Office of Global Health and HIV (OGHH) Office of Overseas Programming & Training Support (OPATS) HIV Prevention Training Package Session 3: Reducing Risk

Session Learning Objectives  Participants define vulnerability and resilience, and risk factors and drivers that put individuals and communities at risk for HIV infection.  Participants identify two key risk behaviors and three risk factors for key populations (PWID, SW, MSM, PLHA).  Participants utilize a participatory tool to analyze risk and risk factors for key populations.

Risk (of contracting HIV)  The probability of an individual becoming infected by HIV, either through his or her own actions, knowingly or not, or via another person’s actions. (UNAIDS)

Risk factor  “…an aspect of personal behavior or lifestyle, an environmental exposure, or an inborn or inherited characteristic which, on the basis of epidemiologic evidence, is known to be associated with health-related condition(s) considered important to prevent.” (Dictionary of Epidemiology, 3rd edition)

Examples of risk factors  Physical factors: – Women, particularly young women and girls – Uncircumcised men – People with STIs  Personal factors: – Lack of knowledge – Lack of skills – Inability to assert needs/desires  Logistical factors  Social and economic factors: practices, beliefs, and laws that stigmatize and disempower certain populations Risk drivers

Vulnerability (to HIV)  Reflects an individual’s or community’s inability to control the risk of HIV infection  Includes factors such as social norms, economic status, political instability, or legal environment  Practices, beliefs, and laws can stigmatize and disempower certain populations

Key populations  Individuals who sit at intersection of vulnerability and high risk and have higher risk of being infected or affected by HIV include: – Those who inject drugs (PWID ) – Sex workers and their clients – Men who have sex with men – PLHA – (COUNTRY Adaptation: Include basic definition and statistics for any additional groups listed in national prevention priorities)  Also called at-risk populations, most-at-risk, or MARP  Key populations play a key role in how HIV spreads and are also key to the response.

Resilience  Allows an individual or community to overcome or bounce back from adversity  Allows an individual or community to adapt to circumstances and ultimately demonstrate a positive outcome  Pro-active — can also reduce risk  Personality traits in individuals  Leadership in communities

Risk drivers for key populations  Marginalization  Criminalization  No political will to address their needs  Violence/extortion  Can’t access appropriate, welcoming prevention services, commodities  Can’t access other services that could reduce risk  Overlapping vulnerabilities  STIGMA AND DISCRIMINATION

Vulnerable populations  Youth/OVC  Young women/girls  Prisoners  Military/uniformed services  Migrants/displaced persons  Slum dwellers  Include any other populations noted in national prevention strategy.