Human-centered design lends a new approach to increase uptake of HIV services among South African men who have sex with men

Population Services International and Matchboxology, with support from the MSD Foundation, have launched a new initiative to improve access to HIV prevention, testing and treatment services for men who have sex with men (MSM).

According to recent data[i], less than half of MSM in South Africa know their HIV status, and only about a quarter are on treatment. While there are a range of programs focusing on MSM, these data indicate that many MSM are not using them, suggesting that we do not yet have an adequate understanding of their healthcare needs and preferences.

With estimates of the number of MSM in South Africa ranging from 300,000 to 1.2 million[ii], improving that understanding may unlock the opportunity to reach thousands more MSM with the healthcare and psychosocial support that they need for better physical and mental health.

Applying principles of human-centered design (HCD), the 3-year project will engage MSM directly in a process of learning and co-creation, identifying barriers and preferences and developing potential solutions that can then be tested, refined, and ultimately scaled and sustained if effective. Intervention areas to be explored include peer support, digital solutions, social media outreach, comprehensive case management, and enhanced psychosocial and mental health support.

One barrier appears to be that MSM need more sensitivity and discretion than most services currently provide.  By some estimates, non-identifying MSM make up three-quarters of the total MSM population in South Africa. Even those who do identify as gay or bisexual often disclose that identity selectively, fearing stigma and discrimination.

“PEPFAR has a long history of supporting the National Department of Health in reaching key populations,” notes Joseph Lawrence, Technical Advisor for HIV Prevention at USAID/South Africa. “We are excited to work with the MSD Foundation and PSI in expanding access to underserved groups, particularly non-gay-identifying MSM. We know it will only be possible to reach HIV epidemic control by providing services that address the needs of all populations.”

The project will be implemented by PSI and Matchboxology and guided by an advisory board comprising the South African National Department of Health, South African National AIDS Council, CDC, USAID, Global Fund, and various NGO partners currently implementing MSM programs.


[i] PEPFAR South Africa FY19 Country Operational Plan

[ii] NDOH & SANAC, 2017; UNAIDS, 2016; Baral et al, 2018; UCSF & SANAC, 2018


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