Prevention with key populations
Purpose
To contribute to enhancing the quality and scaling up of activities in HIV prevention, care and impact mitigation across national borders in sub-Saharan Africa.
Results
Increased levels of quality innovative initiatives that reach out to populations usually left out of activities in mainstream HIV responses.
Target populations
Men who have sex with men; sex workers; drug users; and border populations.
Geographic scope
Senegal – Kaolack, Thies, Diourbel, Louga, Tamba, Kolda, Ziguinchor, Dakar, Saint Louis and Matam.
Background
Alliance partners in high and low prevalence countries identified the need to reach vulnerable populations with comprehensive HIV and sexual health programmes in order to reduce vulnerability to HIV infection and reduce the transmission of HIV.
Alliance Nationale Contre le SIDA (ANCS) in Senegal has been piloting different approaches to reach key populations with comprehensive interventions. In Senegal, HIV prevalence amongst key populations is far higher than in the general population: 21.5% for MSM and 20-30% for sex workers, as compared to 0.7% in the general population (Enquete Demographique et de Sante du Senegal de 2005 (EDS-IV). ANCS and other civil society partners in Senegal have recognised that working with key populations to implement prevention, care and treatment programmes, is crucial both to meet the needs of these marginalised groups and in order to positively impact upon the future dynamic of the epidemic. Strong advocacy by ANCS and its partners has led to the recognition by government, donors, multilaterals and other key stakeholders of the importance of prioritising the implementation of wide-ranging and comprehensive interventions to meet the needs of key populations.
Alliance partners in other countries identified the same need, but faced difficulties in developing and implementing activities in the face of resistance from national and local government and communities. In
many countries, stigma and discrimination are particularly strongly felt against men who have sex with men, sex workers and drug users.
In Senegal, homosexuality is illegal and culturally and socially forbidden. Sex work is slightly more tolerated but interventions are still constrained by the legal and cultural context. Drug use is also illegal and the development of technically sound interventions is impeded by the need to avoid the perception of encouraging drug use.
ANCS has been implementing interventions for almost two years and the focus for the next 12 months will be on continuing implementation, documenting the impact and sharing lessons learned. It is expected that the lessons learned from these interventions will help partners in other countries facing similarly difficult legal and cultural environments to develop interventions to work with stigmatised and vulnerable populations and help mitigate the impact of HIV.
Project strategies
Working through partnerships:
ANCS works with community-based partners, providing technical and financial support to these organisations to implement quality activities that reach those most in need. These partners include associations of sex workers, organisations working with men who have sex with men, drug users’ groups and community organisations in the border areas. Interventions are designed based on participatory needs assessments and programme planning and to meet the specific needs of each group.
Increasing access to HIV information:
These projects provide accurate and comprehensive information to the different groups regarding HIV transmission and prevention. The information is shaped and delivered in a way that is most relevant to the individual. Information is delivered through general awareness campaigns, workshops, literature and peer education.
Training peer educators:
Educators from the associations are trained to work with their peers, to address HIV risks and to refer beneficiaries to relevant prevention, health and care services.
Identifying risk and tailoring appropriate responses according to the population: Interventions are designed to address the needs of the individuals. The risk for drug users is different from that faced by sex workers, border populations or MSM for example. Interventions help identify the nature of the risk – for example the link between HIV and drug use in terms of transmission but also to limit the risks after drug use.
Improving access to and capacity of prevention and care services:
This includes ensuring access to and promotion of condom use; referring clients to voluntary counselling and testing services and other services such as health care, livelihoods or home-based care. One important lesson is that one organisation cannot do everything and that coverage impact is increased if organisations work together.
Creating an enabling environment:
Stigma and discrimination are major barriers to access to services for vulnerable and marginalised populations. ANCS has joined together with other NGOs to form a body advocating to health services for increased quality of services for marginalised populations and helping to reduce stigma and discrimination within the health system. Addressing stigma and discrimination is a major feature of the ARP policy work which aims to create an enabling environment for HIV interventions across the region, and ANCS is one of the lead actors in this work. A module to address stigma and discrimination experienced by men who have sex with men has been developed for the ARP Regional Stigma Training Programme, drawing on the experiences of partners in Senegal and the region, and from the North Africa Regional Programme.
Policy and advocacy:
These programme interventions are supported by the policy and advocacy work of ANCS, which consistently promotes the importance of working with key populations with its community, national and international partners.
