentation by Remco Peters from Anova

Anova's Remco Peters, a clinical programme specialist, together with Erik Schaftenaar, a PhD student doing research with Anova, recently conducted a study on seroprevalence of Human Herpesviruses (HHVs) in Rural South Africa. The study in Mopani District (a rural area in Limpopo) found high seroprevalence of HHVs in HIV-infected people attending primary healthcare facilities in rural South Africa.

Anova would also like to acknowledge the Department of Viroscience, Erasmus Medical Center, Rotterdam, the Netherlands, in their collaboration with Anova on this interesting and informative report.

Seroprevalence data of human herpesviruses (HHVs) are limited for sub-Saharan Africa. These are important to provide an indication of potential burden of HHV-related disease, in particular in human immunodeficiency virus (HIV)-infected individuals who are known to be at increased risk of these conditions in the Western world.
In this cross-sectional study among 405 HIV-infected and antiretroviral therapy naive individuals in rural South Africa the seroprevalence of HHVs was: herpes simplex virus type 1 (HSV-1) (98%), herpes simplex virus type 2 (HSV-2) (87%), varicella zoster virus (VZV) (89%), and 100% for both Epstein-Barr virus (EBV) and cytomegalovirus (CMV).
Independent factors associated with VZV seropositivity were low educational status and having children. Lack of in-house access to drinking water was independently associated with positive HSV-1 serostatus, whereas Shangaan ethnicity was associated with HSV-2 seropositivity. Increasing age was associated with higher IgG titres to both EBV and CMV, whereas CD4 cell count was negatively associated with EBV and CMV IgG titres. Moreover, IgG titres of HSV-1 and 2, VZV and CMV, and CMV and EBV were positively correlated. The high HHV seroprevalence emphasises the importance of awareness of these viral infections in HIV-infected individuals in South Africa.
In a recently published ANC survey on HSV-2 prevalence in four provinces (not Limpopo though), prevalence was in a similar range for HIV-infected individuals, but much higher than among those without HIV infection.
The study, High Seroprevalence of Human Herpesviruses in HIV-Infected Individuals Attending Primary Healthcare Facilities in Rural South Africa, which was published in a science journal Plos One, is available for you to read below:


 High Seroprevalence of HHVs in HIV-Infected Individuals Attending PHC Facilities in Rural SA
A study conducted by Remco Peters and Eric Schaftenaar

Last year Anova has seen a reshaping of priorities and a renewed focus on sustainable support of the SA government's leadership on HIV and AIDS.
We have seen huge strides in health systems strengthening activities, including increased effort in clinical mentorship and effective data collection.
It has been a productive and innovative year.
Read more on what 2013 has meant for Anova and the health sector.


 Annual Report 2013
PDF version

Two accepted publications about the work done on side-effects in HIV-infected children on antiretroviral treatment (ART) in Mopani were recently published. You can access the study done on lactate levels here, and the neuropathy manuscript. To read the full study you need to subscribe to the relevant journals.
In one recent case study conducted by Anova, led by clinical programme specialist, Remco Peters, on the side-effects of ART in children, interesting findings were made around prepubertal gynecomastia.
It was the first reported case of prepubertal gynecomastia in a young girl attributed to efavirenz use. Prepubertal gynecomastia is a rare condition and most frequently classified as idiopathic. The study looked at a seven-year-old African girl presented with true gynecomastia four months after initiation on ART (abacavir, lamivudine, efavirenz). History, physical examination and laboratory tests excluded known causes of gynecomastia and efavirenz was considered as the most likely cause. Six weeks after withdrawal of efavirenz the breast enlargement had completely resolved.
In HIV-infected adults gynecomastia is a recognised but infrequent side-effect of ART and mostly attributed to efavirenz use. In the medical literature only five cases of prepubertal gynecomastia in children taking ART are described and underlying pathogenesis was unknown. The occurrence of adverse effects of ART may interfere with therapy adherence and long-term prognosis and for that reason requires attention.
Read the full research report below:

 Case study

Dr Andrew Tucker from Anova spoke at the SAfAIDS tweetable dialogue on April 3 forming part of their rock leadership programme, which seeks to promote access to integrated SRH and HIV services for key populations in East and Southern Africa. Dr Kevin Rebe from Health4Men was also involved in putting the presentation together.
Dr Tucker's presentation focused on Homophobia and MSM Health and showed that through their recent research with Health4Men, an Anova project, that we can now see a scientific chain from homophobia to poor health outcomes for men who have sex with men (MSM). Health4Men project which is dedicated to addressing this heightened HIV risk through the provision of competent, prejudice-free sexual healthcare for MSM and the promotion of a sex-positive attitude among healthcare workers.
The purpose of the Tweet@ble Regional Policy Dialogue is to explore policy options for strengthening sexual and reproductive health services access and uptake in reducing the burden of HIV among key populations in east and southern Africa. It is also hope that it will generate practical recommendations for policy on how to address SRH and HIV concerns for key populations in the post 2015 development agenda.
Running under the theme: “Guaranteeing SRHR for Key Populations in the Post-2015 Development Agenda: A call for Leadership and Accountability for Improved Health Outcomes in ESA”, the dialogue was attended by representatives of the African Union, SADC, Key populations, civil society organisations, National AIDS Councils, relevant Ministries and funding agencies. The Former President of Mozambique, Joaquim Chissano also attended. {image_2}
The dialogue forms part of the SAfAIDS rock leadership programme, which seeks to promote access to integrated SRH and HIV services for key populations in the region.  Join the dialogue on SAfAIDS Twitter,#SRHRkeypops or Stay Connected on SAfAIDS Facebook Page.
You can follow Anova and Dr Tucker on Twitter.
Read Dr Tuckers' SAfAIDS presentation below.


 Homophobia and MSM health
Health4Men’s approach to homophobia and men who have sex with men (MSM)

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