Innovation at the cutting edge of HIV prevention for key populations in Asia
  •  

     

    There is no time to lose. In Asia, HIV epidemics among key populations show no sign of abating. At the same time, key populations for HIV are least likely to come forward for health services. The HIV Foundation Asia designs innovations that close gaps in urban health systems and minimize discrimination so people can get what they need to live long and healthy lives with HIV.

    The HIV Foundation Asia acts as a regional technical hub that designs new service methods to interrupt HIV transmission, illness and death. We aim to deliver these innovations in multiple Asian cities to people living with and affected by HIV.

    We publish what we do freely – in an online open-source environment – so that governments and service organisations can use what we learn. We also translate our technical resources in to local languages to support grassroots organisations to easily adopt what we do.

    We are technically supported by the health development organisation APMGlobal Health. We owe much to APMGlobal Health for our management and technical expertise. In this section of our website you’ll find helpful descriptions of the current key innovations we are implementing in Asia.

    Photos
  •  

     

    The HIV Foundation Asia designs service models that close gaps in urban health systems and minimizes discrimination so people get what they need to live longer lives with HIV or stay HIV-free. We focus on new approaches to HIV prevention that incorporate treatment-as-prevention and that prevent loss-to-follow-up among people with HIV.

    The HIV Treatment Cascade is a recent policy innovation that supports HIV policy makers and programmers to prioritize the diagnosis, treatment and suppression of HIV through treatment. It emphasises identifying and then preventing loss to follow up among people with HIV. Donors and governments are in the process of reorienting their policy focus to incorporate the elements of the HIV Treatment Cascade.

     

    HIV Treatment Cascade

    The HIV Treatment Cascade (click to enlarge)

     

    Treatment-as-prevention involves the use of antiretroviral treatment (ART) to decrease the risk of HIV transmission and acquisition. PrEP means Pre-Exposure Prophylaxis and it is the use of anti-HIV medication by HIV negative people (people not infected with HIV) so they can avoid infection with HIV. PEP means Post-Exposure Prophylaxis and it is the short-term use of anti-HIV medication by people who may have just been exposed to HIV in order to avoid infection with HIV. It is increasingly acknowledged that people with HIV who maintain durably suppressed HIV viral load are unlikely to transmit HIV to others.

    Photos
  •  

     

    New diagnosis with HIV is a traumatic and life changing event that can feel like, suddenly, one’s life has been ‘short circuited’ or dramatically disrupted by the information. The news that a person is living with HIV can push them out of the habits of their normal daily life. It can have an immediate and dramatic impact upon their thoughts, emotions and behaviour. The HIV Foundation Asia has considerable experience working with newly diagnosed people with HIV. There are questions that people with HIV tend to ask and answer when they are newly diagnosed. What follows is some guidance for service providers who support newly diagnosed people with HIV.


    Am I dying? A common reaction to the news is an immediate fear of illness and death. “Am I dying?” and “Am I going to die?” are common questions posed by newly diagnosed people living with HIV. Our experience is that you can confidently tell the majority of newly diagnosed people with HIV that they are not dying. You can tell newly diagnosed people with HIV that, while there is yet no cure, there is effective treatment available that can stop HIV causing illness and death as long as they start treating early in their diagnosis and take their treatment on time, every time. There is no reason that a newly diagnosed person with HIV cannot go on to live a healthy and successful life.


    Will I be able to find love and have a family? HIV is sexually transmitted and so sex and romance can be important. “Can I still have sex?” and “Will I be able to find love now that I have HIV?” are two common questions among the newly diagnosed. The answer to both these questions is ‘yes’ with support to manage HIV disclosure and condom-use. For women and men wanting to start a family, knowing that they can still have children simply by taking HIV treatment and following a competent doctor’s advice is important. Where a person is in a relationship with a significant partner at the time of their HIV diagnosis there is the immediate concern of how and when to tell them. Diagnosis with HIV in the presence of a compromised immune system or serious illness complicates the news even more. Engaging with the hospital system, immediately initiating ARV treatment and presenting at a clinical service with an HIV related illness can be confronting.


    Who should I tell? HIV is often associated with sex, sex work and injecting drug use. HIV has a negative social stigma attached to it. Because of this, many will feel shame, embarrassment and guilt at learning they have HIV. The news can threaten their sense of security in relationship to both friends and family. Feeling suddenly disassociated or disconnected from the intimacy of friends and family is not uncommon. “Who should I tell?” and “When should I tell them?” are two concerns for people newly diagnosed with HIV. We tell people that they don’t need to move quickly to tell others. Where someone feels the need to tell we recommend telling only (a) people who will not get angry and those who not be verbally or physically abusive (b) people who will not judge them and (c) people who will not gossip.

