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)
Survivors Organization had a dialogue sensitization with the law enforcers in Butula sub-county, Busia countyAgenda of sensitization was about sex workers and human violation thank to the Ocs Butula police station for the mobilization because we managed to have 24 and above police officer in the room we were privileged to have a session with you and hoping that the message we deliver to you will not taken for granted but you are becoming now our AmbassadorsGetting in touch with the law enforcers will survivors organization and it’s members to run their activities smoothly in a conducive environmentWithout stigma and discrimination from the police officers#Sexworkiswork#Sexworkersarehumanrights#RespectMyworkitsmychoice
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.
In the middle of every difficulty lies opportunity. Everyone has inside them a piece of good news. The good news is you don’t know how great you can be! How much you can love! What you can accomplish! And what your potential is. This was part of what UPENDO Group, one of the strongest Female Sex workers group (FSWs) who was part of the groups trained on Village Banking on how they can improve on their livelihood. After a long journey. They decided to show their gratitude’s. They took their time and sacrificed to show their appreciation. Salute to UPENDO Group. It is time for us all to stand and cheer for the doer, the achiever – the one who recognizes the challenges and does something about it. Character cannot be developed in ease and quiet. Only through experience of trial and suffering can the soul be strengthened, ambition inspired, and success achieved.
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
Client violence against sex workers should be considered in the context of the high levels of violence against women in the society. A sturdy conducted a few weeks ago showed that, a quite number of sex workers have been violated and mistreated by clients, police, health workers in the hospitals and even family members.
In our investigations, some of the sex workers shared their experience of which some cases revealed to us that some of them were even raped. In the health sector, some were not given proper care when they went for services at the health facility. Their was a case where by a male sex worker was given drugs that are not subjected to P.E.P after the health attendant realized that he is a sex worker. This negative attitude has left sex workers fear to go for services at the health facility with the fear of getting exposed. This leads to improper care and support with the MARPs of which the reduction of health issues as been a barrier at the Key Population. This are the state actors who should be on the front line in implementation of health but some of them still have negative attitude of which it has to be eliminated at all cost.
Other state actors who still need to be equipped with knowledge are the police. Still some of the have been using their powers to manipulate and harass sew workers on their hotspots. Some have even ended up demanding for sex through threat, creating a bigger barrier when it comes to law enforcement. Secondly some of them have been involved in cases where by they end up being suspended or get transferred due to their irresistible attitudes and behaviors.
With all this issues, we as Survivors have tried with all efforts to ensure that meeting and forums have been organized with the aim of passing information to the Police, Health Implementer s and Key people in the society including religious leaders.
Not only on human rights advocacy, we also advocated for health rights. We have been doing this for the past sixteen years, helping the entire western community in creating awareness in reduction of HIV new infection, reduction of stigma to zero percent and also share ring information on importance of knowing their health status.
This has enhanced a positive change where by we have been conducting health campaigns in various hotspots in the entire community in the western Kenya thus in Busia town, namable, samia and also Matayos.
Being a sex workers organization, at first we had a very big challenge where by the community had a negative attitude in terms of publicity, but through sensitization meetings with stakeholders, this has created positive impact and gave us a platform in achieving our mission and goals.
Since the community at large challenges that lead to the lost of our loved one’s , we felt it was our responsibility to ensure the key population (Female sex workers and Msm,s)know the facts on health issues especially on risk reduction plan.
organization would like to congratulate, I HUB team from Nairobi which has been in the upper hand making sure survivors organization enhance the quality communication skills in the world of I.T.
Through the support from Open Society foundation OSEA, the organization has not only benefited from legal aid support program me but also managed to enhance new look creating vital channels in strategizing effective communication.
In creating workable ideas and mission, the organization also restructured their logo with the aim of making effective impact in order to enhance clear perspective and vision for their members. This has also enabled us to get more support from stakeholders and donors at large creating impact in our local surrounding and the world at large through share ring success stories, news and also human rights advocacy.
This great innovation will surely enhance the quality of services, empowerment, vision and mission at large .It is indeed a step forward in fulfilling the visions we have for the organization as a whole securing an internationally recognized reputation as one of the finest most diverse organization.
We believe this will greatly help us enhance and get more support leading to success and great achievements.
To all who took part in Nelly funeral ,giving her last respect on 14th Fed 2015 in Ong’iende village,Ojwando sub location in Siaya County.Special thanks to Survivors Organization,Nelly’s family and relatives,Church members,friends and all well wishers.WE LOVED YOU NELLY BUT GOD LOVED YOU MOST