Two centuries of experience in providing dedicated STI (and more recently HIV)

Two centuries of experience in providing dedicated STI (and more recently HIV) services to MSM through both the
public and private sectors were outlined, and highlighted the following components as being important for ensuring
that the acceptability and effectiveness of service provision is high:
• Health services should be MSM-friendly – staff should be well trained, and confidentiality paramount and
assured.
• Some MSM have other sexual health issues apart from STIs/HIV. These include physical conditions such as
anal fissures, as well as psychological and mental health issues that need to be addressed.
An essential package of services designed specifically for MSM was outlined, i.e. over and above the services
provided for all clients. These include routine screening and treatment as necessary for rectal and pharyngeal
infections; screening for hepatitis viruses B and C; vaccination against hepatitis B virus and possibly hepatitis A,
with discussions under way about vaccination against human papillomavirus (HPV); provision of post-exposure
prophylaxis (PEP) for HIV exposure, as necessary; provision of condoms and lubricant; and MSM-specific risk
reduction counselling.
In order to equip staff to provide these services in an MSM-friendly manner, specific training is provided to all staff.
The training focuses on addressing attitudes and challenging prejudice, conducting motivational interviewing, with
a strong emphasis on communication skills. Staff is also trained in the clinical diagnosis and management of anal
conditions. They are supported in their service delivery with the use of tailored clinic proformas (e.g. with
opportunities to record rectal and pharyngeal exposure), as well as specific protocols for the clinical investigation
of MSM and administration of PEP. The presence of MSM among staff members builds confidence in the service
and is believed to give clear signals that the service management does not discriminate against MSM.
The MSM clinics are run alongside other clinical services in the same building, and some clinics are integrated with
more general services (for STIs and HIV). A separate STI/HIV clinic for young MSM (under the age of 21 years) ran
for several months, but declining attendance rates led to its eventual incorporation into the mainstream services. It
was noted that once young men knew about the overall clinic, they accessed appropriate services when convenient
to them rather than only at the times when the young men’s clinic was open