Background: In Malawi, HIV prevalence is 8.8 percent among the general population but higher among key populations (KPs): 62.7 percent among female sex workers (FSW) and 17.5 percent among men who have sex with men (MSM). FHI 360, through the USAID/PEPFAR-funded LINKAGES project, provides comprehensive HIV prevention, care, and treatment services for KPs. We present our experience implementing this project over a two-year period.
Description: We engaged government structures at all levels, KPs, and civil society organizations (CSOs) to get the project running. Programmatic mapping of hot spots and size estimation were conducted through engagement of KPs. Using a peer-led model, KPs were recruited to support others with HIV prevention services, linkage to care, antiretroviral therapy (ART), and retention. We built the capacity of peer leaders through trainings and microplanning, created safe spaces, and trained health care workers to mitigate stigma and discrimination.
Lessons learned: From October 2016 to June 2017, the project reached 9,601 FSWs, 3,609 (38 percent) of whom were already HIV positive, and 5,136 of whom were eligible for HIV testing; of the latter, 2,068 (40 percent) tested HIV positive and 1,862 (90 percent) were initiated on ART. The total number of HIV-positive cases detected, 5,677/9601 (59.1 percent), is close to the 62.7 percent estimated HIV prevalence among FSWs in Malawi. A total of 3,025 HIV-positive FSWs were enrolled in community care. We screened 13,827 FSWs for STIs, diagnosed 5,119 (37 percent) cases, and treated 5,108. Of 2,696 MSM reached with services, 2,561 were tested for HIV, 188 (7 percent) tested HIV positive, and 114 (61 percent) were initiated on ART. We screened 4,726 MSM for sexually transmitted infections, diagnosed 1,585 (34 percent) cases, and treated 1,507. Eighty-seven FSW and 39 MSM reported gender-based violence and received services. We identified 239 transgender women and are now receiving HIV prevention, care, and treatment.
Conclusions/Next steps: Empowered KP members positively contribute to their health. In addition, engagement with government, health care workers, and peer leaders is key to ensuring a successful KP program. Efforts are ongoing to document and scale up some of the best practices emanating from the program.