WHO RECOMMENDS SOCIAL NETWORK- BASED HIV TESTING APPROACHES FOR KEY POPULATIONS AS PART OF PARTNER SERVICES PACKAGE NOVEMBER 2019 POLICY BRIEF 2 WHO recommends social network-based HIV testing approaches for key populations as part of partner services package The World Health Organization (WHO) recommends voluntary HIV testing services (HTS) for sexual and drug- injecting partners of all people with HIV. An effective approach is provider-assisted referral when a trained provider offers voluntary HTS to partner(s) with the consent of HIV-positive client. Provider-assisted referral is a safe and effective strategy for identifying additional HIV infections and prioritizing prevention services for partners who are vulnerable to HIV acquisition. Many countries are now routinely offering provider-assisted referral. However, its implementation remains limited in key populations.1 Members of key populations are often reluctant to identify their partners to providers, due to fear of stigma, discrimination and lack of confidentiality. Social network-based HIV testing is an approach for engaging sexual and drug injecting partners and social contacts of key population members with HIV and of those who are HIV-negative and at ongoing risk in voluntary HTS. By addressing people’s confidentiality concerns and broadening the reach to social contacts, social network-based HIV testing approaches can improve the acceptability of partner services among key populations and so reach more people who may not otherwise test for HIV. WHO now recommends that social network-based HIV testing approaches can be offered for key populations. WHO Recommendation Social network-based approaches can be offered as an approach to HIV testing for key populations as part of a comprehensive package of care and prevention (conditional recommendation, very low-quality evidence). 2016 WHO Recommendation Voluntary provider-assisted referral (often called assisted partner notification) should be offered to people with HIV as part of a comprehensive package of testing and care (strong recommendation, moderate-quality evidence). 1 Key populations are men who have sex with men, people who inject drugs, people in prisons or other closed settings, sex workers and transgender people. Definition of social network-based HIV testing approaches A social network refers to a group of individuals linked by a common set of relationships or behaviours and includes sexual and drug-injecting partners as well as social contacts. Social network-based HIV testing approaches are an extension of HIV partner services: A trained provider asks people with HIV or those who are HIV-negative and at ongoing risk of HIV to encourage and invite individuals in their sexual, drug injecting or social networks to participate in voluntary HTS. Key findings from the systematic review on social network-based HIV testing approaches among key populations To inform new guidance, WHO commissioned a systematic review to assess the effectiveness of social network-based approaches among key populations. Evidence reviewed showed that these approaches: • may increase HIV diagnoses and identify additional people with HIV • may increase the acceptability of HIV partner services • are feasible to implement • can be an efficient use of resources when they focus on people with high ongoing HIV risk • seldom result in social harm or adverse events. WHO recommends that social network-based HIV testing approaches can be offered for key populations as part of a package of partner services. 3Several promising models for social network-based approaches have emerged that can be considered. These include: • use of peers to recruit key populations in their networks for HTS; • distribution of HIV self-testing kits by HIV-positive and HIV-negative clients to their partners and contacts; • use of new tools and technologies, such as digital and social media, text messaging and other web-based platforms, to reach social networks, especially for young key populations; • use of anonymous methods for partner services and social network-based approaches to protect confidentiality, particularly for reaching adolescents and young key populations and in settings where key populations experience stigma, discrimination and criminalization. Operational considerations for partner services and social network-based approaches Ensure confidentiality. It is critical to respect and protect the privacy and confidentiality of clients and their partners when providing partner services including social network- based approaches to key populations, particularly when partners have not yet mutually disclosed their HIV status. Ensure that all services are voluntary. Whenever partner services and social network-based approaches are offered, it is important to make sure that the client is informed of their benefits and cautions and assure that their decisions about contacting partners and other people from their social networks are voluntary and not pressured. Partner services and social network-based approaches should always be voluntary. WHO does not support mandatory or forced partner services or HTS. Differentiate services. Partner services including social network-based approaches can be adapted to suit the local context, setting and clients’ preferences. • While clients should be encouraged to use provider- assisted referral as it is highly effective, they should have the opportunity to choose from all available partner services