In early May, AVAC joined Zambian civil society organizations (CSOs) in Lusaka for a kick-off meeting to plan the country’s Key Population Investment Fund (KPIF) activities. The lessons learned there are highly relevant to civil society in every country where KPIF will be introduced. This is time sensitive and urgent for all of us who want to see this investment have a meaningful impact.

Background

Two years ago, at the United Nations’ 2016 High-Level Meeting on Ending AIDS, the world came together to plan how to achieve the Fast Track goals aimed at radically reducing AIDS deaths and new infections. A few member states, like Iran, pushed back against the bold new initiatives needed to reach and serve key populations in order to achieve those goals. Civil society raised its voice in the halls and in rain-soaked protests to call for approaches that placed services for and led by key populations at the center of the response. Responding to this call, PEPFAR’s Ambassador Debbi Birx announced a new $100 million investment in the KPIF. This investment, modeled on the DREAMS Innovation Challenge, hit a number of delays in its implementation. Now that it has finally been launched, some of the details about its structure are clearer: these PEPFAR grants will be made through USAID and CDC to implementing partners in each country, who then should be directing resources to local key population (KP)-led organizations.

As our experience in Zambia shows, this investment in actual KP-led organizations that have the trust and faith of the community needs to be tracked and made a non-negotiable in every country. The program’s impact will be measured via the Monitoring, Evaluation, and Reporting Indicators that PEPFAR uses to monitor all partners’ performance. Since these have been largely focused on large service delivery programs – testing, linkage to treatment, PrEP enrollment – it can look like a barrier to eligibility if the local KP-led groups do not provide services. However, direct service delivery is not a requirement for receiving KPIF funds. This is another point to emphasize and track as KPIF rolls out.

What happened in Zambia?

AVAC, MPact, Health GAP and many other international groups have worked alongside African KP organizations to demand that the KPIF money flow to groups that know what needs to be done and have the trust of the community. At AIDS 2018, these groups called upon PEPFAR to create an independent KP advisory group for the fund, and they continued to question the funds structure, timelines and purpose at the PEPFAR Regional Planning Meetings in early 2019.

In May, AVAC joined Zambian KP groups and the CDC for the national KPIF planning process. AVAC and these CSOs met separately the day before the meeting to plan demands and review CDC’s proposed approach for implementation, which had been developed without engaging civil society.

Faced with this information, the CSOs decided it was strategic that they speak in one voice and this led to one of the most inspiring moments of the week. A new and entirely unprecedented consortium of Zambian KP CSOs was formed. The Zambian Key Population Consortium (Zam-KPC) aims to push forward an advocacy agenda focused on human rights and HIV prevention, treatment and care, and preventing discrimination and abuses faced by key populations. For far too long, Zambia’s key populations have been left behind in terms of direct engagement on issues that affect them. With this coalition, Zam-KPC intends to not only have a seat at the table but to monitor and implement programs that target KP communities.

Zambian CSOs came up with their own demands for how the KPIF funds should be invested and how civil society should be engaged moving forward:

• No implementation to begin without an identified KP CSO sub-award partner.
• Work with KP groups to develop sub-awards and build technical capacity of KP CSOs.
• Work with CDC Zambia to support the structural development of the KP Consortium.
• Use available funds from PEPFAR’s Zambia-focused country operational plans (COPs) to build capacity in CSOs so they can provide prevention services including PrEP, distribute HIV self-test kits, and understand PEPFAR’s requirements for monitoring, evaluation and reporting (MER indicators).

CDC and their lead implementation partner, Centre for Infectious Disease Research in Zambia (CIDRZ), agreed to all of these demands, and further committed that this work would happen in the next five months before any sub-grants are made to KP organizations.

Next Steps

The next five months are critical to the Zambian KPIF investment. AVAC will continue to provide support to the Zambia KP Consortium in making sure they are holding themselves, CDC and CIDRZ accountable. We will be actively monitoring the same process in other countries and supporting activists in those countries to get involved.

