not valid -- Senegal

(L to R): Dr Toure, Coordinator for WHO’s inter-country team for West Africa, Hedia Belhadj, UNAIDS Director of Partnerships, Mr Jean Tchoffo, Permanent Secretary for the Ministry of Finance, Cameroon, Dr Meskerem Grunitzky-Bekele, Director of the UNAIDS Regional Support Team for West and Central Africa, Dr Sabine Ntakirutimana, Minister of Health and the Response to HIV, Dr Marie Ahouanto, French Cooperation, Bureau des politiques de Santé et de la Protection Sociale, Dr.Manuel Rodrigues Boal, Conseiller du Ministre de la Santém, Cap Vert, Yamina Chakkar, UNAIDS regional support adviser, Macoura Oulare, UNICEF Senior HIV Specialist, Leiliane Corcher M’boa, Secrétaire Exécutive, RAP+ Afrique de l’Ouest

Stakeholders in the AIDS response across West and Central Africa met in Dakar, Senegal from 3–4 March 2011 to review progress made towards achieving universal access to HIV prevention, treatment, care and support. The regional consultation was organized by UNAIDS in collaboration with its Cosponsors, regional civil society networks, government representatives and development partners.

Dr Modou Diagne Fada, Minister of Health and Prevention of Senegal stressed the importance of national ownership, “Leadership and national ownership of the AIDS response will accelerate our action towards achieving universal access and the Millennium Development Goals.”

Participants acknowledged that there has been progress on scaling up towards universal access to HIV prevention, treatment, care and support in the region. Access to antiretroviral treatment has increased from 1% in 2001 to 25% in 2010. There has also been an increase in coverage of prevention of mother-to-child transmission services from 4% in 2005 to 23% in 2010. Most noticeably, the HIV incidence has dropped in ten countries and HIV prevalence has been stable in seven.

The consultation also identified existing implementation gaps in order to achieve the MDGs by 2015. One example discussed was the strong dependence on external financing for HIV and Health programmes. “Advocacy for increased sustainable financing of national AIDS programmes should be evidence based and strongly linked to countries’ development agendas in order to achieve the MDGs,” said Mr Jean Tchoffo, Permanent Secretary for the Ministry of Finance of Cameroon.

Another gap identified was the weak linkages of the HIV response with other health services. The Minister of Health from Burundi, Dr Sabine Ntakirutimana, highlighted the need for an enhanced integration with health services in order to achieve universal access and in particular the virtual elimination of mother-to-child transmission of HIV. “HIV should be used as an entry point to more integrated delivery of health services,” added Dr Ntakirutimana.

Political and social instability in most countries of the region, which aggravates the lack of institutional frameworks related to an effective response to HIV, was also raised by participants as a major obstacle. “In a region where more than 50% of States are either in conflict or post conflict situations it is imperative that the humanitarian response addresses the needs of people living with HIV,” said Dr Meskerem Grunitzky-Bekele, Director of the UNAIDS Regional Support Team for West and Central Africa.

Participants discussed the case of the post-electoral crisis in Ivory Coast and the ensuing instability threatening access to treatment for people living with HIV in the country. With increasing poverty levels and an HIV prevalence rate of 4.7%, the health sector in the Ivory Coast is directly affected by the current economic sanctions. Participants agreed that there is an urgent need to proactively respond to the issue, working with responsible actors to ensure access to HIV treatment is not interrupted.

According to the participants, other gaps hampering progress towards achieving universal access in the region were the inadequate allocation of resources towards the main modes of HIV transmission as well as lack of good governance and mechanisms for accountability. Stigma and discrimination and weak health systems are limiting the supply of services for HIV prevention, treatment and care.

At the end of the meeting, recommendations for enhanced national ownership to achieve universal access in the region were developed and key priorities agreed. These include: strengthening leadership; optimization of domestic and external resources; improving access to treatment; revitalization of HIV prevention; the involvement of young people as agents of change; and the promotion of human rights, gender and social equity in national AIDS plans.

Inputs from a pre-Civil Society Consultation, held on 28 February and a National Ownership Meeting on 1–2 March which also took place in Dakar were also taken into account during the consultation.

A new book publishes research that sheds fresh light on the lives of women living with HIV in African countries and their experience as recipients and givers of care.

