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Daily News from AIDS 2022. July 31

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People at the center

1. HIV and Opioid use are associated with immune activation and inflammation: In people living with HIV who are in care, chronic opioid use exacerbates immune activation and inflammation.
2. Based on a study in India, multiple stigmas are associated with mental health and alcohol use, while gender affirmation (especially legal) and access to resiliency resources are associated with improved mental health and reduced alcohol abuse among transgender women (TGW) living with HIV.
3. Policies and interventions that bolster legal and other types of gender affirmation may improve health of TGW living with HIV.

Enlightenment through estimation: New insights in HIV epidemiology

While trans people have contributed to HIV research, little prospective research designed for trans women in the US exists. Epidemiologic monitoring of HIV, premature death, and other events to inform public health among trans women in the US is almost non-existent. HIV incidence and mortality are high in transgender women, disparate across race and ethnicity, and underscore community calls for multilevel interventions that address social and structural contexts, other health concerns, alongside HIV prevention.

The findings of the study also show that community and location-based efforts should be maintained as HIV research and interventions are increasingly digitally-delivered.

Nothing about us without us

Integration of a peer-led depression screening and linkage-to-care intervention among transgender women living with and at risk for HIV at a transgender-led health clinic in Bangkok, Thailand 

  • The high-acceptance rates of depression screening with linkage to care showed that integration of peer-led mental health services in the trans-led clinic Tangerine was feasible.
  • Counselors and nurses require adequate training and ongoing support.
  • Qualitative data and large scale implementation trials are needed to guide further development of mental health service integration strategies.

Human rights violations faced by women from key populations in Ukraine: evidence collected through the community-based monitoring approach

  • REAct has coverage in 12 implementing countries.
  • State health workers represent 45% of key perpetrators of human rights violations, the most common are 71% of denial to provide assistance.
  • Understanding human rights violations among women and other key populations enables to produce evidence-informed recommendations to promote effective HIV response and facilitating the empowerment and gender equality in the context of HIV.

The Key Populations Investment Fund: Progress, pitfalls, and future directions for key population programs

KPIF Regional Technical Assistance in Asia: The South-South Capacity Strengthening Intervention on HIV testing, PrEP and Transgender-Competent Car

  • IHRI was responsible for improving the technical capacity of healthcare providers and community organizations in the region in Laos, Myanmar, Nepal and the Phillipines. These services include Prep, Transgender-competent care, telehealth and mental health.
  • TA to establish the first transgender clinic in Myanmar.
  • Transgender-competent care is set to expand in the region, with the first AsiaPath being established in 2021.
  • Funding approval represents a great challenge, as well as lack of robust internet capacity and technological devices represents an implementation challenge, as well as reporting system and indicators haven’t been well established.
  • There are opportunities in investing in interactive online platforms, setting clinical program indicators in the region, and strengthening the capacity of local experts.

Creating Connections: Experiences and Lessons Learned from Technical Assistance provision in West and Central Africa

  • There’s opportunities for Key Populations in Ghana, Mali, Togo and Senegal to discuss new approaches and promote African-led initiatives.
  • Key recommendations include promoting advocacy strategies at the regional level, setting-up a pool of KP friendly religious leaders and documenting and sharing advocacy success stories, in addition to developing thematic advocacy tools.

Evaluating the Impact of KPIF Programming in Nigeria, South Africa, and Malawi

  • KPIF facilitated South-to-South learning and service delivery across the cascade, their goal was to collaborate with the U.S Government Missions, key populations stakeholders, and implementing partners of the KPIF to understand the additive value to their investments.
  • Implementing partners modified existing delivery approaches with the aim of minimizing interruptions in testing and treatment for all KPs.
  • Enhanced ART delivery and retention strategies point to improved initiation and treatment continuity for FWS (South Africa).
  • Increase in 30-day ART initiation for all PLHIV following KPIF implementation in January 2020 (Malawi).
  • KPIF supported equitable, sustainable and community-driven efforts central to program design and implementation.

