Linkages Across the Continuum of HIV Services for Key Populations Affected by HIV (LINKAGES) Project in Barbados

The project was implemented in partnership with civil society organizations (CSOs), government stakeholders, and KP individuals, with support from the U.S. Agency for International Development (USAID) and the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). The project's focus was on delivering community-tailored programming across the HIV prevention, care, and treatment cascade for female sex workers (FSWs), men who have sex with men (MSM), and transgender people. The project expanded access to one-stop-shop services in community "safe spaces" and engaged members of KP groups in developing and implementing their own solutions to barriers to getting tested for HIV and initiating and adhering to antiretroviral therapy (ART). The project also established referrals to STI and other sexual and reproductive health services, psychosocial care and support, legal aid, and support for and prevention of gender-based violence. Additionally, the project helped define the scope for CSO engagement in the provision of HIV services and incorporated it into the national approach known as "Shared Care." The LINKAGES project collaborated with the Ministry of Health and Wellness (MHW) and the National HIV/AIDS Commission (NHAC) over the life of the project, demonstrating the government's commitment to HIV services for KPs. The project partnered with two local CSOs: CEED (Community Education, Empowerment and Development) and EQUALS (Empowerment, Quality, Unity, Acceptance, Love, Strength) to implement community-led services. The Barbados Family Planning Association played the important role of providing KP-friendly facility-based services to complement the community-based programming. The project used the HIV services cascade as the overall strategic framework for the project and implemented interventions at select steps along the cascade. Technical support included the development of innovative social media and social network interventions to increase reach and recruitment of KP members into services. The program extended HIV testing and counseling to KPs and improved linkage to and retention in care and treatment via peer navigators; and established referrals to STI services, sexual and reproductive health services, psychosocial care and support, legal aid, and support for and prevention of gender-based violence. The project also made efforts to address the stigma and discrimination that KP members experienced when accessing services while simultaneously bringing services closer to the community. The project's achievements included providing technical support for social media and social network interventions that increased reach and recruitment of KP members into services, extending HIV testing and counseling to KPs, and improving linkage to and retention in care and treatment via peer navigators. The project's success was also reflected in the establishment of referrals to STI and other sexual and reproductive health services, psychosocial care and support, legal aid, and support for and prevention of gender-based violence. Additionally, the project helped define the scope for CSO engagement in the provision of HIV services and incorporated it into the national approach known as "Shared Care." The project's achievements were a result of the collaboration between the government, CSOs, and KP individuals, and demonstrated the government's commitment to HIV services for KPs. The project's impact was also reflected in the improvement of health outcomes for KPs. The project's efforts to address stigma and discrimination and bring services closer to the community resulted in increased access to HIV testing and counseling, improved linkage to and retention in care and treatment, and increased referrals to STI and other sexual and reproductive health services. The project's achievements also highlighted the importance of community-led services and the need for a sustainable systems approach to build capacity in community health delivery and navigation systems, monitoring and data retrieval systems, and systematic comprehensive responses to stigma and discrimination. The project's success was also reflected in the establishment of a technical steering committee, which brought together stakeholders from the government, CSOs, and KP individuals to provide leadership and accountability for the project. The committee's role was to ensure that the project was aligned with the government's national response to the HIV epidemic and that the project's achievements were sustainable and scalable. The committee's efforts resulted in the development of a comprehensive framework for CSO engagement in the provision of HIV services, which was incorporated into the national approach known as "Shared Care."