Ahead of International Women’s Day 2011, the French national agency for AIDS and viral hepatitis research (ANRS), launched Les Femmes à l’épreuve du VIH dans les pays du Sud: genre et accès universel à la prise en charge (Women and HIV in the south: Gender and universal access to care).

It gathers the works of over 15 researchers and explores different aspects of HIV care including equality of access to care, the experience of men and women within health care systems and the significant role of women in the management of infection within the family.

While women living with HIV appear to have better access to health care and other services than men living with HIV, the analysis highlights that their specific needs and experiences, including as mothers, are not sufficiently addressed within HIV programmes.

Women also remain poorly supported in specific areas such as access to contraception and medical care for HIV-related women-specific pathologies. Also burden of care management within families affected by HIV all too often relies wholly on women.

The book also challenges the view of vulnerability traditionally ascribed to exclusively affecting women. Rather, the researchers posit, men are also subject to forms of social vulnerability that limit or delay their access to HIV testing and counselling and care.

Professor Jean-François Delfraissy (Director of the ANRS), Professor Françoise Barré-Sinoussi (2008 Nobel Prize in Medicine, Pasteur Institute Paris) and Mr Michel Sidibé, Executive Director of UNAIDS, have written the preface to the publication.

Published in the ANRS collection “science sociales et Sida”, the book is edited by Alice Desclaux (Aix-Marseille Paul Cézanne University, IRD UMI 233 and Centre for Research and Training in clinical management, Dakar), Philippe Msellati (IRD UMI 233, Yaoundé, Cameroon) and Khoudia Sow (Aix-Marseille Paul Cézanne University, IRD UMI 233, and Regional Centre for Research and Training in clinical management, Dakar).

The book was launched at ANRS in Dakar on 7 March, the eve of International Women’s Day 2011, during a meeting co-organized by the ANRS, UNAIDS and the IRD (the French Research Institute for Development in southern countries). Over 100 participants took part in this meeting, including researchers, representatives of international institutions, health authorities and civil society. ANRS in Cameroon and Burkina Faso also launched the book on the same day.

On 7 February, UNAIDS Executive Director Michel Sidibé spoke at the opening ceremony of a high-level consultation on HIV, the law and human rights in Dakar, Senegal.

Ministers of Justice and judges from across West and Central Africa gathered on 6-8 February in Dakar, Senegal, for a high-level consultation on HIV, the law and human rights. The meeting aimed to increase the engagement of judicial officials in the HIV response at national levels.

Eighty percent of countries in West and Central Africa have laws that criminalize HIV transmission, same-sex relations or sex work. Across the region, people living with HIV experience widespread stigma and discrimination in access to employment, education, health and social services. In many countries, people living with HIV and key populations at higher risk of HIV exposure—including sex workers and men who have sex with men—have limited access to legal support when injustices are committed.

“Laws should work for the AIDS response, not against it—they should never obstruct the health or survival of any individual,” said UNAIDS Executive Director Michel Sidibé, in his opening remarks at the consultation. “We must truly address discrimination and injustice related to AIDS,” he added. Mr Sidibé urged justice ministers to base their laws on science and ensure that all people have equal access to HIV prevention, treatment, care and support.

“We can no longer ignore the law as a means of combating HIV,” said Senegal’s Minister of Justice, Cheikh Tidiane Sy, noting that the epidemic had generated complex legal and human rights issues in the jurisprudence of countries across the region. Mr Sy underscored that judicial officials should not be limited to rendering decisions in a court of law. “It is equally important that magistrates involve themselves in activities that will increase legal knowledge among populations and ensure that they have access to justice,” he said.

The consultation—organized by the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Development Programme (UNDP), the African Association of Highest Francophone Jurisdictions (AA-HJF) and the Office of the High Commissioner for Human Rights (OHCHR)—offered an opportunity for discussion on a range of HIV-related judgements, legal instruments and country-level initiatives. The meeting also provided a forum for individuals directly impacted by HIV-related laws, including people living with HIV, to share their experiences and perspectives.

Speaking to meeting participants on Sunday, Jeanne Gapiya Niyonzima, an HIV-positive woman and President of the Burundian Association of People Living with HIV, recalled how her doctor immediately ordered the termination of her pregnancy and removal of her uterus after she tested positive for HIV. “As magistrates, you can appreciate the gravity of this kind of assault on the physical and social integrity of a human being,” said Ms Niyonzima. “If we fail to provide a conducive social and legal environment, we risk losing all gains in the HIV response,” she added.

