Background: Acute violence, defined as periods of increased severe emotional, physical, sexual, and economic abuse, against key populations?men who have sex with men, people who inject drugs, sex workers, and transgender women?is increasing, including in East Africa. Recent examples include the torture of peer educators, the arrest of mobile outreach teams, and the ransacking of key population-led community-based organizations (CBOs)?all of which disregard human rights and undermine efforts to curb the HIV epidemic. While local actors lead the response to acute violence, international and regional stakeholders?such as global and regional key population networks, international non-governmental organizations (NGOs), and donors?must be able to play an effective role if requested.
Methods: In 2017, the Technical Advisory Group on Violence, Stigma, and Discrimination Against Key Populations supported by the PEPFAR and USAID-funded LINKAGES project, convened CBOs, NGOs, United Nations agencies, donors, security experts, and global and regional key population networks working in East Africa to identify current challenges in acute violence responses, articulate principles for local engagement, and generate recommendations for international and regional actors.
Results: Barriers to appropriate and effective responses by international and regional stakeholders'' include: acting without guidance from those most affected, causing added stress and danger for local actors; a failure to adequately resource program staff most at risk, increasing their vulnerability; and support to individual local partners instead of collectives, resulting in duplicative investments and fractured coalitions. Recommendations include deference to local actors, appropriate resourcing, and pre-emptively forming local collectives and international and regional coordinating bodies that can act in a unified immediate way. Principles to guide international or regional actors'' engagement reinforce the importance of: embracing “first, do no harm” in every aspect of key population programming, avoiding false dichotomies between human rights and HIV objectives, and striving to take a long-term view even during a crisis.
Conclusions: International and regional actors operating in East Africa and beyond can strengthen their responses to acute violence by taking concrete steps, grounded in principles for engagement, thereby protecting key population members'' human rights and removing barriers to the effective implementation of HIV programs.