Dawie Nel is the Director of OUT LGBT Well-being and co-founded the organization in 1994. He has 25+ years’ experience working with and advocating for South African LGBT and MSM health and human rights programs.

OUT is a South African community-based Lesbian/Gay/Bisexual/Transgender (LGBT) organization that has been instrumental in advancing LGBT health and human rights since 1994. In 2019, with funding from USAID, OUT established the Engage Men’s Health (EMH) Program to extend the reach of HIV services to MSM in Johannesburg, East London and Port Elizabeth. To date, EMH has provided HIV testing to 36,684 MSM, initiated 10,073 on pre-exposure prophylaxis (PrEP), and 2,766 on antiretroviral therapy (ART).

Townships are underdeveloped racially segregated urban areas created during the Apartheid era. Despite transition to democracy in 1994, townships continue to be racially segregated and predominantly black and poor. In Soweto township (Johannesburg), EMH works with 17 houses where groups of MSM informally live, and where sexualized drug use (Chemsex) is available to MSM from the broader community. Opposed to the Global North, where Chemsex is organized around online hookup sites frequented by middle class MSM, EMH Chemsex clients are predominantly unemployed, black and poor. Since 2021, 1,662 township-based Chemsex clients have received services from EMH. The majority of Chemsex clients are young (20-34), and the HIV prevalence is high (20%).

Retaining township Chemsex clients on PrEP and ART is a challenge. For example, between April-September 2022, 153 Chemsex clients tested HIV-positive, and 139 were initiated on ART. As of September 2022, despite ART home delivery, only 75 clients were retained in care, representing only 45% retention in care, whereas 70% of MSM in the program overall were retained on ART. The sub-optional retention rate seen in Chemsex clients must be addressed programmatically. New strategies including new models of medicines delivery and those that draw on approaches used to retain people who use drugs in care are required. OUT is exploring factors affecting (and approaches to address) low retention, with a needs analysis planned for 2023.