An African clinic providing targeted healthcare for men who have sex with men
K. Rebe1, G. De Swardt1, D. Pienaar2, H. Struthers1, J.A. McIntyre1
1ANOVA Health Institute, Health4Men, Cape Town, South Africa, 2Department of Health, HIV Directorate, Cape Town, South Africa
Issues: African men-who-have-sex-with-men (MSM) experience high levels of stigma and are difficult to target for healthcare. The Anova “Health4Men” programme, in partnership with the Western Cape Department of Health (DOH) and USAID/PEPFAR, has established a successful and well-utilised service delivering high-quality HIV and sexually transmitted infection (STI) healthcare to MSM in Cape Town, South Africa.
Description: The “Ivan Toms Centre for Men’s Health”, is located in a DOH community-based, primary-healthcare institution. It is promoted as a men’s health clinic incorporating MSM expertise, providing a free service to clients with DOH-supplied medications, including anti-retrovirals (ART).
The service provides HIV and STI testing, monitoring and treatment. Mental health services, prevention messages, condom and lubricant distribution and MSM-targeted literature are provided. Education, technical assistance and MSM-targeted materials are offered to other healthcare providers with MSM clients. Outreach ambassadors provide community-level education and recruitment activities.
1199 clients utilised the service in the first year of operation. The median age is 29 years (15-76); patients are from all socio-economic backgrounds and races. The service has performed 939 HIV tests with 8.4% positive. A total of 446 clients are HIV-positive (79 new diagnoses and 367 transferred-in positive). 249 (55.8%) are on ART, with a median CD4 count at initiation of 178 cells/mm3 (2-355). 114 of 700 (16%) VDRL tests were positive for syphilis.
Lessons learned: We have developed and implemented the first state-sector clinic in Africa providing dedicated medical and psychosocial care for MSM, demonstrating that government health services can provide effective healthcare for African MSM. Retention in care is high at 90% at one year and the programme has achieved high visibility and acceptability across a wide geographic area of urban and peri-urban Cape Town.
Next steps: Replicating this model would increase health services for MSM across Africa but requires political will and community acceptance.