Botswana Conference talk Slide one :Introducing myself and DTHF Hello everyone.

I am Elize Batist working in the Mens Division at DTHF in Cape Town. On behalf of DtHF and my colleagues I would like to thank the sponsors and organizers for the opportunity to talk with you today. Very briefly for those of you who are not familiar with DtHF we are a research unit of the University of Cape Town and a non-governmental organization that specializes in HiV prevention and treatment research with vulnerable and high-risk populations. The topic I will talk about is on MSM and marginilsed populations an African perspective and Iam very please to share some of the pioneering work we have done at DTHF. Allow me to shatre with you that a couple of years back I would not have pictured myself standing in front of an audience and talking about MSM and marginilised populations. Slide 2: Define msM and MARPs and 5 pillars of talk Men who have sex with Men (MSM) defines homosexual, bisexual, transgendered and heterosexual men who engage in sex with other men. It is a known fact that HIV remains one of the major concerns especially in Africa. We are also aware that that there has been signifant progress in slowing the epidemic. But we also know that there is still a very hilly and challenging road ahed to combat HiV infections. Intravenous drug users, sex workers, refugees and MSM classified as most at risk populations(MARPs) are considered to be disproportionately affected by and at risk of acquiring HiV. There are many factors reported for this disproportiate HiV burden among MSM. For this talk I am going to focus on stigma, reaching MSM and their needs, Research, Educating Learning and Advocacy. Slide 3 Discuss stigma, and how DTHF address this We know what causes stigma, where it comes from and the negative impacts this have on society and individuals. This is not an excuse and some of us certainly do not approve of the negative impact this creates on individuals. From an African perspective individuals are raised in way where there is very little exposure to the topic of MSM adding to the vulnerability of MSM. MSM grow up being closeted and think that it is a natural thing to hide. Stigma creates health disparities. MSM are afraid to disclose their sexual orientation to health care workers and are afraid to seek health care.

WHO states: Enjoyment of the highest attainable health is one of the fundamental rights of every

human being Slide 4. How to address stigma DtHF perspective Improving the sensitivity and awareness of health care workers is one way to address these barriers to health ace and help reduce stigma and discrimination. DTHF has been conducting introductory sensitivity training nationally with the support multiple national and international partners. The introductory course focus specifically on supporting health care worker addressing their own stigma as well as institutionalized stigma within their health care settings. Slide 5: Addressing the outcomes of training to date: Two editions and online version have been developed and used in multiplecountries. 600 HCW have been trained consisting of Nurses, Counsellors, trainers and managers since (Feb 2010- Sep 2011. Slide 6: Reaching the MSM community and Undersatnding their Needs MSM is a hidden hard- -to reach population. In order to reach and better understand this population it was important to include 2 different health risk assessments and make associations of HiV infection among MSM in South Africa. One such assessment was done by conducted a surveillance study was first conducted in 2009 among MSM in township area surrounding Cape Town. Recruitment was done mainly via venue-based which was the first of its kind and shared with many other collaborators. The surveillance study reported HiV prevalence of 25.5% (51/200), among MSM 6% of MSM were unaware os their status and 21% reported being afraid to seek health care. Slide 7 identifying leaders (R2P) Another method of was to identify leaders from the community who were then extensively
trained in regards to outreach, education and community building skills and worked hand in ahnd with the staff to help better understand MSM. The outcomes of the R2P study was paired with the surveillance data to better inform heakth care worker needs. Currently DtHF has enrolled MsM from over 42 different communities and is currently conducting community engagement community-based bi-weekly programming and outreach activities in five townships communities.

Other methods of engaging with MSM is by social networking.