Testing for key populations – from the perspectives of those living with HIV

Ed NgoksinGlobal Network of People Living with HIV (GNP+)

Concerns of members of key populations

living with HIV

Individual-level barriers to HIV testing

• Intersecting stigma (or layered stigma)• Fear over how others would treat them should

the result come back positive• Healthcare worker discrimination• Criminalisation• Violence enacted by intimate partners, other

family and/or community members

Individual-level barriers to HIV testing (cont.)

• Fear of not being able to cope with a positive HIV test result• No perceived benefits of finding out if they are HIV-positive• IDUs give precedence to drug use and not health/HIV• Lack of supportive social and peer norms for HIV testing• Denial of risk and low HIV risk perception• Waiting time between blood testing and result of the test

Health care system barriers to HIV testing

• Health provider attitude and discrimination• Location of HIV testing centers• Restricted services hours in government

hospitals• Waiting time for counseling/test and getting

test result• No counseling is made available at all

Policy, program, legal barriers to HIV testing

• Criminal laws against key populations and non-disclosure• Lack of effective coordination and linkages among various

services (such as drug dependence treatment) and HIV testing

• Lack of funding for community-based HIV testing• Government IEC/mass media campaigns only target general

populations• Policy restrictions (e.g. parental consent, policy restrictions

on who can perform rapid testing)• And many more…

Reasons for HIV testing

Reasons for HIV test (%)

Bangladesh Indonesia Lao PDR Nepal Pakistan Philippines Vietnam Consolidated0

10

20

30

40

50

60

70

80

90

100

23.2

3128

34

2925 27 27

34

23

82

28 302829

2125

40

11

52

23

33

28

45.7

Overseas working Refer by a doctor Spouse/partner/children get sick/deathddue to /HIV infection

Want to know Risky behavior Never choose, got result from a doctor

Monitoring access to treatment in Asia – Selected findings community Access to treatment, care and support study, APN+, July 2014)

Some community-based services to promote HTC uptake

Some considerations

• Acknowledge the diversities within “key populations” groups• Invest longer term on capacity strengthening in service delivery and advocacy of

key populations-led initiatives, organisations, networks so that they are able exercise their rights and advocate for systemic/structural changes

• Invest in locally driven initiatives as they are applying evidence to practice, esp. those that promote and increase demand for HIV testing and link people into care and care retention

• Better use of social media is needed to connect with key populations and young key populations

• Sustain support for innovation remain essential• Ensure all kinds of testing conform to ethical standards, including confidentiality,

consent and safeguard the human rights of key populations against all forms of coercive testing. Put an end to mandatory HIV testing

• Advocate for communities as equal partners in delivery of HIV testing services at national level

Thank you