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What a little moonlight can do: HIV treatment for people on the margins

While 5pm is the end of the workday for most staff at Dignitas International (DI) in Malawi, this isn’t the case for George Mulewa. Trained in Key Population and Sexual Reproductive Health, his role usually takes him out after work hours to bars or other “hotspots” that typically have high concentrations of people that face major challenges accessing HIV testing, treatment, and care services.

Key Population (KP) groups are comprised of sex workers, men who have sex with men (MSM), and other people who have a high risk of contracting and transmitting HIV. According to UNAIDS, KP groups and their sexual partners made up 45 per cent of all new HIV infections in 2015.

“I am one of the health workers involved in KP and the HIV Testing Services (HTS) program here,” explained George. “My responsibilities include conducting moonlight activities such as antiretroviral treatment (ART) initiation and referral, viral load monitoring, STI screening and treatment, family planning services, PrEP, and TB Screening in hotspots including bars and clubs. We also offer the same services on the islands of Lake Chirwa and its coastal villages,” he added.

As a second-line ART provider, George has witnessed the challenges many KP groups face:

“The HIV prevalence is very high among KP groups – 26 out of 28 MSM that we tested in Mulanje were found to be HIV positive. In Zomba, out of 64 MSMs that were tested, 23 tested HIV positive. And it was a first time for most of these men to get tested. What is even riskier is the realization that most of the MSMs are bisexual and engage in heterosexual relations with their partners,” George said.

Reducing new HIV infections among key populations is crucial to realizing the UNAIDS 90:90:90 Targets, a set of global goals designed to end the AIDS epidemic by 2030.

Delivering health services to a small island in Malawi's Lake Chirwa is both adventurous and tricky. George Mulewa (3rd from the right) leads a team to Chisi Island, where they will conduct HIV tests for all of the island's residents, including harder to reach individuals such as sex workers and fishermen. Those found HIV+ start on treatment immediately.

Delivering health services to a small island in Malawi’s Lake Chirwa is both adventurous and tricky. George Mulewa (3rd from the right) leads a team to Chisi Island, where they will conduct HIV tests for all of the island’s residents, including harder to reach individuals such as sex workers and fishermen. Those found HIV+ start on treatment immediately.

Making HIV testing, treatment and care accessible – for everyone

Often stigmatized and with limited rights, KPs face big challenges accessing prevention, treatment and care services in many countries around the world. Realizing this critical gap needed to be filled, DI started implementing KP activities under our HIV Testing Services (HTS) program to reduce HIV infection and transmission among KPs and the general population.

He said DI started implementing KP and moonlight activities in January this year.

“We first develop a rapport with KP groups including bar owners, barmen and brothel keepers. The Key Population Officer has to be friendly, approachable and not judgmental. There cannot be a good relationship with the KP groups if you don’t have these virtues,” he explained.

 

A bicycle taxi operator helps carry supplies to the interior coastal areas of Lake Chirwa as the DI team walk in the scorching sun.

A bicycle taxi operator helps carry supplies to the interior coastal areas of Lake Chirwa as the DI team walk in the scorching sun.

After finding out what kind of services they need, DI then trains the KP groups on peer education and encourages them to discuss what they learn with friends. A peer supporter is selected from each hotspot to act as a link.

Before implementing KP and moonlight activities, DI trains health workers in the target area on HIV prevention and care for key populations. Another preliminary step is training law enforcement personnel on sexual and gender-based violence.

Since the initiative started this year, over 500 sex workers and at least 150 MSM have been tested in Zomba, Mulanje, Machinga, and Phalombe.

Help us reach some of the world’s most vulnerable people with life-saving HIV testing, treatment, and care. Your support means dedicated staff like George can continue to bring the right to health to everyone.   

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Dignitas InternationalWhat a little moonlight can do: HIV treatment for people on the margins