Men’s sexual health and rights programme (SHARP)

Why we did it

Gay, bisexual and other men who have sex with men (MSM) experience a disproportionate HIV burden. And yet, appropriate HIV and sexual health services for MSM are lacking or not available in most African contexts.

So, the SHARP programme set about to change this, ensuring that it:

• Involved people living with HIV
• Was based on human rights
• Reflected diversity among the MSM community
• Used and generated evidence.

Before SHARP, the work we were doing was ad hoc and the demand was so overwhelming.Dennis – Icebreakers Uganda

Where we did it

Through SHARP, we contributed to reducing the spread and impact of HIV among men who have sex with men while building healthy MSM communities in Kenya, Tanzania, Uganda and Zimbabwe from December 2012 to November 2015.

We live in a hostile political environment and in a very religious society — at all fronts we are confronted with difficulties.Richard – Sexual Minorities Uganda

How we did it

SHARP worked with partners to:

• Reach more MSM, their sexual partners and family members
• Increase access to and uptake of better quality HIV and health services
• Tackle the social, political and structural barriers in the way of public health for MSM
• Strengthen MSM community-based organisations and networks.

Safety is paramount – we have to make sure that the service providers, the doctors, the outreach team and especially the recipients are all safe.Dennis – Icebreakers Uganda

The results

SHARP reached 14,900 men who have sex with men over three years. Below are our greatest findings.

Peer-driven outreach

• SHARP managed to exceed the target of reaching MSM by 80%.

The goal was originally 8,280 but SHARP reached a total of 14,900 MSM. This was thanks to very effective MSM-led and peer-driven outreach that links MSM to treatment and care.

Linking to services

• SHARP reached 1,206 health care providers.
• SHARP educated 7,927 MSM on HIV and sexual and reproductive health and rights (SRHR) education.

This was achieved by supporting MSM community-based organisations to engage, sensitise and partner with public health facilities. This increased MSM access to quality, stigma-free services.

Advocating for change

• SHARP reached 1,031 policy makers.

MSM continue to be denied access to life-saving healthcare and HIV services. This is because of punitive laws, policies and practices that discriminate on the basis of same-sex relationships, sexual orientation or gender identity. CBOs are well placed to represent the communities’ experiences and needs.

Safety and security

In such hostile environments the threat of violence is very real. The safety and security of staff, volunteers and clients must always be the first priority and assessed before any intervention takes place. It is important to have response mechanisms in place and to follow the lead of in-country partners.

Wider holistic needs

An emphasis on sexual health and wellbeing has allowed MSM to engage with their health using a non-judgemental and sex-positive approach. However, mental health remains a significant challenge. More needs to be done to address the needs of MSM who sell sex, MSM who use drugs, displaced MSM, MSM under 18, and MSM over 30.

Partnership and training

Many clinicians had never received formal training on MSM health. In order to improve healthcare worker knowledge around MSM health, SHARP partnered with Health4Men. They delivered intensive trainings to 63 health care providers covering psychosocial and biomedical needs of MSM.

New technologies

MSM CBOs are early adopters of new technologies and numerous opportunities remain untapped in this area. Through SHARP, we partnered with Health4Men to develop Afya4men.info. This online site provides clearly written sexual health information in Swahili, English and French, targeted to the specific needs of MSM.

Investing in community organisations

CBOs have the expertise, skills and knowledge needed to build resilient and sustainable health systems that meet the needs of MSM. Yet sustainability remains an issue: many countries are still far away from funding programmes targeting MSM.

Previously the Government would have taken us as a threat, but now we can sit together and do programming around HIV for our community – now we are partners with skills.Samuel – Gays and Lesbian of Zimbabwe