Case Study Series
- Africa Gender Compendium (#)
- Alcohol and Risky Sexual Behaviors (#)
- Combination Prevention (#)
- Emergency Planning for ART (#)
- Family Planning and HIV Service Integration (#)
- Food and Nutrition (#)
- Gender-based Violence (#)
- Home based HIV Testing and Counseling (#)
- Implementing WHO HIV Treatment Guidelines (#)
- Intergenerational Sex (#)
- Mental Health (#)
- Mixed Epidemics (#)
- Most-At-Risk Populations (#)
- Multiple and Concurrent Sexual Partnerships (#)
- Private Sector Engagement (#)
- Provider-Initiated HIV Testing and Counseling (#)
- Supporting Youth (#)
In Zambia's border towns and commercial corridors, the HIV prevalence rate has been significantly increased by a high transient population. This case study details the efforts of the Corridors of Hope program to promote HIV prevention and testing efforts in both the general population and among at-risk groups.
This is one of five case studies in the Compendium of Programs in Africa series.
In South Africa, men are increasingly rejecting wide-spread stereotypes of manhood by stepping forward to challenge gender roles that compromise their well-being and the health of their partners and their families. This case study documents the Sonke Gender Justice Network’s Fatherhood project, which was designed to reduce HIV transmission and address related problems, such as gender-based violence, women’s overwhelming burden of care, and the preponderance of children in need of care and support.
This is one of five case studies in the Compendium of Programs in Africa series.
The Polyclinic of Hope in Rwanda takes a comprehensive approach to combating gender-based violence for genocide survivors affected by HIV by facilitating support groups, encouraging income generation activities and providing HIV testing and treatment services.
This is one of five case studies in the Compendium of Programs in Africa Series.
A complex matrix of factors, such as low literacy, early sexual initiation, and limited economic opportunities, increases the vulnerability of women to HIV infection in Mozambique. The Women First program addresses the role that poverty and lack of access to health information play in the spread of HIV through legal rights and income-generating activities.
This is one of five case studies in the Compendium of Programs in Africa series.
In Kenya, the government's work against HIV is supplemented frequently by civil society organizations (CSOs). These organizations, however, are often faced with a lack of available funding and knowledge. The Maanisha Community Focused Initiative, a program that works in many of Kenya's provinces, works to provide CSOs with both grants and capacity building in all HIV program areas while simultaneously addressing multiple gender-related issues.
This is one of five case studies in the Compendium of Programs in Africa series.
In South Africa, where rates of alcohol consumption and HIV are among the highest in the world, sexual risk taking and drinking frequently intersect. In Cape Town, the Phaphama (“Wise Up”) program demonstrated dramatic behavior change in the months following a single, 60-minute counseling session offered to repeat patients at a sexually transmitted infection clinic.
Through their innovative Community Popular Opinion Leader (CPOL) approach, the Y.R. Gaitonde Center for AIDS Research and Education (Y.R.G. CARE) provided peer education on the risks of alcohol consumption and HIV in informal bars known as wine shops in Chennai, India between 2002 and 2007. Using "I statements" to convey relatable personal experiences, focusing more realistically on risk reduction rather than risk elimination, and continually seeking new information on the social and structural environment in Chennai helped Y.R.G. CARE develop an adaptable, peer-based HIV prevention program.
In many countries facing high-prevalence, generalized HIV epidemics, the development of a national prevention strategy is difficult and often does not produce coordinated and comprehensive results. In Namibia's prevention planning process, these challenges were addressed using a combination prevention strategy tailored to local epidemiology and demographics. The development process was furthered by a strong sense of cooperation between Namibia's Ministry of Health and Social Services and staff at UNICEF and UNAIDS, as well as CDC and USAID (funded by PEPFAR).
AIDSTAR-One's first case study in the Promising Approaches to Combination Prevention series examines the efforts of the Alliance-Ukraine to reach most-at-risk populations (MARPs) in Ukraine. Through its partner organizations, the Alliance-Ukraine provides the majority of HIV prevention services in the country, targeting the primary driver of Ukraine’s HIV epidemic: injecting drug use. Community engagement, advocacy for supportive policies, and linkages to government services complement evidence-based programming.