Key Population Community Perspectives on KPIF 

  • Lower middle-income countries have received only 2% of KPIF available funding.
  • Jinsiangu used the KPIF fund to get core instruments in place, they had to come up with strategic post-COVID interventions.

Community monitoring: Key populations in COVID-19

The Caribbean Vulnerable Communities Coalition conducted a number of activities in Central America and Caribbean – the Dominican Republic, Guatemala, and Panama – with an aim at holding the organizations accountable for health services by monitoring projects on prevention and health challenges facing service providers. One of the activities held by CVC is a three-day workshop for transgender women, sex workers and MSM about prevention and health policy advocacy. The organization calls for attention to the relevance of collaborative capacity building between the service users and partner organizations, such as government and service providers, through a rights bases framework capable of empowering individual and institutions.

They highlight the need to mutually support both people and institutions in their communities to analyze their situation and take decisions about their lives, rather than being passive objects of choices made. The main idea is to put people in the center in order to enable decision makers to make informed de visions and policy choices and help governments and institutions to learn directly from communities. This way they hope to implement service improvements that respond to peoples rights, needs and preferences. The approach focuses (i) the rights of the key populations to access information and generate constructive feedback to service providers about their performance and (ii) on the working in different levels of the government and community providers to see how they can meet the needs of the communities

As for the interaction between the COVID-19 pandemic and the HIV response in the national contexts where CVC’s projects occurred, they mentioned the few positive innovations brought by the recent times as in the example of online systems to schedule appointments at HIV healthcare services and multi-month ARV distribution. By the other hand, some people involved at the project report difficulties in getting doctors appointments, overloading of health care services and HIV non related healthcare.

  • When asked about the specify situation of trans women, the researchers reported that situation in Guatemala is the most exciting on: the majority of trans and gender diverse people of Guatemala appreciates and feels comfortable in accessing the health care services they need, as the services are offered by local organizations. One of these organizations offers hormonal therapy for trans women living with HIV, but the sustainability of the offer depends a lot on the funding fluctuations.
  • In the Dominican Republic, 17 organizations partners with the government agencies and authorities in order to provide HIV health care services. Even though they had full access to COVID-19 vaccination, trans and gender diverse people were consistently left behind on the distribution chain of emergency assistance packages.
  • In Panama, the organizations don’t have the chance to collaborate in providing the services. The political background is friendly but the reality is disappointing: gender affirming care for trans women in highly dependent on healthcare workers self disposition to the theme and just one specialized clinic for MSM offers that kind of services.

Breast is best: Making efficient feeding options available to all

WHO 2010 Guidelines on the PLHIV breastfeeding: the initial effort to create an opportunity for women, trans femme and masculine living with HIV to explore alternatives.

In September/2021, the Australian national guidelines on breastfeeding for women living changed after a long advocacy and research process. Since 2015, the National Network of Women Living with HIV conducted a literature review and published a community resource based on UK and several European guidelines previously launched. The Network has conducted several project, as the HIV Focus Group Consultation and the Online Community Forum on Breastfeeding for Women Living with HIV.

As for the Eastern and Southern Africa, a local lawyer calls attention to a regional trend: although the guidelines appear to be supportive, at least 9 women faced prosecuted charges for breastfeeding. Most of the countries recommends not breastfeeding for people living with HIV and have in place HIV specific criminal law based on non disclosure, as in the Uganda, Malawi, Kenya.

A researcher from USA attests that infants who were breastfed had more chance to survive and highlights the long term health impact, specially in higher income countries data reflects lower rates of reproductive cancer and strokes. The doctor says that health workers have consistently neglected to consider the beneficial aspect of breastfeeding and mortality issues related to breastfeeding, in order to stigmatize HIV. This reflects a dispute between prejudice-based medicine which disempower individuals by fear.