In 2014, USAID awarded FHI 360 the Linkages across the Continuum of HIV Services for Key Populations Affected by HIV (LINKAGES) project, a global cooperative agreement funded by PEPFAR and dedicated to addressing the HIV epidemic among key populations — men who have sex with men, sex workers, transgender people, and people who inject drugs. Over the last seven years, LINKAGES transformed how the needs of key populations are addressed in global and local responses to the HIV epidemic. The key-populations-focused programming launched in many countries through LINKAGES now continues under the Meeting Targets and Maintaining Epidemic Control (EpiC) project. As LINKAGES officially comes to an end, we are taking stock of what the project has meant for people, policies, partners, and programming.
This blog is the last in a three-part series dedicated to recognizing and celebrating the achievements of the LINKAGES project around the world. Here we share highlights — with links to technical resources and reports providing more detail — of the work in Latin America and the Caribbean.
LINKAGES Barbados elevated the role of civil society organizations (CSOs) in the national HIV response. The project helped define the scope for CSO engagement in HIV service delivery, which was incorporated into the national approach known as “Shared Care.” The project provided technical support for social media and social network interventions that increased reach and recruitment of key population members into services, and improved linkage to and retention in care and treatment via peer navigators. It supported two local partners — EQUALS and CEED — to expand clinical service offerings at their drop-in centers. EQUALS became the first community site to collaborate with the Ministry of Health and Wellness on the delivery of pre-exposure prophylaxis (PrEP) services for men who have sex with men.
LINKAGES Haiti strengthened the national health information system by providing technical assistance to the government to complete a national key population size estimate, map high-risk hot-spot areas, and harmonize national data collection tools. Through case-finding innovations such as the enhanced peer outreach approach and index testing, the project newly diagnosed nearly 7,000 individuals living with HIV. LINKAGES Haiti negotiated the provision of antiretroviral therapy (ART) at local partner-run drop-in centers, leading to the creation of the first key-population-led treatment site. The project also contributed to the development of critical policy support for HIV self-testing and PrEP, and supported rollout.
LINKAGES Jamaica successfully supported the development an island-wide rollout of a National Peer Navigation System in collaboration with the Ministry of Health and Wellness. The project also contributed to the development of a national “Enhanced Package of Care for Key and Vulnerable Populations.” The project was one of the early adopters of Going Online approaches, training CSO and public health staff to engage key population members through online outreach and connect them to HIV services; launching an Online Reservation Application for appointment booking and case management of clients; and establishing custom indicators to monitor online activities. The LINKAGES Jamaica team also provided south-to-south technical support and coaching to LINKAGES Caribbean programs in Suriname, Barbados, and Trinidad and Tobago.
In Suriname, LINKAGES’ Health4All training was adopted by the Ministry of Health and implemented nationally to address stigma and discrimination against key populations in health facilities. Additionally, peer navigation guidelines that were developed by LINKAGES were adopted by the Ministry of Health to support linkage and retention in HIV care. After the closeout of LINKAGES, the government began social contracting with LINKAGES-supported CSOs, many of which provide holistic, differentiated, and needs-based care through community-level health navigation programs.
LINKAGES Trinidad successfully engaged peer outreach and health navigators to encourage key population individuals to get tested for HIV, enroll in care and treatment, and remain on ART to achieve viral suppression. The project created an online platform through which clients could conduct a risk assessment and make appointments for a variety of services with KP-friendly providers, and supported the Ministry of Health to certify trainers to train health care providers on reducing stigma and discrimination against key populations.
From 2015 to 2017, LINKAGES collaborated with organizations led by and serving key populations in El Salvador, Haiti, Trinidad and Tobago, and Barbados to conduct a participatory research study on gender-based violence (GBV) and HIV to help understand key population members’ experiences of GBV and to explore the connections between GBV, HIV risk, and key population members’ service-seeking behaviors. The study’s recommendations called for educating members about their rights, recognizing the links between violence and HIV, and integrating HIV and violence screening and response services. The study served as a catalyst for action in the region to address GBV as a structural barrier to HIV care for key populations.
Photo Credit: Mikhail Henry/FHI 360