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Creativity Is Key To Ending HIV In El Salvador

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By Bernabe Yameogo

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Twenty-year-old Taty is a trans woman living in El Salvador and working in the sex trade. Fear of discrimination and harassment keep her from visiting clinics and hospitals, meaning that she is at high risk of contracting HIV, but doesn't seek care.

The Global Fund, a partnership comprised of governments, NGOs like Plan International Canada, the private sector, and the general public, is working to end the HIV/AIDS, malaria and tuberculosis epidemics by 2030. It's true that we've made great strides to combat these epidemics in recent years, but make no mistake, this is an ambitious goal. In order to #EndItForGood, we must use creative approaches and innovative partnerships to ensure that support reaches all people -- especially the most vulnerable, like Taty.

Identifying vulnerable populations

What does it mean to reach vulnerable populations? How do we locate them, let alone create programs that will help them to access health care? National statistics tell us that among El Salvador's general population, an estimated 0.5 per cent of people have HIV, consistent with other countries in the region. However, El Salvador's vulnerable populations experience disproportionate rates of infection, namely female sex workers (4.5 per cent) , men who have sex with men (13 per cent) , and transgender women (16 per cent).

It is sadly not uncommon for transgender women to experience abuse and harassment from health-care professionals in El Salvador.

These vulnerable populations are all at greater risk of contracting HIV because they experience increased stigma, and are often overlooked altogether. Female sex workers face dual obstacles to HIV prevention. They are often discriminated against, and face difficulty convincing clients to use protection. Sex workers often go unseen by the health-care system, both because of stigma, and because their work hours do not align with clinic hours, effectively making services inaccessible.

Men who have sex with men are similarly discriminated against when they try to access health services, but they may also struggle with the issue of self-identification. Men who have sex with men but do not identify as gay may not recognize their increased risk of infection, and may not seek out protection or testing.

The highest prevalence of new HIV cases is among transgender women, who are most likely to experience discrimination that will block them from accessing health services. It is sadly not uncommon for transgender women to experience abuse and harassment from health-care professionals in El Salvador. To make matters worse, transgender women often struggle to secure employment, and are more likely to pursue sex work as a way to make ends meet -- a particularly precarious situation when combined with a lack of access to health services.

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An Innovative approach

With the support of the Global Fund and El Salvador's Ministry of Health, Plan International has created an innovative program that provides prevention services and early HIV-care and support services to El Salvador's most vulnerable populations. It uses mobile education units (or Unidades Moviles Educativas, in native Spanish) to bring testing and other services to the people who need them. Minivan-based mobile units are staffed with professionals, including laboratory clinicians, counselors, educators and a driver. They increase awareness of HIV and provide access to condoms and lubricants, rapid HIV testing, pre- and post-test counseling, as well as referrals to health centres and HIV-care clinics.

Much more than a simple HIV testing and condom distribution service, this program helps people to access their fundamental human right to health and dignity.

These mobile units are able to serve people who otherwise would not receive care. They identify routes where vulnerable populations are more likely to be, including bars, brothels, country borders and commercial centres. Visits are often planned outside of traditional business hours to accommodate sex workers' schedules. Perhaps most importantly, each mobile unit employs at least two educators from one of the target populations, meaning that sex workers, men who have sex with men, and transgender women are providing support to members of their own communities. This allows the mobile unit to build credibility among the people it serves, and to provide testing and support that marginalized community members can trust without fear of discrimination.

A step in the right direction

Since launching in 2014, this program has provided prevention tools, testing and referrals to over 20,000 vulnerable people in El Salvador. Much more than a simple HIV testing and condom distribution service, this program helps people to access their fundamental human right to health and dignity. This program has made a difference in the lives of thousands, including Taty. She likes this program because "mobile unit educators walk through the block (area of sex work) and it's easier for us to get tested and to find out if we are infected [with HIV] or not."

Let's End it. For Good.

In my decades of experience in global development, I've seen great strides in HIV/AIDS prevention. But in order to continue to make progress, we must prioritize creative programs like the Unidades Moviles Educativas . A one-size-fits-all approach to prevention is not the solution to ending the HIV epidemic. However, through innovation, creativity, and continued partnership with the Global Fund, we can help all people to access their human rights to health, and can end the HIV/AIDS epidemic for good by 2030.

Bernabe Yameogo is Director of Global Fund Programs at Plan International Canada, where he oversees the development and implementation of programs that work to contribute to ending the tuberculosis, malaria and HIV/AIDS epidemics.

This blog is part of the blog series: AIDS, TB and Malaria: It's High Time for Us to End It. For Good by the Interagency Coalition on AIDS and Development (ICAD) in recognition of The Global Fund's Fifth Replenishment. The blog series runs from August 29 to October 3, 2016 and features a selection of blogs written by our member and partner organizations. Contributors share their broad range of perspectives and insight on the work of The Global Fund and the opportunity that this moment presents us one year following the inauguration of the global Sustainable Development Goals (SDGs).

The views expressed are those of the authors and do not necessarily reflect the views of CCIC or its members.

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