KEY POPULATIONS DIVISION
PI: Prof Linda-Gail Bekker
Project Manager: Karen Dominguez
Study Team: Joshua Kikuvi, Lameze Abrahams, Daniel Ndzuzo, Lindsay Gcwabe, Peter Chodacki, Nehemiah Advance, Nazli Fortune
Community Outreach Team: Brian Kanyemba, Xolani Mvula, Siya Mdlalo, Brave Bangira
When Prof Bekker established the men’s research unit in 2008, little information was known about the HIV epidemic among men who have sex with men (MSM) in South Africa. Additionally, sensitized health care services were nearly none existent and stigma and discrimination were pervasive across the country.
The mission of the Key Populations Division is to conduct research that would provide the platform for advocacy and action in the face of this epidemic. We realized that in order conduct ethical and meaningful research among this hard to reach and high-risk population that we also had to develop advocacy, training, and community engagement programming. Over the years our team, conducted the first MSM HIV surveillance studies in Cape Town, led the continent in cutting edge biomedical HIV Prevention trials such as the global iPrEX study, and have advocated extensively for the rights of MSM by contributing to the South African National Strategic Plan for HIV, STIs, and TB 2011-2016. The team has grown and extended the research into further key populations including sex workers (SW) and people who uses drugs (PWUD). Our team has also trained health care workers throughout South Africa to provide better care for MSM and Key Populations, and our training programme has been adopted in over 5 African countries.
Our current research includes new biomedical HIV prevention strategies such as Rectal Microbicides and exploring the ways in which proven prevention strategies like PrEP will be most effective in our community. We are the first site on the continent to conduct the MTN 017 clinical trial and completed enrolment in 2014. This study explored the acceptability and feasibility of rectal microbicides among MSM. Our team is also overseeing the HPTN 075 study, which involves recruiting and retaining a cohort of MSM over a year. We are also driving research on combination HIV prevention, including PrEP, among MSM through the Sibanye Health Project. The team is excited to be embarking on new horizons with HPTN and HVTN for two new studies beginning in 2016. One is an MSM study assessing safety and effectiveness for long-acting injectable PrEP. Also the Treatment and Key Populations teams operating from Groote Schuur HIV Clinical Research Site are combining their efforts to recruit young women and female sex workers (FSW) for AMP, a broadly neutralising monoclonal antibody infusion study.
The MSM Community Programme
The foundation and heart of the Key Populations Division is our thriving and peer-led community outreach programme. We work in 12 communities across the greater Cape Town metro in order to foster community-centric growth, provide education and HIV prevention supplies, and to make sure that everyone’s voice is heard. A volunteer community leader who is in training to potentially become a full-time staff member in the key populations team manages each community group. We support each community group to conceptualize and implement their own activities, which have included netball, debates, drag shows, days at the beach, hiking, pride parades, and cultural events. An energetic and enthusiastic team of Community Outreach Workers leads the community outreach programme.
HIV PREVENTION ADVOCACY
Through advocacy the division introduced PrEP to the South African NDoH, results were shared and a plan was implemented of which PrEP as a prevention intervention and a gap analysis and recommendation for Key Populations in South Africa, and recommendation for the National Strategic Plan for HIV/AIDS, STIs and TB (2012-2016) Key Populations, Key Solutions. In 2012 through advocacy and policy engagement, the leadership of Prof Linda-Gail Bekker and team, the clinician’s society put together MSM Guidelines to allow the clinicians to prescribe PrEP off label and put together the Southern African guidelines on the safe use of pre-exposure prophylaxis in March 2016. PrEP licensure since 2010 had been problematic, the team lead advocates who worked on the process effectively and in 2015 PrEP was licensed, this came to support our implementation plan and now PrEP has been licensed we are able to provide our participants with PrEP through our partners and looking forward to NDoH public roll out.