Programme Manager: Jacques Livingston (livingstonj@out.org.za)

Historically, OUT had two separate focus areas, including Mental Health and Sexual Health. However, it is increasingly becoming clear that these focus areas/constructs are largely interlinked, and that often one cannot speak of sexual health without careful consideration of mental health and well-being. As such as, of 1 April 2010, these two programmatic areas have merged naturally into one broad focus area: Health and Well-being. What follows is an overview of all the programmes and projects provided under this broad umbrella.

PRISM PROJECT

The word PRISM is an acronym for ‘Prevention and Research Initiative for Sexual Minorities’. The PRISM Project (as it is referred to in Southern Africa) forms part of a collaborative effort between 16 organisations in the global south (including Southern Africa, and Central and South America), and the Schorer Foundation (based in the Netherlands). Partner organisations collaborating in Southern Africa include: OUT LGBT well-being (Pretoria), Triangle Project (Cape Town), Durban Lesbian and Gay Centre (Durban), GALZ (Zimbabwe), and Bonela/LeGaBiBo (Botswana). The aim of the project is to increase the quantity and quality of HIV/STI prevention for men-who-have-sex-with-men (MSM) and women-who-have-sex-with-women (WSW).

As part of the first phase of the project, each partner organisation had to select one or two target groups and conduct a needs assessment on them. OUT selected resourced and under-resourced lesbian women, as well as, resourced gay men to be included in this project. A needs assessment was conducted towards the end of 2007 and a report was compiled at the beginning of 2008. The findings of these needs assessment identified three key areas for intervention:

• Erroneous Risk Perception;
• Internalised Homo-negativity; and
• Negative Peer Norms.

With these three key areas in mind OUT developed an intervention strategy (phase two) to address the needs of lesbian women and gay men in Tshwane. A proposal was submitted and funding was obtained for programmatic work to begin in the middle of 2008. These activities were expanded upon in 2009 and 2010. Key activities for 2010 include the following:

1. OUT provides an extensive, yet appropriate (i.e., sexy, fun, appealing, user-friendly) barrier method (e.g., condoms, flavoured lube, female condoms, dental dams, latex gloves etc) distribution service for both gay men and lesbian women. Currently, OUT distributes safer sex packs (based on the ‘Ready to Play?’ concept) to a range of venues in Gauteng (Tshwane and Johannesburg) that are utilised by gay men and lesbian women. These ‘play safe’ packs include safer sex messaging, appropriate barrier methods and flavoured lube. The provision of barrier methods remains a contentious issue as there appears to be very little local and international consensus on whether to provide lesbian women with barrier methods such as dental dams and latex gloves as there is a wide-spread belief that lesbian women don’t need them, won’t use them, and therefore the provision of these barrier methods is a waste of expensive resources. However, our argument to date is that lesbian women’s sexual health and reproductive health rights have been deprioritised for far too long. More resources are needed to explore lesbian women’s sexual health and needs. It is also our position that while women who have sex with women exclusively are at less risk of transmitting and contracting HIV, they are still at risk of transmitting and contracting other sexually transmitted infections (STIs), such as Genital Warts, Trichomoniasis, Herpes, Chlamydia, Gonorrhea, Syphilis, and Hepatitis for example. There are still many lesbian women who mistakenly believe that they are not at risk (which can be highly problematic in the context where no symptoms are present, where no screening or check-up takes place, where no sexual history communication takes place, and where no safer sex precautions are being exercised). As such we feel that sexual health is a public health issue and that through the provision of barrier methods lesbian women are educated about their potential risks so that they may make more informed choices regarding their sexual health, including their freedom of choice to use the barrier methods we provide. We invite your feedback or comments on our barrier methods and our distribution service (livingstonj@out.org.za).

