Implemention stigma reduction intervention for Key population : Experience in west Africa Sénégal, Guinée Bissau, Guinée, Cap Vert, Mali, Burkina Faso, Niger, Gambie

KP Stigma reduction: difficult context and interventions Despite criminalizing legal environnement Evidences are more and more avalaible in countries High impact interventions implemented

Regional context, specific country realities Difficult social, religious and legal environment High level of stigma and discrimination of KP Very few local stakeholders working with KP More data on HIV epidemic among KP and impact on stigma in reducing access to service( starting) KP community more visible and engaged in the response to HIV and developing rights based intervention  Countries just starting meaningful programming interventions for KP (Niger, Mauritania…) Countries with more structured interventions( Senegal, Cote d’Ivoire, Nigeria, Burkina)

Current situation/INTERVENTIONS High prevalence of HIV and STI among KPs. - Criminalizing law in most of the countries - Stigma and discrimination at community and family level - Limited number of MSM& FSW know HIV status - Low use of condoms and lubricants by KPs HIV/AIDS and STI treament services are not adapted to KPs Stigma and discrimination in health care seeking Stigma/ marginalization Action : Advocacy Action : Prevention Action : strengthening community system, leadership development ² ²²² Action : Improving access to treatment services Health service KP competent

Stigma reduction interventions( 1) A- Prevention and Health Sector Interventions : Prevention activities led by MSM/ FSW : VCT, Condom+ lube promotion, STI care, behaviors change activities MSM and FSW Pilot project( Guinea, Gambia, Niger, cap vert)  Greater or national coverage program( Senegal, Burkina Faso, Cote d’Ivoire) Context sensitive intervention : Mobile clinic and in house activities with peer educators Training and engaging Health care workers : stigma reduction in Health setting and adaptation of services to the need of MSM & FSW VCT/HCT  treatment and prevention services

Stigma reduction interventions( 2) B- Leadership development and community engagement Community systems strengthening (supporting emergence of association): 25 organizations ( MSM and FSW) ( Senegal, Burkina, Guinée, Cap vert, Guinée Bissau, Mali, Niger, Gambia) Strengthening KP leadership : ✓ MSM and FSW as program implementers ✓ Supporting meaning full participation in national political and decision making mechanism: MSM representative in the CCM in Senegal ✓ Engaging more Civil society organizations to develop interventions for KP in west Africa : 20 organizations in 8 countries

Stigma reduction interventions C- Reinforcement of social capital and economic empowerment in a context of unemployement, high school drop out and poverty : ✓ financing professional training ✓ Income generating activities ( IGA) ✓ Reinforce community cohesion with IGA

Stigma reduction interventions( 4) D- Sustained Social dialogue and anticipation strategy : ✓ Setting up “Observatoire” and National MSM steering committee ( anticipation strategy, environment and rights watch ) in Senegal ✓ dialogue with religious leaders, media, parlementarians, KP communities, security forces ✓ Engaging Mass media: advocacy package, working on discourse, enrolment workshop ✓ Research, evidence and stigma reduction ✓ Involvement of KP in research ( IBSS in Gambia, Cote d’Ivoire, Burkina, Togo + qualitative assessment criminalization impact in access to care and treatment in Senegal) ✓ support MSM and FSW community and CS organizations working with KP on how to use data for advocacy and stigma reduction intervention ✓ Use evidences to build progressive acceptance in general population

Funding Stigma reduction: current situation and challenges Independently to the funding sources, Stigma reduction interventions are implemented in most of the west african countries by civil society organisations Stigma reduction interventions are mainly funded by foreign (international) aid ( GF+ bilateral cooperation/ aid) Funding allocation to KP stigma intervention in HIV national response is not proportionate to the burden of the epidemic among KP Questions on future direction in funding : Given social and religious context, criminalization of same sex, how to increase domestic resource for intervention for KP ? NFM new opportunity or statut quo ? How to adress the diffusion effect/ influence of criminalizing law passed in certain countries of the region?

Thank you