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Empowering Special Populations for Better Health Outcomes

During the past two decades, mothers2mothers’ (m2m) peer-led and community-based model has been proven effective at tackling a range of disease areas and serving diverse populations—going far beyond the original scope of preventing the transmission of HIV between mother and child. As the global health community continues to work towards the 2030 deadline to end HIV/AIDS as a public health threat, m2m recognised that to truly serve our communities we need to look at if or how our model can serve special populations (which includes gay, bisexual, and other men who have sex with men-GBMSM)—because our existing client base may be interacting with, or in relationships with, members of these populations. So, with the support of the Merck Foundation, m2m launched a four-year pilot project as part of an operations research and proof of concept on the effectiveness of the m2m peer model amongst key populations (GBMSM) and their families.  

At a community hall in Cape Town, a team from Project AMPLIFY Life and Family Mentors is educating people about health.

The pilot, called Project Activating MSM Peers for Life and FamilY (AMPLIFY), began in January 2021 and is taking place in the Western Cape and Gauteng provinces. It focuses on high population density settings characterised by high levels of unemployment and poverty, and low levels of educational attainment. With guidance from local health officials, Project AMPLIFY serves communities where there are male-centred services, such as male clinics, to make it easier to identify GBMSM. To celebrate Pride Month, we wanted to shine a spotlight on this important work. 

The unique challenges faced by men who have sex with men (MSM) 

In many countries, the health of MSM is greatly affected by highly stigmatised environments and strict laws that mean MSM are especially vulnerable to contracting HIV. Globally, GBMSM are 10 times more likely to be living with HIV than the general population, according to the UNAIDS 2022 factsheet. Data is lacking for GBMSM in sub-Saharan Africa; however, HIV prevalence among gay and bisexual men in this region is estimated to be five times higher than for the general population, according to AIDSMap. In South Africa, which has among the highest number of HIV cases in the world, UNAIDS estimate that nearly 30% of MSM are living with HIV compared to 18% of the general population.  

How m2m seeks to address these challenges 

The Project AMPLIFY team is undergoing refresher training to make sure they are receiving the most recent knowledge on working with clients and maintaining their competence, both of which are essential for providing our clients with the necessary level of support.

With funding and support from the Merck Foundation, m2m consulted with organisations experienced in supporting and providing services to key populations, particularly GBMSM, such as OUT Well-being, ANOVA, FHI 360, AURUM, and PSI to learn best practices and identify potential roadblocks in implementing programmes targeted at GBMSM. The idea being to leverage m2m’s expertise in HIV prevention, care, and treatment with other organisations’ trust and peer networks in vulnerable communities.  

The primary focus of this pilot is to foster health-seeking behaviour, reduce stigma, and minimise risky behaviours through peer-led support networks. By engaging families, especially parents of MSM, we aim to create safe spaces and a supportive interpersonal environment for GBMSM.  

This includes identifying local implementing partners (LIPs) to work with during the pilot and who can take over the project beyond the pilot phase. m2m’s role includes developing a robust training curriculum, materials, and technical assistance tools to ensure LIPs receive adequate support. The pilot sites will serve as benchmarks for possible outcomes, and m2m will continue to monitor service quality and supportive supervision provided by LIPs. 

What we’ve achieved so far 

In 2023, nearly 1,300 GBMSM individuals were enrolled at three health facilities, and the programme reached nearly 8,000 individuals through group health education talks. Life Mentors and Family mentors also reached around 400 people through Family Support Groups and GBMSM Support Groups, plus a further 1,200 people who would not otherwise have known about the programme were reached through community outreach campaigns. 

The learnings generated from Project AMPLIFY will contribute to a sparse evidence base on the multi-layered inequities affecting the health of MSM in South Africa. This data and findings will be published to advocate for more effective, tailored, and comprehensive peer-based health-programs for vulnerable GBMSM.  

Building on strong existing networks across sub-Saharan Africa, m2m will engage funding agencies/donors to support the expansion of Project AMPLIFY beyond South Africa, taking the model into new geographies at scale, ensuring GBMSM across southern Africa are not left behind in the fight to end HIV.   

Maintaining m2m’s core principles while expanding our reach 

Despite this expansion, m2m remains proudly African and female-first. We remain as committed as ever to achieving universal health coverage, which we are contributing to through expanding our proven, peer-led, community-based model to incorporate integrated primary health care services and to reach more populations. Ensuring the people who need it most, get the care they need from someone they trust. 

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