Session Summaries from AIDS 2018 on Key Population

Posted by Maria Codina on July 30, 2018 at 4:31 pm



#PassTheMic: Meaningful youth participation in the fight against HIV

Author: Resty Nalwanga

Session Summary

What is meant by meaningful youth participation (Challenges faced by young people in accessing HIV & SRHR services) Sharing experience from Amsterdam youth force to break barriers hindering young people getting involved in meetings that benefit their health and integration

Session Highlights 

Meaningful participation of young people means more than asking their opinion at the beginning of designing of programs. Youth-friendly psychosocial groups and peer support should be funded as they have pulled many young people in for services and empower them. Youth are pillars of the future nothing about us without us. Some of young people don’t disclose their HIV status due fear of denial, while many of their peers still do not understand stigma faces by people living with HIV. Supporting meaningful youth participation means addressing several aspects that might influence that participation – financial, spiritual, physical, mental. Towards the end of the session, the moderator asked whether people agree that HIV is no longer a priority and teenage pregnancies should have more focus. Panelists saw too great affects and presence of HIV to deprioritize it and pointed to comprehensive responses required – young people are diverse with diverse needs.

Critical Assessment 

Young people are involved at national and international levels. Ambassador Deborah Brix was interested in the panel and also asked how young people should be involved at local level and who should be engaged – it is at grass-roots where young people are doing much actual work and make a difference. The panel concluded with recommendations to invest more in young people, trust their work, consult young people of all ages without discrimination of their gender diversity when designing guideline, bring in young people at local level, build capacities of young people to lead, be transparent and work with them.

 

Protecting people who migrate in countries of origin, transit, and destination

Author: Melania Trejo

Session Summary

This session explored issues around human mobility and the different vulnerabilities to HIV. It also looked at the need for intersectoral cooperation to be able to deliver good services; the consequences of inequality when addressing migrant needs; and the longer-term implications for health systems at recipient countries.

Session Highlights 

  • We are witnessing the greatness mass migration after WW2.
  • Political mechanisms exist to promote cross-border collaboration and reduce health concerns. Particularly, the Global Compact on migration, expected to be approved this year, links migration with global health processes -consistent with the 2030 Agenda.
  • From the richest country to the poorest, there’s pressure about resources and question how to mitigate the resource issue to health systems in recipient countries?
  • Global Fund ED recognized that GF allocation model doesn’t take into account rapid-changing environments with acute need, however, it is currently supporting programs for Burundian refugees; Rohingya, and migrants in Algeria, as well as Syrian refugees in Middle East with US$32 million (additional US$36 million expected for the next phase).
  • Venezuela was pointed as a challenging situation that requires intersectoral collaboration, with a collapsed health system and great numbers of people with HIV crossing borders.

Critical Assessment 

We need to work harder to change the narratives around human mobility, which are contributing to stigma and xenophobia, disproportionally affecting migrants with “irregular” legal status everywhere in the world. “Migration is not a problem to be solved, is a reality to be managed!”, as mentioned by Marc Biot, MSF. A second reflection and criticism to the conference organizers: Where are the migrant community champions and why aren’t their voices represented in this panel? Specially knowing that there are many whom are living with HIV and TB participating in this conference [as pointed out by the audience].

 

The new high risk populations: Who are they?

Author: Tonia Poteat

Session Summary

Emerging data were presented on reducing stigma against key populations in health services in Malaysia, use of gay social networking apps in China, extended risk networks HIV testing in Ukraine, timing of HIV acquisition among sub-Saharan migrants in France, and substance use among MSM in the U.S.

Session Highlights 

Peer case management approaches and sensitivity training at government clinics in Malaysia successfully reduced stigma against key populations. Men using gay social networking apps in China are more likely to test for HIV than non-users and demonstrated a trend toward lower HIV prevalence. Machine learning algorithms to improve HIV case finding among PWID in Ukraine were 83% accurate in predicting which seeds would recruit someone living with HIV; and the best predictor of such recruitment was network size, not the HIV status or vulnerability of the recruiter. Social vulnerabilities experienced early after migration to France are responsible for increased HIV vulnerability prior to settlement; however, migrants who are infected after being fully settled in France have increased risk likely related to local sexual networks. Young Black MSM in the US experience elevated STI prevalence compared with other racial groups despite lower HIV risk behavior (eg. substance use and sexual behavior).

