Thursday, August 11, 2022
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Community-led Approaches Are Pivotal To Respond To HIV, SRHR And Covid-19


Solidarity
and accountability are the hallmarks of tackling public
health problems, as well as health emergencies. We need
integrated interventions that focus on people (and not just
the disease), and address the needs of the individuals
collectively, urged Eamonn Murphy, Regional Director,
UNAIDS, Asia and the Pacific.

Murphy was delivering
the plenary address of twelfth virtual session of the 10th
Asia Pacific Conference on Reproductive and Sexual Health
and Rights (APCRSHR10), which is being held online this year
because of the Covid-19 pandemic.

There has to be
increased joint advocacy and joint programming to improve
sexual and reproductive health and rights and control
HIV/AIDS. We need to mobilize political (governmental) as
well as community leadership to re-energize, he
said.

Agrees Dr Jennifer Butler, Director of UNFPA
Pacific sub-regional office based in Fiji, that community
led approaches are of paramount importance to run their own
services and to shape the services they receive. “In the HIV
‘world’ we knew this from very early on, and in the sexual
and reproductive health and rights (SRHR) field it is
becoming an increasingly critical mode of engagement. Access
to sexual and reproductive health package of services and to
HIV services has long been considered as basic right. But
here we are in 2020, still arguing the case of HIV and
sexual and reproductive health and rights integration. We
are still looking at stigma, discrimination, exclusion; we
are still looking at the need to continue to train
healthcare workers to treat everybody with dignity they
deserve”, she said.

While access to quality healthcare
services, whether for sexual and reproductive health, or for
HIV/AIDS care, is very important, access alone cannot help
shape responses. Not only is community engagement important
but also community-led monitoring, to improve quality and
regularity of appropriate HIV-related services.

Dr
Harjyot Khosa, from YRG Centre for AIDS Research and
Education, India, made a case for establishing community-led
monitoring systems to engage communities on a regular basis
to improve quality as well as accessibility of HIV-related
services.

She gave the example of Community Score Card
as one such systematic and sustained approach by engaging
key populations to facilitate better health, improve HIV
service delivery and overcome stigma and
discrimination.

What is a Community Score
Card?

It is a participatory tool to ensure
accountability, transparency and responsiveness from service
providers and improve quality and efficiency of services by
receiving systematic feedback from the community as well as
service providers. It empowers both – key population
communities and service providers – and has proven to be a
sustainable mechanism to monitor and record changes in
quality and efficiency of services.

Dr Khosa shared
the example of the Community Score Card for HIV affected
communities developed and implemented by India HIV/AIDS
Alliance under its ‘Nirantar’ programme. This Community
Score Card has a set of 7 core indicators and sub-indicators
on a range of issues, including quality of services,
availability and accessibility of commodities/ services,
forms of stigma and discrimination and attitudes of service
care providers towards people living with HIV.

The
community and healthcare providers conduct the scoring on
each issue separately. Next, an interface meeting between
the community members and the healthcare providers is held
where the scores provided (on a scale of 0 to 10) by the
healthcare providers and the community are reviewed to
arrive at consensus scores and develop a mutually agreed
action plan. Any score less than 4 warrants an action. They
look at whether the problem is at healthcare provider level,
HIV prevention programme level, government level or
community level. Then an action plan is drawn whose outcomes
are checked after 3 months in the next quarterly meeting.
Heads of hospitals, healthcare providers, functionaries of
targetted interventions and communities develop and resolve
the action points during the interface meetings.

Under
the abovementioned programme 72 community score cards were
developed and 169 issues out of 230 were resolved till
date.

Samreen, Human Rights and Advocacy Officer at
Asia Pacific Transgender Network (APTN), and Manisha Dhakal,
Executive Director of Blue Diamond Society, Nepal, appealed
for integrating transgender health into HIV and sexual and
reproductive health and rights programming, as the health
needs of transgender community are still not recognized
fully and they lack access to HIV and sexual and
reproductive health related quality care.

They shared
the findings of a community-based study, documenting the
barriers faced by transgender women and transgender men in
accessing HIV, sexual and reproductive health and rights and
other healthcare services in Indonesia, Nepal, Thailand, and
Vietnam.

