Community mobilization and demand creation for the uptake of HIV services by key populations as presented by Kawooya Richard.
Background: Key populations (KPs) in Uganda have a higher prevalence of HIV than the national prevalence (sex workers have up to 12 times prevalence than the national prevalence). HIV testing positive outcomes for KPs is highly dependent on the use of effective community mobilization and demand creation models in response to identified barriers. Demand creation for HIV Testing Services (HTS) comprises outreach and communication activities spreading information on the benefits of HTS and availability of HTS services to the KPs.
Prior to 2018 KPs in the catchment area accessed HTS from AIDS Information Centre (AIC) Kampala facility. With funding received in April 2018 HIV services for KPs mainly Female Sex workers (FSWs), Men Having Sex with Men (MSM) and People who Inject Drugs (PWIDs) were scaled up specifically in Kampala Central Division. As a result of this, the total number of KPs who accessed HIV services between April 2018 to December 2019 was 1,300 (1167FSW, 121 PWID, 12 MSM). This significant increase was not only due to the funding but the various community mobilization and demand creation strategies put in place as stated below.
Materials & Methods:
• Use of peers both in the community and facility: AIC identified, trained and supported peer KPs to take lead in the mobilization of their fellow KPs for the community uptake of HTS services. Each KP category had peers of its own.
• Extending HTS services to KP areas of operation: peers mobilized their communities and HTS were taken to these populations in areas such as Brothels, Bars, streets, and dancing halls.
• Integrated HIV Testing Services: Provision of services other than HIV including Tuberculosis screening, sample collection and return of results; STI screening and treatment, provision of PEP and PrEP services, condom distribution and demonstration, Gender Based Violence (GBV) screening and referrals
• Community dialogues: were used as a platform for Social Behavioural Change Communication (SBCC), as well as provision of HIV services
• Networking with KP Organisations: and piggy banking on their structures for mobilization for services
• Out of 1300 tested, 133 tested HIV positive but only 77 were successfully linked to care. Only 56% FSW were linked to care compared to 100% linkage for MSM and PWIDs.
• Peers were key in mobilizing KPs for Integrated HTS services but the lack of medication for infections particularly sexually transmitted infections contributes to reduced uptake of services.
• Peers were also key in providing SBCC for HIV prevention and acted as role models for those desiring to leave sex work or injecting drug use. Out of 3 PWID peers 2 had stopped injecting drugs and of 10 FSW peers, 3 had left sex trade.
• Integrated services resulted in detecting 12 active TB cases (7 FSWs, 5 PWIDs); 4 of these tested HIV positive and all were linked for TB and HIV services.
• KPs were sensitized on GBV through dialogues but rarely report GBV because they are criminalized.
• Networking with KP Organisations boosted mobilization for uptake of services and demand creation.
Community mobilization and demand creation for the uptake of HTS services among KPs cannot be fully met without engagement of KP peers and KP organisations that have strong community structures. Integrating services in HTS increases uptake and demand creation for HTS.