Key Affected Populations

MSMSex Worker

Transgender

PWUD

PWID

MSM/W

A WINNER of GRAND CHALLENGES EXPLORATIONS ROUND 14 - an Initiative of The Bill & Melinda Gates Foundation

People DO NOT have labels

Men as Key Population: WHY ?ASTRA STUDY: UK

"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 organizations to provide tailored services for HIV-positive MSM who use recreational drugs, and with national HIV and STI prevention programs to address recreational drug use."  - Lancet HIV

Population Fund/PEPFAR Study in Kaduna, Nigeria

• Interventions for MSM should address risks associated with both sexual behaviors 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.

Soweto Study

50% of MSM also sleeps with women.

Thailand study

61% of transgender (male to female) received money or gifts in exchange for sex

PWUD

High proportion of young recreational drug users engage in transactional sex

to obtain drugs – especially young straight (heterosexual) men.

Poor Health Seeking Behavior

Among men in General and specifically men in Key Affected Population Groups

The poorer you are the more likely you are to engage in high risk behavior and less likely you are to seek help from health services

Male Health Seeking Behavior

“Many studies have documented low rates of medical help-seeking among men. This has been associated with poorer health outcomes in men such as diagnosis delay, higher mortality rates, and increased burden on the healthcare system.” SAMJ

• Reasons for Poor Health Seeking Behaviour

• Stigma and Discrimination – MSM, Transgender women, “addicts”, PLWHIV etc

• Embarrassment, distress, and/or fear related to using health services - ideas about masculinity that imply men are ‘weak’ for seeking help.

• Privacy and Confidentiality

• Inconvenient Service Hours

• COST

• Shortcomings in scope of services provided

• Poor communication/rapport with health professionals: Men were uncomfortable with health professionals who were not polite, rushed without explaining important information, used medical jargon, and lacked sensitivity to their needs.

• Viewing symptoms as minor and insignificant: This often resulted from men’s lack of knowledge about symptoms and low interest in their body and health.

• Need for emotional control: Some men felt that by worrying about their symptoms they were ‘losing control’ of their emotions (SAMJ)

Recent spike in HCV in SSA

Chronic viral hepatitis may diminish the gains of HIV antiretroviral therapy in sub-Saharan Africa

In the largest study of its kind to date, researchers from Imperial College London and MSF collated data on over 1.1 million individuals from 213 studies to provide policymakers with robust estimates of the burden of HCV infection.

The report, published in The Lancet Infectious Diseases, found that around three per cent of people in sub-Saharan Africa have been infected with HCV infection, rising to 5.7 per cent in individuals with HIV.

Treatment should be made available to all those who need it.

The “War” on Drugs

Did the “War” have any effect?

Kofi Annan: The war on drugs has failed in West Africa and around the world

Governments that focus on drug users and small-time dealers often create an unsustainable burden on their criminal justice systems while ignoring the health and social problems that have emerged with increasing levels of trafficking, consumption, and production, which goes on unabated.

What we need is comprehensive Harm Reduction Services and Decriminalization

HPV and Anal CancerIn the general population, anal cancer is a rare disease. Few people knew about it before Farrah Fawcett made public her struggle with the illness. Among men who have sex with men (MSM), the incidence of anal cancer is significantly more prevalent and increasing annually…..

Anal cancer incidence in high-risk groups is more than double that of cervical cancer incidence before the initiation of Pap screening. The incidence of anal cancer is increasing, while cervical cancer incidence continues to decrease.

Health care professionals do not know how to and whether to screen for it.

Anal Cancer in Gen Population 2/100 000 MSM HIV negative 20x = 40/100 000 HIV positive 40x = 80/100 000 Screening? Standardised Test not yet available Anal Cytology – PAP smear HICIN vs HIAIN Is it fair to make HPV vaccine available only to girls?

Market News

Xpert® HPV, a 60-minute test for cervical cancer-related human papilloma viruses

Xpert HPV is a multiplexed test that targets the E6 and E7 oncogenes of 14 cancer-related HPV types and specifically calls out high-risk types 16 and 18/45 in separate detection channels, with 11 other high-risk types detected in a combined channel.

High number of men (MSM) have HPV in their mouths – is there a possible link for early referral for Aanal Cancer screening?

Xpert® HCV Viral Load, a quantitative test that provides on-demand molecular testing for confirmation of infection and monitoring of Hepatitis C virus (HCV)

Spike In HIV infections in Russia

Is it drugs or is it Politics?

New research has revealed an alarming spike in the number of HIV infections in Russia, with 200 people being diagnosed with the condition every day.(2014) Vadim Pokrovsky, the head of Russia's AIDS research centre, has said that instead of recognising a crisis - the government is indifferent to the problem.

Exacerbators – Political Figures

Politicians?

The Very Dangerous Religious “Vectors”

Looking Lively

Scott Lively, head of Defend the Family International, will be tried in a Massachusetts court for crimes against humanity. The lawsuit was filed against him by the Center for Constitutional Rights (CCR) on behalf of Sexual Minorities of Uganda (SMUG) last year. They charge that he has spearheaded the Ugandan anti-LGBT movement, advising the government of that country on the “Kill The Gays” bill and conspiring with them for the past decade to persecute LGBT Ugandans.

There is Hope for 90 90 90

Where is this Place?

SMUG Reports:Sexual Minorities UgandaFollowed 163 LGBTI Refugees – Kakuma Camp in

KenyaUgandans Identified in the Camp as LGBTI by

Sudanese and Somali refugeesTargeted, raped, beaten upMove to City to avoid this abusive trend in the

CampBecame involved in sex work to surviveWithin 2 years most of them had their HIV status

turn from negative to Positive

South Africa and Human Rights

On Uganda’s Kill the Gays Bill our President had this to say: "South Africa respects the sovereign rights of other countries to adopt their own legislation.”

UN HRC: New report 2015The high commissioner for human rights, Zeid Raad

al-Hussein, said actions by some countries to reduce violence and discrimination based on sexual orientation and gender identity since the last report in 2011 have been overshadowed by continuing human rights violations against these groups, too often perpetrated with impunity.

 “Violence motivated by homophobia and transphobia

is often particularly brutal, and in some instances characterized by levels of cruelty exceeding that of other hate crimes,” according to the report by the UN Human Rights Office (OHCHR) (A/HRC/29/23)

What to do?HPV Vaccination for boys?HCV treatment for everyone who needs it Screening for HIAINHarm Reduction ServicesLess laws & more service efforts – we cannot criminalize

everything out of existence Aim for 90 90 90 Sensitize health workers to needs of key populations even

as early as college/university level Improve Health seeking behaviour of men in generalA coordinated Human Rights effortEducate Educate Educate

THANK YOU