Getting the architecture right: working out how best to deliver the comprehensive package of HIV prevention and care programs and services among key affected populations Lou McCallum Director, APMG

Where are we up to in the development of Comprehensive Packages for key populations? 2

MSM and TG

MSM

Sex workers 5

Drug users 6

Prisoners 7

y 8 Challenges Health system is isolated o Not an active partner o Not involved in outreach o Depends on donors to bring key populations in Creates long-term problems: o Hard to scale-up a sustainable system o Few links between different key population groups o Focused on numbers o Angry advocates o Like finds like People arent empowered HIV – Current Model and Challenges General Health System Donor Intervention IDUCSWMSMPrisonersMigrantsPLHIV Outreach

9 Strategy Quality improvement enhances outreach, and opens entry points Create demand, ensure supply Focus on long- term engagement Create demand – ensure supply CBO NGO Care Environment Entry Point

Models 10 Humsafar Trust, Mumbai – Mature MSM NGO – Has its own STI/HIV clinic as primary care and a feeder to mainstream services – Sub-population segmentation – Not duplicating government services – advocating and feeding in – Outreach to create demand – Mentor for emerging CBOs – Research arm

Models 11 PT Foundation, Malaysia – Serves MSM, TG, DU and SW – Good links with VCT and PLHIV services, government and private – Has its staff placed in these services to strengthen links, improve quality and acceptance

Balance 12 AIDS exceptionalism: We need specialist, stand- alone HIV services Integration: HIV is just another chronic illness and people need to use general health services

Key point 13 It is only by working out the most appropriate and sustainable connection between demand and supply The key is in the balance