Judicial officials can play a critical role in protecting human rights and pushing forward the HIV response. In Burkina Faso, for example, where an estimated 1.2% of the adult population is living with HIV, the UNDP-led Programme d’appui au monde associatif et communautaire (PAMAC) is collaborating with other non-profit organizations and David Kaboré—a judge and human rights defender—on a legal literacy project to promote and safeguard the rights of people living with HIV. Launched in 2003, the project offers free and confidential legal advice to people living with HIV and has been instrumental in highlighting and addressing cases of HIV-related discrimination in the country.

Many countries around the world continue to have laws or policies that undermine HIV responses and punish, rather than protect, people in need. Seventy-nine countries criminalize same-sex relations between consenting adults. More than 100 countries, territories and areas criminalize some aspect of sex work. And 48 countries, territories or entities impose some form of restriction on the entry, stay or residence of HIV-positive people based on their HIV status.

UNAIDS advocates for protective laws and measures to ensure that all people in need benefit from HIV programmes and have access to justice, regardless of health status, gender, sexual orientation, drug use or sex work.

Last year, UNAIDS and UNDP launched the Global Commission on HIV and the Law, bringing together public leaders from many walks of life and regions, as well as experts in law, human rights and HIV. The UNDP-led Commission is working to ensure that laws support effective AIDS responses.

Mr Michel Sidibé, UNAIDS Executive Director (left) and Dr Luis Sambo, WHO Regional Director for Africa, at the meeting “Optimizing Resource Use and Alternative Health Funding Mechanisms: Prospects for AIDS Funding” held in Dakar, Senegal, on 16 December.

Ministers of Health and Finance from West and Central Africa joined representatives from civil society, the private sector and the United Nations for a discussion on financing and sustaining the AIDS response in a resource-constrained environment. Participants in the meeting, co-hosted by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO), reflected on the impact of the global financial crisis, risk management, alternative funding sources, and optimizing the use of available resources.

According to UNAIDS estimates, international donors and national governments together mobilized US$ 15.9 billion for the global AIDS response in 2009. However, the gap between investment need and resource availability is widening—in 2009 alone, there was an estimated shortfall of US $10 billion for the global AIDS response.

“Gains in the AIDS response are fragile. Resources for AIDS must be predictable and sustainable in the long term,” said Mr Michel Sidibé, UNAIDS Executive Director, addressing participants at the meeting. “Funding for AIDS is a shared responsibility,” he added, calling on both international donors and national governments to increase their investments in the AIDS response.

Nearly 90% of AIDS spending in low-income countries comes from international sources. A new Domestic Investment Priority Index developed by UNAIDS shows that 13 countries in West and Central Africa spend less than their capacity, commensurate to their disease burden and availability of government resources.

Investments in the AIDS response have yielded results: Between 2001 and 2009, for example, 10 countries in West and Central Africa reduced new HIV infections by more then 25%. In that same period, seven countries in the region stabilized the rate of new HIV infections.

To sustain these gains, meeting participants underscored the importance of consolidating HIV programmes and supporting long-term funding approaches that went beyond crisis management. Accountability around resource allocation would be critical, they noted.

From left Meskerem Grunitzky, Director of the UNAIDS Regional Support Team for West and Central Africa, Dr. Ndoye, Executive Secretary of the National AIDS Council of Senegal and Cheikh Tidiane Tall, Executive Director of AfriCASO. Credit: UNAIDS.

During the civil society consultation on universal access and the Millennium Development Goals with the theme "Sustain the results – strengthen links and interactions," the Joint United Nations Program on HIV/AIDS (UNAIDS) and the African Council of AIDS Service Organizations (AfriCASO) signed a memorandum of understanding on 3 December in Dakar. 

The agreement formalizes the longstanding partnership aimed at ensuring effective and quality involvement of African civil society organizations in the promotion of universal access and achieving the Millennium Development Goals in Africa. The memorandum of understanding also extends the collaboration between the parties at the institutional level.

During an official visit to Senegal, the UNAIDS Executive Director Michel Sidibé (left) was received by the President, Mr Abdoulaye Wade on 19 April.

