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Bridging gaps in the HIV prevention and treatment
continuum of care The role of MSM-led organizations in the
implementation of public policy
Rafael Mazín; MD; MPH
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Really?
• Incident cases have had a meager reduction (13%) in 10 yrs. • Mortality hasn’t decreased in a significant manner (50K/yr.)• Transgender persons and gay/MSM still strongly impacted.• Worrisome trend among young MSM.• Main emphasis on palliative-reparative paradigm.
The necessary response seems to be in bad shape
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Repeated erratic approaches by IGO’s and governments
• Avoidance to address sexual health-related issues. • Conflation of populations into amorphous “key” groups.• Disappearance of members of groups once they are submerged • into “cascades”. • Division of labor or defense of territories?• Tepid policies to face homophobia.
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Repeated erratic approaches by IGO’s and governments• Whole attention focused on minimally
impacted groups. • Main interest placed on quantification
rather than on accountability.• Public policies and plans are vertical
and prescriptive. • Politically-driven agendas instead of
guided by public health evidence.• Absence or weakness of mechanisms
to engage CSO’s,
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• Low attention, if any, to male population; • Sexual health restricted to reproductive
events;• Values, beliefs/interests of decision-makers; • Scarce provisions for dealing with stigma and
discrimination & their impact on health; • Absence of optimal “packages of services” &
outreach strategies;
Features of the health sector that affect access, coverage, and utilization of services by MSM
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• Incompatibility between working hours/attention schedules;
• Inadequacy to deal with non-heterosexual sexual activities;
• No continuum of prevention-care whatsoever, care limited to prescription/provision of pharmaceuticals;
• Limited emphasis by services & interest of users on prevention, and of course,
• Homophobia
Features of the health sector that affect access, coverage, and utilization of services by MSM
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• Recognize that affected individuals are often from marginalized populations and subject to stigma and discrimination;• Emphasize prevention so HIV incidence remains low; • Plan service delivery to match the distribution of people most-at-risk of infection and people living with HIV; • Define an optimal “package of services” and outreach strategies.
The necessary responses by the health sector…
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• Reframe primary health care for all young & adult men;
• Plan actions to allow for disclosure of sexual activity;
• Prepare services and staff to meet the needs of gay and MSM;
• Implement “packages of services” within safe and inclusive spaces;
• Ensure appropriate referral and linkages with other social services, including community support and outreach actions.
Actions for Expanding Access, Coverage & Utilization of Services: the Case of MSM
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• Identify the size and severity of HIV-related issues impacting their communities;
• Evaluate the adequacy of the responses carried out by governments and intergovernmental organizations;
• Participate in planning, monitoring and evaluation processes in a deep manner, not only as tokens;
• Identify diverse levels of expertise for ensuring constant representation in political, scientific, academic fora
Necessary Actions to be undertaken by MSM-led groups and organizations
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• Keep the community informed on issues relevant to their health, wellbeing and quality of life;
• Create educational spaces and opportunities to have an in-depth comprehension about developments on interventions in the continuum prevention-care
• Conduct community-based surveillance to ascertain the quality of services for men, particularly for MSM, are of quality
• Develop the capacity to collaborate in outreach, navigation, referral, support to prevention and to treatment adherence with peers
Necessary Actions to be undertaken by MSM-led groups and organizations
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Cascade of HIV Care Mexico, 2014
Source: National estimates by CENSIDA. México; July, 2015.
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Cascade of HIV Care for Gay Men and Other MSM and IDU,
Mexico, 2014
Source: National estimates by CENSIDA. México; July, 2015
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The present and the future responses geared The present and the future responses geared to to gay men and othergay men and other MSM groups and MSM groups and
populationspopulations
• Praiseworthy activities carried out in Brazil, Guatemala, Paraguay, Mexico, Argentina, Ecuador, Peru, Nicaragua…
• Urgent need to expand actions for covering needs and demands of the significant segment of male populations in all countries;
• Big concern with allocation of resources and real political will to address the epidemic among gay men and othergay men and other MSM;MSM;
• A lot is being done by persons, groups and organizations. Much more needs to be done. No more promises, declarations or resolutions what is needed I resources and action!
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AcknowledgmentsAcknowledgments
To each and every individual and organization members of GayLatino
Heartfelt thanks for their comments and suggestions to:
• Simon Cazal• Carlos Garcia de Leon• Jorge Saavedra• Toni Ramos• Ruben Mayorga