Lessons learned reaching key and vulnerable populations in Mozambique

By
SAMU
for on 28/06/2019

LESSONS LEARNED REACHING KEY AND VULNERABLE POPULATIONS: From Médecins sans Frontières’ experience providing HIV and sexual and reproductive healthcare to sex workers, men who have sex with men, and adolescents at risk in Mozambique

Since 2014, MSF has been working with Ministry of Health (MoH) and partners to increase healthcare for sex workers (SWs) and men who have sex with men (MSM)- people who often face hardships to  access healthcare - along main transport routes between Mozambique and Malawi through its ‘key populations’ project.

The programme was established along the main transport corridor between Mozambique, Malawi and Zimbabwe, with the aim of adapting health services to reach groups identified as being the most vulnerable to HIV. Previously known as the ‘Corridor project’, with 4 sites in Malawi and 2 in Mozambique,  it initially focused on long-distance truck drivers and sex workers but over time has expanded to provide support to others at risk of HIV and with equally high needs, namely adolescents and young women engaged in transactional sex, and men who have sex with men.

After 4 years of project’s implementation, MSF brings the main lessons learned by teams on the ground in Tete and Beira sites through this report “Lessons learned reaching key and vulnerable populations” which highlights the main findings and insights on models of care for these groups, successes and failures of the project.

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MSF peer educator, Teodora, searches for patient records at Centro de Saúde Munhava. Photo by Morgana Wingard

Through this project, MSF enrolled peer educators who were former sex workers. This has moved towards Peer-Led HIV and SRH Services for Sex Workers and Men Having Sex with Men. MSF peer educators – themselves SWs and MSM who have been recruited from their local communities and trained to raise awareness about HIV among peers – visit hotspots to communicate with known SWs and MSM and identify those in the KP who are new to the area. Having peers in different positions and participating in the different stages of a project cycle has produced useful perception into programming and thus a greater acceptance of the project by Key Populations groups.

A basic package of HIV and SRH care has been developed under this project and is being offered at the community level with referral to a health centre for a comprehensive medical package. It comprises activities such as health promotion and education on HIV, sexually reproductive health, Sexual Gender Based Violence- SGBV, distribution of condoms and lubricants, HIV testing and counselling, Post-Exposure Prophylaxis (PEP) and referral to Ministry of Health for Anti-Retroviral (ART) services. This is part of model of care centred in Community-Based Approach where prevention and treatment services should be offered at community level as a complement to facility based care in order to overcome barriers faced by Key populations of access to healthcare. 

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Newly recruited MSF peer educators draw body sketches as part of their training program. Photo by Morgana Wingard