Transcript Slides - View the full AIDS 2016 programme

LINKAGES
Mind over matter: Addressing Health
Care Workers Services for Key
Populations
What This Session Looks Like
Time
Topic
11h00 - 11h15
Welcome and overview
Chris Akolo
Why focus on key populations?
Barriers to key populations accessing Kate Stratten
services
11h15- 11h:30
11h:30- 11h:40
11h:40 – 12h:00
12h:00-12h:20
12h:20 – 12h:30
Present top 10 clinical standards of
care for key populations
Small group work – clinical standards
of care per key population and
discussion
Introduction to Gender Based
Violence
Large group exercise- In Her Shoes
and debrief
Questions and closure
Facilitator
Chris Akolo
Chris Akolo, Kate
Stratten, Robyn
Dayton
Robyn Dayton
Chris Akolo
What You Will Learn From This Session
• The top ten standards of clinical care for KPs
and the importance of a KP-friendly clinic
environment
• Why it is important for health care workers
to address gender-based violence
Why Focus on Key Populations?
• Very high burden of HIV
• Poor access to services
• The communities face huge stigma and
discrimination even from HCWs
• Effective and evidence-based interventions are
available to combat HIV among KPs
• Human rights apply to everyone, equally, regardless
of gender, sexual orientation, means of earning a
living, sexual practices, drug use and any other
behaviors
High HIV Prevalence Among MSM Across all the
Regions of the World
Source: Beyrer, C., Baral, S. D., Griensven, F. et al, . (2012). Global epidemiology of HIV infection in men who have sex with men.
Lancet, 380(9839), 367-377.
Stigmatization in the Healthcare Setting
• Stigma, discrimination, and ignorance among health
care providers are a barrier to key populations (KPs)
accessing HIV services, even when available
• The different forms include
– Stigmatization by HCWs of KPs accessing services
– Stigmatization by HCWs of colleagues who are
themselves KP members or who are HIV positive
– Stigmatization by KP members receiving services
from HCWs who are themselves KP members
(confidentiality issues)
Addressing Stigma through Training of
Health Care Workers
• In 2015, the USAID-funded LINKAGES project
commenced the development of a training
manual
• Aim: To build the capacity of HCWs to provide
quality, respectful HIV services to KPs with a
focus on the top ten clinical standards of care
• The curriculum will be used to provide training
of HCWs in a non-judgmental, supportive,
respectful, and responsive manner
Barriers to Key Populations
Accessing Services
Barriers to Accessing Services
• Lack of relevant risk assessment by providers
• Failure to offer necessary physical exams
• Stand-alone HIV services do not meet key
populations holistic health care needs
• Discriminatory attitudes of health care
providers
• Providers’ gossip about key populations’
sexual behavior and gender identity
Barriers to Accessing Services
• Fear among key populations and service
providers of legal ramifications in countries
where they are criminalized
• Fear of being lectured to
• Refusal to provide HIV services
• For transgender people, being mis-gendered
• Not feeling safe in clinics
LINKAGES Health Care
Worker Training Guide
Health Care Worker Training Guide
Module 1 – An Introduction to Key Populations and HIV
• Know your epidemic
• Why focus on key populations?
• Gender and social norms
• Sex and sexuality
• Violence against key populations and human rights
Module 2 – Hearts and Minds
• Beliefs about key population groups
• Our own values, judgements and opportunities to
challenge stigma
• Forms, causes, layers and effects of stigma
Health Care Worker Training Guide
Module 3 – The Top 10 Clinical Standards of Care for Key
Populations
• Top 10 things you can do in your practice to provide quality
services for KPs
Module 4 – Facility and Community Action
• Planning for action in your health facility
Top 10 Clinical Services
1.
2.
3.
4.
5.
6.
7.
8.
9.
Creating a Welcoming Clinic Environment
Promoting Mental Health
Harm Reduction for Substance Abuse
HIV Testing Services
HIV Prevention
HIV Care and Treatment Services
Sexually Transmitted Infections
Tuberculosis Screening
Viral Hepatitis Screening and Prevention
#10 for each Key Population
Female Sex Workers
• Sexual and reproductive health , cervical-anal cancer
screening, eMTCT
Men Who Have Sex With Men
• Male circumcision, Anal STI screening, and anal cancers
Transgender People
• Transition related health care and other drug interactions
People Who Inject Drugs
• Harm reduction, including provision of clean injecting
equipment, (OST), naloxone distribution, wound care and
treatment, drug interactions
Activity
• Break into groups according to color of post it note
• Each group will discuss the clinical standards for a
specific key population
• Answer the following:
• What support do providers needs to introduce
and sustain these standards of care?
• Share responses (2 min per group)
Health Care Workers’ Role in
Addressing Violence Against Key
Populations
What is Health Care Staff’s role in Addressing
Violence Against Key Populations?
Violence
• Increases HIV risk a,b,c
• Decreases testing uptake and disclosure d,e,f
• Decreases adherence to ART g,h
• Causes a host of health issues
• Is often a higher priority than HIV for KPs
a. UNAIDS, 2010a b. Decker, et al. 2013 c. Beattie, et al., 2015 d. Gari, et al. 2013 e. UNIFEM, 2011
f. UNAIDS, 2010b g. Schafer, et al. 2012 h. Mugavero, et al. 2006
Appropriately Responding to KP Survivors is
Vital and Possible in Health Care Settings
• Health care workers’ response matters
• LINKAGES has a 3-day complementary training
on violence screening and response
– In line with WHO, PEPFAR, SWIT, MSMIT, TRANSIT
recommendations on responding to violence in
health care settings
• All clinic staff can learn to respond to
disclosures of violence
References
•
•
•
•
•
•
•
•
Beattie TS et al. Journal of the International AIDS Society 2015, 18:20079
http://www.jiasociety.org/index.php/jias/article/view/20079
Decker, et al. Estimating the impact of reducing violence against female sex
workers on HIV epidemics in Kenya and Ukraine: a policy modeling Am J Reprod
Immunol. 2013 Feb; 69 Suppl 1():122-32.
Gari, Sara, et al. HIV testing and tolerance to gender based violence: a crosssectional study in Zambia. PloS one 8.8 (2013): e71922.
Mugavero, et al. Barriers to antiretroviral adherence: the importance of depression,
abuse, and other traumatic events. N AIDS Patient Care STDS. 2006 Jun; 20(6):41828.
UNAIDS. Women, Girls and HIV Fact Sheet. 2010a
UNAIDS. Report on the Global AIDS Epidemic. 2010b.
UNIFEM. Violence Against Women–Facts and Figures 2011.
Schafer, et al. Intimate partner violence: a predictor of worse HIV outcomes and
engagement in care. AIDS Patient Care STDS. 2012 Jun; 26(6):356-65.
Acknowledgments
Stay Connected with LINKAGES
• Follow LINKAGES on Twitter:
www.twitter.com/LINKAGESproject
• Like the project on Facebook:
www.facebook.com/LINKAGESproject
• Subscribe to the LINKAGES blog
www.linkagesproject.wordpress.com
• Subscribe to The LINK, LINKAGES’s quarterly
project e-newsletter
• Check out LINKAGES’s quarterly research digest