Lessons Learned

We all have to pay attention to how these KPIF funds are moving in country. Here are some of our emerging lessons learned:

• Meet with the funding agencies (CDC and USAID) and their KPIF implementing partner (IP) as soon as possible—ask for updates on the IPs plans for geography, KP partners and roles. No decision is set until KPs sign off. Now is the time to engage. If you don’t know who your agency is or what the schedule is, email avac-compass@avac.org.
• Build a bold, shared agenda. PEPFAR has, in the past, critiqued CSOs for being divided or in competition. Now is the time to work in solidarity—the biggest wins will come from a strong coalition of groups. If there is no KP coalition, you may want to build one; in most countries, KPIF funds can support the work building coalition.
• Consortiums do not have to apply for KPIF funds but member organizations should apply based on needs and strengths. For example, consortiums can work to identify which member is best placed to deliver particular services and decide that they should be the one applying for that portion of the programming.
• Advocacy and activism improve uptake and service delivery. KP groups do not need to be service providers to get these resources, but they do need to understand how the results will be evaluated based on MER indicators.

Cleopatra Shiella Makura is a 2019 AVAC Advocacy Fellow. This post first appeared CHANGE’s blog.

When I hear the phrase “reproductive health,” I find myself having a flashback to each time I was at a clinic either by myself or with someone else. From that I try to understand how and why I get scared about the whole topic, and to my surprise, sometimes I can’t even understand why I get scared. I ask myself this question: Is it worth it to go to the clinic or hospital to get reproductive health services?

Reproductive health is defined as a state of complete physical, mental, and social well-being in all matters relating to the reproductive system. It implies that people can have a satisfying and safe sex life, the capability to reproduce, and the freedom to decide if, when, and how often to do so.

Sixty-two percent of Zimbabwe’s population is young people below the age of 25. Growing up talking about sex was taboo, and one could only get sex-related information from friends and the theoretical information one gets from school is either too scientific or half-baked. Sex education is mostly delivered by tutors and teachers who are almost your parents’ age and the culture clearly defines every adult taking the parental role in society, and schools and colleges are part of society.

Most young people are aware of basic sexual education, however they lack the realities. It is very difficult for young women and girls to decide when they have sex and how. Zimbabwe’s 2012 Violence Against Children Survey found that seven out of 10 girls did not plan their first sexual encounter. Because our culture hands the decision and initiation of sex to men, young girls and women do not decide when and how to have sex. Usually when we are talking about sex education, it’s that moment of flashback and realising the mistakes which would have already been made.

Nowadays, most young people are afraid of getting pregnant rather than contracting HIV. The first thing on a young girl’s mind after unprotected sex is how to prevent pregnancy rather than HIV and other sexually transmitted infections. This can contribute to young women and girls in Zimbabwe at the age of 15 to 17 having an HIV prevalence of 2.7 percent, a figure that sharply rises to 13.9 percent in the 23 to 24 age range, according to 2017 data. Adolescents in Zimbabwe face challenges such as teenage pregnancy, sexually transmitted infections including HIV, unsafe abortions, child marriage, and lack of access to sexual and reproductive health information services.

The golden question is: Why are young people not accessing services? The main barrier to accessing reproductive health services is a lack of youth-friendly services. It’s very interesting that most health workers are trained on how to treat adolescents by people who are far older than adolescents, and who really do not understand the feelings and thoughts of adolescents. Most meetings and youth-friendly packages are based on speculations about how young people want to be treated. There is little to no involvement of young people on matters that affect them.

It is vital to include young people when designing programs which affect them. However, involvement has been tailored to mean showcasing a young person in a room. What we need is a whole group of young people in the room. Young people have different needs and a one-size-fits-all approach does not work. On top of that, we need young people’s voices to be documented. We are sick and tired of attending meetings and contributing our needs, but when information is documented, our voices are not included. Again, nothing for us without us.

Cultural beliefs heighten the risks and worsen the vulnerabilities of young people. Adolescent girls are often already at a disadvantage due to gender discrimination. Young women and girls must overcome not only the crisis of culture itself, but also potential abuse, violence, and exploitation, which can compromise their development and violate their rights. Because of these vulnerabilities, young women need different HIV prevention options.

