The Society for Family Health serves as a prime recipient for the Key Populations Programtitled, HIV prevention for Key Populations since 2011 with funding from USAID. With 7 sub-recipients predominantly KP-led organizations, the program is implemented in 6 sites – Keetmanshoop, Katima Mulilo, Windhoek, Oshakati, Walvis Bay/Swakopmund and Oshikango.
In Namibia, the data from the Integrated Bio Behavioral Surveillance Study (IBB SS) conducted in 2012/13 suggests HIV prevalence among Female Sex Workers (FSWs) was higher than females in the general population while prevalence among Men who have Sex with Men (MSM) was comparable to men from general population in regions studied except Windhoek were the prevalence was almost double that of men in general population.
The term Key Populations vs Most at risk populations
The term ‘key population’ has gained more popularity compared to the earlier term – Most at Risk Population (MARPS) that put together sub- groups that were determined to be at a higher risk of HIV infection by the nature of their behavior, lifestyle or circumstances. This new term is viewed as a more accurate and less stigmatizing description because it seeks to describe the risk factor as opposed to population groups.
In this way MSM or ‘men who have sex with men’ is more accurate than ‘Gay men’ because one could self-describe as Gay but not necessarily be engaging in high risk behavior. In the context of this KP program, populations that are referred to as key populations herein include, Men who have sex with Men (MSM), Female Sex Workers (FSW) and Transgender (TG) women.
Specific objectives of the program:
The core of KP program is case management which aims to provide holistic and comprehensive care to KPs including effective linkages to services. The Care Cascade ensures comprehensive management of clients seeking services and it enforces the 90-90-90 Global Strategy to reduce HIV Infections and death. This approach is implemented at all sites: Keetmanshoop, Windhoek, Walvis Bay/ Swakopmund, Oshakati, Oshikango and Katima Mulilo.
Through this process of case management, clients are provided with information about HIV awareness, risk reduction HIV Testing, enrollment on ART and other services, and facilitating a process to ensure they remain negative. Pre-Exposure Prophylaxis (PrEP) provision and HIV Self-Testing are added components to the program as part of the combination prevention approach.
The Key Populations program is helping to achieve the HIV epidemic control through the following initiatives
Highlight of Achievements:
The chart below indicates that KPs that tested between Oct – Dec 2017, only 159 (9%) out of 1,732 KPs tested. Of those that tested positive, 41% tested less than 12 months followed by 36% that tested 12 months ago, while 24% tested for the first time. This data illustrates that more efforts need to be made to find more KPs that have never tested with the purpose of ensuring that they are immediately linked to treatment and other prevention services.
HIV Self Testing
The graph below shows that over 7,000 KP received HIV Testing Services (HTS) during this period. However, the program will continue to find the best approaches to ensuring that those testing positive are immediately linked to treatment.
Access to HIV treatment
The chart below shows the number of KPs that were enrolled on ART against the target. Performance was below with 27%. Linkage to treatment following diagnosis pose challenges sometimes especially when HIV diagnosis was made through outreach services as clients need to visit the health facility for treatment. Delays in reaching the health facility and loss to follow up (inability to access the clients through mobile contacts provided or incorrect residential area), are some of the contributing factors in ensuring effective and prompt linkage to treatment. Also, ensuring that ART is provided on the mobile van would also increase linkage to treatment.
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