During an official visit to Senegal, the UNAIDS Executive Director was received by the President, Mr Abdoulaye Wade on 19 April. Mr Sidibé thanked President Wade for taking the initiative to include an important item on the agenda of the African Union Summit in July 2010 in Kampala, Uganda, titled “Accelerating measures on HIV and MDGs: Partnership to Eliminate Mother-to-Child Transmission of HIV in Africa.” The Executive Director noted that HIV has been the major cause of child and infant mortality in major parts of Africa, with about 390,000 children under 15 newly infected with HIV in 2008 alone.

Mr Sidibé also thanked President Wade for the successes recorded by his country in the fight against HIV in general and in the eradication of vertical transmission from mother to child in particular.

In response, President Wade assured Mr Sidibé that “Senegal will work with UNAIDS towards the goal of zero new infections in Senegalese children by 2015.”

Mr Michel Sidibé was in Dakar, Senegal, to take part in the UNAIDS Sub-Saharan Africa Regional Management Meeting, with the aim of leveraging HIV for broader health and development outcomes in Africa and to discuss Senegal’s progress on universal access with its authorities.

UNAIDS Executive Director Michel Sidibé (right) also met the Prime Minister of Senegal, Mr Souleymane Ndéné Ndiaye, who reaffirmed Senegal’s commitment to total eradication of mother-to-child transmission.

Mr Sidibé also met the Prime Minister of Senegal, Mr Souleymane Ndéné Ndiaye, who reaffirmed Senegal’s commitment to total eradication of mother-to-child transmission. He said that “the prevention of new infections should be a priority for all African countries.”

During his visit, Mr Sidibé noted that a lot of progress had been made in the AIDS response in Africa. “In 2008, about 45% of pregnant women living with HIV in this region were receiving antiretroviral drugs to prevent transmission to their children, up from 35% the previous year. Tens of thousands of new HIV infections have been prevented as a result of prevention programmes and the efforts of African governments, civil society and youth,” said Mr Sidibé. Yet despite progress, many challenges remain that prevent people from accessing the HIV prevention and treatment services they need, he added.

Participants at the regional consultation organized by the UNAIDS Regional Support Team, in collaboration with three regional civil society networks (AfriCASO, International HIV/AIDS Alliance, ENDA Santé) in Dakar from 11 to 14 August 2009. Credit: UNAIDS

Thirty civil society organizations involved in the HIV response in West and Central Africa (WCA) identified six priority areas for action to accelerate the movement towards universal access to HIV prevention, treatment, care and support in the region. This decision was the outcome of a regional consultation organized by the UNAIDS Regional Support Team, in collaboration with three regional civil society networks (AfriCASO, International HIV/AIDS Alliance, ENDA Santé) in Dakar from 11 to 14 August 2009.

The consultation was an opportunity to define concrete actions to be taken in the West and Central African region to achieve universal access targets and Millennium Development Goals considering the central role played by civil society organizations in the response to AIDS.

Over four days, the consultation brought together representatives of regional and national networks of people living with HIV, women, youth, religious leaders, parliamentarians, media, traditional practitioners, human rights associations, people with disabilities, trade unions, men who have sex with men, international NGOs involved in the HIV response as well UN system representatives.

Despite significant efforts in recent years made by countries to improve the response to the epidemic, participants underscored that many challenges remain to be addressed by all stakeholders to accelerate the movement towards universal access in West and Central Africa. Participants committed to coordinate their efforts towards the following six priority areas: Sustainable funding of the AIDS response; integration of HIV, tuberculosis and sexual and reproductive health services; improving the legal and societal framework; access to treatment and accelerating prevention; access to prevention of mother-to-child HIV transmission services; and innovation, communication and partnership.

For example, only 11% of pregnant women requiring services to prevent mother-to-child HIV transmission have access to them and only 25% of people living with HIV in need of antiretroviral drugs have access to treatment. The participants underlined that the quality and coverage of services and interventions targeting most-at-risk populations need to improve in most of the region. They noted the urgency to support countries in adopting laws protecting human rights that guarantee access to HIV services for all and provide effective protection for the most-at-risk populations. Participants also highlighted the urgent need to integrate HIV services into the tuberculosis programmes.

Michel Sidibé UNAIDS Executive Director and representatives from national civil society organizations and regional networks of people living with HIV after their meeting at SIDA Service, 9 April 2009.
Credit: UNAIDS/C.Diop

UNAIDS estimates that one per cent of adults in Senegal are living with HIV. In 1992, at a time when the full impact of AIDS on society was only beginning to be recognised in the country, the Catholic church in Senegal founded “SIDA Service,” an organization to support and care for people living with or affected by HIV.

