Heartland Alliance /IMHIPP is targeted at prevention of HIV among MSM in Nigeria focusing on strengthening organizational and technical capacity of grassroots MSM organizations, to design, manage and evaluate HIV programs to promote ownership and sustainability. With a five years grant (2009-2014), from USAID, and with technical assistance from Howard Brown Health Center, IMHIPP is being implemented in FCT, Lagos, Cross River, Rivers, Kano State in COP 2012 and a yet to be determined sixth State. Focus for 2012 will also be on other programming for other MARPS.

HA through the Peer Educators (PEs) and Outreach Coordinators (OCs) of local MSM organizations is implementing IMHPP by using the combination minimum prevention package of three out of six strategic interventions relevant to IMHIPP. The interventions promote correct and appropriate HIV prevention messaging, uptake of condoms and lubricants and referral for HTC and ART.

HIV testing and counselling (HTC) is the gateway to various HIV prevention treatment, care and support services. Currently, IMHIPP does not have the mandate to provide HTC. Integrating HTC in COP 2012 will create an enabling environment that will promote universal access to friendly, safe and quality services for MSM, their female sexual partners thus improving couple counselling.

Programming for MSM is a challenge that is underpinned by stigma and discrimination and low technical capacity of MSM organizations to implement HIV and AIDS prevention, care and support interventions. The local partners through several capacity building programs now have a pool of resource persons to reach other hard to reach MSM. Acquisition of skills will continue to create ownership and make local partners technically viable for other donors.

Promoting Positive Health, Dignity and Prevention (PHDP) for MSM+ve through access to palliative care and support is one of IMHIPPs essential components.

Strategies such as provision of psychosocial, nutritional and drug adherence counseling, prevention with positives (PWP), Home-Based Care, provision of HBC materials such as insecticide treated nets, water guards to MSM and their female sexual partners and their dependents. Provision of condom and lubricants, be faithful messaging, improved negotiation skills, support group services and referrals to MSM friendly facility-based service for treatment of STI and ART.

IMHIPP is currently supporting four local partners ICARH, TIER, IMHI and PP in Abuja, Lagos, Cross-river and Rivers States to access MSM friendly community and clinical/facility services to improve the quality of care for MSM+ve and will support a 5th State Kano in COP12. Currently HCT is done through referrals but will be integrated into the care and support services to provide access to all other HIV/AIDS support services in COP 2012

As part of the strategies to effectively monitor care and support services and retain clients is the development of referral system to reduce the Lost-To-Follow-Up (LTFU). HA has a four way referral system introduced to engage and track both the client and service providers in the process of care delivery.

To ensure quality of services will be provided training to acquire skills in palliative service. MSM+ will be equally trained to be able to take care of their members thus promoting ownership and sustainability. Client satisfaction checklists are

The community centers serve as a safe space for the MSM+ve to up-take various support group services without discrimination, couple and discordant counseling, and risk reduction assessments including referrals for specific needs to appropriate health facilities.

Integration of a MARPs Clinic is currently piloted at one project site in FCT ICARHad will be scaled up to the other four states to improve both access and uptake of services at a one stop shop at all community centers amongst others.

Linkages will continue for referral to access to food support to other partners who provide these services.

Strategic information (SI) focuses on capturing of data, review of data tracking tools to reflect effective and high quality data collection. These reviews will be forwarded to the national technical working group on strategic information for inclusion in the national prevention tracking tools to enhance quality of data collected nationally. This is achieved by monthly collation of data from project sites. The authenticity of the information collected from the field is very vital therefore tracking tools incorporate columns for clients phone number, Unique ID, old or new clients for validation purposes and to avoid double counting.

Training of Peer Educators (PEs), Outreach Coordinators (OCs) and program staff is continually conducted on the use of the PITT, CMPPI, DHIS and other relevant national tracking tools to reflect IMHIPP prevention care and support interventions for effective and efficient data quality. In order to ensure that program is aligned to it intended objectives, the Program Monitoring Plan is routinely reviewed.

Periodic data collection, field visits and on the spot check and supportive supervision of PEs and OCs in addition to random validation are ways of ensuring that activities on prevention interventions and palliative care activities are in line with achieving program and national HIV prevention goals.

Training of PEs, OCs and local partners staff on SI management is a way of building the capacity and skills of local implementing partners creating a platform for sustainability and ownership at the exit of Heartland Alliance (HA).

During the COP2012, a mid term evaluation shall be conducted to assess the impact of IMHIPP on the beneficiary target group. SI unit will develop monthly summary report to provide additional insight to the program both for national consumption and for local partners. This will enhance MSM prevention programming in Nigeria. International and national lessons learnt / experience sharing within program States will be organised, promoted and supported to help implementing partners learn from one another, improve programming and compliment each others effort.

Programming for MSM is a challenge that is underpinned by stigma and discrimination and low technical capacity of MSM organizations to implement HIV and AIDS prevention, care and support interventions. Capacity building is provided for Outreach coordinators and peer educators of the local partners to effectively acquire the skills for prevention messaging. This will continue in the COP year 2012 as IMHIPP scales up to other new states. The local partners through several capacity building programs now have a pool of resource persons that will continue to reach other hard to reach members of their community with prevention messages at grassroots. Acquisition of skills will continue to create ownership and make local partners technically viable for other donors.

