Innovative Approaches to Providing HIV Services for Most-at-Risk-Populations

Innovative Approaches to Providing HIV Services for Most-at-Risk-Populations

Over 33 million people are currently living with HIV & AIDS throughout the world. Despite great strides in slowing the epidemic, there remains a stunning gap in prevention, care, and treatment efforts. This is especially true for most-at-risk-populations, which include commercial sex workers (CSWs) and their clients, injecting drug users (IDUs), men who have sex with men (MSM), and prisoners. People in these risk groups are so stigmatized and discriminated against in many countries that it becomes extremely difficult – sometimes impossible – to provide them with much-needed HIV prevention, care and treatment services. Even more, MARP behaviors often are illegal, which then compromises needed action and support from government authorities.

Denial of such basic human rights as access to prevention, care, and treatment for the most-at-risk-populations is unacceptable. It leaves those most in need underserved and severely marginalized. As World AIDS Day 2010 approaches with this year’s message of “Universal access and human rights,” I am reflecting on the specialized HIV interventions that MSH helps provide to most-at-risk populations.

At MSH, we have found it takes an innovative and integrated approach to deliver HIV prevention, care, and treatment services to most-at-risk populations. We work within at-risk communities to provide solutions and throughout the health system up to the Ministry of Health to promote strategies and programs that support access to prevention and care services for this underserved and vulnerable population.

The MSH-led, USAID-supported AIDSTAR-Two project exemplifies our approach to working with most-at-risk populations. The project works with local civil society organizations (CSOs) and Ministries of Health to improve access to and quality of HIV-related prevention, care, and treatment services to most-at-risk-populations. In Honduras, we are working to help local CSOs, and community leaders to increase their organizational and technical capacity to deliver quality prevention services to groups including men who have sex with men, commercial sex workers, transgender, and Garifuna. The project is also working to support these vulnerable populations in Eastern Europe, the Central Asia Region, Vietnam, Jamaica, and other parts of the world, with the support of the International HIV AIDS Alliance, an AIDSTAR-Two partner.

In Vietnam, the Supply Chain Management System (SCMS) project, funded by PEPFAR and led by the Partnership for Supply Chain Management, a nonprofit organization established by the JSI Research & Training Institute and MSH, is working with the Vietnam Administration for AIDS Control (VAAC) at the Ministry of Health to improve HIV & AIDS efforts in two critical ways: distribution and dispensing of drugs. In Vietnam, the HIV & AIDS epidemic is concentrated in three most-at-risk populations: commercial sex workers, men who have sex with men, and injecting drug users. SCMS is implementing the first PEPFAR-funded methadone treatment program in Vietnam which integrates addiction treatment with HIV & AIDS care and treatment for Injecting Drug Users. Through a pilot program, which started two years ago, 3,000 patients are on methadone treatment. After seeing the success of the pilot program, the government has set a new target - to have 80,000 people on methadone treatment by 2015. SCMS is working in partnership with the Government of Vietnam to design the scale up of this program.

In Guyana the GHARP II project, worked with the Guyana Business Coalition on HIV & AIDS prevention to reach companies in the mining and logging industries that often employ most-at-risk-populations. Through the same program, we helped strengthen the ability of the Ministry of Health and NGO partners to target most-at-risk-populations with programs that provide prevention, care, and support services, including encouraging clinics to stay open for longer hours so these populations can access quality services. GHARP II is also collaborating with the Ministry of Health’s National AIDS Program; so far they’ve trained 12 men who have sex with men peer educators to serve as outreach workers within the at-risk community.

To continue turning the tide of new infections we must redouble our efforts to the bridge the gap in access to HIV services for most-at-risk-populations. Doing so requires respecting the human rights of all people and working at all levels of the health system from community outreach to hospitals and from civil society groups to the Ministry of Health to provide targeted HIV services to most-at-risk-populations.

Jonathan D. Quick, MD, MPH is President and Chief Executive Officer of MSH. Dr. Quick has worked in international health since 1978, he is a family physician and public health management specialist.