Since those early days, and continuing today, it actively seeks to change peoples’ attitudes of stigma towards, and discrimination against, people living with HIV.

SIDA Service has grown to 500 volunteers and employees with 23 branches across Senegal as well as a presence in neighbouring Guinea Bissau and Gambia. Its Dakar health centre was the first in the country to offer HIV testing that is free, voluntary and confidential. In addition to voluntary counselling and testing and support to people living with HIV, SIDA Service also cares for orphans and vulnerable children.

While in Senegal this week, UNAIDS Executive Director Michel Sidibé visited the SIDA Service’s health centre which is making a significant the contribution towards Senegal’s goal of universal access to HIV treatment, prevention, care and support. His visit took place on Wednesday 8 April where he had an opportunity to listen to those who use the services.

The medical team at the centre offer a range of services to the local community including HIV treatment, treatment of opportunistic infections, gynaecological health and pre-natal services. There is a laboratory for biomedical analysis and an on-site pharmacy. In addition to health care, food support is available and staff and volunteers offer time to listen as well as give counselling, psycho-social support and spiritual care to any in need.

SIDA Service has also led in promoting dialogue within faith communities on AIDS. It has co-organized a number of important conferences and gatherings of religious communities on AIDS in Africa and was a founding member of the National Alliance of Religious and Medical Experts against AIDS in 1999.

Mr Sidibé also met with civil society leaders in Senegal as well as from wider the West Africa region.

President Abdoulaye Wade

President Abdoulaye Wade of Senegal (front right) hosted a meeting with Michel Sidibé UNAIDS Executive Director. Also present were (from left) Dr Meskerem Grunitzky Bekele, Director, UNAIDS Regional Support Team for West and Central Africa; and United Nations Resident Coordinator Mr Bouri Jean Victor Sanhouidi.
Credit: UNAIDS/C.Diop

Later on Wednesday Mr Michel Sidibé met with Senegal’s President Abdoulaye Wade where they discussed Senegal’s progress in the national AIDS response. The country has made good progress in access to HIV treatment in recent years with 56 per cent of people in need of HIV treatment accessing it in 2007, up from 26 per cent in 2004.

Mr Sidibé also met with the Senegalese Minister of Health Dr Safiatou Thiam.

Regional Dialogue on Universal Access in West and Central Africa

On Thursday, Mr Sidibé opened a Regional Dialogue on Universal Access in West and Central Africa.

The Dialogue was chaired by Dr Thiam and brought together senior government and UN officials, civil society from across West and Central Africa including representatives from networks of people living with HIV, representatives from donor countries and the Global Fund.

Addressing the gathering Mr Sidibé urged participants to work together to achieve universal access which he said “is more than a motto but a way to bring about fundamental transformation.”

He called for AIDS to remain a political priority of governments in the region and emphasized the need for an expansion of HIV prevention efforts. Expanded partnerships including with the women’s movement, TB community, others working on development goals, are key to the strategy of universal access he proposed. Mr sidibé also called for respect for human rights: “I ask the UN system, governments and civil society to come together to build a response to HIV that does not drive people underground through fear of the criminal law”.

Dr Luis Gomes Sambo, Regional Director for Africa, WHO; Mr Jean-Christophe Deberre, Deputy Regional Director for West and Central Africa, UNDP; and Dr Meskerem Grunitzky Bekele, Director, UNAIDS Regional Support Team for West and Central Africa also spoke.

Mr Sidibé will conclude his visit later today by meeting with the First Lady of Senegal, Ms Viviane Wade who is a long term advocate on AIDS and health issues in her country and an active member of Organization of African First Ladies against HIV/AIDS.

(from left) Ambassador Louis Charles Viossat; Tim Martineau, UNAIDS Director of the Technical and Operational Support Division.
Credit: UNAIDS/Mamadou Gomis

Assessing what really works in the AIDS response, and understanding how it works, is all the more pressing in the current context of global financial slowdown said experts at an ICASA session on Friday.

"The current economic downturn leads us to redouble our efforts and look carefully at the effectiveness of programmes and whether or not they are delivering the results we want," stressed Tim Martineau, UNAIDS Director of the Technical and Operational Support Division.

