1. Effective HIV & SRH Responses Among Sex Workers and other Key Populations Module 3: Engaging Key Populations with HIV and SRH Services

2. Session 4 Engaging Key Populations with HIV and SRH Services PREVENTION AND TREATMENT CASCADES

3. Overview  Explore the relationship between the full range of SRH services and HIV Prevention, Testing and Counselling, Treatment, Care and Support services  Look at innovative ways to strengthen linkages between services  Discuss needs of people living with HIV from Key Populations

4. Number of people in Key Populations Number accessed regularly with BCC and means of HIV prevention Number of KPs who access testing Number of KPs who know and understand result Number of KPs with HIV who are linked to treatment, care and support services Number of KPs with HIV who start ART Number of KPs with HIV who maintain viral suppression HIV Prevention & Treatment Cascade 90% of all people with diagnosed HIV will receive sustained ART 90% of PLHIV on ART will have viral suppression PLHIV

5. HIV Prevention & Treatment Cascade KPs with HIV maintain viral suppression KPs with HIV who 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 90-100% Desired HIV Treatment Cascade

6. HIV National Overview

7. GROUP DISCUSSION The Prevention And Treatment Cascade How do we improve outcomes for KPs down the Cascade? Identify the key barriers to achieving higher proportion of key populations at this level Identify key strategies for removing barriers Thinking Innovatively About HTC, Treatment, Care and Support

8. Thinking Innovatively About HTC, Treatment, Care and Support Outreach programs often only reach a small portion of the total Key Populations Some sub-populations are reached more easily, more often –Sex workers in registered entertainment establishments rather than street-based or informal –MSM who identify and will attend a drop-in centre rather than those who are less identified Some outreach is not linked to testing Number accessed regularly with BCC and means of HIV prevention

9. Thinking Innovatively About HTC, Treatment, Care and Support  Not enough sex workers, MSM and transgender people 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 KPs accessing HIV testing

10. Methods of delivery  HTC services can be provided in a variety of settings:  Mobile community outreach  Health facilities  Drop-in centres  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 Thinking Innovatively About HTC, Treatment, Care and Support

11.  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. Thinking Innovatively About HTC, Treatment, Care and Support KPs know and understand their result

12. 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 and hostile – need advocates KPs with HIV are linked to treatment, care and support services

13. 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 KPs with HIV start ART

14. Thinking Innovatively About HTC, Treatment, Care and Support  Sustained low viral has health and HIV prevention benefits  Long-term adherence is supported by ­Treatment 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 KPs with HIV maintain viral suppression