HIV community-led monitoring (CLM) is an accountability mechanism for HIV responses at different levels, led and implemented by local community-led organizations of people living with HIV, networks of key populations, other affected groups or other community entities.
Community-led monitoring (CLM) is a technique initiated and implemented by local community-based organizations and other civil society groups, networks of key populations (KP), people living with HIV (PLHIV), and other affected groups, or other community entities that gather quantitative and qualitative data about HIV services. The CLM focus remains on getting input from recipients of HIV services in a routine and systematic manner that will translate into action and change.
The sensitization supported by KESWA (Kenya Sex Workers Alliance)
Here are ways of Preventing the spread of Cholera:
1. Boiling or treating all drinking water or water used for cooking and storing it in clean covered containers.
2. Safe disposal of faeces, including children’s faeces, in toilets/latrines.
3. Always wash your hands with soap under running water before handling, preparing, serving, and eating food; feeding your child and after using the toilet or handling a child’s faeces
4. Cooking food thoroughly and serving it while still hot. All remaining food should be safely stored and covered to avoid contamination.
5. Wash fruits and vegetables thoroughly with clean running water, especially if they are to be eaten raw.6. Get vaccinated against Cholera. The Oral Cholera Vaccine is given through the mouth and it’s free, safe, and effective. Please note: Patients with Cholera must be taken to a health center immediately. If not treated, Cholera may cause severe dehydration, leading to death.
As the saying goes, “Safety comes first!” Survivors organization is in the frontline to ensure that all the covid-19 rules, measures and regulations have been followed. The risk of exposure to COVID-19 in the workplace depends on the likelihood of coming within 1 metre of others, in having frequent physical contact with people who may be infected with COVID-19, and through contact with contaminated surfaces and objects.
For each risk assessment, consider the environment, the task, the threat, resources available, such as personal protective equipment, and the feasibility of protective measures. The risk assessment should also extend to collective accommodation provided by the employer for workers, such as dormitories. Essential public services, such as security and police, food retail, accommodation, public transport, deliveries, water and sanitation, and other frontline workers may be at an increased risk of exposure to occupational hazards for health and safety. Workers who may be at higher risk of developing severe COVID-19 illness because of age or pre-existing medical conditions should be considered in the risk assessment for individuals.
WHO and public health authorities around the world are taking action to contain the COVID-19 outbreak. However, long term success cannot be taken for granted. All sections of our society – including businesses and employers – must play a role if we are to stop the spread of this disease.
Our main aim was to create a free working environment with bunyala sub-county between the key populations and the public health providers. This was one way of promoting positive attitude between the KP community and health providers.
In terms of :
Reduction of stigma and discrimination from the health care workers.
The COVID-19 pandemic has affected everyone, including key populations at higher risk of HIV. And the gains made against other infectious diseases, including HIV, are at risk of being reversed as a result of disruptions caused by COVID-19. This is the background to a new report published by FHI 360, in collaboration with UNAIDS and the World Health Organization (WHO), which gives advice on how to minimize the impacts of COVID-19 on key populations.
“With a focus on key populations, this guidance complements ongoing efforts to sustain access to HIV prevention services and commodities, sexual health and family planning services, prevention of gender-based violence and HIV counselling, testing and treatment during the COVID-19 pandemic,” said Paula Munderi, Coordinator of the Global HIV Prevention Coalition at UNAIDS. “Preserving essential HIV services for key populations and promoting the safety and well-being of staff and community members during the COVID-19 pandemic is vital to maintaining the hard-fought gains of the AIDS response.”
With practical guidance on how to support the continuation of HIV services for people living with HIV and key populations, the report is aimed at helping the implementers of programmes to carry on their work.
“Key populations are particularly vulnerable to HIV service interruptions and additional harm during the COVID-19 pandemic. We urgently require rights-based solutions that maintain or increase key populations’ access to HIV services while minimizing potential exposure to COVID-19 and promoting individuals’ safety. These must support physical distancing and decongestion of health facilities, but in ways that respond to the current realities of key populations,” said Rose Wilcher, from FHI 360.
The report gives practical suggestions in three main areas.
The first is on protecting providers and community members from COVID-19. HIV services can only continue to be provided during the COVID-19 pandemic if steps are taken to prevent coronavirus infection among programme staff, providers and beneficiaries. Links to COVID-19-related screening and care, and services to support the mental well-being of providers and beneficiaries, can also be given as part of HIV services.
The second area is supporting safe and sustained access to HIV services and commodities. HIV programmes can integrate physical distancing measures, offer virtual consultations and give multimonth dispensing of HIV medicines. Physical peer outreach should be continued where possible.
Monitoring service continuity and improving outcomes is the third area covered by the report. Since there are likely to be service disruptions, HIV programmes will need to adjust their monitoring and evaluation systems in order to allow for regular assessments of continued HIV service delivery and of the impact of COVID-19 on HIV programmes and their beneficiaries. This may require setting up strategic information systems that use physical distancing measures such as virtual data collection and reporting tools.
