Abstract

Scaling-up HIV Testing, Treatment, Care, and Support for Men who have sex with Men,
Transgender, and Sex Workers in Liberia.

Isaac Tibenkana Sempungu, Cyriaque Ako, Evans Adofo, Stop AIDS in Liberia

Background: In Liberia, HIV prevalence rate among (15-49 year) age group is 2.1%. The -
situation is however, different among the key population with an HIV prevalence of 19.8% for men
who have sex with men (MSM) and 9.8% for female sex workers (FSWs). A combination of factors
explain the HIV situation among key population in Liberia, but most notable are limited access to
HIV testing, treatment and care services, stigmatization, and sexual and gender based violence.

Methods: As a strategy to contribute to a reduction in HIV prevalence rates among the key
population, Stop AIDS in Liberia (SAIL) is implementing a project with support from the Global
Fund against AIDS, Tuberculosis, and Malaria (GFATM), titled, HIV Prevention Care and Support
for the Key Population, People Living with HIV and the General Population. The 1 ½ year project
begun in July 2016 and will end in December 2017. The project involves HIV prevention and
treatment interventions in a coordinated manner integrating both clinical services and intensified
community outreach targeting MSM, TG, and FSWs. Some of the key steps undertaken by the
project in scaling up HIV prevention, care, and treatment services for MSM, TG, and SW include
peer educator community outreach, Peer educator training, condom and lube distribution, service
linkage with existing government health facilities, and advocacy to reduce stigma and
discrimination. Between November 2016 and June 2017, the project established 3 drop in centers
(DICs), two in Monrovia, and one in the upcountry town of Zwedru located about 467 kilometers
from Monrovia. Key services provided in the DICs include STI diagnosis and management, HIV
counseling and Testing, TB symptomatic screening, psychosocial support, Legal support, condom
and lubricant distribution, and ART enrolment.

Since its inception, the project has registered 1,695 MSM and TGs, and 2,055 SWs through the
use Unique Identification Codes (UIC). Out of them, 660 MSM/TG have tested for HIV and 50
(7.6%) are HIV positive. Similarly, among the SWs, 402 have tested for HIV and 38 (9.5%) are HIV
positive. Further, the project has trained 142 MSM/TG and 148 SW as peer educators. A total of 5
HIV Testing events have been conducted in which we take took HTC services to the key population
in an informal and non-clinical setting. In addition, an estimate of 4,750 Male and 1750 female
condoms and 3,000 lubes (male) and 1000 lubes (female) have been distributed among MSM/TG
and SW population. Service linkages with seven government health facilities in five counties across
Liberia have been created, and key stake holders including 97 police personnel (29 female), 40
media personnel (15 female), 60 religious leaders (24 female) and 62 medical practitioners (10
female) have been trained in human rights advocacy for the key population.

Lessons Learnt: Integrated approach has promoted access to HCT and SRHR services among
the key population and enabled client tracing through use of UICS. There has been high demand
for condoms and lubes, and increased referral for HIV testing, STI diagnosis and treatment, and
treatment of opportunistic infections.

Conclusion and recommendations: To galvanize the existing successes, we will need to improve
on documentation of project outcomes for advocacy, scale up to involve other key population
groups such as people who inject drugs (PWID), and improve quality control in HIV and STI service
provision for MSM/TG and SW.

Key words: Men who have sex with men, Transgender, Sex Worker, Unique Identification code,
HIV Testing and Counseling.