1. Module 4: Engaging KPs with HIV and SRH Services
Effective HIV & SRH Responses among Most at Risk Populations in Papua New Guinea
Module 4: Engaging KPs with HIV and SRH Services

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

3. Overview Introduce the concept of HIV, STI and SRH Continuum of Care
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
What are the needs of KPs living with HIV?

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

5. Continuum of Care The purpose of the Continuum of Care is to:
Link HIV and STI prevention services with the full range of SRH and other clinical and support services
Provide KPs with access to fair and appropriate STI and HIV diagnosis and treatment services linked to the full range of SRH services and care and support services for KPs living with HIV
Address HIV as a chronic disease and develop systems that provide humane, effective, high-quality comprehensive and continuous care to PLHIV and their families

6. HIV TREATMENTS CASCADE - CURRENT
Thinking Innovatively About HTC,
Treatment, Care and Support
HIV TREATMENTS CASCADE - CURRENT
KPs living with HIV
KPs with HIV 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
Proportion decreases

7. HIV TREATMENTS CASCADE - DESIRED
Thinking Innovatively About HTC,
Treatment, Care and Support
HIV TREATMENTS CASCADE - DESIRED
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%

8. How do we improve outcomes for KPs down the Treatment Cascade?
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

9. Thinking Innovatively About HTC, Treatment, Care and Support
KPs with HIV access testing
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.

10. Thinking Innovatively About HTC, Treatment, Care and Support
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.

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

12. Thinking Innovatively About HTC, Treatment, Care and Support
KPs with HIV are linked to treatment, care and support services
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.

13. Thinking Innovatively About HTC, Treatment, Care and Support
KPs with HIV start ART
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.

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

15. 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

16. End of Session
THANK YOU