Building Partnerships with Key Populations in HIV Research

2. Building Partnerships with Key Populations in HIV Research “Success and Gaps” Reflections from the Field Dr Joshua Kimani, SWOP UOM – Kenya

3. Early 1980s: Risk groups and peer leaders used for community engagement 1990s: Partnerships created to facilitate research studies. -Peer educators/ leaders key 2000+: New focus where SW groups are partners in HIV prevention and care: Peer Educators key Peer Leaders Consulted on study design/implementation/ CAB Members of the MOH –TWG Sub-grantee’s for structural interventions UOM-UON Long Partnership with FSW in Nairobi Kenya“From Being A Stigmatized Group to Agents of Change”

4. UOM Partnership with FSW in Nairobi Kenya “25 years plus of interventions with sex workers – Majengo Clinic Year 2014 NB: HIV Prevalence Average- 27.8% HIV incidence of 2.2% (95% CI 1.6, 3.1)

5. LGBT/MSM and FSWNational Guidelines & Strategic Plan Development as Key stakeholders

6. NB: Sex workers through their leaders defended the program to the last woman!!!!!

7. Our Program Interactions with MSMs Began in 2009!!!

8. Working with MSMs in Kenya A partnership approach used from 2009 due to:- • Tested process • New frontier for us • Rampant stigma • Discrimination • No socio-protection • Challenges with legal framework • etc

9. Why Partnership with MSM • Trust and respect created quickly • Peer educators key in community engagement • Peers used for demand creation • Also helped in recruiting MSMs into the program • Tracing those lost to follow-up • Created shared responsibilities • Key populations participation in knowledge production- Questionnaires, Informed consent documents and tracing tools • Peer leaders emerged who helped in programming

10. MSM (SW) Enrollment into Program (1011) HIV Prevalence – 34%

11. In 2010 SWOP created a safe space for the MSMs within the clinic Trust cemented and clinic became popular Number of Peer Educators increased and formally trained Recruitment and retention efforts proceeds effectively Peer leadersemerge around 2010/2011 Request for assistance to form a “collective” provided in 2011 2011 – HOYMAS registered as a CBO UOM SWOP Team and HOYMAS Partnership 1 *HOYMAS- Nairobi MSM collective

12. Adherence to ARVs then noted as a big challenge - 2011 SWOP Team and HOYMAS discussed the issue “Encounter groups” adopted as a way of addressing poor adherence HOYMAS mobilizes team members to register – a success story HIGH HIV INCIDENCE then emerged as challenge in 2012 NB: “Encounter groups” continue to date with HOYMAS taking a big role UOM SWOP Team and HOYMAS Partnership 2

13. HIV Status by Age Group-MSM HIV Prevalence - 34.0% HIV incidence of 10.9% (95% CI 7.4, 19.3)

15. High HIV incidence remain a challenge in 2013 Community insights into the problem & potential role in helping with solutions noted A study to evaluate the increased HIV risks among the MSM mooted A joint proposal was then developed with HOYMAS as key partners and submitted – “HIV Vulnerability Study” Submitted to CIHR in 2013 Funded by CIHR Project Started – June 2014 - HOYMAS – Key Implementers SWOP Team and HOYMAS Partnership 3

16. UOM - HOYMAS Nairobi Proposed Study Title: HIV Vulnerability Study The proposed study has two overarching and staged objectives: (1) To produce a reliable evidence base that can explain the individual, social, environmental and structural factors that shape the HIV-vulnerability of MSM sex workers in Nairobi; and (HOYMAS – LEAD) (2) To design and pilot test a community-based intervention that can address these various levels of vulnerability ( JOINT EFFORTS)

17. Innovative Approaches to Sustain Partnerships - 2014 • Capacity building in research methods for LGBT held • Gay and Lesbians Coalition of Kenya (GALCK) funded to establish an LGBT national research advisory group (G10) • LGBT/MSM, Funder’s and researchers sensitized on HIV and SOGI issues – March 2014 • Researchers, key populations, Funder’s and NASCOP- MOH held a meeting on how to strengthen partnerships and coordinate research – March 2014 • LGBT/MSM develops a research agenda • Researchers and LGBT/MSM agree on a research agenda and implementation plan – May 31 2014 • LGBT are part of the KP Technical Working Group – NASCOP- MOH

18. Partnership Challenges • Limited knowledge/ capacity on research methods among LGBT/MSM team • Power imbalance between the researchers and the LGBT/MSM community • Some researchers keen on status quo • Clarity of roles and responsibilities in research/program implementation • Post trial obligations • Security • Limited number of LGBT/MSM hired by the research/programs • etc

19. Conclusions HOYMAS / UOM partnership has made huge strides from 2010 Partnerships between researchers and key populations the only way Engagement should be based on Respect/ Protect/ Fulfill platform LGBT/MSM groups need capacity building in leadership, fund raising, management, research methods etc Community engagement with the broader LGBT groups is also critical Qualitative and quantitative studies on HIV vulnerabilities, role of PrEP, PEP, TASP, Microbicides (Rectal) and vaccines among the LGBTs/MSM are priority areas

20. Acknowledgements NASCOP – MOH and partners HOYMAS leadership and members GALCK SWOP – UOM and UON Team amfAR – the Foundation for AIDS Research IAVI (support from USAID) jkimani@csrtkenya.org Asante sana / Thank You