As a young woman walks her journey of life, abstinence can work at one moment but then there comes a point when abstinence cannot work, and condoms can protect her instead. However, there may be a point when condoms cannot work due to negotiation issues, and pre-exposure prophylaxis can work. But taking a pill every day when you are not sick can be tiresome, and one might prefer the dapivirine ring as it gives a woman power and control. And still others would prefer an implant or an injection.

There is a need for different HIV prevention methods for young people to use. Because if we acknowledge everyone’s needs together, we can end the HIV epidemic.

AVAC is pleased to announce the next offering of its global Good Participatory Practice Online Training Course! This course offering will run May 29 through August 2, 2019.

Click here to apply. Completed applications are due by May 24th.

The Good Participatory Practice (GPP) Online Course is designed for research implementers, specifically those individuals directly responsible for community engagement in a research or implementation context. (To learn more about GPP, click here.) Learners develop practical GPP plans for their context and those who complete the course receive a GPP Implementer Certificate.

For this upcoming course offering, applicants are encouraged to enroll in pairs as team members who have complementary research and implementation expertise, since clinical trials and rollout of new products have a natural relationship with regard to community outreach and stakeholder engagement. An ideal partnership would include someone from the public health or service delivery arm of an institution and someone currently or about to be working on a clinical trial, but all partnerships will be considered.

The pairing is not required for participation but encouraged. We won’t match those who do not have partners but will try to balance the cohort with a mix of those working on clinical trials and those on service delivery and/or public health projects. Over the years of implementing the GPP Online Course, AVAC has learned that the participants who have worked in teams have enhanced their learning experience by having a thought partner to with whom to brainstorm and advocate for tangible changes that can be made at the institution level.

To date, over 150 learners have been certified through AVAC’s GPP Online Course, and nearly all of them have ranked their learning experience as “excellent” or “very good”. The majority report significant gains in their ability to “develop measurable objectives” and “self-efficacy to identify stakeholders”. These metrics indicate learners are better equipped to measure engagement and identify stakeholders in the community who can help advance engagement goals.

Today, a robust pipeline of products are moving through testing, not only for HIV prevention, but for tuberculosis, emerging pathogens, and other disease areas where GPP is being applied. As products progress through trial phases and beyond, important lessons are being learned about translating research into rollout. GPP can play an important role, not only in preparing communities for results and future implementation, but also in incorporating lessons from rollout back into the clinical trials process. By enrolling the pairs as described, we hope that this course can start to add to that body of knowledge.

Join these learners to strengthen your GPP implementation and to add to this growing global community of practice!

For more information about the program, please contact Jessica Salzwedel (gpponlinecourse@avac.org).

Please join us on May 21, 9-10:30am EDT for a webinar, Breaking the Cycle of Transmission: Increasing uptake and effective use of HIV prevention among high-risk adolescent girls and young women in South Africa—quantitative findings & segmentation.

This webinar is the second in a series presenting the work of the HIV Prevention Market Manager’s project researching what encourages or discourages the effective use of HIV prevention among adolescent girls and young women. Check out part one for the qualitative results.

Click here to register.

This webinar will review the findings from quantitative research on the needs, desires, and structural elements that impact the effective use of HIV prevention products by adolescent girls and young women (AGYW) in places where they are at high risk of exposure to HIV. Join to learn about the results from a survey of 2,000 girls and women and some of the major drivers they contend with as they make decisions about their sexual and reproductive health.

This research initiative of the HIV Prevention Market Manager (PMM) is conducted in partnership with the behavioral research firm Final Mile, user-centered design firm Upstream Innovation and the market research group Ask AfriKa, with the Surgo Foundation providing strategic guidance. The work is funded by the Bill & Melinda Gates Foundation.

PMM applies behavioral research and human-centered design to generate product-agnostic information that will inform the development of HIV prevention interventions that are the most likely to succeed.

The webinar will be recorded and a link posted—and if you have any questions ahead of time, please let us know!