Effective HIV & SRH Responses among Key Populations Module 3: Engaging Key Populations with HIV and SRH Services

Module 4 Session 3 Engaging KPs with HIV and SRH Services LINKING PEOPLE TO SERVICES

Overview  Introduce the concept of HIV, STI and SRH Continuum of Care  Explore the the full range of SRH services and HIV Prevention, Testing and Counselling, Treatment, Care and Support services that contribute to overall health for KPs  Critically examine current achievements in reach, coverage and health improvement  Identify ways to improve health outcomes – HIV, STI, SRH 2

Continuum of Care 3 A Continuum of Care (CoC) is defined as a network of linked, coordinated prevention, treatment, care and support services provided by collaborating sectors.

The prevention and treatment cascade 3  A tool to help track genuine health outcomes for KPs rather than just activity  Measures how successful programmes are at reaching KPs, providing them with what they need and improving their health  Can assist in identifying and overcoming barriers and obstacles

The prevention and treatment cascade Number of KPs at risk of or living with HIV (population size estimate) % of KPs regularly accessed with BCC & condoms % of KPs regularly visiting HCT/STI services % of KPs who know their HIV status % KPs with HIV who commence ART % of KPs with HIV with viral suppression KPs living with HIV All KPs

Improving health outcomes for people living with HIV 3 HIV TREATMENTS CASCADE – CURRENT SITUATION Proportion decreases KPs living with HIV % KPs with HIV who access testing % KPs with HIV know and understand their result % KPs with HIV are linked to treatment, care and support services % KPs with HIV start ART % KPs with HIV maintain viral suppression

HIV TREATMENTS CASCADE - DESIRED 3 Improving health outcomes for people living with HIV KPs with HIV maintain viral suppression KPs with HIV access testing KPs with HIV know and understand their result Of the KPs living with HIV KPs with HIV are linked to treatment, care and support services KPs with HIV start ART 100%

3 GROUP ACTIVITY THE TREATMENT CASCADE How do we improve outcomes for KPs down the Treatment Cascade? Each group allocated one level of the cascade Identify key barriers to achieving higher proportion of KPs at this level Identify key strategies for removing barriers Report back

 Not enough sex workers, MSM and transgender people and people who inject drugs know their HIV status  HTC services need to be accessible, KPs friendly, safe and confidential, linked to ongoing HIV treatment and support  Laws that prohibit sex workers with HIV from working act as a disincentive for testing  Breaches of confidentiality can lead to violence, expulsion from community, arrest, death  Lack of a sense of future act as a disincentive to knowing HIV status. 3 Thinking Innovatively About HTC, Treatment, Care and Support KPs with HIV access testing

Methods of delivery  HTC services can be provided in a variety of settings:  Mobile community outreach  Health facilities  Drop-in centers  Bars, clubs and brothels  Homes or households  Finger-prick blood sample or mouth swab are preferred collection methods because:  Methods can be performed by a trained outreach worker  May be more acceptable to people who have injected drugs and have difficulty with venous blood access or have concerns about drug use disclosure. 3 Thinking Innovatively About HTC, Treatment, Care and Support

 Meaningful knowledge of HIV status – telling a person their result does not mean that they know and understand its meaning  Testing services need to be directly linked to ongoing support so newly-diagnosed sex workers are not lost to follow-up  This requires HIV peer support, counselling, case management  Diagnosis can trigger increase in drug and alcohol use, depression – need to ensure access to services  Information needs to be reinforced – build a sense of future. 3 Thinking Innovatively About HTC, Treatment, Care and Support KPs with HIV know and understand their result

Thinking Innovatively About HTC, Treatment, Care and Support  There is often a gap between people being diagnosed and then getting on to ARV treatment  This gap is life-threatening  Peer support needed to assist newly-diagnosed people to access treatment, care and support services  Late HIV diagnosis often means that ART needs to be started at HIV diagnosis  Fear, as testing may be anonymous but treatment is not  Health system can be bureaucratic, hostile – need advocates. 3 KPs with HIV are linked to treatment, care and support services

Thinking Innovatively About HTC, Treatment, Care and Support  Advocacy needed to ensure KPs can get onto long-term ART programmes  Problems with accessibility of treatment – needs advocacy  Need TB and OI prevention, diagnosis and treatment  Need flexible arrangements around supply of ART – flexible clinic hours, flexible appointments systems for people running low on supplies, supply tracking and follow-up mechanisms 3 KPs with HIV commence ART

Thinking Innovatively About HTC, Treatment, Care and Support  Sustained low viral has health and HIV prevention benefits  Long-term adherence is supported by ­ Treatments literacy ­ Access to peer support ­ Stable care and case management team  Other parts of the person’s life need to be supported to assist in maintaining health: ­ Safe and secure housing ­ Good nutrition ­ Financial security ­ Mental health ­ Absence of violence and fear, sense of purpose and future 3 KPs with HIV maintain viral suppression

Needs of KPs Living with HIV Health Needs Voluntary counseling and testing ART and clinical services Contraception and assistance with planning pregnancies Reproductive health Livelihood Needs Assistance (without coercion) with exit options from sex work Microfinance Vocational training Community Support Needs Family support Access to community care service Safe and secure housing Good nutrition Absence of violence HIV Prevention Needs Access to condoms and lubricant STI prevention and treatment Assistance with disclosure of status PMTCT if diagnosed with HIV during pregnancy