Launched in 2003, the Avahan-India HIV prevention program has become a global model for combination HIV prevention programming that meets the complex and varied needs of most-at-risk populations. This case study describes Avahan’s behavioral, biomedical, and structural components and how the program was able to quickly scale up its activities across 82 districts in India.
During emergencies, the fragile healthcare infrastructures in many developing countries cannot address acute injuries while continuing to manage chronic illness. Potential interruptions in antiretroviral therapy (ART) for people living with HIV are serious concerns because continuity of treatment is critical to prevent transmission and ensure individual and community health. This case study documents Uganda's planning process for continuity of HIV programs in the event of emergencies and highlights changes to the process since the violence from northern Uganda's civil war ended.
In 2007, Kenya experienced a wave of violence following its presidential elections. This case study documents the emergency plans that had been in place to ensure continuity of HIV treatment programs prior to the outbreak of violence, and the events that occurred during the period of violence. It also highlights the changes to contingency planning for HIV that have taken place since the violence ended.
Multimedia EnhancedIn regions of high fertility and HIV prevalence, integration of family planning and HIV services has emerged as a promising strategy to prevent transmission of HIV, particularly from mother to child. This case study explores different models of integration and how they have been realized in Kenya and Ethiopia, two pioneers in family planning and HIV service integration.
Chronic food insecurity and achieving strict adherence to antiretroviral therapy (ART) are global challenges that, together, have a deleterious effect on children and pregnant women living with HIV. In Ethiopia, where the child malnutrition rate is one of the highest in the world, side effects of treatment threaten to reduce adherence to drug regimens and contribute to the development of drug-resistant strains of HIV. This case study examines how the Breedlove Project integrates HIV programming (treatment and PMTCT) with nutrition programming to address short-term and long-term needs of families and households in Ethiopia.
Gender-based violence (GBV) is widely recognized as both a cause and a consequence of HIV infection. To help program managers integrate GBV prevention and response strategies into existing HIV, family planning, and reproductive health services, AIDSTAR-One conducted three case studies in countries where GBV services were available. This case study documents Vietnam’s Improving Health Care Response to Gender-based Violence project—a public sector intervention that builds on a medical model and links survivors to ongoing counseling and support.
Although many in Ecuador do not recognize the link between gender-based violence (GBV) and HIV, the Ministry of Public Health has made an effort to include this link in guidelines and protocols to improve the national health sector response to violence. In partnership with the government, Centro Ecuatoriano para la Promoción y Acción de las Mujeres (CEPAM) is a major force in providing care and support to GBV survivors while raising awareness about this important issue. This case study documents CEPAM's leadership in the GBV response and the NGO's partnership with the Government of Ecuador to take a holistic approach to GBV services and prevention.
Entrenched gender inequality is a major contributor to Swaziland's HIV prevalence rate, which in turn, hinders poverty reduction and national development activities. For the past ten years, the Swaziland Action Group Against Abuse (SWAGAA) has been addressing the links between the HIV epidemic, gender-based violence (GBV), and human rights. Although SWAGAA was initially formed to provide counseling services to survivors of GBV, it has expanded its programs to better meet the needs of the community.
Home-based HIV testing and counseling (HBHTC) has emerged as a promising approach to meet the Kenyan government’s challenge—that 80 percent of all Kenyans to know their HIV status by the end of 2013. By using rapid tests, HIV programs are able to offer HTC services to individuals and families within the privacy and convenience of their own homes. Furthermore, HBHTC provides an entry point at the community level for referrals and integration of other health messages, such as family planning, tuberculosis screening, and malaria prevention. This case study provides program planners, implementers, and decision makers with examples of strategies and approaches for ensuring quality in HBHTC.
After the 2009 release of WHO’s Rapid Advice for HIV treatment in adults and adolescents, Zambia launched a broad-based effort to update its national treatment protocols. The Ministry of Health succeeded in creating an efficient and inclusive review and revision process for the guidelines, which they began implementing in 2011.
This case study details Guyana's process for revision of their national HIV treatment guidelines, based on WHO's 2010 revised recommendations 
. While many countries are still working to revise their national guidelines in response to WHO's latest guidance, the National AIDS Programme in Guyana has been implementing elements of WHO's 2010 recommendations since 2006.
