1. High Coverage of Most-at-Risk Populations Reduces HIV Risk: Results from Central Asia Anna Deryabina, David S. Hausner, Bibigul Aubakirova, Yana Dobronravova, Saltanat Ashimova, Yelena Kudussova, Zarina Musaeva, Rakhima Nazarova, and Lev Khodakevich Global Health Council Conference Washington, DC 16 May 2010

2. Learning Objective To understand how to implement comprehensive HIV prevention services to vulnerable populations and to understand the value of doing so.

4. Expected program outcomes Knowledge: Increasing level of knowledge among vulnerable populations about HIV/STIs, ways of HIV transmission and prevention Behavior: Decreasing rates of highly unsafe practices among target groups Disease burden: Decreasing rates of HIV and STIs

5. Program Objectives To provide IDUs and sex workers with individual means of protection To provide information and education on HIV prevention To provide quality medical services when needed To decrease stigma & discrimination related to HIV and PLHIV

6. Main activities

7. Working with Partners Technical working groups were set up at every site Partnership was developed with local administrations, religious leaders, law enforcement bodies, and others Agreements were signed with medical institutions for the provision of medical services to clients

8. Training Service providers, journalists, law enforcement officers, religious leaders –1,571 people trained during 125 trainings

9. Drop-in centers for IDU Aksu, Kazakhstan Kurgan Tube, Tajikistan Almaty, Kazakhstan Karasuu, Kyrgyzstan

10. Drop-in centers for sex workers Osh, Kyrgyzstan

11. Outreach with IDU

12. Outreach with sex workers Osh, Kyrgyzstan

13. Development and distribution of IEC materials Brochures for clients Video clip for clients and general population Outreach guidelines for outreach workers

14. Referrals to medical services Detoxification STI diagnosis and treatment Treatment for injection-related complications VCT PMTCT

15. Drop-in Center Detoxication STIs treatment Treatment for surgical complications VCT PMTCT Outreach

16. Ongoing Monitoring of Coverage

17. Cumulative number of contacts with clients

18. Cumulative number of clients by month and type of contact

19. End-line evaluation

20. Behavioral Survey Design: Comparison of project and control sites at end-line Sites: 5 intervention and 5 control sites –IDUs: 3 intervention and 3 control sites –Sex workers: 2 intervention and 2 control sites Sample: 150–250 respondents per site –Respondent design sampling Timing: June 2009

21. Key Results: Sex workers

22. Condom use behavior IndicatorProjectControl Always used condoms with clients during the last month 79%60%60% Used condoms with the last client 91%69%

23. Diagnostic testing behaviors IndicatorProjectControl Had an STI test during last 6 months 69%36%36% Had an HIV test during last 6 months 57%29%

24. Knowledge about modes of HIV transmission IndicatorProjectControl Identified injecting drug use68%32% Identified sex94%70% Identified both injections and sex and had no misperceptions 47%47%20%20%

25. Key Results: IDUs

26. Injecting behavior IndicatorProjectControl Never shared needles and syringes during the last 6 months 95%95%60%60% Did not use someone else’s syringe during the last 1 month 98%98%71%71% Did not give a syringe to someone during the last 1 month 99%99%83%

27. Condom use and diagnostic testing behaviors IndicatorProjectControl Always used condoms during the last 12 months 46%27%27% Never had HIV test4%4%33%33%

28. Knowledge about modes of HIV transmission Indicator ProjectControl Identified injecting drug use96%58% Identified sex98%64%64% Identified both injections and sex and had no misperceptions 89%52%

29. Conclusion TUMAR achieved a high level of coverage in a short time period TUMAR clients had: –Higher levels of HIV knowledge –Lower proportion of reported needles and syringe sharing –Higher proportion of reported condom use –Higher levels of HIV testing

30. Acknowledgements Central Asian AIDS Control Project (CAAP) USAID All community partners in the 7 sites 8 local sub-grantees Outreach and Drop-in Center workers Clients JSI country staff in Central Asia