INCLUSION OF KEY POPULATIONS CRITICAL IN HIV FIGHT
MILESTONES such as the decrease in HIV/AIDS-related mortality by 45 percent and a spike in antiretroviral therapy (ART) uptake; with more than 25 million people living with HIV (PLHIV) currently on ART, has inspired global confidence that the epidemic control of HIV is achievable by 2030 (UNAIDS, 2019). In Zimbabwe, there are an estimated 1.4 million PLHIV and of these, 97 percent are on the ART programme. Among PLHIV (15-64 years) who self-report current use of ART, 90.3 percent are virally suppressed (ZIMPHIA, 2020).
Despite the accomplishments, key populations are still faced with limited access to health services, increasing their likelihood of developing one or more of the HIV/AIDS-related diseases.
Key populations are sub-groups of the population at higher risk of being infected by HIV/AIDS, who play a key role in how HIV/AIDS spreads, and whose involvement is vital for an effective and sustainable response to the pandemic. Too often, people most affected by HIV/AIDS and tuberculosis (TB) are the same people who do not have access to health care.
Widespread stigma and discrimination, harassment, restrictive laws, and policies, as well as the criminalization of behaviors or practices that put key populations at heightened risk, are among the barriers that prevent them from accessing health services.
According to the UNAIDS (2019) estimates, Zimbabwe has 23 000 men who have sex with men (MSM) and 45, 000 sex workers.
In the context of HIV/AIDS, Zimbabwe considers MSM, sex workers and their clients, transgender people, and people who inject drugs as the four main key population groups. However, groups such as prisoners and people with disabilities are also acknowledged as at-risk populations as they are also particularly vulnerable to HIV/AIDS and frequently lack adequate access to health services (ZNASP3).
These populations are socially marginalized, often criminalized, and face a range of human rights abuses that increase their vulnerability to HIV/AIDS.
To overcome these barriers, the Zimbabwe Association of Church-Related Hospitals (ZACH) through the United States President’s Emergency Plan for AIDS Relief (PEPFAR)/CDC supported health sites tailor services to the specific needs of these populations, as well as invest in programs that address the underlying causes of discrimination.
ZACH offers friendly clinical and support services like HIV testing services (HTS), sexually transmitted infections (STI) screening, and treatment and management of co-infections, such as TB and viral hepatitis. On the provision of HTS, ZACH is scaling up innovative and differentiated HIV/AIDS testing models. And treatment and care support is offered to those living with HIV.
The organization is also strengthening community systems through advocacy structures, peer groups, and networks. These provide the space and opportunity for the key populations to act together, and to campaign for their rights.
ZACH also offers pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), and condoms to the vulnerable groups.
The COVID-19 crisis has exacerbated the previous inequalities for key populations affected by HIV/AIDS, thereby rolling back the wins gained in the fight against HIV/AIDS. Indeed, the abuse that these populations suffer as well as stigmatization, and criminalization impacts negatively on the health of these already vulnerable populations as they will also be less willing to engage with the health services. Key populations may also be vulnerable to mental health problems and poor mental health may be a barrier to testing or treatment for HIV/AIDS, and to continue in care for those who are living with HIV.
Despite the efforts by ZACH to reach out to the key populations with health services, a lot still needs to be done.
A call is being made to development partners and the Government to develop strategies to reduce stigma and discrimination including self-stigma of the key populations, as well as conduct awareness campaigns and decriminalization to promote access to health care.
Though several behavioral, biomedical, and structural interventions operating at an individual and population/community level are being widely used for HIV/AIDS prevention and support, the best way is to involve key populations in the design, implementation, and monitoring of those health services, as well as in policy decisions that affect them.
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