options. They can choose different methods for different partners but also be free to decline. • Where feasible and supported by national policy, social network-based approaches can be offered to both HIV-positive and HIV-negative members of key populations. Social network-based approaches can be particularly helpful where clients from key populations have been reluctant to take up the offer of provider- assisted referral because it requires disclosing their partners to providers, or for fear of stigma, discrimination or prosecution. Early experiences show social network-based approaches are feasible and effective Early implementation experiences show that social network-based HIV testing approaches are feasible to implement among key populations in various settings. The LINKAGES project is carrying out both provider-assisted referral and social network-based testing among men who have sex with men, female sex workers, transgender people and their partners in Democratic Republic of Congo, Haiti and Malawi. These approaches were operationalized through a range of strategies such as peer navigators and educators, outreach workers and by clients themselves using referral coupons and online, social media and mobile app-based platforms, which were particularly attractive for key populations. Voluntary provider-assisted referral and social network-based approaches proved feasible and acceptable among key population clients as well as their partners and contacts. These approaches were successful in identifying partners and contacts with HIV who were undiagnosed. For example: in Democratic Republic of Congo (October to December 2018), 99 contacts from 143 index clients were tested and 47 (48%) of those were diagnosed HIV-positive; in Haiti (April to December 2018), 369 contacts from 286 index clients were tested and 83 (22%) were diagnosed HIV-positive; and in Malawi (January to February 2019), 126 contacts were tested and 35 (25%) were diagnosed HIV- positive. Source: FHI 360/LINKAGES. 4 WHO recommends social network-based HIV testing approaches for key populations as part of partner services package4 For more information, contact: World Health Organization Department of HIV/AIDS 20, Avenue Appia 1211 Geneva 27 Switzerland E-mail: hiv-aids@who.int www.who.int/hiv WHO/CDS/HIV/19.32 © World Health Organization 2019 Some rights reserved. Licence: CC BY-NC-SA 3.0 IGO POLICY BRIEF HIV TESTING SERVICES • All members of key populations newly diagnosed with HIV can be offered voluntary partner services, including social network-based approaches where appropriate, at the time of diagnosis and periodically thereafter; clients’ willingness to accept partner services may change over time, or they may have new partners. • Consider whether it is beneficial to offer social network- based approaches for a limited duration (or waves) or on an ongoing basis. Social network-based approaches will be most effective when focused on networks of higher-risk people in key populations. Longer duration or more waves generally allow deeper penetration into these social networks and, thus, may identify more people with undiagnosed HIV, but they will need more resources. Ensure client safety. People with anxieties about a partner’s or social contact’s reaction to offer of HTS should be able and supported to decline partner services. People from key populations, particularly sex workers, often experience sexual violence and other abuse. Making sure that services are voluntary and informed is critical to avoid any adverse consequences. Women who disclose previous partner violence should be offered immediate first-line support by the health- care provider or another provider within the same health service or in another easily accessible service. Engage communities and raise awareness to support effective implementation of partner services including social network-based approaches. It is particularly important to empower key populations and ensure that they are educated about the potential benefits and cautions. Review and remove legal and policy barriers to safely implementing and scaling up partner services including social network-based approaches without fear of criminalization. Train and build the capacity of providers. Capacity- building should cover how to identify clients who would benefit from these services, how to engage with clients in discussion about partners and social contacts in non- judgemental ways, how to locate partners and social contacts and how to offer them voluntary HTS or to support clients in offering HTS, and how to facilitate mutual disclosure for couples. Providers will require training in minimizing the risk of harm and violence for clients and themselves, awareness of legal and policy issues, and documenting and reporting of partner service attempts and outcomes as part of routine programme monitoring. Monitor and evaluate partner services, including social network-based approaches, regularly to improve service delivery and optimize impact. This will require defining and collecting relevant indicators and developing a monitoring and evaluation plan. It is also important to monitor for social harms and, if unintended adverse outcomes are identified, to review and adjust programmes promptly. Ph ot o co ve r © P AT H/ Vu N go c Du ng
