Bringing HIV Services to Hard-to-Reach Populations
“Good evening, do you have a moment to talk with us? Do you have friends who would like to join us?” These are some of the questions you can hear as the KP-STAR project team engages female sex workers on a street in Windhoek on a Friday night. KP-STAR is a United States Government-funded program that provides access to HIV services for Key Populations which include gay men, other men who have sex with men, transgender individuals, female sex workers, and clients of sex workers.
Once a week, the project team sets up a mobile van at night to provide HIV and reproductive health services that include HIV testing and treatment, access to family planning options, condoms, and lubricants as well as protective Pre-Exposure Prophylaxis (PrEP) at identified hotspots. This outreach method is commonly known as “moonlighting” and is especially popular with female sex workers.
“We don’t do moonlighting often in the same places because we do not want to keep testing the same people. The team also asks sex workers to share the information with their friends. We often address them in smaller groups to avoid congestion and create a sense of privacy,” explains Zieglinde Trooiitha Jod, IntraHealth Namibia’s Coordinator for the KP-STAR project in the Khomas Region.
“To ensure continuous provision of services to Key Populations, we make weekly rounds at hotspots. This has led to good working relationships. For example, whenever sex workers see our car approaching, they freely come to us for services and commodities such as condoms to protect themselves,” adds Kenneth Kamwi, a Senior Project Coordinator at the Walvis Bay Corridor Group – a KP-STAR partner.
It is past 9 o’clock in the evening and the bars in the area are gradually getting busy. A lady, seated adjacent to the van waits to be assisted. She chooses to remain anonymous but says: “These services are very important for us. Some people are ashamed to come to health facilities during normal working hours, so the moonlighting approach is helpful.”
She further explains how the health education offered by the program has helped her to be HIV virally suppressed: “I have been HIV positive for 12 years now and I am happy that my viral load is finally down.” This means that a blood test does not detect the virus in her blood anymore and she can no longer transmit HIV to a sexual partner.
Another client, who prefers to be called Marvelous, joins the conversation: “We really like how the KP-STAR team assists us.” She adds that, because sex work puts them at high risk of HIV infection, they also appreciate the condoms and HIV self-test kits distributed free of charge which they can even pass to their clients and partners.
“I am HIV positive, therefore, I need to protect my clients by using condoms every time I have sex with them. I also need to keep taking my medication to be virally suppressed. We really need these services,” says Marvelous before she disappears with a handful of condoms into the night.
KP-STAR is funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID) and implemented by Intrahealth Namibia and other partners in Gobabis, Swakopmund, Walvis Bay, Windhoek, Oshakati, Rundu, Katima Mulilo, Oshikango, Keetmanshoop, and Otjiwarongo.