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Promoting the Health of Men Who Have Sex with Men

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Promoting the Health of Men Who Have Sex with Men PROMOTING THE HEALTH OF MEN WHO HAVE SEX WITH MEN WORLDWIDE: A TRAINING CURRICULUM FOR PROVIDERS “A young gay man who I know reported to us an experience at the hospital where he had gone to seek treatment for a potential sexually transmitted infection. The nurses literally laughed at him when he divulged his sexual orientation during sexual history taking. They called each other and made a spectacle of him. … Men who have sex with men stay away from services because they fear being ridiculed.” — 26-year-old gay man and HIV professional, sub-Saharan Africa Contents A. Overview of the MSMGF-JHU Curriculum h. Why talk about sexual health? i. The larger context B. Pilot Test with GALZ, Zimbabwe j. Sexual and reproductive rights of gay men and C. Technical Advisory Board & other MSM Acknowledgements k. Key points from the module D. Facilitator’s Guidelines Module III: Barriers to Health a. Conceptual Framework: Facilitators, barriers, E. Tools for Evaluating Your Training and critical enablers to service access Module I: Understanding Gay Men and Other i. Structural-level factors MSM ii. Community and interpersonal-level factors a. Who are MSM? iii. Individual-level factors b. Evidence for male-to-male sex b. What are stigma and discrimination c. Key terminology i. Stigma d. Myths concerning homosexuality ii. Discrimination e. Common sexual practices of gay men and iii. Homophobia other MSM c. Stigma within the gay community i. Penetrative anal sex d. HIV-related stigma ii. Other sexual practices e. Link between social discrimination and health f. Relationships among gay men and other MSM i. Criminalization and HIV prevention g. Unique health needs of gay men and other ii. Internalized homophobia and sexual health MSM iii. Mental health i. Higher rates of HIV and other STIs iv. Homophobia and the health system ii. Greater risk for developing mental health f. The role of health professionals in advocacy on problems behalf of gay men and other MSM iii. Physical and sexual violence g. Key points from the module h. Current global HIV and health trends among Module IV: Creating a Friendlier Environment gay men and other MSM a. Anticipating concerns about discrimination i. MSM and the health system b. The importance of culturally competent care j. Provider roles and responsibilities for gay men and other MSM k. Discussing sex with clients c. The Ottawa Charter l. Principles for effective clinical practice and d. Key areas for reorienting services for gay men engagement with gay men and other MSM and other MSM m. The importance of focusing on gay men and e. Communication other MSM f. Intake forms n. Key points from the module g. Key points from the module Module II: Sexuality and Health Module V: Promoting Mental Health a. Key concepts a. Factors leading to poor mental health out- b. Male reproductive system comes among gay men and other MSM c. Sexual practices of gay men and other MSM i. Criminalization d. Normalizing anal sex ii. Discrimination within healthcare settings e. Sexual concurrency iii. Reparative therapies f. Situational same-sex behavior iv. Family rejection g. Gay men and other MSM in long-term v. Difficulty in coming out relationships Promoting The Health of Men Who Have Sex With Men Worldwide Contents 1 vi. Maturing and late adulthood h. Drug and alcohol use screening tools b. Common mental health issues for gay men and i. Interventions for decreasing drug and alcohol other MSM use i. Anxiety j. Potential signs of drug or alcohol abuse ii. Depression k. Gay men and other MSM who do not report iii. Suicide problematic drug or alcohol use iv. HIV-related stress disorder l. Key points from the module v. Sexual problems Module 8: Interventions for HIV and STI vi. Eating disorders Prevention vii. Physical and sexual violence a. Combination HIV prevention c. The importance of relationships and communi- b. WHO recommendations for HIV prevention, ty building care, and treatment for gay men and other d. Addressing mental health in the clinical setting MSM e. Key points from the module c. Correct and consistent condom use Module 6: Taking a Sexual History d. Lubricants a. Confidentiality e. Pre-exposure prophylaxis b. Barriers to sexual history taking f. Post-exposure prophylaxis i. Provider barriers g. Male circumcision ii. Client barriers h. Risk reduction issues to consider c. Steps for addressing barriers i. Sex without a condom d. Asking about same-sex behavior in men ii. Strategic positioning e. Key communication issues iii. Oral sex f. Questions to include and how to ask them iv. Viral load calculation i. Assess the partner situation v. Serosorting ii. Assess sexual practices i. HIV testing and counseling iii. Assess sex partner meeting venues j. Motivating behavior change iv. Assess HIV and STI status of client and i. Brief sexuality-related communication partners ii. Target behaviors