WHO RECOMMENDS SOCIAL NETWORK- BASED HIV TESTING APPROACHES FOR KEY POPULATIONS AS PART OF PARTNER SERVICES PACKAGE NOVEMBER 2019 POLICY BRIEF 2 WHO recommends social network-based HIV testing approaches for key populations as part of partner services package The World Health Organization (WHO) recommends voluntary HIV testing services (HTS) for sexual and drug- injecting partners of all people with HIV. An effective approach is provider-assisted referral when a trained provider offers voluntary HTS to partner(s) with the consent of HIV-positive client. Provider-assisted referral is a safe and effective strategy for identifying additional HIV infections and prioritizing prevention services for partners who are vulnerable to HIV acquisition. Many countries are now routinely offering provider-assisted referral. However, its implementation remains limited in key populations.1 Members of key populations are often reluctant to identify their partners to providers, due to fear of stigma, discrimination and lack of confidentiality. Social network-based HIV testing is an approach for engaging sexual and drug injecting partners and social contacts of key population members with HIV and of those who are HIV-negative and at ongoing risk in voluntary HTS. By addressing people’s confidentiality concerns and broadening the reach to social contacts, social network-based HIV testing approaches can improve the acceptability of partner services among key populations and so reach more people who may not otherwise test for HIV. WHO now recommends that social network-based HIV testing approaches can be offered for key populations. WHO Recommendation Social network-based approaches can be offered as an approach to HIV testing for key populations as part of a comprehensive package of care and prevention (conditional recommendation, very low-quality evidence). 2016 WHO Recommendation Voluntary provider-assisted referral (often called assisted partner notification) should be offered to people with HIV as part of a comprehensive package of testing and care (strong recommendation, moderate-quality evidence). 1 Key populations are men who have sex with men, people who inject drugs, people in prisons or other closed settings, sex workers and transgender people. Definition of social network-based HIV testing approaches A social network refers to a group of individuals linked by a common set of relationships or behaviours and includes sexual and drug-injecting partners as well as social contacts. Social network-based HIV testing approaches are an extension of HIV partner services: A trained provider asks people with HIV or those who are HIV-negative and at ongoing risk of HIV to encourage and invite individuals in their sexual, drug injecting or social networks to participate in voluntary HTS. Key findings from the systematic review on social network-based HIV testing approaches among key populations To inform new guidance, WHO commissioned a systematic review to assess the effectiveness of social network-based approaches among key populations. Evidence reviewed showed that these approaches: • may increase HIV diagnoses and identify additional people with HIV • may increase the acceptability of HIV partner services • are feasible to implement • can be an efficient use of resources when they focus on people with high ongoing HIV risk • seldom result in social harm or adverse events. WHO recommends that social network-based HIV testing approaches can be offered for key populations as part of a package of partner services. 3Several promising models for social network-based approaches have emerged that can be considered. These include: • use of peers to recruit key populations in their networks for HTS; • distribution of HIV self-testing kits by HIV-positive and HIV-negative clients to their partners and contacts; • use of new tools and technologies, such as digital and social media, text messaging and other web-based platforms, to reach social networks, especially for young key populations; • use of anonymous methods for partner services and social network-based approaches to protect confidentiality, particularly for reaching adolescents and young key populations and in settings where key populations experience stigma, discrimination and criminalization. Operational considerations for partner services and social network-based approaches Ensure confidentiality. It is critical to respect and protect the privacy and confidentiality of clients and their partners when providing partner services including social network- based approaches to key populations, particularly when partners have not yet mutually disclosed their HIV status. Ensure that all services are voluntary. Whenever partner services and social network-based approaches are offered, it is important to make sure that the client is informed of their benefits and cautions and assure that their decisions about contacting partners and other people from their social networks are voluntary and not pressured. Partner services and social network-based approaches should always be voluntary. WHO does not support mandatory or forced partner services or HTS. Differentiate services. Partner services including social network-based approaches can be adapted to suit the local context, setting and clients’ preferences. • While clients should be encouraged to use provider- assisted referral as it is highly effective, they should have the opportunity to choose from all available partner services options. They can choose different methods for different partners but also be free to decline. • Where feasible and supported by national policy, social network-based approaches can be offered