Improving Access to HIV Prevention Messages and Services among Men Who Have Sex with Men in Togo

This brief explores a peer-education-based programme launched by Population Services International (PSI) in 2007 in an effort to reach men who have sex with men (MSM) in Lomé, Togo, with HIV prevention messages and products, referrals to appropriate HIV counselling and testing (CT) services, psychosocial counselling, and diagnosis and treatment of sexually transmitted infections (STIs).

As detailed here, PSI recruited and trained 17 young men to serve as peer educators and reach MSM with HIV prevention messages and products. Each month, they reach more than 300 men and distribute over 2,000 condoms and 70 tubes of water-based lubricant. Peer education activities are complemented by the sponsorship of social activities, such as monthly movie nights, which serve as opportunities to further promote HIV prevention messages and products. Since March 2008, PSI has collaborated with a local organisation, Espoir Vie Togo (EVT), to provide mobile HIV CT services to MSM during these types of social events. In a 3-month period, the mobile HIV CT programme served 79 men, of which 29 (36.7%) tested positive for HIV. Men who tested positive were referred to EVT centres for follow-up care and counselling.

The brief includes a personal story from Serge, a peer educator based in Lomé who has served the PSI MSM programme since February 2009. "Being a peer educator has given me more confidence in life; I feel that I can be more open with myself. It has also shown me the importance of getting tested [for HIV]. I was tested for HIV three months ago. I know my status and I know how to take better care of myself. I hope that people look up to me for having the courage to live a healthy life. I have also gained a certain amount of respect from the community by being and living a good example. I have learned so much from speaking with others in this community....It is my passion to help other men, to understand their risks and motivate them to change their behavior....For the first time in my life I feel I can make a difference."

In its work in Togo, PSI has learned that:

• Engaging local MSM communities and/or associations in programme design, message development, and programme implementation (including monitoring) is crucial.
• Employing community-based participatory research methods is essential to understanding MSM while building their trust and facilitating access to subsequent programme activities.
• Developing a referral system for HIV prevention and other services must be centred on the development of providers who are sensitive to the specific needs of MSM.
• Establishing condom and lubricant distribution channels that respond to the needs of the population is especially important with MSM.
• Empowering leaders in the MSM population requires significant time and effort but has the potential to maximise the sustainability of programme efforts, particularly with respect to mobilising MSM for HIV testing, healthy decisions, and developing local responses to harassment and stigma.
• Assuring security and privacy is important.
• Recruiting peer educators who represent the diversity of the local MSM population enables the programme to reach all sectors population.