Ayden Scheim

This session focused on innovative strategies to enhance access to HIV testing for key populations, as well as ongoing barriers to testing. Strategies to increase uptake of testing and linkage to care included key population-led services, network-based outreach, and integration of gender affirmation care for transgender persons.

In Malawi and Vietnam respectively, peer engagement and services led by key population CBOs increased access to prevention and treatment for KPs. In Malawi, training of health care providers and differentiated service delivery modalities including peer-led outreach successfully increased case finding and linkage to care among FSWs and MSM. More than half of those tested by KP CBOs in Vietnam were first-time testers, and 90% of those diagnosed enrolled in treatment. In India, respondent-driven sampling was more efficient than integrated care centres for identifying PWID living with undiagnosed HIV. An Australian rapid HIV testing service added STI testing and SMS reminders to improve return HIV testing. As overseas-born medicare-ineligible patients must pay for STI tests, the intervention did not improve return HIV testing for them. At Bangkok’s Tangerine clinic, transgender women accessing gender-affirming hormone therapy were more likely to repeatedly test for HIV and syphilis and to access PrEP.

As a CBO-based lay testing provider quoted in Huu Ngo’s presentation said, “clients know and trust us”. In contexts of stigma towards key populations, building on trusting relationships is key to facilitating access to HIV testing and linkage to care. Trusting relationships are necessary but insufficient to improve outcomes for all KPs; gender-affirming care is a key unmet need for transgender women and should be integrated into HIV programming. For these KP-focused differentiated service models to be sustainable, domestic funding is required. Exclusion of migrants from universal healthcare schemes may contribute to worsening HIV-related inequalities.