2. OUT launched the Men2Men website in May 2007. The website is the first of its kind in South Africa. The website targets young resourced gay men (between the ages of 18 and 39) who make use of the internet to access lifestyle information, pertaining to a range of gay-related health and social aspects. Devised in collaboration with the Centre for the Study of AIDS at the University of Pretoria, the site aims to provide advice and information about male sexuality, safer sex and sexual health. The site currently contains extensive information on a broad range of topics, which can be accessed in a convenient and user-friendly manner. The site is also very interactive, including a monthly poll, an HIV/STI risk calculator, and a question and answer section (Ask Dr Dick). The site also boasts an ever expanding library of useful articles and reading material catering to the needs of gay men. Plans are under way to develop it further by including a new introductory section on ‘Human Sexuality’, a news bulletin, and a convenient on-line booking system for our clinic. You can log onto this site by going to www.men2men.co.za. Any suggestions or comments on how to improve the site to meet your needs are most welcome (livingstonj@out.org.za).

3. OUT launched the Womyn2womyn website in February 2010. Hot on the heels of the successful men2men website, this website for lesbian women is another first of its kind in South Africa. The website targets resourced lesbian women (between the ages of 18 and 39) who make use of the internet to access lifestyle information, pertaining to a range of lesbian-related health and social aspects. Devised in collaboration with experts in the field of lesbian sexual health, the site aims to provide advice and information about female sexuality, safer sex and sexual health. The site currently contains extensive information on a broad range of topics, which can be accessed in a convenient and user-friendly manner. The site is also very interactive, including a monthly poll, an HIV/STI risk calculator, and a question and answer section (Ask Dr Delicious). The site also boasts an ever expanding library of useful articles and reading material catering to the needs of lesbian women. Plans are under way to develop it further by including a news bulletin, and a convenient on-line booking system for our clinic. You can log onto this site by going to www.womyn2womyn.co.za. Any suggestions or comments on how to improve the site to meet your needs are most welcome (livingstonj@out.org.za).

4. OUT remains committed to public education and strives towards increasing initiatives aimed at providing up-to-date and user-friendly information to lesbian women and gay men. In 2008 OUT developed the easy-to-use Sexually Transmitted Infections (STI) fold-out informational card for men and women. This convenient pocket-sized product can be stored and used as an immediate quick reference should any potential concerns arise. Although OUT advocates for regular STI screening and testing, it is our contention that lesbian women and gay men become and stay informed about the range of STIs available and the potential health-related risks should they remain undetected. These resources are also available for download on the men2men and womyn2womyn websites. OUT also routinely creates fact sheets that are topical (in that they reflect current trends or address a particular information gap that arises from the work that we do) and are easy to read. These fact sheets are readily available at OUT or can be downloaded from either the men2men and womyn2womyn websites. Any suggestions or comments on how we can address your informational needs please let us know (livingstonj@out.org.za).

5. OUT launched the PRISM Lifestyle Centre in May 2009. Representing the ‘direct service’ arm of the organization, the Lifestyle Centre aims to become a centre of excellence, whereby a range of expertly managed health and well-being services cater directly to the needs of gay men and lesbian women, at an individual, couple and group level. The HIV and STI Clinic is managed by a warm and professional nurse. Services provided by the clinic include:


• General Physical Examinations;
• HIV Counselling and Testing;
• CD4/Viral Load Testing;
• STI Screening and Testing;
• PAP Smears (Vaginal);
• Provision of Post-exposure Prophylaxis (PEP);
• Wellness Adherence and Referral; and
• General Referral and Follow-up.

These services are based on an appointment system and are provided Monday to Friday between 09h00 and 16h30. The clinic is also open after hours (up to 19h00) on an appointment basis. This service is free but is subject to a nominal facility fee, which will be used to assist the organisation in covering increasing administrative costs.



A doctor is available, at no charge, on Tuesdays and Wednesdays (please contact us for an appointment).



