amfAR, The Foundation for AIDS Research

Developing New Strategies to Reduce HIV Rates among GMT Worldwide

 In January 2012, amfAR launched the Evidence in Action project in response to a need for more evidence-based strategies to reduce the spread and impact of HIV among GMT. Using three-year funding from ViiV Healthcare Positive Action and the Elton John AIDS Foundation, amfAR recruited six past or current grantee network partners from diverse geographical regions for the project. The participants work with an external expert evaluator to formally evaluate their programming efforts. Through this process, they develop a set of evidence-based strategies that can help replicate and scale up their activities and programs at the local and national level.

 Eric Castellanos, executive director of CNET+,  explains the organization’s nutrition program.
Eric Castellanos, executive director of CNET+, explains the organization’s nutrition program.

“What is extremely rewarding is the ownership the grantee network partners have over these formal evaluations, which helps them to analyze and use the data systematically for their own advocacy purposes,” says Kent Klindera, director of amfAR’s GMT Initiative. The results will also inform the amfAR Public Policy Office’s global advocacy efforts to improve HIV policies targeting GMT communities worldwide. In 2013, four additional GMT Initiative grantee network partners were added for phase two of the project, making a total of ten participating organizations.

The partners were asked to develop and submit research proposals based on lessons learned from past experience.  At the same time, a local or regional evaluation specialist was recruited, from either a local university or research institution, to design a formal evaluation for each partner’s program.  These evaluation experts worked with the grantee partners, amfAR staff, and colleagues from the Center for Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health to develop research protocols for the studies. Once finalized, most of the teams sought national-level internal review board (IRB) approval to formalize the research. 

Evaluation expert Sergio Montealegre (right) conducting a baseline assessment with CNET+ outreach worker Kenny White (left),  while Rick Campos (center), CNET+ program manager, learns interviewing ski 
Evaluation expert Sergio Montealegre (right) conducting a baseline assessment with CNET+ outreach worker Kenny White (left), while Rick Campos (center), CNET+ program manager, learns interviewing skills.

Most of the GMT Initiative’s network grantee partners are working to integrate the science of effective HIV prevention with efforts to reduce the stigma and discrimination GMT often face in the health sector and among the general population—which greatly impacts their ability to access care, get tested, and adhere to their HIV treatment regimens.  The majority of the Evidence in Action partners are evaluating their combination prevention programs, with a focus on HIV testing, but others are evaluating their stigma reduction efforts, and the program will therefore produce evidence-based strategies for both areas.

The Collaborative Network for Persons Living with HIV (CNET+) in Belize City, Belize, is measuring the effectiveness—including cost-effectiveness—of their community-led “home visits.”  CNET+ staff or volunteers conduct visits with Belizean GMT individuals living with HIV on a weekly basis.  These visits often take place in individuals’ homes, but also in more public spaces such as beaches, cafes, and parks.  The visits focus on both the physical and mental health of the clients, working to improve adherence to treatment, reduce viral load, and increase HIV transmission risk reduction abilities. “For us, it’s a marvelous thing when after two, three months we see the huge difference in the conditions people are living in,” says Eric Castellanos, CNET+’s executive director.  “They are still very poor, but they’re well dressed and their houses are clean, because they have hope.”

CNET+ and amfAR selected Sergio Montealegre—a regional expert affiliated with the Central American PLWHA Network REDCA, based in San Salvador, El Salvador—as the evaluator.  In addition to a quantitative assessment with CNET+ clients, Sergio has interviewed numerous stakeholders—clients, public sector healthcare providers, and CNET+ staff and volunteers. 

Grantee partner Alternatives-Cameroun, located in Duala, Cameroon, is evaluating their HIV testing and healthcare programs and working to formalize their program data. “When we meet with our government for our advocacy efforts they always say homosexuality doesn’t exist in Africa,” says Yves Yomb, executive director of Alternatives. “With the Evidence in Action program, it means we can have this data and use it in our advocacy with the government, the Ministry of Health, and other people in Cameroon.”

Evidence in Action’s Asia partners include the Bandu Welfare Society in Bangladesh, the only organization in the country working directly with GMT. Bandu is actively involved in advocating for policy makers to better address the needs of GMT nationally, and having formalized strategies to offer them could prove essential to this effort.

The Evidence in Action grantee partners and amfAR intend to disseminate results from the project in each partner’s respective locality and country, as well as globally at the 2014 International AIDS Society Conference in Melbourne, Australia. In addition to developing strategies, the process is also strengthening the participant organizations’ monitoring and evaluation skills, as the evaluation experts work directly with these community-led organizations on formal research techniques. “We are very excited to see the results that will be coming from the partners in the coming months,” says Klindera.