Critical Assessment 

Despite a title suggesting that new key populations would be discussed, the session provided data on known key populations. The strength of the session was the provision of data from regions that get less attention in the HIV response (eg. Malaysia) as well as information on emerging technologies (eg. machine learning) that can improve the ability to reach hidden populations with HIV interventions. The Q&A included a robust discussion of the lack of presentations about transgender men and the need for the conference and researchers more broadly to include data on HIV among this population.

 

Key population-led health services: Optimizing prevention and care

Author: Pedro Carneiro

Session Summary

This session described key population community-led strategies implemented in diverse settings around the world to engage KPs in HIV prevention and treatment services. It underscored the message that communities are best served when those providing the HIV prevention and treatment services are part of these communities and look like them.

Session Highlights 

With a message of “chase the virus, not people”, Svetlana Moroz spoke about the barriers to care PWID face in Eastern Europe/Central Asia. Alicia Kruger spoke of the transgender paradox in Brazil, a country with liberal social policies, yet alarming murder rate of trans people. She discussed inclusion of trans people in decision making and described how Brazil is ensuring their well-being. Margaret Hellard spoke of the need to implement changes in the healthcare system to allow professionals to expand their roles, and increase community participation. Pongthorn Chanleunr (Thailand), described how KP-led services have increased outreach and yield better results than facility-based services. Paula Simonsen, a holistic health practitioner from Norway, reminded us that we must address not just the physical body but the whole being. Dr. Phan reported on the incredible progress Vietnam has made into including KP-led services into their national strategic plan.

Critical Assessment 

This session highlighted the importance of KP-led services in enhancing the prevention and care cascades. Whether developing campaigns and guidelines in Brazil or providing direct services in northern Thailand, KPs have the potential to significantly impact their communities and expand the reach of healthcare to their peers. Governments can and should be more inclusive of KP-led services to ensure that offered services are necessary, appropriate, effective, sustainable and acceptable to the communities they serve.

 

Girl or Gurrl: A tale of a south Asian young man who has sex with men and his risk-taking behaviour in Sydney, Australia

Author: Cindy Amaiza

Session Summary

Key populations and Risky behaviors predisposing them to Hiv infection.

Session Highlights 

He is born in Bangladesh raised in a muslim family that forbids display of affection or attraction let alone to a man. He has one role only in this life to find a wife and make babies live happily ever after. Moving to Australia a modern city his dreams come true to express himself as gay but in such a city money to pay tuition fee, rent and living expenses is required. He rans to the bright city lights of Sydney where men pay well for sexual services but he has to compromise if he wants extra dollars. He takes the risk, more money for no condoms with various clients. He predisposes himself to drugs introduced by clients just to live a better life. Mahee Haque uses story telling to pass a message on how immigration and poverty are the main reasons that predispose humans to HIV acquisition.

Critical Assessment 

Immigrants and poverty-stricken individuals are at a higher risk of acquiring HIV for this reason programs should be able to curb prevention for immigrants who would risk their health to get a chance to live quality life.

 

Leaving no one behind: Stigma interventions for youth

Author: Jenelle Babb

Session Summary

The session presented the outcomes of Project Shaan, implemented by the Indian NGO, GAURAV. The project aimed to: reduce HIV-related stigma among health providers, facilitate an enabling environment amongst duty bearers and support social mobilization in support of the LGBT and sex worker communities.

Session Highlights 

GAURAV supports HIV prevention, health and rights of young LGBT and young sex workers including through their group, Rainbow Tigers. This is a platform across India that provides a safe space and networking zone for the LGBT and sex work communities while carrying out advocacy to shift negative public attitudes.
LGBT youth in Maharashtra, India, are disproportionately likely to be HIV positive and face distinct challenges. Understanding the unique socio-cultural issues and how they relate to HIV risk could maximize prevention efforts.
Programme strategies and objectives include to: increase access to justice; reduce stigma and discrimination through capacity building of youth community leaders; advocacy and networking with law enforcement officers; advocacy with and orientation of health care workers; youth community mobilization; awareness sessions with educational institutions; sensitizing and engaging media and mass communication sectors.

