How to break the cycle of violence against MSM in Africa?

Since 2004, our Middle East and North Africa programme has been successfully building the capacity of groups of men who have sex with men to undertake HIV prevention. This is despite operating in countries where same sex activity is criminalised. How can the rest of Africa learn from this programme?

Jamel, 21, is a gay peer outreach worker in Morocco. He initially came in contact with OPALS, one of the community-based organisations supported by Alliance Linking Organisation AMSED, as a client. Prior to that he had struggled to accept his sexuality.

“In the past I was so concerned I couldn’t sleep. I suffered a lot from stigma,” he explains. “Now I am supported by the NGO. I feel that I have dignity and I have the right to live as I wish. After the training I wanted to put everything into practice and share the information…I have a great responsibility and commitment to my peers.”

AMSED and OPALS are working in Morocco alongside five other implementing partners in Algeria, Tunisia and Lebanon as part of the Middle East and North Africa (MENA) Programme, which is supported by the USAID capacity building programme, AIDSTAR Two.

HIV in the MENA region

Although overall HIV prevalence is low, the region has one of the fastest growing concentrated epidemics in the world, with HIV infection rising rapidly among populations at highest risk. Between 2001 and 2011, the number of people newly infected with HIV increased by 35%.

According to Manuel Couffignal, MENA Regional Advisor, “the populations most affected are MSM, people who use drugs and female sex workers. Sex between men accounts for nearly one quarter of new infections and this is exacerbated by high rates of stigma and rising homophobia – a negative impact of the Arab Spring after which people feel more free to express their sexuality, and their prejudices.”

About the programme

The MENA programme provides a package of combination prevention services aimed at MSM and other most affected populations, including peer education, condom distribution, HIV testing and counselling, referral for STI diagnosis and treatment and social and other support.

Manuel Couffignal said“Partners also work to identify the needs of communities and feed these back to the project. By being responsive, they have been able to deliver highly effective community-based outreach programmes in each country.”


The MENA programme has clearly demonstrated ways to reach MSM in a region where such work was once thought to be near to impossible. A recent report, Most Significant Change: Demonstrating results of responding to most at risk populations in the Middle East and North Africa Region gathered the views and experiences of MSM to identify the main changes as a result of this HIV prevention programme.

The analysis concluded that not only have MSM participants in the programme improved their life skills, self-esteem and self-confidence, they have also increased access to HIV prevention, care and support services. In addition, many have been employed by the traditional AIDS service organisations in their countries, allowing them to transition from simply being a beneficiary of the programme, to become a full actor in the national HIV response. According to the report, “The program has played an undeniable role in advancing MSM rights and improving their quality of life in the locations concerned.”

What can the rest of Africa learn?

Shaun Mellors, Associate Director for Africa said, “This programme has demonstrated that it is only by supporting and developing the capacity of groups of men who have sex with men that we can truly develop programmes that can fully meet their needs.

“In this way we can start to tackle the extreme stigma and discrimination against MSM that exists in so many countries and which limits their access to essential services.

“As we continue to implement the Alliance’s global strategy which prioritises access to HIV and health programmes for those most in need, we are able to draw upon the MENA programme’s success and share their learning with Alliance linking organisations and partners in the rest of Africa.”

Some of the programming tools from the MENA project – such as the participatory community assessment – have already been used in the work planning for the Alliance’s new men’s sexual health and rights project in Africa, SHARP (operating in Kenya, Tanzania, Uganda and Zimbabwe).

Tools to share learning

This year, the programme has developed two new tools to tackle stigma and discrimination around MSM and build the capacity of organisations working with MSM which we would urge others to share and use:

  • Understanding and challenging HIV stigma: toolkit for action – adapted for use in the MENA region from our ‘best-seller’ toolkit which was developed by and for African trainers, and has been used extensively around the continent to support HIV stigma reduction programmes. 
  • NGO communications guide - this guide is designed to give practical knowledge and tools to help tell the story of the work that you do, and also to develop an organisational communications plan. It was written for those with little training or background in organisational communications.