While most respondents of the study had been
tested for HIV, quite a few delayed seeking treatment,
largely due to fear of discrimination by healthcare
providers. Delaying treatment due to invasive questions was
a stressor and reduced healthcare seeking behaviour.
Respondents also reported that barriers to accessing health
services were correlated with worse physical and mental
health, and many of them exhibited severe symptoms of
depression and anxiety.

The study clearly shows that
transgender people’s right to health is compromised across
the Asia Pacific region. There are gaps in availability of
sexual health services for transgender women and no services
targeted at transgender men. Gender affirmative healthcare
is limited and unregulated. Transgender people desperately
need mental health support services. Stigma and
discrimination limit transgender people’s access to general
healthcare services.

Rate of new HIV infections is
not declining steeply enough

Sharing the latest
HIV/AIDS data for the Asia Pacific Region, Eamonn Murphy
said that a mere 12% decline in new HIV infections over the
last decade is not reason enough to celebrate. Also there
are wide variations between countries- new HIV infections
declined by 81% in Singapore but rose by 207% in
Philippines. AIDS-related deaths also declined overall by
29% in the region. While India recorded a whopping decline
of 66%, Pakistan and Philippines saw a 4-fold and 3-fold
increase in them over the same period. In 2019, 98% of the
new infections were among key populations and their
partners, with the most affected being the under 25 years
old men who have sex with men.

“It (HIV infection) is
rising amongst the young, and the most marginalised in
societies are bearing the greatest impact, but that does not
always attract the political leadership and support that is
required to address these issues effectively. We see a focus
very much on treatment but not so much on prevention so we
have got the tap running while we are trying to empty the
bowl underneath”, said Murphy.

He also stressed upon
the need to ensure the linkage between testing and treatment
for those who test positive, and between testing and
prevention for those who test negative for HIV. Another area
of concern for both, HIV and sexual and reproductive health,
is to get the young people to be able to access the
services.

impact of Covid-19

Both HIV and
sexual and reproductive health services have been affected
by Covid-19, further widening the already existing
faultlines. More than 80% of women living with HIV in Asia
Pacific region reported that they lacked access to sexual
and reproductive health services, including contraception,
during covid-19 lockdowns. Transgender women reported
difficulties in accessing hormone replacement
therapy.

Young key populations of the region
experienced disruptions when accessing condoms, Pre-Exposure
Prophylaxis (PrEP), HIV testing and medication, mental
health medication and psychological support.

Gender
identity related stigma and discrimination also increased
significantly during this time and amplified sexual and
other forms of gender-based violence as well as violence
against key populations by their families because people are
spending a lot more time together in closed personal
spaces.

Community solidarity and resilience in times
of Covid-19

There are countless examples of how
community solidarity has been at the forefront of doing
their bit to maintain continuum of HIV care and service
delivery, despite lockdowns. These include community-led
innovations on differentiated service delivery, multi-month
distribution of home antiretroviral (ARV) refill delivery
and PrEP delivery service in Philippines; adapting service
delivery to meet the needs for PrEP in Viet Nam; community
ARV dispensing in India, Nepal, Papua New Guinea,
Philippines, and Thailand; key population led PrEP service
delivery in Thailand, to name a few. Regional community
networks have also amplified the impact of these and other
community-led responses.

However, such solidarity
cannot be the sole responsibility of communities.
Governments cannot absolve themselves from their
responsibility to accelerate and sustain progress on every
evidence-based intervention for HIV prevention, treatment,
care and support. They also have no excuse to not invest
fully for universal access to health through universal
health coverage, which should be focussed not only on issues
of health financing, but anchored in the right to health for
everyone.

Shobha Shukla is the award-winning
founding Managing Editor of CNS (Citizen News Service and is
a feminist, health and development justice advocate. She is
a former senior Physics faculty of Loreto Convent College
and current Coordinator of Asia Pacific Media Network to end
TB & tobacco and prevent NCDs (APCAT Media). Follow her
on Twitter @shobha1shukla or read her writings here
www.bit.ly/ShobhaShukla

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