AIDSTAR-Two: Addressing Challenges for Most-at-Risk Populations around the World

Vilma (in blue shirt) sharing HIV/AIDS prevention messages with others in her community. {Photo credit: MSH.}Photo credit: MSH.

Although Vilma and Chaker live on two different continents, come from two different cultures, and face their own unique challenges as persons at greater risk of being infected or affected by HIV, they have more in common than they might think. Both of them have faced stigma and discrimination, and both are now finding support through local organizations providing services to vulnerable populations and people living with HIV.

Vilma, 39, is a sex worker living in Honduras. At age 12, she ran away from home with the dream of making money to support the grandparents she was leaving behind. She joined a traveling circus and sold her body to men who were looking for sex. Eventually she ended up in Tegucigalpa, the capital of Honduras, working as a dancer and sex worker, engaging in high risk behavior such as sex without condoms, and struggling with drugs and alcohol. Her life changed when educators from the local organization Asociación Hondureña Mujer y Familia (Honduran Association of Women & Families, known locally as AHMF) came to a nightclub where she was working to train workers on how to protect themselves against HIV/AIDS.

Chaker, 31, lives in Tunisia where, as a self-identified gay man, he says he was forced to live in hiding and felt socially isolated. For years, he did not have anyone to talk to about his sexual orientation, behaviors, or risks, and he was not screened for illnesses or tested for HIV. Two years ago, a friend introduced him to the Association Tunisienne de Lutte contre les MST/SIDA (Tunisian Association for the Fight Against Sexually Transmitted Diseases and AIDS, or ATL-Tunis for short) where he has since found emotional support and access to health services. He has taken part in HIV prevention sessions, had his first screening, and has been tested for HIV.

Both AHMF and ATL-Tunis are supported through the global, USAID-funded AIDSTAR-Two project, which has been providing organizational capacity building support to HIV/AIDS implementing organizations since 2008, with an emphasis on management, leadership, governance, and HIV/AIDS technical strengthening.

In Honduras, where most-at-risk populations, including sex workers, men who have sex with men, and others, have HIV prevalence rates ranging from 4.4 to 9.9%, AIDSTAR-Two has been partnering with local nongovernmental organizations (NGOs) who serve these vulnerable groups. These NGOs promote prevention and health services to women like Vilma as well as to men, train them how to protect themselves against HIV/AIDS, and motivate them to visit health centers and get tested.

“The project has changed my life,” says Vilma. “They have taught me how to negotiate condom use and how to take care of myself as a woman; now I am a mentor, an example to all the others. I invite my friends and clients to get tested for HIV.”

In the last three years, with AIDSTAR-Two’s support, the six NGOs it is working with in Honduras have trained more than 4,400 people from most-at-risk groups to become leaders and mentors to their peers; the role of the leaders and mentor is to reach out to others to spread awareness, prevention, and health messages related to HIV/AIDS within their communities. Vilma is just one of 1,500 commercial sex workers trained as mentors who have benefited from AHMF’s interventions.

North Africa and the Middle East is one of the two regions in the world with the fastest growing AIDS epidemic, and sex between men reportedly accounts for nearly one quarter of all new HIV infections in the region. Coverage of prevention programs for most-at-risk populations in the region is low, and many countries have discriminatory laws and policies which are hindering an effective HIV response. Working through the Responding to Most-at-Risk Populations in the Middle East/North Africa (MENA) Region project, AIDSTAR-Two is supporting ATL-Tunis and seven other organizations in four countries – Tunisia, Algeria, Lebanon and Morocco – to strengthen health service delivery, build internal organizational capacity, and improve advocacy for increasing access to health services in locations where most-at-risk populations suffer from stigma and discrimination.

“In regards to HIV/AIDS prevention, I can easily get the information through various media sources such as the internet,” says Chaker. “But what attracted me the most to ATL-Tunis was their MSM program and the services it provides. ATL-Tunis represents a space of freedom and tolerance, where I could express myself freely. I speak freely and with ease about my sexual practices and can share my worries with other members of the gay community.”

The Responding to Most-at-Risk Populations in the MENA Region project has established outreach programs in more than 10 sites in the four target countries, which offer a package of combination prevention in accordance with U.S. government guidelines for HIV prevention. They also offer peer education, HIV testing and counseling, social support, and other services.

In addition to its work in Honduras and the MENA region, AIDSTAR-Two has provided direct organizational capacity building support to local HIV/AIDS implementing organizations in Guatemala, Mexico, El Salvador, Jamaica, Tanzania, Malawi, Namibia, Kazakhstan, Tajikistan, Kyrgyzstan, Vietnam and the Eastern European region.

Funded through the Global Health Bureau’s Office of HIV/AIDS, AIDSTAR-Two contributes to stronger and more sustainable, country-led HIV/AIDS programs, organizations and networks by offering systematic institutional capacity building assistance to local HIV/AIDS implementing organizations. Led by MSH, the project is supported currently by consortium partners the International HIV/AIDS Alliance and Save the Children as well as the Human Sciences Research Council in Durban, South Africa. Other partners in the AIDSTAR-Two consortium include Cardno Emerging Markets; Health and Development Africa; Initiatives, Inc.; and Religions for Peace. To learn more, visit