BACKUP Health invited partners to explore strategies aimed at helping policymakers and civil society to safeguard access to HIV services for key vulnerable populations (KVPs).

More than 11,000 participants gathered at the International AIDS Conference in Munich in July 2024 to discuss challenges and progress regarding HIV/AIDS.  With a focus on a people-centred, evidence-based approach, attendees tackled the latest breakthroughs and devised future strategies. The global programme BACKUP Health, implemented by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH and commissioned by the German Federal Ministry for Economic Cooperation and Development (BMZ), hosted three dynamic sessions with valuable insights from partners at the German Pavilion. BACKUP Health brought together partners from different countries as well as the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) to discuss access to HIV/AIDS services for KVPs and human rights. They shared inspiring experiences, best practices, and forward-thinking solutions. As one attendee noted, ‘We are not just discussing problems; we are driving real change for the people who need it most.’

Access to HIV services in the context of fragility and war

The session titled “Save Your Life ≠ Save Your Health” addressed the challenges of providing HIV services in conflict zones, with a focus on Ukraine.

Dr. Tania Rödiger-Vorwerk, Deputy Director General Global Health, Resilience, Equality of Opportunity at BMZ emphasized Germany’s commitment to supporting KVPs amid the ongoing conflict in Ukraine. She commended Ukraine for its efforts in integrating health services during conflict and suggested adapting the learnings to be emulated in other fragile settings.

---

Valeriia Rachinska from 100% Life and Dr. Andriy Klepikov from the Alliance for Public Health shared their experiences on Ukraine’s front lines, illustrating the complexities of delivering essential health services, as well as the importance of using innovative solutions in responding to the needs of KVPs. Ongoing challenges such as complicated logistics, resource allocation or safety issues hinder accessing basic HIV services due to the war. However, Valeriia Rachinska is determined: ‘We cannot control changes, and we cannot change anything – but we can control our responses, what we are doing, how we are doing, which way, where, and where responding. We are resistant and we are not going to give up.’

Dr. Klepikov also answered with innovative solutions and stressed the importance of mobility for the provision of services stating, ‘…it’s critical to be mobile, reaching people in their locations, and offering the services which are critically needed.’ With 7 million people displaced and hospitals destroyed, mobile clinics were deployed to provide essential healthcare in war-affected areas, including HIV/AIDS care, hepatitis treatment, and screenings for at least 120 people. This aspect of mobility was underlined by Valeriia Rachinska. She described how people could be reached under the current conditions, such as delivering medications by bicycle to the front lines, using online applications to connect with patients and establishing digital shelters, a network for vulnerable groups to know where free spaces are.

They highlighted the importance of being responsive to immediate needs while remaining adaptable to the unpredictable challenges of war. Both described the importance of international partnerships such as the one with the German Government and GIZ. Dr. Klepikov underlined: ‘Partnership is critical. We are able to persist and sustain – thanks to our international partners support in Ukraine. Because we couldn’t do it on our own.’

Best practices for engaging key vulnerable populations and human rights

The second session, titled “Learning from Each Other” brought together partners from Malawi, Kyrgyzstan, and Uzbekistan to share their experiences in overcoming barriers such as stigma, discrimination, limited organisational capacity, limited understanding of the role of human rights and political restrictions.

Emily Kayimba from the Malawi Network of Aids Service Organizations (MANASO) described challenges faced by KVPs. These include stigma and discrimination deeply rooted in religious and cultural beliefs, which, on the one hand, are major barriers to accessing HIV services, and on the other, affect program planning and service provision due to under-reporting.

Dr. Beatrice Lydia Matanje from Malawi’s National AIDS Council emphasized that community engagement is crucial to reducing stigma and improving services for vulnerable populations. Despite these efforts, the restrictive legal framework makes it difficult for KVPs to openly participate and assert their rights. According to her, “…the policy environment allows participation, but the legal environment is not there”.