The event, “Public private partnerships against HIV: how can we together turn the tide?” was organized by UNAIDS as part of the conference’s Leadership Programme. Ambassador Louis Charles Viossat chaired a discussion with panelists who included representatives from the Nigerian Business Coalition Against AIDS, Versteergard Frandsen, the Cameroon Business Coalition against AIDS and the United Nations Economic Commission for Africa.

The event explored the benefits and challenges of public-private partnerships in the global response to AIDS.

A public-private partnership (PPP) is defined as an “institutional relationship between the state and the private profit and/or the private non-profit sector, where the different public and private actors jointly participate in defining the objectives, methods and implementation of an agreement of cooperation”. They are characterized by the sharing of common objectives, as well as risks and rewards.

For governments, PPPs can be an opportunity to harness experience in areas where they lack expertise, as well logistical efficiencies that enable better delivery of prevention and treatment services, reducing costs.

For the private sector (profit and non-profit), PPPs may mean a gain in business opportunities, and an enhanced social and economic environment to operate in.

Participants were agreed that attention should be paid to ensure wide participation and representation across the private sector including from the labour unions, employers’ federations, small and medium enterprises and the informal sector. While progress has been seen, there is still a lot to do to improve participation by small and medium enterprises and the informal sector which employ most of the labour force in Africa.

The group identified four factors as critical in creating and sustaining successful PPPs:

• Clear definition of partners’ roles and responsibilities
• Transparency and respect for ethical standards
• Coordination between partners
• Periodic assessments of the partnership

For Ambassador Louis Charles Viossat, "public-private partnerships have proved to be effective and a way forward to better respond to AIDS. However, we need to acknowledge that they are not a silver bullet.”

“Training, information, periodic assessment of the partnership and application of ethical standards are all important," he continued.

Innovation was stressed as a key factor for any public-private partnership to be successful. Navneet Garg, Global Business Manager from Danish company Versteergard Frandsen, "The Millennium Development Goals (MDGs) of stopping the transmission of HIV by 2015 can only be met by using innovative approaches which facilitate rapid scale-up targeting one and all.  Public and private partners should utilize their respective strengths and enhance their partnership accordingly. The enormous challenge needs both partners to step up to achieve what is needed to meet the MDGs".

From Cape Town to Lagos, several new studies are starting to provide a better understanding of men who have sex with men (MSM) within the context of HIV in Africa.

“Homosexuality is very much understudied in West Africa, and in Nigeria it is criminalized, making it difficult to reach MSM,” said Sylvia Adebajo, a researcher at the University of Lagos, Nigeria. “As a result, the lives of MSM are characterized by denial, violence, and stigmatization”.

Ms Adebajo was speaking at an ICASA session held yesterday on men who have sex with men and HIV infection in Africa. She said that a significant hurdle in reaching out to MSM in Africa, and in particular in West Africa, is criminalization; few MSM come forward for fear of stigma, discrimination, and legal repercussions.

At this forum researchers presented several findings, some preliminary, that shared similar conclusions: HIV prevalence for MSM is many times higher than ‘background populations’, few self-identified MSM seek medical support or identify themselves in their communities, startling numbers do not wear condoms when having sex, many engage in bisexual behaviour, and few get tested to know their HIV status.

“Many MSM when they finally had a HIV test and it was positive, had not known their status and had continued to engage in high-risk behaviour for some time,” said researcher Earl Ryan Burrell of the Desmond Tutu HIV Foundation. “HIV programmes in South Africa are heavily heterosexual and female focused… more recognition of MSM as a risk group is needed,” he added. His ongoing study in Cape Town and its surrounding townships showed that many MSM are not aware of the risks associated with certain sexual acts, despite self-identifying as MSM and having varying levels of access to HIV prevention information.

A study completed in 2006 in Nigeria revealed that little is known about the link between HIV prevalence and MSM in the country. But of those surveyed nearly all reported having multiple concurrent partnerships with both male and female sexual partners. Condom use was low and when condoms were worn, many men used saliva or soap or oil-based lubricants, such as domestic cooking oil which can damage the surface of  condom.

The researchers ended the session by encouraging African governments to invest more resources in supporting HIV prevention and, most importantly, to recognize MSM as a group that requires tailored programmes. “More is needed to be known. Each of these communities have their unique prevention and treatment needs,” said Ms Adebajo.