Key populations at risk, including injection drug users, men who have sex with men, and sex workers, have up to 20 times higher rates of HIV than the general population in Zanzibar, the archipelago in the Indian Ocean off the coast of Tanzania. With an estimated total population of 1.2 million, there are approximately 6,000 people living with HIV/AIDS on the islands. High HIV prevalence among key populations at risk is attributed not only to the high tourist flow in the area, but also to a considerable level of opiate drug trafficking that occurs in this region. Various risk behaviors, such as multiple sexual partners, needle sharing, low utilization of condoms, and low levels of HIV testing, contribute to the high HIV infection rates among these populations.

In 2008, ICAP formed the United for Risk Reduction and HIV/AIDS Prevention (URRAP) program—a comprehensive risk and harm reduction program that provides education, counseling, support, and accessible linkages to HIV services for at-risk groups, their partners, and families. Supported by a grant from the US Centers for Disease Control and Prevention (CDC), the program uses existing community support networks of peer educators to provide high-quality services to people who inject drugs, men who have sex with men, and other key populations. ICAP partnered with the Tanzania Ministry of Health, the Zanzibar AIDS Control Programme (ZACP), the Zanzibar Drug Control Commission (ZDCC), and four non-governmental organizations—Zanzibar Youth Education, Association and Development Support Association (ZAYEDESA), Zanzibar Youth Forum (ZYF), Zanzibar Association of Information Against Drug Abuse and Alcohol (ZAIADA), and Zanzibar NGOs Cluster (ZANGOC)—to implement the program, which has now been in place for four years.

“URRAP emphasizes both personal interaction with key populations as well as partnerships with health care providers and policy makers. The program’s development of education, outreach, and training activities has led to significant improvements and has helped build a strong relationship with the community,” said Frida Radegunda Godfrey, an ICAP program manager who leads the URRAP team. Since the launch of the program, 205 health care providers and 24 pharmacists have been trained on how to support key at-risk populations and 100 people from at-risk populations have been trained and deployed as peer educators.

The program has succeeded in increasing the number of people in most-at-risk populations who receive counseling, HIV testing services, and HIV care and treatment, with more than 1,900 at-risk individuals tested for HIV and 98 HIV-positive clients successfully linked to care and treatment. The program also has educated at-risk groups about HIV prevention practices such as the consistent use of condoms. Enrollment in URRAP-sponsored HIV awareness classes and access to sober houses for injection drug users seeking support has also increased.

In order to reach these achievements, ICAP overcame several challenges. When first embarking on this work in 2008, there were limited drug rehabilitation programs for injection drug users in Zanzibar, few services available for key at-risk populations, and very low adherence to HIV care and treatment services from these key populations. A high degree of stigma and discrimination against at-risk populations was also apparent, and heightened the need for strengthened outreach and education.

Today, ICAP continues to support outreach activities that target key at-risk populations in Zanzibar, conducting ongoing sensitization and advocacy with key community leaders and continuing its trainings of health care workers and peer educators. Through URAPP, ICAP also aims to scale up and promote access to appropriate treatment for drug overdose. Additionally, ICAP will adapt the URRAP model for a new program that targets key at-risk populations in Mwanza City, Tanzania. Similar to the approach taken in Zanzibar, ICAP will collaborate with local organizations in Mwanza to carry out prevention, care, and treatment services tailored for key populations.

“URRAP has made significant breakthroughs in demonstrating the importance of reaching key populations at risk by working with them to utilize prevention and care services. The lessons learned from URRAP will help inform similar efforts in other communities and enable these disenfranchised groups to access the services they need,” said ICAP Director Wafaa El-Sadr.

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