Pride in Our Progress: Reaching the UNAIDS 90-90-90 Goals

In honor of Pride month and the recent 15^th anniversary of the PEPFAR program, the JSI-implemented USAID Strengthening the Care Continuum Program is running a blog series reflecting on the success Ghana is having in preventing and treating HIV among the LGBTQ community.

This first blog looks at three unique aspects of the Care Continuum program and its contributions toward the global 90–90–90 goals.

As Ghana successfully moves toward reaching the 90–90–90 goals, there is a lot to celebrate. In the last 15 years, we have moved closer than ever before to controlling and preventing the epidemic, saving lives, families, and futures from disease and death. The PEPFAR program has galvanized global attention on HIV and the 90–90–90 targets have shaped programs and structured funding in a way that inspires countries to ambitiously hope for an end to the epidemic within their current populations’ lifetimes.

We are proud of what we’ve achieved so far.

But amidst the success, the healthy families, and fresh starts, there are still those who are marginalized, discriminated against and are at risk, those who are alone in their fight against HIV, and those who could prevent HIV infection but don’t know their options.

These individuals have been the focus of my career and the passion behind my work. For the last 15 years, I have dedicated my time to working with groups known as key populations (KPs)—the broader category applied to those most at risk for HIV infection—particularly around their access to services, enrollment in care, and empowerment to live long, healthy lives.

As the Chief of Party for the USAID Strengthening the Care Continuum Project, I have the privilege of working alongside those who share a similar dedication to this work and the people we serve.

The goal of the Project is to improve the capacity of the Government of Ghana (GoG) and its partners to provide quality and comprehensive HIV services for KPs (which include female sex workers (FSW), men who have sex with men (MSM), transgendered persons, and their partners) and people living with HIV (PLHIV) by improving access to and use of quality HIV services. A key aspect of this work is capacity building at the community level; the Care Continuum works closely with civil society organizations in key areas to enhance the effectiveness of their interventions, strengthen the services they provide, and invest in their commitment to the KP community for long-term sustainability.

In 2016, Ghana adopted the WHO’s “treat all” policy recommendation, which mandates HIV treatment for all those who test HIV positive. As one of the partners working to improve HIV services and increase enrollment in care, the Care Continuum has adopted innovative strategies to reach KPs.

Stigma, particularly self-stigma, keeps many members of these communities from discussing their status or engaging in care. Stigma from families, communities, and even health care providers further alienate these groups. To reach KPs who are unreached, the Care Continuum uses a combination of differentiated service models to reach out to the different groups within the KP community. These approaches include social network testing, ring-leader approach, targeted outreach testing, social media contact and referral, healthy living audio messaging and helpline counseling, and community-based case management.

My experience has taught me that while community action and local interventions are important, support from aligned national policies and procedures is essential for long-term change.

In the last year, the Care Continuum supported the GoG in revising and releasing new standard operating procedures governing HIV treatment for members of KPs. The revised KP SOP 2017, developed through a multi-stakeholder engagement, take into consideration the new focus of KP intervention in Ghana, the changes in the global HIV arena, and the peculiar needs of KPs in the most vulnerable communities in Ghana.

While these guidelines improve the quality of care KPs receive, the information they provide also reduces the stigma KPs encounter in health facilities, making it more likely that KPs enroll in HIV care, remain in HIV care, and return to health facilities routinely for other health needs.

But policies only do so much without actually changing behavior. For this reason, the program worked closely with KPs themselves to develop a new suite of training materials designed to provide KPs with the information they need to live healthy lives. This set of materials, which is designed to be used by peer educators when working with FSW, MSM, and PLHIV community members, includes tools, job aides, and a training manual for facilitators. These new materials ensure standardization of learning and the application of tools and messages.

The Care Continuum’s differentiated approach to service engagement, support for KP-friendly policies, and leadership in crafting new behavior change communication materials all speak to the success we have had as a program in the first half of the Project. While these achievements make me proud of my team, community partners, and the work we do together, they also remind me there is still so much more to accomplish.

We are certain the next phase of the Care Continuum will continue to focus on interventions that achieve the maximum yield that will accelerate gains toward the attainment of the Project goal and objectives and more importantly those interventions that can be sustainably scaled up.

In the upcoming blog posts in this series, you will learn about two ways the Care Continuum is investing in Ghana’s future by using technology to engage KPs and empower them to enroll in care and by using a unique capacity building approach to ensure long-term sustainability.

Read the second blog.

Written by Henry Nagai