The clinic also hosts the Womyn2womyn Open Day and the monthly Know Your Status Open Day. The Womyn2womyn Open Day is held on a Saturday once a quarter with the aim of prioritising lesbian women’s sexual and reproductive health by advocating for the need for regular check-ups and routine pap smears. The Know Your Status Open Day is an initiative aimed at encouraging gay men and lesbian women to take up testing on a regular basis. The open day is provided on the last Tuesday OR Thursday of each month and the clinic remains open until 18h30. Individuals and groups are encouraged to make use of this confidential and professional service. For more information on the clinic or if you have any suggestions or comments on how we can improve this service please contact our nurse Gérard (damstrag@out.org.za).

The psychosocial support service is overseen directly by a registered counselling psychologist and co-ordinated by a professionally trained social worker. Face-to-face Counselling sessions are based on an appointment system and are provided Monday to Friday between 09h00 and 17h00. This service is free but is subject to a nominal facility fee, which will be used to assist the organisation in covering increasing administrative costs. Online Counselling is also available for clients who stay far away and are constrained logistically or financially from accessing the face-to-face counselling service. Online counselling is provided by writing to Trish (dzingirayit@out.org.za).

Telephonic Counselling is also provided via the OUT Helpline. You can access the helpline by dialing 0860 OUT OUT (0860 688 688). The OUT helpline has been in existence for 15 years provides immediate telephonic support, information and referral to callers. Counselling is provided mainly in English and is available daily from 09h00 to 22h00. Reverse charge calls are accepted. There is also a range of support groups available catering to a wide range of needs.

Two Psychotherapeutic Groups are provided for gay men and lesbian women interested in developing insight into the self and the relationship between the self and others. Facilitated by trained therapists, these psychotherapeutic groups are closed (meaning that group members must commit to the 8 week period and that no new members will be accepted once group work begins), and will run for a period of 8 sessions, every second week, over a 4 month period. The group will be offered in two cycles, starting in April and August, at which point new members will be accepted. Attendance is subject to a nominal facility fee, which will be used to assist the organisation in covering increasing administrative costs.

An HIV Support Group is also provided on a monthly basis for HIV positive individuals. Facilitated by trained professionals, the aim of this group is to provide group members a safe and affirming space in which to share their experiences in relation to being positive, to enable group members to give each other much needed support, and to provide a platform to share much needed information. This group is open (meaning that group members do not need to commit for any period of time, although regular attendance is highly recommended in order to be beneficial for all group members, and that new members are accepted at any point if space permits). For more information on these services or if you have any suggestions or comments on how we can improve these services please contact Trish Dzingirayi (dzingirayit@out.org.za).

A Study Group is provided for mental health care professionals interested in learning more about the experiences and needs of gay, lesbian, bisexual and transgender clients. The study group meets on the last Friday of every second month. Professionals can earn CPD points by attending these sessions. For more information on the study group or if you have any suggestions for future topics please contact Trish Dzingirayi (dzingirayit@out.org.za).

OUTside is a group-based programme aimed at providing gay men and lesbian women an alternative and affirmative safe social space to congregate and build meaningful interpersonal connections and a sense of community. OUTside occurs the last Saturday of each month (14h00 – 16h00). Various group-based activities and informational talks make up the programme and are rotated every second month (12h00 – 14h00). Attendance is subject to a nominal facility fee, which will be used to assist the organisation in covering increasing administrative costs. Supamoms is a space for lesbian mothers from all walks of life to meet and discuss unique experiences and challenges relating to motherhood and being a lesbian woman. PFLAG is a space for parents and friends of lesbian women and gay men to process their experiences and to share much needed information. The Book Club is a space for gay men and lesbian women to engage around a shared interest in reading. The Lesbian Interest Group is a space for lesbian and bisexual women to get together and share experiences around a range of relevant topics. The Gay Interest Group is a space for gay and bisexual men to get together and share experiences around a range of relevant topics. The Trans Group is a space for transgender people to get together, build connections, and share experiences and information around a range of relevant topics. In addition, there are a range of other activities also on offer throughout the year, including Mosaics, Self-defense, Painting, Creative Writing, and Meditation, to name just a few. Check the OUT website for an up-to-date OUTside programme. OUT also has an ever expanding resource centre, which boasts an impressive collection of LGBT-related books, magazines, videos and DVDs, and online resources. If none of these activities are of interest to you then let us know what you would ike to see and we will see how we can make that happen. For more information on these services or if you have any suggestions or comments on how we can improve these services please contact Senkhu (maimanes@out.org.za).