“The COVID-19 pandemic shouldn’t be used as an excuse to slow momentum in the global response to HIV among key populations. Instead, the pandemic is a time to draw lessons from our work to end AIDS. It is also an opportunity to provide relief to health systems overstretched by COVID-19 by fully funding community-based organizations led by gay and bisexual men, people who use drugs, sex workers and transgender people to ensure improved access to HIV services for key populations,” said George Ayala, Executive Officer of MPact.
“It remains critical to ensure access to HIV prevention, testing and treatment services during COVID-19 and sustain access to life-saving services. This document provides practical guidance and know-how on maintaining essential health services for key populations in these challenging times,” said Annette Verster, the technical lead on key populations at the WHO Department of HIV, Hepatitis and STIs.
The report was developed by FHI 360 as part of the Meeting Targets and Maintaining Epidemic Control (EpiC) project, which is supported by USAID and the United States President’s Emergency Plan for AIDS Relief. UNAIDS, WHO, the Global Fund to Fight AIDS, Tuberculosis and Malaria and partners gave inputs and advice.
Kenya Key Population Consortium wrote to partners and donors on the proposal by the Kenya Government – funded by the Global Fund (GFTAM) and with technical assistance from PEPFAR – to use biometric fingerprinting for the collection of Key Population size estimates during upcoming IBBS Study.
The communication highlighted fears of safety that the populations faced with the use of biometrics due to criminalization of the three target groups for the study.
Consultative meetings were held with Government and stakeholders post the letter to try and come to an agreeable conclusion and the consortium reached out to researchers, allies and partners on safe methods of data collection and would also minimize duplication fears by the Government.
The Kenya Key Population would like to share this after the various meetings with partners, donors and Government.
We would like to reiterate that the Kenya Key Population Consortium is in support of the IBBS study and its component of collection of size estimate for key populations but do not support the use of biometrics as a method of data collection.
The Consortium believes that any use of biomarkers—finger printing, iris scanning, toe scanning—will introduce fear and uncertainty among communities facing criminalization about the safety of healthcare clinics. This will serve only to drive people away from healthcare and reduce participation in the IBBS.
The Consortium also notes that experts suggest previous estimates significantly under-estimate the size of key populations, so evidence suggests under-sampling is a far greater concern than duplication.
Size estimation surveys do not require such biomarkers—capture/recapture as well as a range of other methodologies have been used with success (although they generate conservative estimates, see point 3).
Highly respected researchers have collected data through referral systems and have not had major challenges of duplication of participants that would skew the findings.
Most of the highly respected key populations estimates have not used biomarkers in any form.
Methods researchers have effectively used in these studies to reduce duplication of participants without the use of biometrics include UIC introduction for all health system users, not just for key populations (which could help with retention and mobility), effective staff training and timely completion of the study without major staff turnover, which would ensure repeat visitors would be noticed by staff, coupons for referrals which are linked to each other, to help identify clusters of unusual answers, research notes that highlight physical features/characteristics of the participants (linked to the coupon) and would be able to be used to identify repeat participants, entry of characteristic data of participants in real time could also reduce duplication of numbers in the different study locations.
Despite the widespread call for data disaggregation, there has been relatively little discussion on the concrete methods of data storage that ensure safety of data collected and implications of data falling in the wrong hands. Methods of storage of data can pose challenges if the safety, handling and security are not of high quality. There are still questions on data access by unauthorized persons and capacity by various sections of government to force data handlers to share information collected. Our research of current methods of storage of data collected from Kenya (SWOP Clinic) have very basic methods of data storage that does not ensure safety of end users. Kenya also has example of cases where data for people living with HIV being collected without the consent by government in an effort to reach children living with HIV. Kindly refer to the KELIN case on the presidential directive on HIV data collection
The use of coded fingerprints does not stop unauthorized persons who are unable to gain access the the larger database but have access to the data collection machines from using them at areas considered as hotspots to identify key populations whose data is in the system without the need to access the larger database.
A human rights approach to data disaggregation requires not only reaching the most vulnerable and marginalized groups, but implies ensuring that high human rights driven safeguards are in place for the collection, processing, analysis and storage. The use of biometrics has no benefit such as increase of retention and adherence and other programmatic benefits to the communities and will only be used to reduce challenges of duplication. The use of biometrics will only increase the fears of already stigmatized and criminalized communities to access services and increase the level of the threat of harassment by law enforcement agencies in the country. The Kenya Key Population Consortium retains its stand: We do not support the use of any biometric data collection but instead recommend enhancing the use of the other methods to ensure a high quality study generating data in order to promote and defend the human rights of Key Population to quality, stigma-free services.
The Kenya Key Population Consortium consists of networks of sex workers, men having sex with men and people who inject and use drugs in Kenya