C-Change/FHI 360 (Cushnie); Independent Consultant (Ivey)
This report from FHI 360's Communication for Change (C-Change) details a 2012 assessment that used a checklist to map a range of supportive services in public as well as private health facilities in Jamaica that are considered to be friendly to most-at-risk populations (MARPs) for HIV, including men who have sex with men (MSM) and social workers (SWs). It emerged from the C-Change project, which is funded by the United States Agency for International Development (USAID) and the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). This project provides technical assistance in social and behaviour change communication (SBCC) in an effort to improve the quality and scale of Jamaica’s response to the HIV and AIDS epidemic. From the mapping activity, C-Change hopes to present a picture of the level and availability of supportive services in MARP-friendly facilities in Jamaica to inform future programme planning.
Nineteen public and private health facilities in 4 cities across Jamaica participated in the mapping exercise. Findings showed that:
- Public facilities offered greater services specific to MARPs, and they were free of cost. Public facilities also had attached outreach and support programmes facilitated by trained staff, such as peer education and community education/outreach - for example, during "Lunch & Learn" days, people living with HIV (PLHIV) and MSM were given a meal and hygiene package while engaging in an HIV 101 and risk-reduction discussion. Sexually transmitted infection (STI) testing at these facilities was limited to HIV and syphilis rapid tests, and pre- and post-test counselling was routine. Staff members at these facilities were also more likely to have received training related to MSM and SWs than those from the other facilities mapped.
- At private facilities, MARP-specific services were rare, and outreach and support groups were not available. Services from some of these facilities were available at a cost. While private facilities offered a broader range of STI testing, pre- and post-test counselling was infrequent due to lack of trained staff.
- HIV-related information, education, and communication (IEC) materials, such as the one pictured above, were observed at all public and one public-private health facility, but none specifically targeted MARPs. Reasons given for the lack of MARP-specific materials were: cultural attitudes toward specific populations, safety, security, comfort of clients, and the desire to prevent the facility from being branded or known as one that provides services to MARPs.
An excerpt from the report follows:
"Overall, planners and implementers should consider using evidence-based approaches to develop and implement basic packages of essential services for MARPs, which address their direct health needs and are driven by client demand and illness presentation. More specific recommendations are summarized below:
- Conduct staff training to provide support and psycho-social services for MARPs, free access to condoms with condom demonstration, VCT [voluntary counselling and testing], HIV and other STI testing, or referrals for these services. Training should discuss MARP sexual practices and their basic and specific needs. In addition, training and retraining should be conducted on a continuous basis for health care workers on interpersonal communication and counseling, especially in public facilities where most MARP-specific services are provided...
- Provide anonymous and confidential services in light of the stigma and discrimination MARPs face locally. Positively branding health facilities and clinics that have successfully packaged essential services for MARPs as offering high quality sexual and reproductive health services for all may prevent labeling, which health facilities are eager to avoid.
- Establish links among government facilities, private facilities, and civil society organizations to strengthen the quality, scale, and sustainability of services available to MARPs by playing on the strengths of these service providers.
- Strengthen policies to ensure that health care providers are stringent in their provision of VCT at all health facilities.
- Develop and use MSM/SW-targeted materials to close gaps and enable direct engagement with these groups. Use nontraditional SBCC messaging channels such as social media and the Internet to provide the anonymity that MARPs need and request."
C-Change website, May 1 2012.