Transcript Social Franchise - Gateway Health Institute

Aimed at Key Affected Population Groups
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Clinical social franchising is a model for
organizing networks of private providers
to deliver a range of standards-based health
services under a common brand.
The goals of social franchising are to improve
results in health, equity, quality of services,
cost-effectiveness, and new usership.
In the case of KAPs new usership is linked to
improved health seeking behaviour
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MSM
PWID ( we prefer PWUD)
Sex Workers
Transgender people
Prisoners etc
All these Groups use various substances for
various reasons
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Epidemiology
The 2012 UNAIDS report on the global AIDS
epidemic states that people who inject drugs
(PWID) are at least 22 times more likely to be living
with an HIV infection than the general population of
49 countries with available data. In some countries,
the HIV prevalence of PWID is up to 50 times higher
than that of the general population. Recent reports
show that China, Russia and the USA have the
largest populations of PWID living with HIV.
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The prevalence of injecting drug use (IDU) varies considerably
around the world, both between and within countries. An estimated
15,9 million people worldwide are injecting drugs and up to 3 million
of them are infected with HIV (noted in 2010 by the regional office
for Southern Africa of the United Nations Office on Drugs and
Crime).
Until recently IDU was thought to be a problem in Asia, America and
Europe only, but the data indicate that it is increasing in Africa.
Although South Africa has one of the highest levels of HIV and AIDS
infection in the world, the extent of IDU and its relationship to the
epidemic have not been researched adequately.
The CDA in collaboration with the UNODC is preparing to determine
the extent of the link between HIV and IDU in South Africa.
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It is also important to note that although
heroin is mostly smoked, SACENDU data
(Dada et al., 2011) suggest that injection of
this drug is not uncommon. For example, and
with regard to the period January to June
2011, respectively 6%, 16% and 11% of those
patients who were in treatment centres in the
Western Cape, Gauteng and in the
Mpumalanga-Limpopo region for primarily
heroin use reported that they injected this
drug (Dada et al., 2011).)
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New research published in The Lancet HIV shows that
polydrug use is common among HIV-positive men who
have sex with men (MSM) and is strongly linked to sex
without a condom
This is the largest questionnaire study of people living
with HIV in the UK, accounting for about 5% of all HIVdiagnosed MSM in the UK. The findings show that half of
MSM surveyed had used recreational drugs at least once
in the previous 3 months. About half of those who used
drugs took three or more different types of drugs, while
roughly 20% said they had used five or more different
drugs in the past 3 months. Condom use was markedly
lower with increasing polydrug use. For example, over
75% of participants who said they had used five drugs
or more in the past 3 months also reported condomless
sex, compared with less than 25% of those who
reported no recent drug use.
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"The majority of these men would not
consider or self-refer to traditional harm
reduction services. Our findings highlight the
need for cross-agency collaboration between
HIV treatment and drug support
organisations to provide tailored services for
HIV-positive MSM who use recreational drugs,
and with national HIV and STI prevention
programmes to address recreational drug
use." - Lancet HIV
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Drug and alcohol use is common; injecting
drug use not common.
Drug and alcohol use among MSM is high and
is associated with sexual risk behaviours.
Interventions for MSM should address risks
associated with both sexual behaviours and
recreational drug and alcohol use.
MSM-friendly clinics can be an effective way
to reach a high number of MSM and provide
risk reduction services.
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Sex work and injecting drug use often tend to
be interconnected. Individuals who fall into
both groups become increasingly vulnerable
to HIV infection.7 Sexual partners of injecting
drug users constitute a channel of HIV
transmission between PWID and the general
population.
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Harm reduction is a comprehensive package of
interventions widely recognized around the world
as an evidence-based approach to HIV
prevention, treatment and care for PWID. (PWUD)
It includes opioid substitution therapy (OST). As
of 2010, data reveals that OST coverage has only
reached 6-12% of PWID on a global scale with a
wide gap between regions depending on wealth
distribution. Harm reduction methods have been
proven to respect human rights of PWID,
decrease the spread of HIV and encourage more
people to receive treatment.
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Most discussion on men’s help-seeking positions
them as reluctant consumers or “behaving badly”
with respect to their health. Few studies have
explored whether health service providers are
equipped to deal with men’s health issues
appropriately. The current health system appears
not to be tailored to meet the health needs of
men especially those in KAPs. Better
collaboration is required across disciplines, to
further investigate men’s health using both
qualitative and quantitative research methods.
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2 year project to measure impact of SF4
Health
Impact on health seeking behaviour both
sexual health and substance abuse
Impact on Health outcomes
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Measurements such as impact, cost
effectiveness, equity and quality of service to
determine if SF4Health contribute to
improved health seeking behavior and
whether such a model is sustainable and
could be scaled up nationally to have a real
impact on health outcomes.
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Client Surveys and Feedback – questions such as
Talked with a doctor or health professional about HIV
Talked with a doctor or health professional about having sex with men
Attended a safer sex workshop or other HIV-prevention program
On-line Sources
 Sought out information using a search engine
 Sought out information using a GLBT website
 Sought out information using a health website
 Sought out information using a bulletin board
 Sought advice from an online HIV expert
 Sought out information using a federal government website
 Sought out information using a national radio and television website
 Sought out information using a health insurance website
 Emailed a health provider
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Measurements of Social Franchise
effectiveness
Quality of services - Metric: client feedback,
internal audits
Health Impact - Metric – DALY averted
Cost effectiveness - Metric – cost per DALY
averted
Equity - Percentage/number of clients in
lowest 2 quintiles of wealth index.