IAS 2017: Knocking down barriers between services and populations facing highest risks, lowest access, takes time, gathers momentum

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Science Speaks is in Paris this week covering the 9th IAS Conference on HIV Science.

PARIS – From a social worker in Botswana who tackles bureaucracies and prejudice to help her clients get the papers, income, and respect they need to access services, to a Kenyan nurse counselor who told an audience that she has learned to put her professional ethics ahead of her “personal and religious values,” to support the patients she serves, a session today presented evidence that slowly, incrementally, and somewhat uncertainly, the work to knock down barriers between health care and those known as “key populations” is, at least, underway.

Barriers to basic human rights facing men who have sex with men, people who earn income through sex work, people who inject drugs, and all people living with HIV “reduce the impacts of investments” in controlling HIV and promoting health, Kate Thomson of the Global Fund noted at the session’s start.

Support for tackling those barriers in 2014 to 2016 Global Fund grants and structure had been inadequate, she acknowledged. The 2017 to 2018 funding cycle, she said, will allow the opportunity to do better.

Over time, publications, training and other resources have begun to tap into the vast experiences of affected and marginalized communities while support, particularly through a U.S. President’s Emergency Plan for AIDS Relief partnership with the Elton John Foundation, has begun to put those experiences to work.

The session today presented the beginnings of results on the ground.

Stella Chege is a Kenyan nurse counselor who has learned, she said, that the health of men who have sex with men “is the nation’s health.” While widespread data remains out of reach in her country, she has learned that HIV prevalence among men who have sex with men in Nairobi is 18 percent, and she has learned that men who have sex with men are hesitant to seek health services because of the stigma and discrimination they face. For that reason, she said, she has also learned to “separate” her “personal and religious values” from her professional life, “for the sake of HIV prevention in Kenya.”

Neo Nametso Monnapula, who works with sex workers in Botswana, takes on the barriers facing her clients on multiple fronts. She helps her clients get the national identification cards they need to get free antiretroviral treatment — a privilege that is reserved for citizens in a country where proof of that citizenship can be out of reach for criminalized populations. Her clients face obstacles that can cause them to miss appointments. So she got trained to dispense emergency antiretroviral treatment doses. Her clients face prying questions and insulting assumptions when they go to clinics and pharmacies, so she works to teach her colleagues the impacts of their words and attitudes on the people they are supposed to serve. And when her clients seek income through entrepreneurial activities that include raising chickens, Monnapula spreads the word and sells eggs. She never forgets her clients are human beings, mothers, sisters, and daughters, she said.

She seeks to respond to every obstacle her clients and her work brings to her attention, she said, because: “I don’t want to be standing here today, and saying ‘How did I miss them.'”

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