Little attention is paid to the potential risk of HIV exposure in intergenerational relationships, through which older men offer young women money or goods in exchange for sex. In Tanzania, the Fataki radio campaign uses humor and familiar stories to foster dialogue around the dangers of intergenerational sex and to empower community members to intervene.
A step-by-step example of how a program in Vietnam integrated mental health services into 1) a HIV care and treatment program and 2) a methadone maintenance treatment to improve the quality of life among PLHIV. These two examples show how mental health services can be integrated into the health system through technical, financial, and policy support to improve the well-being of PLHIV.
An in-depth look at the Peter C. Alderman Foundation's efforts to integrate HIV services and referrals into their mental health program in the post-conflict area of Northern Uganda. This case study provides concrete recommendations for programs to increase the links between mental health and HIV services thus providing holistic care for PLHIV.
Prompted by a growing knowledge of the complexity of HIV transmission, many countries are reassessing the nature of their HIV epidemics. "Mixed" epidemics, or concurrent epidemics experienced by both the general population and members of most-at-risk populations (MARPs), are of growing importance in HIV programming. Nigeria, a country with a range of regional and local epidemics, is now attempting to incorporate programming for MARPs into the national HIV response. This case study documents the country's analysis of its epidemics and the efforts of the Nigerian government to adjust their national strategic plan according to the results of the analysis.
Men who have sex with men (MSM) have been neglected in HIV programming in sub-Saharan Africa, frequently ignored in national strategies and hidden in the face of intolerance, stigmatization, and punitive laws. In Ghana, community-based organizations (CBOs) have been at the forefront of HIV interventions for MSM. Among the small number of CBOs working with this highly vulnerable population are the Accra-based Center for Popular Education and Human Rights, Ghana (CEPEHRG) and Maritime Life Precious Foundation (Maritime) in Takoradi. With the support of PEPFAR, these two organizations have been part of much-needed efforts to reach MSM with prevention messages, condoms, and lubricant and to increase uptake of HIV-related services using cell phone-based communications.
Recent studies confirm that globally men who have sex with men (MSM) are at significantly greater risk for HIV infection than other adults of reproductive age, due to a combination of biological, behavioral, and structural factors. In a sometimes difficult cultural and political environment, the Humsafar Trust works with MSM in Mumbai and successfully links community advocacy and support activities to the development of effective HIV prevention and health services. In India as elsewhere, the development of responsive programming and service options for MSM will help reduce their vulnerability to HIV and improve the overall effectiveness of the HIV response.
Along the U.S.-Mexico border, a growing HIV epidemic fueled largely by commercial sex and injecting drug use threatens both countries. Working in an often dangerous climate, two Mexican NGOs provide most-at-risk populations in Tijuana and Ciudad Juarez with HIV prevention services that use a combination of approaches.
In Peru, where cultural norms emphasize women's subordination and the importance of masculinity, programs with a focus on gender—particularly those involving sex workers are often underfunded and underrepresented. This case study (one of nine in a series) describes how three organizations focused on sex workers and transgendered and transsexual people have joined together to advance the rights of sex workers. The Sex Work, HIV, and Human Rights Program uses a democratic and participatory approach in order to raise awareness of human rights and advocate for sex workers' rights on both national and local levels.
This is one of nine case studies in the Gender Strategies in Concentrated Epidemics series.
Together, a support network plus access to legal and psychological support are essential components of HIV programming for most-at-risk populations. In Colombia, obtaining this support is difficult for many members of the lesbian, gay, bisexual, and transgender (LGBT) community due to pervasive stigma and discrimination. Bogotá's LGBT Community Center was founded in order to help fill this need and serves a clientele comprised mainly of men who have sex with men. This case study (one of nine in a series) examines the center's efforts to provide a social and educational base for its clients while also advocating for their rights.
This is one of nine case studies in the Gender Strategies in Concentrated Epidemics series.
In Nicaragua, HIV prevention for "sexually diverse" populations, including men who have sex with men (MSM), is made significantly more difficult by societal norms that stigmatize same-sex sexual activity and favor conformity to strict gender roles. Centro para la Prevención y Educación del SIDA (CEPRESI) is addressing this issue by both working to change perceptions of masculinity in Nicaragua's general population and educating MSM on HIV prevention and treatment.
