Getting the architecture right: working out how best to deliver the comprehensive package of HIV...

Getting the architecture right:working out how best to deliver the comprehensive package of HIV prevention and care programs and services among key affected populations

Lou McCallumDirector, APMG

Where are we up to in the development of Comprehensive Packages for key populations?

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MSM and TGMSM and TG

MSMMSM

Sex workersSex workers

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Drug usersDrug users

6

PrisonersPrisoners

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yy

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Challenges

Health system is isolatedo Not an active partnero Not involved in

outreacho Depends on donors

to bring key populations in

Creates long-term problems:

o Hard to scale-up a sustainable system

o Few links between different key population groups

o Focused on numberso Angry advocateso Like finds like

People aren’t empowered

HIV – Current Model and Challenges

General Health System

Donor Intervention

IDU CSW MSM Prisoners Migrants PLHIV

Outreach

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Strategy

Quality improvement enhances outreach, and opens entry points

Create demand, ensure supply

Focus on long-term engagement

Create demand – ensure supply

CBOCBO CBO

NGO

NGO

NGO

Care Environment

Entry Point

Entry Point

ModelsModels

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• Humsafar Trust, Mumbai– Mature MSM NGO– Has its own STI/HIV clinic as primary care and a

feeder to mainstream services– Sub-population segmentation– Not duplicating government services – advocating

and feeding in– Outreach to create demand– Mentor for emerging CBOs– Research arm

ModelsModels

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• PT Foundation, Malaysia– Serves MSM, TG, DU and SW– Good links with VCT and PLHIV services,

government and private– Has its staff placed in these services to

strengthen links, improve quality and acceptance

BalanceBalance

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Key pointKey point

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• It is only by working out the most appropriate and sustainable connection between demand and supply

• The key is in the balance