Effective HIV & SRH Responses among Key Populations Module 2: The Comprehensive Package of Programmes and Services

Session 1 A Comprehensive Package to support HIV Prevention and Care and Sexual & Reproductive Health among Key Populations Global and National Guidance on HIV and SRH

Overview  Global Guidelines for HIV and SRH among Key Populations.  Regional Documents for HIV and SRH among Key Populations.  National and Provincial response mapping 2

Comprehensive Package of Services A Comprehensive Package of SRH & HIV Services for Key Populations:  Defines a package of services that, if delivered to a percentage of the key affected populations, would halt the HIV epidemic and improve the sexual and reproductive health. 3 A set of interventions that promotes attainment of the highest possible standard of sexual and reproductive health for key populations

Consolidated Guidelines WHO, UNAIDS, UNDP, UNFPA and UNODC (2014) HIV Prevention, Diagnosis, Treatment and Care for Key Populations. Consolidated Guidelines. Brings together existing WHO guidance on five key populations:  MSM  PWID  People in Prisons & other closed settings  Sex Workers  Transgender People 3

Consolidated Guidelines The Consolidated Guidelines aim to: 1.Provide comprehensive package of evidence-based HIV related recommendations for key populations. 2.Increase awareness of the needs of, and issues important to key populations. 3.Improve access to, uptake and coverage of effective and acceptable services. 4.Catalyse greater national and global commitment to adequate funding and services. 3

Consolidated Guidelines The Comprehensive Package Essential Health Sector Interventions: 1.HIV prevention – condoms and lubricant, PrEP (new), PEP 2.Harm reduction interventions for substance use (NSP, OST) 3.HIV testing and counselling 4.HIV treatment and care 5.Sexual and reproductive health interventions 6.Prevention and management of co-infections and other co-morbidities, including viral hepatitis, TB and mental health conditions 3

Consolidated Guidelines The Comprehensive Package: Essential Strategies for an Enabling Environment 1.Supportive legislation, policy and financial commitment 2.Addressing stigma and discrimination 3.Community empowerment 4.Addressing violence against people from key populations 3

Consolidated Guidelines HIV Prevention Recommendations: 1.Correct and consistent use of condoms and condom compatible lubricants for all key populations. 2.Among MSM, PreP is a NEW RECOMMENDATION as an additional HIV prevention choice within comprehensive HIV prevention. 3.For serodiscordant couples, daily oral PreP is a NEW RECOMMENDATION for HIV negative partners. 4.PEP should be available voluntarily for key populations on a voluntary basis post possible exposure to HIV. 5.Voluntary medical male circumcision recommended for prevention of heterosexually acquired HIV in men, in settings with hyperendemic and generalised HIV epidemics. 3

Consolidated Guidelines Harm Reduction Recommendations: 1.All people from key populations who inject drugs should have access to sterile injecting equipment through needle and syringe programmes 2.All people from key populations who are opioid dependent should be offered access to opioid substitution therapy 3.All people from key populations with harmful alcohol or other substance use should have access to evidence-based interventions, including brief psychological interventions 4.A NEW RECOMMENDATION is that people likely to witness opioid overdose should have access to naloxone and be instructed in its use for emergency overdose. 3

Consolidated Guidelines HIV Testing and Counselling (HTC) Recommendations: 1.Voluntary HTC should be routinely offered to all KPs both in the community and in clinical settings. Community-based HIV testing and counselling for key populations, linked to prevention, care and treatment services, is recommended, in addition to provider-initiated testing and counselling. 3

Consolidated Guidelines HIV Treatment and Care Recommendations: 1.Key populations living with HIV should have the same access to ART and to ART management as other populations. 2.All pregnant women from key populations should have the same access to services for prevention of mother-to-child transmission of HIV (PMTCT) and follow the same recommendations as women in other populations. 3

Consolidated Guidelines Prevention and Management of Coinfections and Co-morbidities Recommendations: 1.Key populations should have the same access to TB prevention, screening and treatment services as other populations at risk of or living with HIV 2.Key populations should have the same access to Hepatitis B and C prevention, screening and treatment services as other populations at risk of or living with HIV 3.Routine screening and management of mental health disorders (depression and psychosocial stress) should be provided for people from key populations living with HIV order to optimise health outcomes and improve adherence to ART. 3

Consolidated Guidelines Sexual and Reproductive Health Recommendations: 1.Screening, diagnosis and treatment of STIs should be offered routinely as part of comprehensive HIV prevention and care for key populations. 2.People from key populations, including those living with HIV, should be able to experience full, pleasurable sex lives and have access to a range of reproductive options. 3.Abortion laws and services should protect the health and human rights of all women, including those from key populations. 4.It is important to offer cervical cancer screening to all women from key populations. 5.It is important that all women from key populations have the same support and access to services related to conception and pregnancy care, as women from other populations. 3

Consolidated Guidelines Critical Enablers: 1.Laws, policies and practices should be reviewed and revised to work toward decriminalisation of behaviours and other unjust applications of civil law and regulations. 2.Countries should work towards implementing and enforcing antidiscrimination and protective laws, derived from human rights standards, to eliminate stigma, discrimination and violence. 3.Health services available and acceptable to key populations. 4.Programmes work toward implementing a package of interventions for community empowerment among key populations. 5.Violence against people from key populations should be prevented in partnership with key population led organisations. Monitor violence and establish redress mechanisms. 3

Global Guidance Group Check In Global Recommendations  Which of the Essential Health Sector recommendations in the global recommendations are most relevant to the sex work environment in this country?