The influence of religious groups in parts of Latin America positions them to target most at risk populations (MARPs) who may have been overlooked by traditional HIV prevention outreach. In Mexico, La Iglesia de la Reconciliación, VIHas de Vida, and El Mesón de la Misericordia are challenging assumptions about faith-based organizations (FBOs) and the role they can play in HIV prevention. These three FBOs integrate spirituality and a holistic vision of health into their activities, sharing information on HIV and providing other HIV-related services in Mexico City and Guadalajara.
Integrating strategies to address gender inequity and change harmful gender norms is an increasingly important component of HIV programs, including those targeting most-at-risk populations (MARPs). This case study (one of nine in a series) documents Indonesia’s STIGMA Foundation, which uses a peer outreach model to help men and women who inject drugs live safer, healthier, more productive lives through community organizing, advocacy, and networking.
This is one of nine case studies in the Gender Strategies in Concentrated Epidemics series.
Successful outreach to most-at-risk populations (MARPs) recognizes the sociocultural context and particularly the gendered norms in which MARPs live. This case study (one of nine in a series) documents how outreach workers in Lebanon raise awareness about how gender norms can increase HIV risk; deliver basic information on HIV, hepatitis, and other STIs; offer counseling to support positive behavior change, and distribute free condoms, syringes, and lubricants.
This is one of nine case studies in the Gender Strategies in Concentrated Epidemics series.
Programs focused on promoting gender equity and combating detrimental gender norms play a key role in HIV prevention. This case study (one of nine in a series) documents how the PRASIT program in Cambodia targets entertainment workers, their mainly middle class and male clients, and males who have sex with males using strategic behavior communication. Although the programs vary in their approaches, strategies employed by PRASIT have focused on community outreach, mass media campaigns, and peer education.
This is one of nine case studies in the Gender Strategies in Concentrated Epidemics series.
Integrating strategies to address gender inequity and change harmful gender norms is an increasingly important component of HIV programs. However, gender integration among programs targeting most-at-risk populations (MARPs) is much less prevalent. This case study (one of nine in a series) reviews how SANGRAM, a women-led network of collective empowerment groups in India, is developing and administering projects that promote and protect the rights—and health—of MARPs.
This is one of nine case studies in the Gender Strategies in Concentrated Epidemics series.
Gender norms affect the behavior and life choices of both men and women. In Vietnam, these norms sometimes drive people into situations where they are at increased risk of violence, STI acquisition, and/or incarceration. This case study (one of nine in a series) examines CARE International's STEP program, which seeks to ensure that both men and women have equal access to services to prevent STIs, safeguard their health, avoid gender-based violence, and participate in income-generating activities.
This is one of nine case studies in the Gender Strategies in Concentrated Epidemics series.
Although transgender individuals are a highly vulnerable segment of El Salvador's population, the national political climate has only recently begun to support HIV programming that is tailored to their needs. Additionally, limited access to medical services and legal protection and considerable societal stigma and discrimination means that organizations working with transgender individuals must meet a variety of complex and varied needs. This case study, one of 9 in a series, describes the challenges and successes of the Solidarity Association to Promote Human Development (ASPIDH), an NGO that promotes transgender rights via sensitization, education, and advocacy activities.
This is one of nine case studies in the Gender Strategies in Concentrated Epidemics series.
Gender inequality is a major contributor to men who have sex with men's (MSM) vulnerability to HIV. Understanding the gender dynamics of MSM, as well as their specific sexual identity issues and concerns, is important for delivering effective HIV services. This case study (one of nine in a series) describes how an NGO in Russia created an MSM-supportive environment and provided free access to HIV services through its "Follow the Voice of Life" program.
This is one of nine case studies in the Gender Strategies in Concentrated Epidemics series.
In India, most new HIV infections are concentrated in specific groups within the population and in certain areas of the country. To effectively reach most-at-risk populations, including sex workers, people who inject drugs and men-who-have sex with men, the Mumbai-based Avert Society is working with other nongovernmental organizations in five districts of Maharashtra to deliver HIV and STI testing via mobile testing clinics. Although the mobile clinic program is less than a year old, it has shown promising results to date.
