1. Building Awareness for Action Why MARPs Matter and What Matters for MARPs An Assessment of Policy toward Most-at-Risk Populations (MARPs) for HIV/AIDS in West Africa A. Dutta, M. Maiga, C. Fung, L. Kapesa ICASA Session MOPDC01

2. Action for West Africa Region II AWARE II Region: 21 Countries in West Africa AWARE II Key Priorities include: Identify, involve, and respond to needs of most- at-risk populations (MARPs) for HIV/AIDS This presentation introduces a major report: Dutta, Modibo, et al. (2011)AWARE-2, Accra: Ghana

3. Who are the MARPs in West Africa? Most-at-risk – Risk of getting infected with HIV (if HIV-negative) – Risk of transmitting HIV (if HIV-positive) – Based on HIV prevalence rates and data on sources of HIV incidence – Key populations for HIV policy Three key MARP groups of West African relevance : 1.Female Sex Workers (FSWs) 2.Clients of female sex workers (clients) Includes truckers, migrants, men in uniform, students, etc. 3.Men who have Sex with Men (MSM) When present in AWARE II countries: 4.Injecting Drug Users (IDUs)

4. Why MARPs Matter: Importance to HIV Policy Established importance: Prevention Prevention for MARPs is essential to reducing incidence in the region Mixed epidemics: 16/20 countries Concentrated epidemics: 3/20 countries Resource allocation and targeted interventions are key Heterogeneity within MARPs and barriers to reaching MARPs, including stigma & discrimination (S&D), must be appreciated Emerging importance Care & Treatment Size and vulnerability of MARPs means a focus on them in HIV policy can help reduce overall morbidity/mortality MARP groups often large HIV prevalence higher than general population in AWARE II region Substantial care & treatment needed among MARPs Social marginalization, stigma and discrimination lead to clandestine living, creating a barrier to accessing care & treatment

5. What matters for MARPs: Policy change Formal Policies and Policy Implementation for MARPs: Framework Analysis Policy input: A specific area of HIV-related policy that has a bearing on MARPs Laws and Regulations (Formal Policies), Interventions (related to Policy Implementation) Individual/Direct: 7 policy inputs Individual/Indirect: 6 policy inputs Structural/Direct: 7 policy inputs Structural/Indirect: 4 policy inputs Data Collection and Analysis Secondary data from 20 AWARE-II countries Issue, Background, Data, & Conclusions analyzed for each policy input Allocated HIV prevention resources for MARPs analyzed: AWARE II region vs. other sub-Saharan countries (data: UNAIDS)

6. Conclusions Is prevention in the region responsive to importance of MARPs? NO Inappropriate and inadequate at individual and structural levels Promising interventions : Small scale and not combined for synergy Community approaches : Untried Resources for MARPs: Proportionally inadequate Need to tackle stigma & discrimination (S&D) Is treatment/care responsive to the needs of MARPs? NO MARP-friendly services that work within the constraints of S&D are Lacking (or) Adopt ‘verticalization’ and/or are at small scale Targeted programs for FSW; few for MSM Do govts. recognize the importance of MARPs in HIV policy? MIXED Punitive laws hamper interventions with MARPs Government policy often contradictory