Delivering transformative, rights-based family planning
Project Name: Continuum of Prevention, Care and Treatment of HIV/Aids with Most-at risk Populations in Cameroon (CHAMP)
Donor: President’s Emergency Plan for AIDS Relief (PEPFAR), U.S. Agency for International Development (USAID)
Partners: Johns Hopkins School of Public Health, METABIOTA, Moto Action
Duration: April 2014 - April 2019
Objective: CHAMP aims to reduce HIV and other sexually transmitted infections and related morbidity and mortality, and to ease the impact of HIV on the socioeconomic development of Cameroon.
With a national prevalence of 4.3% among individuals aged 15-49 years (2011 DHS), HIV/AIDS contributes significantly to mortality in Cameroon. Evidence shows that risky behaviors (multiple sexual partners, low condom use, ignorance of HIV status) persist, and stigma and discrimination remain high. Prevalence varies significantly by age, gender and geographic locus with women bearing greater disease burden (5.6% compared to 2.9% among men). Poverty, gender-based violence (GBV) and harmful cultural practices are among the contributing factors to women’s vulnerability. According to the 2016 Cameroon Integrated Behavioral and Biological Survey, HIV is disproportionately high among female sex workers (FSW) at 24.3%, and men who have sex with men (MSM) at 20.6%. Sex work as well as homosexuality are punishable by law, which makes it difficult for members of these key populations to access HIV screening and STI diagnosis and treatment, enroll in treatment, advocate for their health and wellbeing, and/or address the structural drivers of the epidemic, including violence.
CHAMP collaborates with PEPFAR agencies, the Government of Cameroon, the Global Fund, other key stakeholders, and community-based partners to strengthen and expand human rights-affirming, evidence-based, client-friendly HIV prevention, treatment and care services for key populations (KP), including MSM, FSW, and clients of sex workers. The program has also created partnerships for effective referrals for orphans and vulnerable children and adolescent girls and young women who are linked to key populations engaged in the program. CHAMP is also a learning program that helps drive strategic decision-making and resource planning in Cameroon and across West and Central Africa by contributing to the evidence base.
Community-based outreach, peer mobilization, and network mapping/contact tracing leverage social media and social networks to increase cohesion, social inclusion, and individual and group-level capacity to ensure clients have access to essential commodities, including condoms and lubricants, and client-centered risk reduction interventions to prevent HIV infection, and improve management of people living with HIV as they are linked to care. Clinical interventions increase the cultural and clinical competency of health care providers to address the needs of KPs who are at risk of HIV acquisition or are already living with HIV. Peer navigation, electronic client tracking, and retention interventions help maintain clients living with HIV within the services continuum by further leveraging social networks and community mobilization activities to provide care and support, to reinforce strategic behavioral communication, and to promote clinically competent, non-stigmatizing services.
Implementation science initiatives and routine program monitoring are leveraged to provide feedback on KP experiences in accessing services, to monitor community and clinical outcomes, and make real-time programmatic changes to improve interventions. The program is evaluating new models of service provision, with decentralized “hub and spoke” approaches that deliver services to and by the communities including incentives-based peer-driven recruitment, HIV and STI testing, laboratory diagnostics, treatment of STIs, linkage to treatment, health navigation, initiation and retention in treatment, prevention and care for violence, and sexual, reproductive health, family planning, legal, and psychosocial services.
- CHAMP helped lead the development of a national Minimum Package of Services for key populations, guidance and standard operating procedures on prevention, care and treatment for key populations, and national and local multidisciplinary action plans to help prevent and address instances of violence.
- CHAMP has conducted over 44,000 prevention interventions, including the provision of condoms and lubricants, with members of key population groups.
- The program has tested over 43,000 members of key populations for HIV.
- Over 4,200 members of key population groups have been effectively linked to treatment, and 3,800 are currently receiving ARVs.
- Over 127 clinical providers have been trained in non-stigmatizing clinical care and treatment for FSW and MSM.
- Key population members and organizations have been empowered to design, implement, evaluate, and lead the HIV response in their communities.