The International Conference on AIDS and sexually transmitted infections (STIs) in Africa (ICASO) was held in Harare, Zimbabwe, from Nov. 27 to Dec. 4, 2015. The conference, which was shaped by the powerful presence of LGBTI communities from across sub-Saharan Africa, followed the launch of new international guidelines recommending that people with HIV be immediately offered treatment upon diagnosis.
On behalf of TheBody.com, Maureen Milanga, Health GAP's national organizer in Kenya, asked three advocates from ISHTAR-MSM, an Kenyan organization that works with men who have sex with men (MSM), to talk about their work and experiences at ICASO. This is a lightly edited version of collaborative responses from ISHTAR's executive director Peter Njane, clinical officer Macland Njagi and board member Ruth Njambi Kimani.
Tell us about ISHTAR.
ISHTAR works with MSM in Kenya. Based in Nairobi, it is one of the oldest Kenyan LGBTI organizations. It began in 1999 and was registered in 2002. The organization focuses on HIV prevention, care and treatment for MSM and male sex workers and runs a wellness program offering HIV testing and counselling, and STI screening and treatment.ISHTAR also advocates -- targeting governments and donors such as the Global Fund and PEPFAR [The President's Emergency Plan for AIDS Relief] -- for increased funding and quality services for key populations in the country, for community development and for research targeting MSM.
What are your views about the defence of human rights of key populations in African countries?
People from key population networks were mistreated at the airport as they were coming for the conference. It was clear evidence of why more advocacy and mobilization is needed. There is much more that needs to be done -- and we need to focus on building the capacity of key populations to advocates for themselves.
In Kenya, despite the various challenges, we are doing a lot. For example, we have literacy training on the subject across the country with various stakeholders so that members of key populations feel free to discuss on the TV and radio the various issues affecting them. There is a need for increased advocacy in Zimbabwe to educate ordinary people, members of law enforcement and politicians.
We are tackling our challenges by building stronger networks, by training each other in how to fight for our rights, and by strengthening quality prevention and treatment programs run by and for key populations. ICASA provided important opportunities for us to learn more about innovations from all over the continent.
The World Health Organization (WHO) officially launched new treatment guidelines saying that all people with HIV should be immediately started on treatment when they are diagnosed as a new standard of care. What must happen to put these guidelines into operation in African countries and to ensure quality care for all, including key populations?
Governments in Africa need to align with the new WHO recommendations and work on the operationalization and domestication of these guidelines to ensure services reach the people. Activists will have a major role to play in their countries to ensure government ministries adopt and urgently implement these guidelines.
Discussion in Kenya suggests that, despite the science showing that all HIV-positive people should be tested and started on treatment, there will likely be a phased-in approach for treatment access, meaning that the country might focus on various geographical areas and populations instead of rolling out the service to the whole country at the same time. What do you think of this approach?
If we are going to say that the fight against HIV is all-inclusive, then the country needs to treat the whole population. There is no way we can fight HIV in certain populations and leave others behind. There is danger in such progression because funding also is limited to selected interventions in such cases, and community-based interventions tend to suffer with provider-initiated treatment becoming a central part of the response. The rollout should not forget to have combination interventions, such as by creating demand through increasing the literacy of the people to access treatment and other behavioural interventions.
Maureen Milanga works with Health GAP in Kenya to increase access to treatment and high-impact prevention. She supports criminalized populations -- in particular sex workers, people who use drugs and MSM -- fighting for real accountability from donors and the Kenyan government. Milanga, whose background is in human rights, was an AVAC 2013 fellow working with AIDS Law Project and Health GAP. She was chosen by POZ magazine as one of the 100 most effective HIV/AIDS activists under 30 of 2014.