Ensuring Universal Access to Comprehensive HIV Services for MSM in Asia and the Pacific

This report from amfAR, The Foundation for AIDS Research, summarises an assessment that was carried out in early 2009 to identify priorities for operations research to better understand effective models for HIV prevention, treatment, care, and support among men who have sex with men (MSM) in Asia and the Pacific. This assessment involved a desk review of the formal and informal literature describing the response to HIV among MSM in Asia and the Pacific, along with visits to selected services and non-governmental organisations (NGOs) in Malaysia, Cambodia, Thailand, Vietnam, India, and Nepal. The report provides a summary of recent history and current data leading to the current focus on MSM in Asia and the Pacific; an analysis of community, identity, space, and sexual desire and behaviour among MSM and transgendered people for the purposes of developing policy, strategy, and service programming; and examples of successful community- and facility-based services.

Recommendations for operations research to improve the quality and reach of HIV prevention - several of which have strategic communication elements - are also included. In summary:

• Two distinct service models emerged from this assessment. The first involves supporting MSM NGOs in their efforts to integrate sexually transmitted infection (STI) and HIV clinical services into their overall HIV prevention and care programmes. The second model involves increasing access for MSM to existing, mainstream STI and HIV prevention and care services. This usually involves hiring MSM staff, training all staff in MSM sensitivity, training medical and nursing staff in STI prevention and treatment for MSM, and adjusting opening hours to increase access. A third possible model is a hybrid of these two and involves setting up MSM clinics run by mainstream health or community NGOs that provide clinical services and a safe space for MSM to gather and support one another.
• As explained here, an important next step would be to carry out a more comprehensive mapping exercise that would examine in detail the characteristics of each of the models being used and compile what is known about access levels, reach into sub-populations, quality of care, and longitudinal engagement with MSM.
• amfAR suggests conducting regional consultations with key stakeholders: "The operations research agenda needs a high level of local relevance and ownership. This requires regional, national, and local input from individual and group consultations to identify local needs and concerns, special considerations, potential obstacles, opportunities for collaboration, and so on."
• amfAR contends that operations research will need to build on existing work, which means identifying sites where interventions for MSM HIV prevention, treatment, and care are in place and helping the organisations and groups working in those settings formalise and strengthen the approaches they are using, expand their reach and range of services, and put in place an operations research framework to provide answers to a set of measurable questions.
• "Strengthening high-quality, evidence-based MSM HIV prevention and care interventions across Asia and the Pacific requires establishing a set of foundation documents to provide policy guidance, regionally relevant best practices, and evidence for action. The global documents developed to support HIV prevention and care among injecting drug users (IDUs) are a good example of this foundation..." amfAR notes that several of these key foundation elements already exist in the Asia-Pacific region but will need to be compiled, further developed, and promoted. This will require broad collaboration by regional groups, United Nations (UN) organisations, key regional donors, and other key regional players. Furthermore, and on a related note: "It is essential that the expansion of MSM HIV prevention and care services across Asia be driven by an agreed set of quality standards and guidelines."
• amfAR suggests that it would be desirable for operations research to work alongside services and programmes that are receiving their core operational funding from other sources. The operations research resources could then be used to focus on issues of model clarification and strengthening, and service consistency and quality.

In short, "amfAR believes that operations research can provide policymakers and national program managers with new options, generating compelling evidence about program models that engage heavily affected populations with an appropriate spectrum of services in a manner that reduces HIV transmission and minimizes the impact of HIV infection. A key focus of this operations research should be the identification of program models that have significant reach into MSM populations, that are replicable across many settings, and that produce sustained HIV prevention and care outcomes."