A Programme to Improve Male Involvement in Sexual & Reproductive Health (Mpilonhle-Mpilonde)

Category 2

The intervention consists of three parts: (1) community, (2) health facility (public, private and traditional), and (3) an integration component. The program included a formative research phase, a population-based baseline survey of behavior and biological markers of HIV risk, the development of an intervention, and detailed process evaluation.
The intervention consisted of an integration component that was designed to foster collaboration and prevent duplication through Technical and Community Advisory Groups.

The community component was built upon Quality Life Clubs (QLC), which were introduced at each of the project sites targeting residents in the inner city hostels and informal settlements with the aim of building the capacity of individuals who attend the clubs to move from survival mode to one where they can cope and respond to daily stresses and shocks and move towards aspiring to a better life. Members met twice a week for 6 months to learn, reflect, and change and mobilized urban communities. Three rounds of the 6-month “Learn, reflect, change" program were implemented. The QLC was primarily aimed to address HIV/AIDS with the club members, who after a few months of affecting change in other areas of their lives, will be receptive to discussions around behavior change, specifically relating to HIV prevention, testing, treatment access and wellbeing.

A community-based organization, Sipho Eshihle (Precious Gift) attempted to ensure the sustainability of the QLC approach beyond the life of the donor funding cycle to lead the QLCs in this area, with the support of local organizations.
QLCs furthermore were used to forge stronger ties between residents and government services, ensuring issues relating to rights, participatory decision-making and citizenship are addressed.

The health facility component builds upon an Attitude Adjustment Programme and competency training for public, private and traditional practitioners. Service providers were put through an intensive experiential and drama based training program with the goal of shifting poor attitude and cultivating empathy. Clinical competency training addressing syndromic management, VCT and ARV literacy were made available to the biomedical health service providers, while VCT, ARV and STI literacy courses were directed at traditional healers (emphasis on referrals) and community health wardens/workers.

Goal of the Practice
  • To strengthen male utilization of sexual health and HIV services at Esselen Clinic Region F as a whole, through identification & initiation of services relevant for men’s participation
  • To improve the quality and availability of the services in primary health care facilities in particular to men
  • To identify the needs of male clients on ARV’s; and to increase adherence to treatment
  • To increase awareness of HIV and sexual health; and men’s health seeking behavior
Core Components
  • Quality life clubs were used at each of the project sites with the aim of building the capacity of individuals and mobilize communities
  • An intensive experiential and drama based training program for service providers focused on improving attitudes and cultivating empathy
  • Clinical competency training addressing syndromic management, VCT and ARV literacy were made available to the biomedical health service providers; while VCT, ARV and STI literacy courses were made available to traditional healers and community health wardens/workers
  • Male acceptability of circumcision study was conducted
Noteworthy Results
  • Results from male acceptability of circumcision study were used to inform policy
  • Life clubs were effectively used to mobilize and build capacity of hard-to-reach migrant men
  • Increase of men’s health-seeking behavior: this was measured by an upward trend in men’s uptake of VCT at 4 primary health care sites in the inner city of Johannesburg, with approximately 36% positivity rate; upward trend on HAST service uptake
  • Uptake of HIV/RH services among target population
  • 24 modules designed by a range of expert groups were covered by trained male peer counselors
  • 'Graduate' members continued to design and run their own club meetings and enrolled and trained new members to develop income generating health enhancing activities
  • Cost-effective mobile health units were established, in particular mobile and men’s clinic to reach 24,000 men to improve their health and wellbeing
  • Effective training for health care providers, supervised community health warden/ worker team was provided to increase access care at facilities
Lessons Learned
  • Forecasting to determine the need for male circumcision
  • Integration and collaboration among different projects and services (i.e. Sex Worker Project, VCT at Esselen Clinic, Maternal Health and HIV Project) has created opportunities for recruiting men to test and receive treatment for HIV, as well as facilitated a coordinated response in the provision of special services such as mobile and men’s clinic, women at risk project and youth friendly services
  • Program design additionally should address gender-based violence, as there is an interrelated synergy between HIV, GBV and health-seeking behavior. It would also be useful for reproductive health services within the program to include family planning elements that interplay with HIV and GBV; to assess HIV exposure risks related to family planning practices (i.e. condom use)
  • Baseline study is needed to assess HIV exposure risks related to men and use of family planning
Focus Areas
Prevention
Implemented By
Reproductive Health & HIV Research Unit of the Univ of the Witwatersrand, South Africa
Participating Organization
  • Greenhouse Project
  • Market Photo Workshop
  • IDASA
  • Soul City
  • Freeplay Foundation
Region
Africa
Country
South Africa
Environment
Community/Household
Setting
Urban
Target Population
  • Adults (over 18)
  • Males
  • Females
Scope
25000 - 50000
Implementation Years
12/2003 - 12/2009