#IAS2017 @IAS_conference Access to Stigma-Free Healthcare Settings for Key Populations: Challenges and Opportunities Dr. R. Cameron Wolf Senior HIV/AIDS Advisor for Key Populations U.S. Agency for International Development IAS 2017 - Paris, France #DoingTheRightThing July 25, 2017
-Ambassador Deborah Birx, MD, U.S. Global AIDS Coordinator #IAS2017 @IAS_conference We know that if any one of our populations is left behind, if any one of us is left behind, all of us are left behind and we won t be able to control the pandemic.
UNAIDS, 2017 Better Understanding the Pandemic 44% 25% 80%
A Defined Comprehensive Package for Key Populations Condom and lubricant programming Harm reduction interventions Behavioural interventions HIV testing and counselling HIV treatment and care + PrEP Prevention and management of viral Hep, TB and mental health conditions Sexual and reproductive health interventions Supportive legislation, policy and funding Addressing stigma and discrimination Community empowerment Addressing violence Health Interventions Structural interventions Source: WHO Consolidated Guidelines for KPs (2016)
We Must Confront Stigma and Discrimination To Get to 90/90/90
#IAS2017 @IAS_conference
#IAS2017 @IAS_conference
#IAS2017 @IAS_conference While many people with HIV are now enjoying strong, healthy, full lives; urgency and collaboration are needed to ensure dignity, decency, and survival for the many more people living with HIV and key populations still struggling. GNP+ Executive Director, Dr. Laurel Sprague
Cameroon Thailand Uganda PNG. Jamaica Cote d Ivoire Viet Nam Guyana Malawi Ghana Namibia Dominican Rep Botswana Zambia Rwanda India Nigeria Ukraine Barbados Ethiopia Tanzania Angola DR Congo Mozambique Cambodia Burma South Africa Haiti Zimbabwe Kenya Lesotho Swaziland Guatemala Honduras Nicaragua Tajikistan Kazakhstan PEPFAR Implementation
PLHIV Stigma Index The PLHIV Stigma Index measures trends in S&D to promote action addressing stigma Administered by and for PLHIV, with strong involvement from Civil Society 10 years since its creation, 100,000 PLHIV have been interviewed in >90 countries With PEPFAR support in partnership with UNAIDS, the Revised PLHIV Stigma Index is being updated to reflect the new dynamics (i.e., treatment and PrEP) in the response and targeted sampling of Key Populations
Pilot PLHIV Stigma Index Data for Key Populations Senegal (n=100) MSM Uganda (n=37) Sex Workers Senegal (n=87) Uganda (n=130) Excluded from family activities 17% 11% 17% 9% Family members made discriminatory remarks 37% 24% 29% 27% Afraid to seek health services 24% 11% 12% 12% Avoided seeking health services 26% 14% 15% 8% Verbally harassed 44% 32% 40% 30% Blackmailed 33% 27% 41% 33% Physically harassed 28% 19% 28% 21% Forced to have sex 30% 16% 40% 32% Preliminary data from pilot testing the updated PLHIV Stigma Index, led by the Population Council through Project SOAR, in collaboration with UNAIDS, GNP+, ICW, and Johns Hopkins University.
Systems for Monitoring Human Rights
Building Partnership in Confronting Violence LINKAGES Thematic Advisory Group on Violence, Stigma and Discrimination Against Key Populations Prevention and Response to violence Consolidate best practice and guidance for responding to KP human rights abuse (building off HIV/AIDS Alliance / Elton John AIDS Foundation) Integrating violence prevention, detection and response systems into PEPFAR country programs and dashboards
Partners Sharing Tools for Violence, Stigma and Discrimination LINKAGES project and core partners
Baral et al., IAS 2017 #IAS2017 @IAS_conference Implementation Science presented at IAS: Integrated Stigma Mitigation Intervention Framework for Key Populations Peer-based approach Peer led groups sessions INTERVENTION COMMUNITY (Preclinical) Increase participants efficacy in preventing HIV infection CLINICAL Training of healthcare workers Reinforce cultural and clinical competency in service provision to key populations POSTCLINICAL (Web-based) Peer-to-peer anonymous referral system Information on health services and prevention STIGMA Reduction of perceived and anticipated stigma Reduction of experiences of stigma in health settings Reduction of individual stigma OUTCOMES Improve effectiveness of existing HIV services Increased uptake of these services by key populations Decrease in reported experienced and perceived stigma Increased consistent use of condoms and condom compatible lubricants Increased adherence to HIV treatment regimens Decreased community HIV viral load
Combining Assessment with Training Multiple curricula and tools for sensitization and clinical training have been developed and tested (Nyblade, HP+)
Integrating KP Feedback with Innovative Service Quality Monitoring System (SMS 2 ) Continual engagement to support behavior and attitude change pinpointing challenges for performance improvement & training (Health4All) Service Users KPs SMS messages sent to patients, peers, and HCWs with info on health services Service Providers Healthcare workers Outreach Workers/PE
Resources for Implementing Comprehensive HIV and STI Programs for Key Populations: Community Leadership in Responses
We Must Do Better Country has any Training Programme on Non- Discrimination Country has Done Training on Human Rights for PLHIV and KPs in Past 2 Years UNAIDS, 2017
PEPFAR Stigma and Discrimination Task Force Expert Consultation Nov 2 3, 2016
Summary There have been significant advances in measurement, stigma monitoring tools, methods and violence response systems Time to Scale Better feedback between KPs and care providers leads to Accountability & continuous quality improvement Full Community Engagement and Leadership leads to better impact across the cascade and better programs. Partnership, mutual respect and trust must be instilled between KP community members, CBOs, healthcare providers, allies and champions, and key decision makers Making the Impossible Possible -- The Time is Now!
#IAS2017 @IAS_conference Alison Cheng, USAID Tisha Wheeler, USAID Kent Klindera, USAID Noah Metheny, The Global Fund Stefan Baral, Johns Hopkins University Tonia Poteat, Johns Hopkins University Julie Pulerwitz, Population Council/SOAR Barbara Friedland, Population Council/SOAR Laura Nyblade, Health Policy+ Diego Solares, GH Pro Chris Akolo, FHI360/LINKAGES Hally Mahler, FHI360/LINKAGES Ben Eveslage, FHI360/LINKAGES