Objective 2: Reduced HIV transmission in vulnerable populations

Target populations

Indicators

Expected Results

Vulnerable populations: youth SW, MSM, DU, and prisoners; migrants.

2.1 Number of countries reporting that 50% of females and males aged 15‐24 correctly identify ways of preventing sexual transmission of HIV and reject major misconceptions about HIV transmission (UNGASS 13).

By 2014 the number of countries meeting these criteria will have risen from 4‐5 (in 2008) to 12. Target to be reviewed based on 2010 UNGASS data.

2.2 Number of countries incorporating outreach programmes for key vulnerable groups (MSM, SW, marginalised youth) using models developed by this grant.

By 2014 6 additional countries will report adoption of HIV outreach programmes for MSM, SW, and marginalised youth.

2.3 Number of countries where 70% of men report the use of a condom the last time they had anal sex with a male partner (UNGASS 19).

Ten (10) of 16 countries will exceed 70% of MSM reporting condom use by 2014, compared to 5 in 2008. Target to be reviewed based on 2010 UNGASS data.

2.4 Number of countries incorporating harm reduction approaches to HIV prevention among cocaine users.

By 2014 6 countries will report adoption of HIV prevention programmes among cocaine users with harm reduction measures (up from 2 in 2008). Illustrative; target to be reviewed in function of 2010 baseline.

Overview of Approach: The overall strategy to reduce HIV transmission involves combining individual approaches to reducing transmission, like peer‐mediated behaviour change interventions, with structural approaches to modify conditions that underlie and influence patterns of individual behaviour, like policies and legislation, empowerment of vulnerable groups (with increased participation and solidarity), and the involvement of schools, churches, and workplaces to reduce stigma and discrimination (S&D).

Despite the success of a number of peer‐based outreach programmes for MSM and for FSW in the Caribbean, effective strategies to address key vulnerable populations and to change their behaviours to lower the risk of HIV transmission have not been widely disseminated in the region. In part that is because different countries have very distinct levels of prejudice and tolerance, and different approaches have been found to work; in some places very little has been possible. This will be addressed by the Caribbean Coalition of Vulnerable Communities, a recently formed regional network In the process of consolidation. It comprises a variety of MARP community groups that provide HIV services across the region [http://www.cvccoalition.org/index.html].

CVC will work with MSM, DU, and prison inmate populations (the latter two via a CVC member, Caribbean Drug Research Institute [CDARI], as well as on its own institutional capacity building. In this it will be under the wing of one of its more distinguished members, the well‐established Dominican Republic NGO COIN, which will serve as an administrative umbrella and also lead the activities with local and migrant SW and with marginalised youth.

Working with member organisations in each country, the project will assess and compare current practices that correspond to different situations of in‐country stigma and discrimination (separately for each vulnerable group).

Best practice guidelines will be adopted or developed, drawing on the experience of successful projects around the Caribbean and beyond, and shared with national HIV programmes, local authorities, and regional entities. Pilot projects will be established in countries that have not already met the threshold levels for the outcome indicators and that commit to work with the pilot and continue to work with its target populations after the project.

After training and initial programme development in Phase 1, these peer outreach programmes will be gradually turned over to the local MARP organisations (or other CBO collaborators where stigma and discrimination do not permit open MARP entities), working also with local health services and other service providers.

COIN will create in‐country capacity to work with marginalised youth (of several types) and both local and mobile SW in 6 countries, with support from CBMP and International Federation of the Red Cross (IFRC) for the youth programme. Under its auspices, CVC will concentrate directly on building implementation capacity and leading MSM activities that will take place in 6 countries.

CDARI, specializing in work with DU and prison populations, will lead pilot interventions in those areas, initially in 2 countries, and with DU expanding to 6.

The project will work with key Ministry of Education personnel to overcome barriers and facilitate the roll‐out of these programmes in at least 12 countries. While not as effective as might be hoped, the initiation of school‐based HIV education is an extremely important, wide‐reaching first step towards propagating safe behaviours among young people. After school, out‐of‐school, and faith based community programmes will extend and mainstream HIV awareness‐building to reach broader and at‐risk youth populations (12‐25 years) in targeted subgroups.

These interventions will also help bring HIV into focus in places like religious institutions, schools, and other public spaces, tending to normalise the subject and lower stigma and discrimination.

As mentioned above, programmes to reach marginalised youth; among them gay, trans, SW, DU, and impoverished males and females, many living on the streets) will be piloted in 6 countries, building on existing institutional bases, including drop‐in centres, youth clinics and other safe places.

People Living with HIV
Prevention measures for PLH communities will be addressed both here, in terms of reaching HIV+ persons among the vulnerable groups, and under Activity 1.2.1 to increase HIV service capabilities of PLH organisations.

Improved PMTCT, VCT, HIV/TB, and STI prevention, diagnosis and treatment will not be separately targeted but handled in collaboration with national programmes, PAHO programmes, and fully integrated with the prevention activities focused on vulnerable groups in each country. Condom social marketing will be handled by a parallel PANCAP project, but fully coordinated with prevention activities in each country.

Regional coordination of such activities will allow for cost effective broadcast of mutually supporting mass media messages, especially in the smaller countries. Media leadership will commit free broadcasting time and personnel effort to reach youth and other target groups; media personnel will be trained and engaged in youth prevention messaging using innovative approaches with websites, mobile phone messaging, texting and twittering.

The focus of all such activities will be to build country‐based capacity to reach key vulnerable groups and to improve related organisation and skills in the broader health system (including civil society) to work with them on HIV prevention, testing and counselling, treatment, and care. This will draw on the greater know‐how in some countries to build capacity in others. Staff, volunteers, promoters, and counsellors will include peers, if feasible.

SDA 2.1 Behavioral Change Communication—Community Outreach and Schools


Activity

Expected results

2.1.1 Develop model outreach programmes to reach key vulnerable groups, targeting MSM, local and migrant SW, prison inmates, drug users, and marginalised youth.

Methods reviewed and validated based on current experience; peer‐based prevention programmes established for SW, MSM, and marginalised youth in 6 countries each; for DU in 4; and for prisoners in 2 countries.

2.1.2 Promote implementation of life skills‐based HIV education for in‐school youth, involving parents and teachers.
This will be done via training and mentoring of ministerial focal points (EduCan), with indirect support for training academic leadership, guidance counsellors, sports and arts teachers in human rights and self empowerment approaches to enable and empower in‐school youth in peer support groups. [EDC; UWI]

Twelve (12) education ministries with HIV policies in place and financial support for HIV prevention programmes (up from 5).

2.1.3 Strengthen involvement of faith‐based communities in evidence‐based HIV prevention (especially aimed at key vulnerable groups), as well as S&D reduction and PLH care and support. [CCC; CCNAPC]

FBOs from main faiths develop and disseminate prevention and S&D reduction programmes, establishing models on 7 islands.

SDA 2.2 Behavioral Change Communication—Mass Media

Activity

Expected Results

2.2.1 Utilize regional partnerships with broadcast and other media in support of campaigns aimed at youth, PLH, and MARPs in support of prevention and stigma reduction activities. (CBMP)

Production and dissemination of messages that reach the targeted vulnerable groups and support prevention, S&D reduction, and other project activities: 75% of youth in participating countries.

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