Building Partnerships with Key Populations in HIV Research

“Success and Gaps”

Reflections from the Field

Dr Joshua Kimani,

SWOP UOM – Kenya

UOM-UON Long Partnership with FSW in Nairobi Kenya“From Being A Stigmatized Group to Agents of Change”

• Early 1980s: Risk groups and peer leaders used for community engagement

• 1990s: Partnerships created to facilitate research studies.-Peer educators/ leaders key

• 2000+: New focus where SW groups are partners in HIV prevention and care:– Peer Educators key– Peer Leaders Consulted on

study design/implementation/ CAB

– Members of the MOH –TWG– Sub-grantee’s for structural

interventions

UOM Partnership with FSW in Nairobi Kenya

“25 years plus of interventions with sex workers – Majengo Clinic

0%

10%

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30%

40%

50%

60%

70%

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100%

85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

YEAR

PERC

ENT

(%)

HIV Incidence Condom use with Casual client Gonorrhea Infection rate/visit Chlamydia Infection rate/visit

Year 2014NB: HIV Prevalence Average- 27.8%HIV incidence of 2.2% (95% CI 1.6, 3.1)

LGBT/MSM and FSWNational Guidelines & Strategic Plan Development as Key stakeholders

NB: Sex workers through their leaders defended the program to the last woman!!!!!

Our Program Interactions with MSMs Began in 2009!!!

Working with MSMs in Kenya

A partnership approach

used from 2009 due to:-• Tested process• New frontier for us• Rampant stigma• Discrimination• No socio-protection• Challenges with legal

framework• etc

Why Partnership with MSM

• Trust and respect created quickly• Peer educators key in community engagement• Peers used for demand creation• Also helped in recruiting MSMs into the program• Tracing those lost to follow-up• Created shared responsibilities• Key populations participation in knowledge

production- Questionnaires, Informed consent documents and tracing tools

• Peer leaders emerged who helped in programming

MSM (SW) Enrollment into Program (1011)

HIV Prevalence – 34%

UOM SWOP Team and HOYMAS Partnership 1

• In 2010 SWOP created a safe space for the MSMs within the clinic

• Trust cemented and clinic became popular• Number of Peer Educators increased and

formally trained • Recruitment and retention efforts proceeds

effectively• Peer leaders emerge around 2010/2011• Request for assistance to form a

“collective” provided in 2011• 2011 – HOYMAS registered as a CBO

*HOYMAS- Nairobi MSM collective

UOM SWOP Team and HOYMAS Partnership 2

• Adherence to ARVs then noted as a big challenge - 2011

• SWOP Team and HOYMAS discussed the issue

• “Encounter groups” adopted as a way of addressing poor adherence

• HOYMAS mobilizes team members to register – a success story

• HIGH HIV INCIDENCE then emerged as challenge in 2012

• NB: “Encounter groups” continue to date with HOYMAS taking a big role

HIV Status by Age Group-MSM

HIV Prevalence - 34.0%HIV incidence of 10.9% (95% CI 7.4, 19.3)

SWOP Team and HOYMAS Partnership 3

• High HIV incidence remain a challenge in 2013

• Community insights into the problem & potential role in helping with solutions noted

• A study to evaluate the increased HIV risks among the MSM mooted

• A joint proposal was then developed with HOYMAS as key partners and submitted – “HIV Vulnerability Study”

• Submitted to CIHR in 2013• Funded by CIHR

Project Started – June 2014- HOYMAS – Key Implementers

UOM - HOYMAS Nairobi Proposed Study

Title: HIV Vulnerability Study The proposed study has two overarching and staged objectives: • (1) To produce a reliable evidence base that can explain

the individual, social, environmental and structural factors that shape the HIV-vulnerability of MSM sex workers in Nairobi; and (HOYMAS – LEAD)

• (2) To design and pilot test a community-based intervention that can address these various levels of vulnerability ( JOINT EFFORTS)

Innovative Approaches to Sustain Partnerships - 2014

• Capacity building in research methods for LGBT held• Gay and Lesbians Coalition of Kenya (GALCK) funded to

establish an LGBT national research advisory group (G10)• LGBT/MSM, Funder’s and researchers sensitized on HIV and

SOGI issues – March 2014• Researchers, key populations, Funder’s and NASCOP- MOH

held a meeting on how to strengthen partnerships and coordinate research – March 2014

• LGBT/MSM develops a research agenda • Researchers and LGBT/MSM agree on a research agenda

and implementation plan – May 31 2014• LGBT are part of the KP Technical Working Group –

NASCOP- MOH

Partnership Challenges• Limited knowledge/ capacity on research methods among

LGBT/MSM team• Power imbalance between the researchers and the

LGBT/MSM community• Some researchers keen on status quo• Clarity of roles and responsibilities in research/program

implementation – Post trial obligations– Security

• Limited number of LGBT/MSM hired by the research/programs

• etc

Conclusions

• HOYMAS / UOM partnership has made huge strides from 2010• Partnerships between researchers and key populations the only

way• Engagement should be based on Respect/ Protect/ Fulfill

platform• LGBT/MSM groups need capacity building in leadership, fund

raising, management, research methods etc• Community engagement with the broader LGBT groups is also

critical• Qualitative and quantitative studies on HIV vulnerabilities, role

of PrEP, PEP, TASP, Microbicides (Rectal) and vaccines among the LGBTs/MSM are priority areas

Acknowledgements

•NASCOP – MOH and partners•HOYMAS leadership and members•GALCK •SWOP – UOM and UON Team•amfAR – the Foundation for AIDS Research •IAVI (support from USAID)

jkimani@csrtkenya.org

Asante sana / Thank You