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

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

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?

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.

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

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

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%

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

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.

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.

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.

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.

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.

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

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

End of Session THANK YOU