MODULE 3: Engaging Key Populations

This module explores the elements of the Comprehensive Package of Services for Key Populations that relate to prevention, treatment, care and support. It begins with a brief presentation on the concept of Demand and Supply for services and provides an opportunity for people working on both the demand and supply side to talk about the work that they do and the obstacles and challenges they face and the successes they have had. The module uses activities and presentations to answer the following questions:

  • Who creates demand of HIV & SRH services?
  • Who supplies HIV & SRH services?
  • What sectors are responsible for delivering the elements of the comprehensive package of services for Key Populations? What challenges do these sectors face and what strategies can be used to overcome these challenges?
  • What innovations are in place to combine demand and supply?
  • Session 1: Demand, Supply and the space between

    The previous module covered WHAT HIV and SRH services need to be provided to KPs, and this session follow up with HOW they might be provided to make sure that KPs can access them.

    Participants explore DEMAND and SUPPLY for services - how do we create a demand for services among KPs and and how are services best supplied? We also look at the space between demand and supply - how we make sure that people not only know about services but are assisted to access them.  Demand refers to the effort that is made to engage with KPs, provide information, familiarize them with services and bring them in touch with services. Supply refers to the provision of the services – HIV and STI testing, drug treatment, reproductive health and clinical management of HIV.

    The session involves a Group Check In to identify examples of demand and supply for services. If you think about demand creation and supply as two different domains of activity, you can also see that there are times when they overlap - when agencies create demand and slo supply services, or where NGOs and health services work together to combine demand and supply.

    The space where demand and supply overlap is proving to be a very interesting one for ensuring that Key Populations get better access to services. This section introduces examples of effective strategies to bring supply and demand together. Read the examples provided on the slide and recap interventions identified during the activity that help bring supply and demand together. Involve the group in the recap discussion and brainstorm additional strategies that have not yet been identified.

    Examples of innovations that work in the space between between Demand and Supply include:

    • Providing rapid HIV testing as part of outreach by Peer Educators – linked directly to case management for newly-diagnosed PLHIV
    • Having peer educators from CBOs working shifts in HCT or treatment clinics
    • Having female doctors from the local public health unit come to sex on premises venues to talk to sex workers about sexual and reproductive health
    • Having part-time HCT, HIV and STI clinics in CBOs to provide immediate diagnosis and treatment and to feed people from Key Populations directly into other mainstream clinics 
  • Session 2: Using the Prevention and Treatments Cascade to identify and address obstacles

    The Prevention and Treatment Cascade provides a useful tool for tracking the extent to which the interventions being provided are reaching KPs and bringing about positive health outcomes.

    For the entire KP population:

    • Proportion of the population regularly reached with a package of HIV prevention services (BCC, condoms, lubricant, STI prevention and treatment)
    • Proportion of the population accessing HIV testing and knowing their HIV status

    For PLHIV within the population:

    • Proportion of people with HIV from within the KP who know their status
    • Proportion of people with HIV from within the KP being monitored by health services
    • Proportion of people with HIV from within the KP who are enrolled on antiretroviral treatment
    • Proportion of people with HIV from within the KP who have long-term suppressed viral load

    The objective of this session is to try to shift the thinking of the participants from merely listing the services that are available in their area of KPs, to reflecting critically on what is actually being achieved. Service planers and implementers often think that merely providing the service is enough. People working with KPs know that there are many barriers that prevent people from KPs from consistently accessing services. The Cascade helps to shine a light on successes and opportunities for improvement.

  • Session 3: Lessons from the Region

    This session provides an opportunity to examine lessons learned by NGOs and government in engaging with KPs. In a national workshop, this is a good opportunity to bring forward lessons and models that have been in place in the country, as these will be more relevant to local context. Examining lessons from the Region also provide an opportunity to discuss options for strengthening the connection with KPs and innovations that can increase reach into KPs.

    Participants are often very interested in looking at 'lessons learned' and these sessions often rate highly in Participant Evaluation, but it is important to move slowly through the examples in the ppt asking participants to look for elements that they could adapt to their work. Try to set aside time for some genuine 'experience sharing' among the participants - not just presentations on their projects or their work, but some critical reflection on what actually worked. Appreciative Inquiry techniques are useful here - asking people to reflect on the parts of the work where the most energy or success was felt by them, their staff, volunteers and beneficiaries, why they think that was and what lessons can be drawn from that.