“It Makes Me Want to Come Back Here”: Silom Community Clinic’s Approach to HTC Among MSM in Thailand
High rates of HIV infection among men who have sex with men (MSM) in the Asia-Pacific region are a concern. Many MSM living with HIV remain unaware of their status and are often diagnosed in late stages of the disease. In 2005, the Silom Community Clinic was established in Bangkok to promote HIV testing and counseling while conducting high-quality HIV prevention research among MSM, including transgender populations. The clinic provides supportive, confidential, non-judgmental, and client-centered HIV rapid testing and counseling for MSM.
In many cases, HIV programming collapses transgender people under the umbrella category of men who have sex with men without taking into consideration the particular needs of transgender people. Yet, surveys of transgender populations in Thailand report extremely high HIV prevalence and very limited access to HIV prevention. Sisters, a transgender-focused, community-based organization in Thailand, helps to fill this gap. Sisters' approach helps transgender people in Pattaya, Thailand access the health system, providing a safe place for health education, prevention services, and overall support.
Makhwapheni Uyabulala, or “Secret Lovers Kill,” was Swaziland’s first national media campaign to focus on the HIV risk of multiple and concurrent sexual partnerships (MCP). The campaign promoted HIV prevention in the country with the world’s highest HIV prevalence by broadcasting a powerful message that resonated with the public and encouraged behavior change. The Makhwapheni Campaign launched a widespread public exchange about multiple sexual partnerships and the spread of HIV, a topic rarely discussed in Swazi society.
Launched on South African television in June 2008, the Scrutinize Campaign was a year-long series of HIV prevention ads targeting multiple and concurrent sexual partnerships. Irreverent and humorous, with strong, colorful visuals, the campaign’s ads were markedly different from previous South African HIV prevention campaigns for youth. Rather than telling the audience what to do, the Scrutinize campaign messaging encouraged those in the audience to scrutinize their own behavior, resulting in dramatic uptake of key HIV prevention messages.
As a lynchpin of its bold goal of zero new HIV infections by 2016, Botswana's national O Icheke: Break the Chain campaign offers a wake-up call on the risks of multiple and concurrent sexual partnerships. O Icheke (“Check Yourself” in Setswana) combines mass media with district-level interventions targeting community norms change and individual behavior change.
Multimedia EnhancedAddressing multiple and concurrent sexual partnerships (MCP) and other drivers of HIV in Zambia, this fictional mini-series and its associated One Love Kwasila! multimedia campaign encouraged viewers to protect themselves and their partners by “cutting their connections to HIV.”
Multimedia EnhancedThe Health Initiatives for the Private Sector (HIPS) Project is a model for involving private providers in a national HIV/AIDS prevention and treatment approach, while strategically planning for long term sustainability. This case study looks at the issues around decentralization of HIV treatment to private providers, as well as how private sector engagement can support the goals of the PEPFAR strategy.
Despite scale-up of HIV testing and counseling (HTC) interventions mostly involving voluntary counseling and testing (VCT) or client-initiated testing and counseling sites, HTC uptake and individual knowledge of HIV status in many countries remains low. Provider initiated testing and counseling (PITC) is an emerging model of HTC that aims to increase testing rates. The private sector provides a significant portion of care in resource-poor countries, yet these providers are often left out of training or other capacity building efforts, which can affect a country’s ability to effectively implement and expand health services, such as PITC. To our knowledge, APHIA II Western is one of few programs engaging private providers in PITC efforts. Lessons learned from this project can be applied to other countries seeking to initiate, roll-out, or expand PITC activities.
Orphans and other vulnerable children (OVC) are susceptible to abuse, exploitation, violence, and neglect and often do not have access to support systems designed to assist in these instances. This case study examines Legal Units in Côte d’Ivoire, a network of individuals and resources that can be tapped as needed to protect the rights of children and their families. Their mission is to help resolve legal problems for OVC and their families either by mediation or prosecution, and to raise awareness about children’s rights among OVC and their communities.
An example of how assistance can be mobilized from within communities to protect young people’s access to education, Youth Alive Tanzania’s Youth and Parents Crisis Counseling Center (YOPAC) is implementing "community-enforced agreements"—simple and straightforward commitments of support—that give orphans like Jamilla confidence and optimism about their futures.