    Photos
  •  

     

    The HIV Foundation Asia uses a community-based prevention-outreach system that borrows from the research sector. We map urban settings to identify undiagnosed people with HIV. We use a traffic light system to categorize urban networks for HIV. We categorise sites as high, medium or low for HIV. HIV outreach in our work prioritises HIV testing. When we identify a new network we test 10 people randomly in that place. Our aim is to keep HIV case finding at-or-above the municipal or national prevalence rate for HIV among the key populations we serve. We track what we learn on a map of the city. Our service decisions are based on the numbers of people who test HIV positive in one place who didn’t previously know their HIV status.

     

    traffic_red
    Red: high

    High is when 4-or-more out of 10 people tested in one place were positive for HIV. Conclusion: stay in this network and keep testing. Engage other organizations at this site to provide the means to prevent HIV as well as HIV and STI health education.

     

    traffic_yellow
    Amber: medium

    Medium is when 2-to-3 out of 10 people tested in one network were positive for HIV. Conclusion: stay in this network and keep testing. Engage other organizations to provide the means to prevent HIV as well as HIV and STI health education.

     

    traffic_green
    Green: low

    Low is when 0-to-1 out of 10 people tested in one network were positive for HIV. Conclusion: move on from this network and find a new site. Encourage other organizations to service this site so that people here can stay HIV free.

    In weekly team meetings staff work with a hard copy map to identify and discuss priority sites. At month’s end they transfer this information to Google Maps to preserve a record.

    Urban Mapping for HIV

    Urban Mapping for HIV (click to enlarge)

    Photos
  •  

     

    HIV case management is sometimes called HIV case coordination. HIV case management or coordination links people living with and affected by HIV to care and treatment and also helps them meet their life goals. We use a traffic light system to categorize the needs of clients in to high need, medium need and low need. We work within a client-centered framework to determine with the client their level of need.

     

    traffic_red
    Red is high need

    A client with high needs has a CD4 result of 200 or below and CD4 percentages of 15% or lower but is not yet taking ART. These clients may present with HIV-related illnesses but are not yet taking prophylactic medication. Many require hospitalization or intensive outpatient support. Pregnant women with HIV in their last trimester but not yet taking ART are always high need. Suicidality is always high need, regardless of other factors. Psychosocial factors are also considered. High need clients receive intensive support – accompanying to hospital appointments and linking to health, welfare and community services beyond HIV.

     

    traffic_yellow
    Amber is medium need

    A client categorized as having not urgent but significant need is someone with a CD4 test result of between 350 and 201 and CD4 percentages between 16-24% but is not yet taking ART. Pregnant women with HIV in their first or second trimester are categorized as medium need. Psychosocial presentations such as mental health issues, migration, homelessness, social isolation, violence and poverty are all part of a medium need assessment. Medium need clients receive semi-intensive support that includes accompanying to hospital appointments, online and face-to-face workshops and group support.

     

    traffic_green
    Green is low need

    A client categorized as having non-urgent need is someone with a CD4 test result of 500 or more and CD4 percentages above 24%. These are often newly diagnosed clients who have considerable psychosocial adjustments to the news they are living with HIV. They may be emotionally distressed and, although they may have partners, friends and family nearby, may not disclose their HIV status to them. Low need clients receive initial intensive support to ensure baseline CD4 results and ART initiation where possible. Low need clients are connected to other people with HIV through online and face-to-face workshops and groups and are, once stable, supported by phone.

    Photos

Our Partners

What Our Partners Say ?

  • “I undertook a small internal review in the foundation in April 2014. I interviewed 10 staff and clients, reviewed case files and other documents. What I found was inspiring. This is an organization that does what it promises to do.”

    Dr Jan Willem de Lin van Wijngaarden
    HIV development practitioner
  • “We find the foundation to be a responsive, professional and accountable partner. Their leadership team has a great mix of management, HIV technical, research and service delivery skills. We love their passion, their focus, their commitment to innovation.”

    Lou McCallum
    Director at APMGlobal Health
  • “I’ve interviewed Khun Nikorn and his team at length about their work and seen their comprehensive data set which demonstrates their results firsthand. I strongly believe their model should be better understood and replicated in other cities around the world.”

    Don Baxter
    Co-Chair of The Global Forum for MSM
  • “We are a small, unregistered group in Chiang Mai, Thailand. In 2013 we partnered with The HIV Foundation to deliver HIV case management. Now, we are an organization that has the confidence of staff in local hospitals and clinics.”

    Ms Kaewta Sangsuk
     Director of Our Choice, Chiang Mai
  • In 2014 we asked the HIV Foundation to act as a fiscal agent for a UNAIDS grant. We were so pleased with their financial competence that we quickly moved all our grants over to them until we receive our own local registration.

    Ms Natt Kraipet
    Coordinator of the Asia Pacific Network of Transgender People