to both HIV-positive and HIV-negative members of key populations. Social network-based approaches can be particularly helpful where clients from key populations have been reluctant to take up the offer of provider- assisted referral because it requires disclosing their partners to providers, or for fear of stigma, discrimination or prosecution. Early experiences show social network-based approaches are feasible and effective Early implementation experiences show that social network-based HIV testing approaches are feasible to implement among key populations in various settings. The LINKAGES project is carrying out both provider-assisted referral and social network-based testing among men who have sex with men, female sex workers, transgender people and their partners in Democratic Republic of Congo, Haiti and Malawi. These approaches were operationalized through a range of strategies such as peer navigators and educators, outreach workers and by clients themselves using referral coupons and online, social media and mobile app-based platforms, which were particularly attractive for key populations. Voluntary provider-assisted referral and social network-based approaches proved feasible and acceptable among key population clients as well as their partners and contacts. These approaches were successful in identifying partners and contacts with HIV who were undiagnosed. For example: in Democratic Republic of Congo (October to December 2018), 99 contacts from 143 index clients were tested and 47 (48%) of those were diagnosed HIV-positive; in Haiti (April to December 2018), 369 contacts from 286 index clients were tested and 83 (22%) were diagnosed HIV-positive; and in Malawi (January to February 2019), 126 contacts were tested and 35 (25%) were diagnosed HIV- positive. Source: FHI 360/LINKAGES. 4 WHO recommends social network-based HIV testing approaches for key populations as part of partner services package4 For more information, contact: World Health Organization Department of HIV/AIDS 20, Avenue Appia 1211 Geneva 27 Switzerland E-mail: hiv-aids@who.int www.who.int/hiv WHO/CDS/HIV/19.32 © World Health Organization 2019 Some rights reserved. Licence: CC BY-NC-SA 3.0 IGO POLICY BRIEF HIV TESTING SERVICES • All members of key populations newly diagnosed with HIV can be offered voluntary partner services, including social network-based approaches where appropriate, at the time of diagnosis and periodically thereafter; clients’ willingness to accept partner services may change over time, or they may have new partners. • Consider whether it is beneficial to offer social network- based approaches for a limited duration (or waves) or on an ongoing basis. Social network-based approaches will be most effective when focused on networks of higher-risk people in key populations. Longer duration or more waves generally allow deeper penetration into these social networks and, thus, may identify more people with undiagnosed HIV, but they will need more resources. Ensure client safety. People with anxieties about a partner’s or social contact’s reaction to offer of HTS should be able and supported to decline partner services. People from key populations, particularly sex workers, often experience sexual violence and other abuse. Making sure that services are voluntary and informed is critical to avoid any adverse consequences. Women who disclose previous partner violence should be offered immediate first-line support by the health- care provider or another provider within the same health service or in another easily accessible service. Engage communities and raise awareness to support effective implementation of partner services including social network-based approaches. It is particularly important to empower key populations and ensure that they are educated about the potential benefits and cautions. Review and remove legal and policy barriers to safely implementing and scaling up partner services including social network-based approaches without fear of criminalization. Train and build the capacity of providers. Capacity- building should cover how to identify clients who would benefit from these services, how to engage with clients in discussion about partners and social contacts in non- judgemental ways, how to locate partners and social contacts and how to offer them voluntary HTS or to support clients in offering HTS, and how to facilitate mutual disclosure for couples. Providers will require training in minimizing the risk of harm and violence for clients and themselves, awareness of legal and policy issues, and documenting and reporting of partner service attempts and outcomes as part of routine programme monitoring. Monitor and evaluate partner services, including social network-based approaches, regularly to improve service delivery and optimize impact. This will require defining and collecting relevant indicators and developing a monitoring and evaluation plan. It is also important to monitor for social harms and, if unintended adverse outcomes are identified, to review and adjust programmes promptly. Ph ot o co ve r © P AT H/ Vu N go c Du ng
