Applying Innovative Approaches for Reaching Men Who Have Sex With Men and Female Sex Workers in the Democratic Republic of Congo

Although political and economic progress has been achieved in recent years, the DRC remains one of the least developed countries, ranking 186 out of 187 on the Human Development Index in 2014. The country's health care system was severely damaged during the conflict, and the government is currently working to rebuild it. However, the government faces several challenges that hinder its ability to deliver high-quality health services to its citizens, including inadequate transportation and energy infrastructure and limited financial resources devoted to health. The DRC has a national HIV prevalence of 1.4% among individuals aged 15-49 years, according to preliminary results from the 2013-2014 Demographic and Health Survey. However, HIV is concentrated in certain geographic areas and populations, and key populations, particularly men who have sex with men (MSM) and female sex workers (FSW), are disproportionately infected with HIV. The HIV prevalence rate among MSM is 17.4%, and the rate among FSW is 6.9%. Research has shown that stigma, discrimination, and criminalization can impede access to care, inhibit service uptake, and increase the vulnerability of MSM and FSW to HIV. To address the needs of key populations, the Projet Intégré de VIH/SIDA au Congo (ProVIC) implemented a 6-year project funded by the US President's Emergency Plan for AIDS Relief through the US Agency for International Development. The project began in 2009 and focuses on building the capacity of health facilities, health facilities, and nongovernmental organizations (NGOs) to provide HIV prevention, counseling, testing, care, support, and treatment services to key populations. ProVIC engaged with both communities and health facilities to provide a holistic package of HIV services to individuals in the project's targeted areas in the DRC. ProVIC's primary strategy for mobilizing communities in HIV prevention and mitigation was through the Champion Community (CC) approach, a participatory process that empowered communities to identify needs and self-organize, plan, and evaluate tailored, community-level responses to the HIV epidemic. The CC approach was adapted to create CCs of key populations, including MSM and FSW, to provide them with HIV/AIDS knowledge, best practices, and information on safe and responsible behaviors. ProVIC established 5 key population CCs in major urban hubs in the 5 provinces where the project operated. ProVIC also provided follow-up testing, care, and treatment to HIV-positive individuals through local health facilities and community-based mobile HIV testing activities. Individuals who tested positive at community HCT sessions were referred to health facilities where they received a comprehensive package of services, including HIV treatment, prevention of mother-to-child transmission services, palliative care, screening for other sexually transmitted infections, and counseling on family planning. The ProVIC project implemented several interventions to better reach high-risk population groups, including MSM and FSW. The project adapted the traditional CC model to create CCs around key population networks, offered prevention, counseling, and testing services at MSM and FSW hotspots, and referred HIV-positive MSM and FSW to "friendly" health clinics. Through these interventions, ProVIC was able to reach 2,621 MSM and 12,745 FSW with targeted prevention messaging in 2013 and provide testing and counseling services to 4,366 MSM and 21,033 FSW from 2012 to 2014. ProVIC's targeted interventions for MSM and FSW provide promising examples of programming that can be used to meet the HIV prevention and testing needs of key populations and improve referrals for care and treatment, particularly in complex and unstable settings similar to the DRC.