HIV and Sexual reproductive health integration: reaching adolescents and young people. What does this (the above) look like for key populations. JIM, IRENE FRIDAY
Presentation Outline Definition of Terms Introduction SRHR in Nigeria What you need to know about adolescent FSW, MSM & PWID Strategic area of work Expected contribution Integration Service Provision Strategic objectives and actions Conclusion
Definition of Terms ASRH Adolescent Sexual and Reproductive Health SMC Safe Male Circumcision AKAP Adolescent Key Affected Population FSW Female Sex Workers MSM Men who have Sex with Men PWID People Who Inject Drugs
SRHR In Nigeria SRHR programs in Nigeria in the last couple of years have predominantly targeted adolescents and youths. These efforts have yielded reports of significantly improved SHRH awareness among people in this targets group but little increased access to SRH services. No intervention addressing the sexual and reproductive health needs of key population.
What do you need to know about adolescent FSW, MSM and PWIDs. Findings showed that most KPs start engaging in high-risk behaviors during their adolescent years. However, initiation into protective behaviors such as condom use, start two to three years later on the average. Apart from possible exposure to HIV during this condom lag (i.e. the gap between first sex and first condom use), further analysis indicates that the likelihood of eventual condom use decreases as the gap grows wider Findings also show that some AKAP may be found in schools. More than half of AKAP were students while among FSW, MSM and male PWID, 29%, 32% and 13% were students.
What do you need to know about adolescent FSW, MSM and PWIDs. A number of AKAP also reported having social networking accounts to look for partners. More than half of AKAP have at least one social networking account used to look for partners. Further findings on an average showed that among AKAP, 65% still go to cruising sites to find male partners. Among adolescent FSW, 51% go to bars and clubs, and 40% go to streets, hotspots, brothels and bunks to find paying partners. Almost half of AKAP are having anal sex and condom use is way below target Knowledge about HIV and perception of risk is low AKAP have the lowest access to prevention commodities and services Less than 15% of AKAP know their HIV status
STRATEGIC AREA OF WORK To create a conducive environment for SRHR for adolescent key population, the following strategies are required: Advocacy for legal, policy and program development and sustainable funding KAP specific studies implementation research, cost and benefit analysis, quality of care research and clinical trials - to advance evidence based program development Monitoring and evaluation Pre-service and in-service training and sensitization of stakeholders including users/clients Media training for public awareness and support.
INTEGRATION SRHR should be integrated into the plan of action which is intended to be a road map for implementation. The plan should focus on not limited to the following areas: Integration of Sexual and Reproductive Health (SRH) services into One Stop Shop, primary health care & other virtual and non virtual outlets. Repositioning family planning, Developing and promoting key population friendly services Unsafe abortion Quality safe motherhood Resource mobilization Commodity security and Monitoring and evaluation.
EXPECTED OUTCOME An integrated SRHR and HIV/AIDS programming for key population will lead to: Reduction in new HIV infections Increase in male involvement Reduction in gender based violence Reduction in unsafe abortions Reduction in maternal mortality Reduction in neo-natal and infant deaths Reduction in mother to child transmissions Increase in voluntary couples HCT Increase uptake of SMC
SERVICE PROVISION Services should help adolescent Key population: Learn their HIV status and access services Promote safer and healthier sex Learn reproductive cancer status and access services Promote combination prevention Optimize connection between SMC and HIV
STRATEGIC OBJECTIVES AND ACTIONS 1. Advocacy and policy dialogue Key advocacy and policy dialogues in the area of policy reviews, sustainable funding and to ensure the participation of the private health sector. 2. Research, monitoring and evaluation To ensure evidence-based program development and utilization of operations, research, monitoring and evaluation have been identified as key to strengthen the integration process
STRATEGIC OBJECTIVES AND ACTIONS Cont. 3. Training Pre- and in-service training is very important for delivering quality integration. Key personnel to be trained are health providers. Training should focus on how to be adolescent friendly and key population friendly. Prejudices and bias need to be addressed. 4. Service provision Integrated services provision at identified strategic locations within various public and private facilities is key. These include promoting community based service provision through NGOs. Tagged service provision can increase stigma and reduce service use. 5. Strategic partnerships Partnerships to include development partners, CSOs, NGOs, CBOs, and the media among others. Key populations have their strategic presentatives. We need to be included at programme conceptualization stage NOT invite us to endorse your programmes.
CONCLUSION Adolescents need to have access to interventions to halt the growing HIV epidemic. Adolescent key population have their peculiar differences from other adolescents. When training on adolescent friendly services, these differences need to be highlighted and effectively managed. Key populations need to be actively engaged when planning and implementing for us. We however need our capacity to be built so we can engage actively. Invest in our capacity building.
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