Critical Assessment 

The session offered up useful information on GAURAV’s programme experience on multi component approaches to preventing and responding to stigma and discrimination faced by young LGBT and young sex workers. The presentations focused on what was done (activities) rather than processes, outcomes or lessons learned. All of these would have been valuable additions. As the session was poorly attended there was also no audience interaction to provide other opportunities to draw out this information.

 

Leaving no one behind: Stigma interventions for youth

Author: Cindy Amaiza

Session Summary 

Activism advocacy and self care

Session Highlights 

In an era where activists are required to be be effective in mobilizing a global response to AIDs and facing personal challenges, limited resources, education and high workload they rarely get time to go off activism and if these situations are not carefully navigated they are prone to burn out.The panelists,Ms Bakita Kasadha,Vuyiseka Dubola and Abheena Aher who are all activists in different communities shared different innovative strategies for self-care to prevent burnout which include setting personal space, trainings, out of reach days, forgiving yourself for not doing everything, saying no,inclusion of community in making self care decisionsand having positive mentors that can monitor you both professionally and personally . It was advised that structures need to be put in organizations to ensure activists are not judged when taking time for self care.

Critical Assessment 

Self care is not selfishness but self preservation and that is active political warfare.

 

Global Village – 26th July Daily update

Rapporteur Name: Dezio Macheso

Summary of the Conference Day

The sessions for the day touched on three themes: Unsuitability of HIV interventions to key populations, use of evidence in programming and financing of HIV interventions

Highlights of the Day

Regarding marginalization of key populations, session “Defining the 4th “90”: Quality of life –The role in determining outcomes and person-centered interventions” provided a platform where the three 90s approach was challenged to be less sensitive to key populations. The discussion provided evidence which support the need to add a fourth 90 which represent quality of care.
The second major theme for the day’s session was use of evidence in targeting population and in shaping intervention for such groups. Sessions “Theory in practice: Combining new methods and data for HIV prevention” “Precision programming: Using data to deliver the right program to the right people” provided opportunity for discussions on the current practices and recommendations for improvements. An example was given on how the DREAMS program supported by PEPFAR targets adolescent girls. Regarding using data to constantly refine programs, it was highlighted that the DREAMS project has been successful in many ways. However, data show that coerced sex/sexual violence is one of the issues that may have to be dealt with.
On financing there are a number of issues. The first is that more resources are need to sustain and make more gains in the fight against the HIV AIDS epidemic. While more resources are needed, funding levels of flattening and in some cases going down. A study by ViiV established small organization with budgets lower than 10,000 USD are the once mostly affected with funding cuts compared to big organization that have 50,000 and above. In the spirit of SDGs which emphasizes domestic financing, some countries like Kenya are reported to be advanced in increasing domestic resources for HIV. The case of Kenya, which was said to be similar to south Africa, provides hope to many other countries that it is possible to finance HIV AIDS programs using domestic funds. The Global Fund is still there, however it is reported to be in need of between 15 to 18 Billion USD just to get to on track. As a result, some discussion touched on how other countries are transitioning from the imminent withdrawal of global fund.

Critical Assessment 

Regarding dwindling of resources for HIV , there is little or no mention on why there are the budget cuts, and where is the allocation which was going to HIV is now going to. Such knowledge would assist in the thinking of multi-sector collaboration, or integration and linkages, stimulate thinking in which HIV programs could be mainstreamed. For instance, in Uganda there is a model called community health entrepreneurs who are said to effective than would underpaid government health care workers. It therefore means that if funding is going to support entrepreneurship for instance, programmers would strategize possible package of HIV which could aligned to that.
Secondly, even though domestic financing is a way to go, it should be a concern that key populations would not be prioritized in HIV programs, due to existing evidence and the fact that key populations are mostly served by non governmental organizations. There is therefore to ensure that the key population in covering in future funding arrangements.
The presentations were generally good, with rich evidence which was easy to understand which could be scaled up or adapted to many locations.

 

‘Nothing about us without us’: Advancing human rights for key populations’

Author: Sandra Hsu Hnin Mon
Session Summary 
Session Highlights
Critical Assessment