Inability of MSM to have access to necessary services has made them more vulnerable to HIV infection in Nigeria. In order to improve access to services MSM friendly Health Care, facilities, other relevant organizations and state actors will be continually trained on MSM specific health needs and stigma reductions in the project States. This will also be achieved through advocacy and creating of referral linkages.

Through these linkages MSM have been able to leverage services such as HTC, STI management, ART and income generation activities. In line with the objectives of IMHIPP, strengthening the relationship between the MSM local partners and service providers will create ownership and sustainability. Leveraging from NDE programmes has also provided skills acquisition to unemployed MSM to provide other alternative sources of income. HA will to facilitate these state partnerships to ensure better understanding of MSM issues and improved health outcomes at all levels.

Though these opportunities highlighted have been explored some missed opportunities have been identified such as engaging with other CSOs to leverage other services that IMHIPP does not have mandate to provide. The COP year will see greater engagement with CSOs to expand MSM access and network to leverage resources and services.

Target population Approximate Dollar Coverage-number Activity

MSM 28,217 Condom& lube distribution Messaging on the 3Cs programs Peer educating

MSM are male persons who engage in same sex activities. MSM are one of the high risk groups to HIV transmission and other sexually transmitted infections associated with unprotected anal sex. Stigmatization, discrimination and low self esteem amongst MSM increase their vulnerability too.

HA through the Peer Educators (PEs) and Outreach Coordinators (OCs) of local partners is implementing IMHPP using the combination minimum of three out of six strategic interventions. These are, Community Outreach, Peer Education Models (PEMs), and PEMs+, STI management, specific population awareness and vulnerability issues. The selection was based on the effectiveness and avenues for engagement with the target group. It combines a mix of strategies that reinforce sustained behavioral change at the individual and community level. The interventions promote correct and appropriate HIV prevention messaging, uptake of condoms and lubricants and correct and consistent usage as well as referral for HTC and ART. MSM community centers in all project sites serve as safe spaces to access prevention services without fear of stigma and discrimination.

IMHIPP is designed to be implemented in five States over a period of five years 2009-2014 Lagos, FCT, Cross River, Rivers and Kano States to start in COP 2012.

Regular field visits are conducted, data collated and validated by PEs, OCs and Program Officers (POs). This process ensures high quality of data flow. The Program Advisors and other HA technical staff supervise programmatic and technical interventions to ensure quality of services. It is a combination of quality service delivery and multi-level capacity development program through mentoring, coaching and transfer of knowledge and skills to ensure ownership and sustainability.

The current minimum package intervention in Nigeria incorporates the provision of comprehensive HIV prevention services to individuals and groups at the community level. The IMHIPP project is reaching out to MSM in five current operational states through the Outreach coordinator- Peer education model and achieving remarkable success. However, there are still identified gaps in the prevention as stipulated by the National prevention guidelines particularly in the provision of HTC. Acknowledging the importance of HIV testing and counseling (HTC) as the gateway to various HIV prevention, treatment, cares and support services, the IMHIPP established community centers (CC) within all program sites to facilitate the uptake of services in partnership with other service providers. Heartland Alliance through IMHIPP also has been engaged in advocacy with public and private health care facilities to ensure friendly MSM services uptake.

Monitoring referrals to these services, has shown enormous limitations in reaching clients with qualitative HIV care and support services as most positive clients are usually being Lost-to-follow-up (LTFU). This has ultimately affected not only the outcome of service delivery, but has impacted on the number of positive MSM that enroll in the IMHIPP Palliative Care/Home Based Care and support services as well as the as enrollment into support groups.

Integrating the provision of HTC at the community center will create an enabling environment that promotes universal access to friendly, safe and good quality HTC services for MSM. Also, integrating HTC services into the community centers as against a low referral rate (16.2%, IBBSS 2010) will reduce the time lag between HTC and enrolment into care services for HIV positive MSM.

Target population Approximate Dollar Coverage-number Activity

MSM 28,217 Condom& lube distribution Messaging on the 3Cs programs Peer educating

MSM are male persons who engage in same sex activities. MSM are one of the high risk groups to HIV transmission and other sexually transmitted infections associated with unprotected anal sex. Stigmatization, discrimination and low self esteem amongst MSM increase their vulnerability too.

HA through the Peer Educators (PEs) and Outreach Coordinators (OCs) of local partners is implementing IMHPP using the combination minimum of three out of six strategic interventions. These are, Community Outreach, Peer Education Models (PEMs), and PEMs+, STI management, specific population awareness and vulnerability issues. The selection was based on the effectiveness and avenues for engagement with the target group. It combines a mix of strategies that reinforce sustained behavioral change at the individual and community level. The interventions promote correct and appropriate HIV prevention messaging, uptake of condoms and lubricants and correct and consistent usage as well as referral for HTC and ART. MSM community centers in all project sites serve as safe spaces to access prevention services without fear of stigma and discrimination.

IMHIPP is designed to be implemented in five States over a period of five years 2009-2014 Lagos, FCT, Cross River, Rivers and Kano States to start in COP 2012.

Regular field visits are conducted, data collated and validated by PEs, OCs and Program Officers (POs). This process ensures high quality of data flow. The Program Advisors and other HA technical staff supervise programmatic and technical interventions to ensure quality of services. It is a combination of quality service delivery and multi-level capacity development program through mentoring, coaching and transfer of knowledge and skills to ensure ownership and sustainability.