v. Assess condom use k. Single-session counseling vi. Assess drug and alcohol use l. HIV prevention and people living with HIV vii. Ending the interview m. Key points from the module g. Motivational interviewing Module 9: Clinical Care for HIV and STIs h. Charting sexual history a. Sexually transmitted infections (STIs) i. Key points from the module b. The importance of testing gay men and other Module 7: Supporting Gay Men and Other MSM MSM for STIs Who Use Drugs and Alcohol c. Human immunodeficiency virus (HIV) a. Getting comfortable talking about drugs and d. Recommended steps for STI testing alcohol e. HIV testing b. Do gay men and other MSM use drugs and f. Treating STIs alcohol more than others? g. HIV treatment c. Why do gay men and other MSM use drugs h. Considerations in initiating antiretroviral and alcohol? therapy d. What are the known patterns of drug use i. Benefits of early therapy among gay men and other MSM? j. Treatment as prevention e. The link between drug use and HIV k. Treatment 2.0 transmission l. Tuberculosis co-infection and HIV f. Drugs commonly used by MSM and their m. Viral hepatitis co-inection and HIV effects n. Conclusion g. Approaching drug use in the clinical setting o. Key points from the module Promoting The Health of Men Who Have Sex With Men Worldwide Contents 2 Overview of the MSMGF-JHU Curriculum Gay men and other men who have sex with men (MSM) around the world face significant challenges to accessing healthcare services. Discomfort with a healthcare provider for fear of being ridiculed, harassed, or even denied care altogether is one key barrier. This is sobering considering that MSM shoulder higher rates of HIV and other sexual- ly transmitted infections (STI) compared to adults in the general population. In addition to HIV and other STIs, gay men and other MSM present in the clinical setting with a range of unique health needs, therefore requiring provid- ers to be uniquely qualified to deliver care to this population. Knowledge, skill, and sensitivity needs among healthcare providers to handle health issues of concern to gay men and other MSM are inadequately addressed by general medical education curricula the world over. For providers to fulfill their ethical obligation to serve all people seeking care, they must receive specific guidance on promoting the health of gay men and other MSM in their communities. Currently, a broad range of tools for training providers in specific local and regional contexts exists to address these needs. However, these tools – or the resources to develop them – are unavailable in far too many settings globally. Therefore, the need persists for a comprehensive tool to train healthcare providers that can be locally adapted with minimal resources. In places where engagement and training efforts with providers are ongoing, such a framework can strengthen and complement those efforts. The MSMGF-JHU Curriculum for Providers The Global Forum on MSM & HIV (MSMGF), in partnership with Johns Hopkins University (JHU), developed a training curriculum that aims to provide local community groups serving gay men and other MSM with the ability to independently implement training programs to build cultural and clinical competency among healthcare providers serving their communities. The curriculum leverages the strengths of existing training tools while drawing from up-to-date and emerging research and clinical guidance on the health of gay men and other MSM. With a strong focus on sex positivity, the curriculum shifts away from the disease model, in which negative health outcomes are viewed as embarrassing “diseases” that are the consequences of socially unacceptable behavior. It instead centers on a sexual health and harm reduction framework, focusing on health as a basic human right with sexual health as only one component of health more broadly. Organized across nine distinct modules, the curricu- lum is designed for easy use by trainers to impact healthcare providers’ knowledge, attitudes, and skills on a range of clinically relevant topics. What are the nine modules? The titles of the nine modules in the MSMGF-JHU curriculum are listed in the text box below. The introductory modules are designed to normalize same-sex sexuality and promote a broad understanding of the contexts in which gay men and other MSM navigate their healthcare needs. Subsequent modules offer specific provider-led strate- gies for increasing access to and quality of care for gay men and other MSM. These strategies include, for example, Promoting The Health of Men Who Have Sex With Men Worldwide Overview of the MSMGF-JHU Curriculum A.1 creating an enabling clinical environment, taking a complete and accurate sexual history, and effectively managing HIV and other STIs among gay men and other MSM. What’s in each module? Each module is designed to be delivered as a stand- MSMGF-JHU Curriculum: alone training or in conjunction with other modules Module Titles from the curriculum depending on local training needs.
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