Transcript Health4Men - World Bank

Service Delivery for Vulnerable
Groups
Health4Men
Helen Struthers, PHRU
Death Rates by age per 100,000 by sex:
1997 and 2004
14,000
12,000
10,000
Female 2004
Female 1997
Male 2004
Male 1997
8,000
6,000
4,000
2,000
0
15-1
9
25-2
9
35-3
9
45-4
9
55-5
9
Source: Statistics SA: Adult Mortality (age 15-64) based on death notification data in South
Africa: 1997-2004
Constitution and HIV/AIDS Strategic Plan
•South African Constitution – Bill of Rights
The equality clause states: “The state may not unfairly discriminate directly or indirectly
against anyone on one or more grounds, including race, gender, sex, pregnancy marital
status, ethnic or social origin, colour, sexual orientation, age, disability, religion,
conscience, belief, culture, language and birth” Chapter 2, Clause 9(3)).
•Operational Plan for Comprehensive HIV and AIDS Care and Treatment for
South Africa - 2003
Universal care and equitable access regardless of “race, colour, gender and economic
status
•National Strategic Plan for HIV/AIDS and STI’s (2007 – 2011)
expands on the 2003 plan with guiding principles including promoting social change and
cohesion, talking inequality and poverty, promoting equality for women and girls,
recognising diversity, ensuring equality and non-discrimination and personal
responsibility. Through these principles the vulnerability of women and girls, gender
violence, male sexual health and high-risk groups are addressed.
HIV prevalence among ANC attendees
PHRU Soweto PMTCT service,
1987 - 2008
South Africa National Survey,
1990 to 2007
35
35
30
30
25
25
20
20
15
15
10
10
5
5
0
19 19 19 19 19 19 19 20 20 20 20
87 89 91 93 95 97 99 01 03 05 07
Prevalence (%)
0
19
90
19
92
19
94
19
96
19
98
20
00
20
02
20
04
Prevalence (%)
100 fold increase: from 1 in 300 to 1 in 3 over 20 years
Source: 1] PHRU, 2] SA Dept. of Health, 2008
20
06
MSM Prevalence studies in Soweto
Soweto MSM Study: Respondent driven sampling design
368 Soweto resident MSM
• HIV prevalence 25.3% overall – 49% in MSM 20 - 49
• 33.1% of men who reported women among their last 5 partners
report unprotected anal intercourse (UAI) with other men (54/163)
• >90% of UAI among MSM+W is reported as insertive, but 39.6%
reported unlubricated UAI
Source: Lane, Dladla, Struthers & McIntyre,
AIDS Priorities Conference, 2008
HIV among Youth in South Africa
50
45
40
35
30
25
20
15
10
5
0
49.0
38.5
23.9
9.4
8.5
9.8
6.0
3.2
Age 15-19
Men
Women
Age 20-24
All MSM
Gay identified
Source: 1] HIV Prevalence, Incidence, Behaviour and Communication
Survey 2005, HSRC, Nelson Mandela Foundation. 2] Soweto Men’s Study,
Lane, T. et al, ICASA 2008
Prevention and treatment initiatives for MSM
playnice
An innovative, multimedia campaign
promoting safe sex, health sexuality,
HIV counselling and testing and care and
treatment to MSM of all races and ages in
South Africa
Health 4 Men
A comprehensive HIV and STI testing, and
HIV/AIDS care and treatment clinical
service, predominantly aimed at MSM, in
male friendly dedicated public sector
facilities.
The range of PHRU activities
PREVENTION
Community
prevention
strategies
Individual
prevention
strategies
TREATMENT
CARE
VCT
PMTCT
Medical care
and
monitoring
OI prevention
& treatment
Impact of HIV & national and international policy and advocacy
Psychosocial care and support: PLWA and families
Antiretroviral
treatment
Health4Men Services
• Risk assessment
• Sexual behaviour
• Drug use
• Specific at-risk MSM (Sex workers, discordant couples)
• Sexual health assessment
• Clinical STI screening including assessment of anal and prostatic
health
• VDRL
• Hepatitis A antibodies
• Hepatitis B antibodies (and antigen if HIV positive)
• VCT (with CD4 and appropriate linkage to care)
Health4Men Services
• Mental health assessment
• Double stigma and discrimination due to MSM and
HIV status
• High depression rates (gay teenage suicide rates...)
• Relationship and support issues
• Risk reduction measures
• Counselling and referral (drug and alcohol)
• Hepatitis A and B vaccination
• Condoms and lube for Africa
Health4Men Services
• HIV assessment
• Huge variation in knowledge
• Huge variation in expectations of treatment
• Specific HIV treatment issues among MSM
• D4T is often not acceptable
• Recreational drugs
• Anabolics
Thanks!