They described successful strategies, such as community-led monitoring and engagement of communities in data collection, advocacy, and other efforts to reduce stigma and improve service provision for KVPs.  In Malawi, community-led monitoring initiatives have been instrumental in identifying and addressing gaps in HIV service delivery, leading to an increase in KVPs accessing care over the last year.

Natalya Shumskaya from Kyrgyzstan’s AIDS Foundation East-West (AFEW) shared strategies to reach KVPs and combat stigma. Their initiatives include targeted outreach to individuals, expanding access to HIV services through web outreach and online counselling, promoting rapid HIV testing, and providing comprehensive social support.

Utkur Pulatov from Istiqbolli Avlod, Uzbekistan, highlighted the success of collaborating with government agencies to implement HIV prevention programmes, particularly among Uzbekistan’s labour migrants, stressing the importance of expanding services to address the broader health needs of these populations.

The panel concluded with a set of recommendations to improve conditions for KVPs. This includes, for instance, training service providers and police officers on how to communicate with KVPs, engaging communities to enhance access to health services such as testing, prevention, and treatment and to reduce stigma. All partners emphasized fostering partnerships between civil society and government, improving monitoring, and addressing legal barriers to reduce stigmatization. These actions are crucial for overcoming barriers faced by KVPs and strengthening their empowerment in healthcare and advocacy.

Implications for KVPs rights in the context of HIV/AIDS: responses from the GFATM

The third session “Advocating for Human Rights”, focused on the human rights challenges affecting HIV/AIDS responses, as well as the important role of the GFATM’s Breaking Down Barriers Initiative in addressing them.

Dr. Olayinka Anthonia Falola-Anoemuah from Nigeria’s National Agency for the Control of HIV/AIDS (NACA) shared Nigeria’s perspective as a new participant in this Breaking Down Barriers Initiative. She noted that the biggest challenges KVPs face when accessing HIV services are discrimination and stigma, in a context where laws and cultural and religious beliefs are not permissive of sexual diversity.

Dr. Alexandrina Iovita from the GFATM echoed these sentiments, describing discriminatory laws and policies, stigma, and lack of knowledge about human rights as barriers experienced globally among key populations. She explained “…participation in the Breaking Down Barriers Initiative has helped to shift the narrative,” adding that efforts have resolved 75% of key population-related human rights cases in the past year.

The session concluded by emphasizing the vital role of strong community-led programs, such as community-led monitoring, in fostering accountability and feedback mechanisms, while also underscoring the importance of peer-to-peer learning. This approach ensures that lessons learned are not confined to a single context but are scaled up to benefit other countries, driving broader systemic change.

The dialogues facilitated by BACKUP Health at the AIDS Conference 2024 focused on critical issues surrounding access to HIV services for vulnerable populations. BACKUP Health sessions provided a platform for discussing the challenges faced in various contexts where human rights are under threat.  BACKUP Health partners from different countries identified several barriers to accessing HIV services, including stigma and discrimination, which continue to hinder individuals from seeking necessary care. Additionally, challenges such as limited organizational capacity, complex logistics, security concerns, restrictive legal frameworks, and insufficient awareness of human rights were also identified as significant obstacles.

In response to these challenges, the discussions emphasized the importance of innovative solutions. The use of artificial intelligence, for instance, was proposed as a means of increasing outreach and improving service delivery. Other strategies included leveraging web outreach to expand access and utilizing stigma index surveys to better understand and address the needs of affected populations.

Ultimately, the discussions underscored the necessity of ensuring that resources are directed towards organizations capable of implementing effective human rights- and community-based interventions. This approach is vital for improving access to HIV services and fostering an environment where people can receive the care they need without fear of stigma or discrimination.

About BACKUP Health

BACKUP Health is a global programme commissioned by the BMZ and implemented by GIZ. It advises partner countries worldwide to make efficient use of resources provided by global initiatives to strengthen health systems.

As a technical cooperation partner of the GFATM the programme supports national partners through all stages of the funding cycle in line with the countries’ priorities and the systems strengthening strategy of the GFATM.

Maja Bernhardt and Leona Aschentrup
September 2024