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MSM & HIV, United Nations Development Programme, World Health Organization, United States Agency for International Development, World Bank

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MSM & HIV, United Nations Development Programme, World Health Organization, United States Agency for International Development, World Bank IMPLEMENTING COMPREHENSIVE HIV AND STI PROGRAMMES WITH MEN WHO HAVE SEX WITH MEN: PRACTICAL GUIDANCE FOR COLLABORATIVE INTERVENTIONS COLLABORATIVE FOR GUIDANCE SEX WITH MEN: PRACTICAL IMPLEMENTING COMPREHENSIVE HIV AND STI PROGRAMMES WITH MEN WHO HAVE For more information, contact: Implementing Comprehensive United Nations Population Fund 605 Third Avenue HIV and STI Programmes with New York, NY 10158 USA Men Who Have Sex with Men www.unfpa.org PRACTICAL GUIDANCE FOR COLLABORATIVE INTERVENTIONS Empowered lives. Resilient nations. Implementing Comprehensive HIV and STI Programmes with Men Who Have Sex with Men PRACTICAL GUIDANCE FOR COLLABORATIVE INTERVENTIONS Empowered lives. Resilient nations. Recommended citation: United Nations Population Fund, Global Forum on MSM & HIV, United Nations Development Programme, World Health Organization, United States Agency for International Development, World Bank. Implementing comprehensive HIV and STI programmes with men who have sex with men: practical guidance for collaborative interventions. New York (NY): United Nations Population Fund; 2015. © United Nations Population Fund 2015 The designations employed and the presentation of material in maps in this publication do not imply the expression of any opinion whatsoever on the part of UNFPA concerning the legal status of any country, territory, city or area or its authorities, or concerning the delimitation of its frontiers or boundaries. Cover photograph courtesy of Nadia Rafif, The Global Forum on MSM & HIV. Layout L’IV Com Sàrl, Villars-sous-Yens, Switzerland. Contents Acknowledgements ............................................................... vii Acronyms and abbreviations ........................................................ x Glossary .......................................................................... xi Introduction ....................................................................... xv 1 Community Empowerment ...................................................... 1 1.1 Introduction ................................................................. 5 1.1.1 Power and health ........................................................ 6 1.2 Key elements of community empowerment .................................. 10 1.2.1 Working with communities of men who have sex with men .................. 11 1.2.2 Fostering programmes led by men who have sex with men .................. 12 1.2.3 Developing cohesive communities ........................................ 13 1.2.4 Strengthening community systems ....................................... 15 1.2.5 Promoting a human-rights framework ..................................... 17 1.2.6 Shaping policy and creating enabling environments through advocacy ......... 19 1.2.7 Adapting to local needs and contexts ...................................... 20 1.2.8 Supporting community mobilization and sustaining social movements ......... 21 1.3 Monitoring progress ......................................................... 22 1.4 Resources and further reading ............................................... 26 2 Addressing Violence against Men Who Have Sex with Men ....................... 29 2.1 Introduction ................................................................ 33 2.1.1 Contexts of violence .................................................... 36 2.1.2 Values and principles for addressing violence ................................. 38 2.2 Promising interventions and strategies ....................................... 39 2.2.1 Building capacity and self-efficacy ......................................... 40 2.2.2 Working for legal and policy reforms ...................................... 41 2.2.3 Fostering police accountability ............................................ 43 2.2.4 Promoting safety and security ............................................ 45 2.2.5 Providing health services ................................................. 46 2.2.6 Providing psychosocial, legal and other support services ..................... 47 2.3 Management, monitoring and evaluation ..................................... 50 2.4 Resources and further reading ............................................... 53 iii 3 Condom and Lubricant Programming ............................................ 57 3.1 Introduction ................................................................ 61 3.1.1 Principles of condom and lubricant programming ........................... 62 3.2 Steps in effective condom and lubricant programming ........................ 64 3.2.1 Establishing accessible supplies .......................................... 67 3.2.2 Condom and lubricant social marketing programmes ........................ 70 3.2.3 Creating demand ....................................................... 71 3.2.4 Creating an enabling environment for condom and lubricant programming ..... 74 3.2.5 Lubricant programming .................................................. 76 3.2.6 Other considerations in condom and lubricant programming .................. 78 3.3 Programme management, monitoring and evaluation ......................... 79 3.3.1 Roles and responsibilities ................................................ 80 3.3.2 Programme monitoring .................................................. 81 3.3.3 Evaluation .............................................................. 82 3.4 Resources and further reading ............................................... 82 4 Health-Care Service Delivery .................................................... 85 4.1 Introduction ................................................................ 89 4.1.1 The HIV prevention, care and treatment continuum ......................... 89 4.1.2 Providing comprehensive health services to men who have sex with men ..... 91 4.2 Combination prevention ..................................................... 94 4.2.1 Individual and group-level behavioural interventions ......................... 96 4.2.2 Sexual or other risk history-taking ......................................... 98 4.2.3 Adaptive strategies (serosorting, strategic positioning) ...................... 100 4.2.4 Voluntary medical male circumcision ..................................... 101 4.2.5 Condom and lubricant promotion ....................................... 101 4.2.6 Voluntary HIV testing and counselling.................................... 104 4.2.7 Pre-exposure prophylaxis (PrEP) ........................................ 109 4.2.8 Post-exposure prophylaxis (PEP) ........................................ 115 4.2.9 Sexually transmitted infection services ................................... 116 4.2.10 Other sexual-health services .......................................... 124 4.3 Care and treatment ........................................................ 127 4.3.1 Antiretroviral treatment and care ........................................ 127 4.3.2 Tuberculosis .......................................................... 130 4.3.3 Mental health......................................................... 131 4.3.4 Drug and alcohol use .................................................. 135 4.4 Service delivery approaches ............................................... 137 4.4.1 Clinical approaches .................................................... 137 4.4.2 Community-led approaches ............................................ 141 4.4.3 Using information and communication technology ........................ 154 4.4.4 Safe spaces ........................................................... 155 4.5 Resources and further reading ............................................. 157 iv 5 Using Information and Communication Technology ............................ 165 5.1 Introduction ............................................................... 169 5.1.1 Background ........................................................... 170 5.2 ICT programme planning and integration .................................... 171 5.2.1 Is ICT the appropriate solution? .......................................... 171 5.2.2 Assessing the ICT landscape and identifying online leaders ................. 171 5.2.3 Designing a behavioural intervention for ICT .............................. 172 5.2.4 Safety and ethical concerns ............................................. 174 5.3 ICT and programme implementation across the HIV continuum ............... 175 5.3.1 Increasing reach and promoting HIV prevention and testing ................. 175 5.3.2 Promotion of commodities and services .................................. 177 5.3.3 Strengthening service quality ............................................ 178 5.3.4 Virtual supportive communities .......................................... 179 5.4 ICT for the enabling environment ........................................... 180 5.5 Engaging the private sector ................................................. 181 5.6 ICT and programme management ........................................... 181 5.6.1 Data collection ......................................................... 181 5.6.2 Monitoring and evaluation .............................................. 181 5.7 Resources and further reading ............................................... 183 6 Programme Management ..................................................... 185 6.1 Introduction .............................................................. 189 PART I. 6.1.1 What are the challenges for programme management? .................... 190 6.1.2 Managing programmes with men who have sex with men ................. 190 6.2 Planning and implementing
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