MITIGATING THE IMPACT OF COVID-19 ON KEY POPULATIONS

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.

SAFETY FIRST IS SAFETY ALWAYS

Survivors Director Madam Carole Kemunto(on the left)Distributing Hand Sanitizers to Staffs and Members

For safety is not a gadget but a state of mind therefore, better a thousand times careful than once dead. Precaution is better than cure we should ensure that as we fight the COVID 19 Corona virus, we must be on the front line taking the right actions, measures and observe rules and regulations given by the World Health Organization (W.H.O). Safety is a cheap and effective insurance policy. Safety means first aid to the uninjured. So let’s focus and act positively in ensuring that our relatives, friends and the community at large get proper information whereby none of us will be at a high risk of being exposed to this deadly pandemic. Prepare and prevent, don’t repair and repent. Working together…work safely if everyone is moving forward together and taking responsibility for their safe work environment then our safety takes care of itself.Prevent the worst and Put safety first, because being Safe today will keep you Alive tomorrow.

Protect yourself and others around you by knowing the facts and taking appropriate precautions. Follow advice provided by your local health authority.

To prevent the spread of COVID-19:

Clean your hands often. Use soap and water, or an alcohol-based hand rub.

Maintain a safe distance from anyone who is coughing or sneezing.

Wear a mask when physical distancing is not possible.

Don’t touch your eyes, nose or mouth.

Cover your nose and mouth with your bent elbow or a tissue when you cough or sneeze.

Stay home if you feel unwell.

If you have a fever, cough and difficulty breathing, seek medical attention.

Calling in advance allows your healthcare provider to quickly direct you to the right health facility. This protects you, and prevents the spread of viruses and other infections.

SUCCESS STORY

Survivors Director being awaded by upendo group for the good work and support

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.

KEY POPULATIONS

Key populations are defined groups who, due to specific higher-risk behaviours, are at increased risk of HIV irrespective of the epidemic type or local context. Also, they often have legal and social issues related to their behaviours that increase their vulnerability to HIV. These guidelines focus on five key populations: 1) men who have sex with men, 2) people who inject drugs, 3) people in prisons and other closed settings, 4) sex workers and 5) transgender people. People in prisons and other closed settings are included in these guidelines also because of the often high levels of incarceration of the other groups and the increased risk behaviours and lack of HIV services in these settings. The key populations are important to the dynamics of HIV transmission. They also are essential partners in an effective response to the epidemic (1).

Key Population Consortium Analysis & Conclusion On Use Of Biometrics In IBBS In Kenya

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.

  1. 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.
  2. 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.
  3. 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.
  4. 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).
  5. Highly respected researchers have collected data through referral systems and have not had major challenges of duplication of participants that would skew the findings.
  6. Most of the highly respected key populations estimates have not used biomarkers in any form.
  7. 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.
  8. 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
  9. 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

WHAT IS ADVOCACY?

Definitions and Examples
Effective advocacy enable
s
nonprofits to shape the public debate on important social issues and
ensure that underserved communities have a voice in the policies that impact their lives. T
he term
“advocacy” encompasses a broad range of activities
(including
research
,
public educatio
n
,
lobbying
,
and voter education
)
that can influence public policy.
Advocacy
is the number one way nonprofits can
advance the issues they care about and help bring about systemic, lasting change.
How is advocacy different from lobbying?
Lobbying is only
one kind of advocacy.
There are many avenues of advocacy that nonprofits can
engage in that do not constitute lobbying. Federal tax law define
s
lobbying only
;
“non
lobbying
advocacy” is often used to refer to those activities that don’t meet the definition of lobbying.

FACTS ABOUT GONORRHOEA

Gonorrhoea is a sexually transmitted infection also known as the ‘clap’ or ‘drip’
Gonorrhoea can be treated with antibiotics, but doctors are finding the condition is becoming resistant to some common antibiotics.

What causes gonorrhoea?

Gonorrhoea is caused by Neisseria gonorrhoeae, a bacterium that can grow and multiply easily in the mucous membranes of the body. Gonorrhoea bacteria can grow in the warm, moist areas of the reproductive tract, including the cervix (opening of the womb), uterus (womb) and fallopian tubes (egg canals) in women, and in the urethra (the tube that carries urine from the bladder to outside the body) in women and men. The bacteria can also grow in the mouth, throat and anus.

How do I know if I have gonorrhoea?