6. Everything in life is about balance. With all the heavy serious work comes the equally important need to celebrate who we are as a diverse group of people. Each year, OUT is involved with the Soweto Pride, the Johannesburg Pride, and Sexpo (in Midrand). But besides these events, OUT remains committed to reminding LGBT people just how special and important they are.

PLAY SAFE CAMPAIGN

The PLAY SAFE Campaign, initiated at the end of 2007, is based on international findings that substance use/abuse plays a direct and indirect role in the transmission of sexually transmitted infections, including HIV. Research generally shows that substance use/abuse is related to impairment of judgement, a decrease in inhibitions, an increase in sexual risk-taking, an increase in number of sexual partners, and an increase in the odds of engaging in unprotected sex. Research conducted by OUT (in collaboration with the Centre for the Study of AIDS and Mambaonline.com) in 2004/5 revealed that:

• 47% of gay men between the ages of 16 and 35 drank alcohol at least twice a week; 22% indicated that they got drunk at least twice a week;
  
• 35% indicated that they sometimes used condoms, and 19% never or almost never used condoms, after consuming alcohol/drugs;
  
• 17% indicated that they enjoyed the moment and did not worry about safer sex after consuming alcohol/drugs; and
  
• 5% could not recall what they did, and 15% could mostly not recall what they did, after consuming large quantities of alcohol/drugs.

Based on these and other research findings, it was felt that a targeted long-term intervention was needed. The PLAY SAFE Campaign is just such an intervention. As part of this campaign, outreach workers and nurses are trained to provide a professional service to substance using clients. This consists of HIV counselling and testing (HCT), substance use screening, risk reduction counselling, routine follow-up, and if necessary referral for treatment. These services are provided at five clinics/sites (Joburg, Pretoria, Mamelodi, Mafikeng and in Nelspruit). In addition to these services, nurses and outreach workers also provide HCT at these clinics/sites, at a number of participating nightclubs in Joburg and Pretoria, and at large-scale events (such as the Pink Jacaranda and Joburg and Rosebank Pride in 2009). We have just launched the “What you need to know about drugs” booklet. The response and support from community members has been incredible. With such favourable responses and ongoing encouragement we will continue with the campaign for as long as possible. For more information on these services or if you have any suggestions or comments on how we can improve these services please contact Gerard (damstrag@out.org.za).

ONE2ONE PEER EDUCATION

OUT has developed a One2One Peer Education Programme (which compliments both the Play Safe Campaign and the Prism Project), where peer educators are recruited directly from the community and trained to become effective role models and opinion leaders who work directly and informally within their own social and sexual networks on an ongoing basis. The peer educators will make use of easy-to-use fact sheets as a resource. We are the process of recruiting and training the peer educators. If you feel passionate about becoming involved and playing your part then please volunteer some of your time to this worthy cause. If interested in becoming involved or would like to know more about One2One please contact us (livingstonj@out.org.za).

ON-LINE CONTRIBUTIONS

OUT has made regular written contributions to Mambaonline (www.mambaonline.co.za). Articles written include:

• Bottoms Up! A closer look at anal sex (April 2008)
• So Many Men…So Little Time! (June 2008)
  
• Higher, Longer, Faster…More! (August 2008)
  
• It’s Only Sex, Right? (April 2009)
  
• Men Staying Healthy: Part 1 (June 2009)
  
• Men Staying Healthy: Part 2 (June 2009)
  
• The Man In The Mirror (October 2009)
  
• What Are We Doing? (December 2009)
  
• Man-handling Your Man-Handle (May 2010)
• Loving Across the HIV Line (February 2011)

For more information regarding the topics covered in these articles or suggestions on future topics to be covered contact Jacques Livingston (livingstonj@out.org.za).