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

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

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.

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,

• 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

• 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

• 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…

• 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

• 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

• 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

Cascade of HIV Care Mexico, 2014

Source: National estimates by CENSIDA. México; July, 2015.

Cascade of HIV Care for Gay Men and Other MSM and IDU,

Mexico, 2014

Source: National estimates by CENSIDA. México; July, 2015

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!

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