Not all people infected with gonorrhoea have symptoms, so knowing when to seek treatment can be tricky. When symptoms do occur, they often appear from two to ten days after exposure, but can take up to 30 days and include the following:

Gonorrhoea symptoms in women

1. Greenish yellow or whitish discharge from the vagina
2. Lower abdominal or pelvic pain
3. Burning when urinating
Conjunctivitis (red, itchy eyes)
4. Bleeding between periods
5. Spotting after intercourse
6. Swelling of the vulva (vulvitis)
7. Burning in the throat (due to oral sex)
8. Swollen glands in the throat (due to oral sex)
In some women, symptoms are so mild that they go unnoticed.

Many women with gonorrhoea discharge think they have a yeast infection and self-treat with medications purchased over-the-counter. Because vaginal discharge can be a sign of a number of different problems, it is best to always seek the advice of a doctor to ensure correct diagnosis and treatment.

Gonorrhoea symptoms in men

1. Greenish yellow or whitish discharge from the penis
2. Burning when urinating
3. Burning in the throat (due to oral sex)
4. Painful or swollen testicles
5. Swollen glands in the throat (due to oral sex)
In men, symptoms usually appear five to seven days after infection.

Can gonorrhoea be cured?

Yes. Gonorrhoea can be treated and cured. However, gonorrhoea resistance to antibiotics is a growing problem according to Public Health England.
This infection is very good at developing resistance to new drugs all of the time and ‘frontline’ treatments have to keep being changed to keep ahead.

What happens if I don’t get my gonorrhoea treated?

Untreated gonorrhoea can cause serious and permanent problems in both women and men.

In women, if left untreated, the infection can cause pelvic inflammatory disease, which may damage the fallopian tubes (the tubes connecting the ovaries to the uterus) or even lead to infertility, and untreated gonorrhoea infection could increase the risk of ectopic pregnancy (when the fertilised egg implants and develops outside the uterus), a very dangerous condition.

In men, gonorrhoea can cause epididymo-orchitis, a painful condition of the testicles that can sometimes lead to infertility if left untreated. Without prompt treatment, gonorrhoea can also affect the prostate and can lead to scarring inside the urethra, making urination difficult.
Gonorrhoea can spread to the blood or joints. This condition can be life-threatening. Also, people with gonorrhoea can more easily contract HIV, the virus that causes AIDS. People with HIV infection and gonorrhoea are more likely than people with HIV infection alone to transmit HIV to someone else.

How does gonorrhoea affect pregnancy and childbirth?

Gonorrhoea in a pregnant woman can cause premature delivery or spontaneous abortion. The infected mother may give the infection to her infant as the baby passes through the birth canal during delivery. This can cause blindness, joint infection, or a life-threatening blood infection in the baby. Treatment of gonorrhoea as soon as it is detected in pregnant women will lessen the risk of these complications. Pregnant women should consult a doctor for appropriate medications.

How can I prevent infection?

To reduce your risk of infection:
1. Use condoms correctly every time you have sex.
2. Limit your number of sexual partners, and do not go back and forth between partners.
3. Practise sexual abstinence, or limit sexual contact to one uninfected partner.
4.If you think you are infected, avoid sexual contact and seek medical advice.
Any genital symptoms such as discharge or burning during urination or an unusual sore or rash should be a signal to stop having sex and to seek medical advice promptly. If you are told you have gonorrhoea or any other sexually transmitted infection and receive treatment, you should notify all of your recent sex partners so that they can be tested and treated.Sings of gonnorea in men

A WIN FOR HUMAN RIGHTS!

The Court of Appeals in Mombasa has ruled that the use of forced anal examinations by the Kenyan state is unlawful.

On Thursday 22nd March 2018, a three judge bench handed down a ruling in a case brought forward by the National Gay and Lesbian Human Rights Commission (NGLHRC) appealing the state’s cruel and degrading treatment of two Kenyan men while under arrest in 2015. The men were arrested in Kwale county, on suspicion that they were gay. They were then subjected to forced anal examinations and HIV testing under a magistrate’s order to determine if they had engaged in consensual sexual acts in private—a crime punishable with up to 14 years imprisonment in Kenya.

The violating examinations, which include being made to lie with legs up in a humiliating position and having instruments forced into your rectum, are widely accepted to have no medical merit. NGLHRC has long argued that the tests are a violation of rights to privacy and dignity and amount to torture.

After a three year legal and public advocacy campaign to end the practice in Kenya, the Court of Appeals ruled in our favor, stating that our clients rights had been violated. We cannot underscore the significance of this win.

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