P43.03
Background: Despite significant changes in the HIV epidemic landscape among MSM and transwomen (TW) to date, the national program remains essentially as it was designed in the late 1990s, with limited discussion of potential changes. Together with the Ministry of Health, we are conducting, documenting and analyzing a process seeking to enhance the program with combined prevention strategies, through stakeholder involvement, health systems assessments and mathematical modelling. Here we present the background stakeholder analysis.
Methods: We conducted in-depth interviews and focus groups with community members (MSM/TW), in-depth interviews with community leaders, health providers and decision makers, and two policy discussion workshops (with civil society and government representatives, respectively).
Results: Among community members and stakeholders alike, condom use is still the epitome of prevention, and its limited use is explained only as resulting from poor individual commitment and insufficient prevention work. Knowledge of ETfP is almost absent, but there is some knowledge of PrEP, together with resistance to its potential use. The lack of information, misconceptions and confusion reflect limited public discussion on new HIV prevention technologies. On an operational level, participants consider the need of well-trained health providers as part of a renovated program. People agreed with the idea of comibined biomedical, behavioral and structural strategies based on appropriate evidence. All recognized the need for continuing professional HIV educaiton, and also for spaces to evaluate and improve current programming. Renovated leadership will play a key role.
Conclusions: Community members and stakeholders in Peru agree on the need to bring the HIV prevention response to date among MSM/TW with combined strategies. Many feel that HIV prevention programming is loosing momentum and needs new leadership and tools, and are interested in an evidence-based process where the HIV response can be reconceptualized.
