Training Toolkit on MSM Programming for the MENA Region

This 4-volume training toolkit on men who have sex with men (MSM) programming for the Middle East and North Africa (MENA) region was developed jointly by the International HIV/AIDS Alliance and Joint United Nations Programme on HIV/AIDS (UNAIDS), in the framework of a regional programme designed to reach MSM and people living with HIV funded by the United States Agency for International Development (USAID) and implemented through the Leadership, Management & Governance (LMG) Project in partnership with civil society organisations in Algeria, Lebanon, Morocco, and Tunisia. It is intended for training and guiding community outreach workers, peer educators, and managers of organisations that want to start MSM programmes in their country or town.

From 2005 to 2015, the Alliance worked with 8 CSOs in Algeria, Lebanon, Morocco, and Tunisia to respond to the sexual health and HIV/sexually transmitted infection (STI) prevention needs of MSM in an exceptionally hostile environment. The Alliance started from scratch, setting up community-led health initiatives designed by and for MSM, where there were previously virtually no services. The CSOs that were part of the programme distributed condoms and lubricant, and provided HIV counselling and testing and STI diagnosis and treatment in various cities in the 4 countries. They also provided psychosocial support and legal advice, and undertook a range of activities aiming to raise awareness of HIV prevention, the importance of knowing your status, individuals' right to health, services and non-discrimination, and where to go for support. Given the sensitive context, the work was largely done under the radar. The fact that the services were aimed for MSM was usually concealed from any signs and printed material, and the address of the MSM community spaces was communicated by word of mouth only. The sexual orientation of peer educators was kept confidential, and there was limited communication about and visibility of the reach or results of the programme to avoid being attacked as CSOs promoting homosexuality. In parallel, those involved in the project advocated for a more positive environment for MSM and CSOs working with MSM. They spoke up for the inclusion of MSM in the national AIDS programmes, and they challenged stigma and discrimination through sensitisation workshops with health service providers, policemen, journalists, lawyers, and religious leaders. The programme lives on today, thanks in part to the MSM-friendly tools and other material created as part of the programme. This toolkit incorporates the experience from the pioneer MSM programme in MENA, but also builds on international good practices on MSM programming.

The toolkit is made up of 2 parts:

1. The MSM project orientation manual provides planners and managers with the information to develop sympathetic, evidence-based, and comprehensive HIV prevention and support services for MSM. The manual is organised into 3 sections. The first 2 sections (Part A: Situational Analysis and Part B: Conceptualisation) cover information related to the awareness part of the dynamic "from a process of awareness to a process of commitment". They provide scientific, factual, and contextual information needed by programme planners and managers in order to develop effective and ethical HIV prevention and support services for MSM that are informed and guided by human rights and public health imperatives. They contain links and references to other documents for those planners and managers who want to further explore the issues raised in this part of the toolkit (see Annex 2). The third section (Part C: Towards action) covers the commitment aspect. This section describes the kinds of interventions and processes necessary to develop effective programme interventions in response to the prevention and care needs of MSM in the MENA region.
2. The 3-module training manual for MSM peer educators is a standardisation of the training materials that the CSOs developed and used in the past 10 years for training their volunteer peer educators.
   • Module 1 provides peer educators with the technical knowledge needed to be able to conduct effective outreach to raise awareness about the risks of drug use and HIV and other STIs.
   • Module 2 supports participants to practise the skills necessary to implement outreach-based educational activities aimed at promoting behaviour change among MSM. (The theory outlined is based on the Transtheoretical model of behaviour change, which assesses an individual's readiness to act on a new healthier behaviour and provides strategies or processes of change to guide the individual through the stages of change to action and maintenance of this new behaviour.)
   • Module 3 is a guide to analysing the components needed to design effective outreach programmes. It is focused on: developing an enabling environment for programme implementation through partnership development and advocacy; mapping; reviewing the different components of an effective programme; the importance of developing effective referral mechanisms; how to develop indicators to measure progress and monitor programme outputs; the importance of supervision; programme documentation; and reflecting on an ethical framework to guide programme implementation.