WHO RECOMMENDS SOCIAL NETWORK- BASED HIV TESTING APPROACHES FOR KEY POPULATIONS AS PART OF PARTNER SERVICES PACKAGE NOVEMBER 2019 POLICY BRIEF 2 WHO recommends social network-based HIV testing approaches for key populations as part of partner services package The World Health Organization (WHO) recommends voluntary HIV testing services (HTS) for sexual and drug- injecting partners of all people with HIV. An effective approach is provider-assisted referral when a trained provider offers voluntary HTS to partner(s) with the consent of HIV-positive client. Provider-assisted referral is a safe and effective strategy for identifying additional HIV infections and prioritizing prevention services for partners who are vulnerable to HIV acquisition. Many countries are now routinely offering provider-assisted referral. However, its implementation remains limited in key populations.1 Members of key populations are often reluctant to identify their partners to providers, due to fear of stigma, discrimination and lack of confidentiality. Social network-based HIV testing is an approach for engaging sexual and drug injecting partners and social contacts of key population members with HIV and of those who are HIV-negative and at ongoing risk in voluntary HTS. By addressing people’s confidentiality concerns and broadening the reach to social contacts, social network-based HIV testing approaches can improve the acceptability of partner services among key populations and so reach more people who may not otherwise test for HIV. WHO now recommends that social network-based HIV testing approaches can be offered for key populations. WHO Recommendation Social network-based approaches can be offered as an approach to HIV testing for key populations as part of a comprehensive package of care and prevention (conditional recommendation, very low-quality evidence). 2016 WHO Recommendation Voluntary provider-assisted referral (often called assisted partner notification) should be offered to people with HIV as part of a comprehensive package of testing and care (strong recommendation, moderate-quality evidence). 1 Key populations are men who have sex with men, people who inject drugs, people in prisons or other closed settings, sex workers and transgender people. Definition of social network-based HIV testing approaches A social network refers to a group of individuals linked by a common set of relationships or behaviours and includes sexual and drug-injecting partners as well as social contacts. Social network-based HIV testing approaches are an extension of HIV partner services: A trained provider asks people with HIV or those who are HIV-negative and at ongoing risk of HIV to encourage and invite individuals in their sexual, drug injecting or social networks to participate in voluntary HTS. Key findings from the systematic review on social network-based HIV testing approaches among key populations To inform new guidance, WHO commissioned a systematic review to assess the effectiveness of social network-based approaches among key populations. Evidence reviewed showed that these approaches: • may increase HIV diagnoses and identify additional people with HIV • may increase the acceptability of HIV partner services • are feasible to implement • can be an efficient use of resources when they focus on people with high ongoing HIV risk • seldom result in social harm or adverse events. WHO recommends that social network-based HIV testing approaches can be offered for key populations as part of a package of partner services. 3Several promising models for social network-based approaches have emerged that can be considered. These include: • use of peers to recruit key populations in their networks for HTS; • distribution of HIV self-testing kits by HIV-positive and HIV-negative clients to their partners and contacts; • use of new tools and technologies, such as digital and social media, text messaging and other web-based platforms, to reach social networks, especially for young key populations; • use of anonymous methods for partner services and social network-based approaches to protect confidentiality, particularly for reaching adolescents and young key populations and in settings where key populations experience stigma, discrimination and criminalization. Operational considerations for partner services and social network-based approaches Ensure confidentiality. It is critical to respect and protect the privacy and confidentiality of clients and their partners when providing partner services including social network- based approaches to key populations, particularly when partners have not yet mutually disclosed their HIV status. Ensure that all services are voluntary. Whenever partner services and social network-based approaches are offered, it is important to make sure that the client is informed of their benefits and cautions and assure that their decisions about contacting partners and other people from their social networks are voluntary and not pressured. Partner services and social network-based approaches should always be voluntary. WHO does not support mandatory or forced partner services or HTS. Differentiate services. Partner services including social network-based approaches can be adapted to suit the local context, setting and clients’ preferences. • While clients should be encouraged to use provider- assisted referral as it is highly effective, they should have the opportunity to choose from all available partner services options. They can choose different methods for different partners but also be free to decline. • Where feasible and supported by national policy, social network-based approaches can be offered to both HIV-positive and HIV-negative members of key populations. Social network-based approaches can be particularly helpful where clients from key populations have been reluctant to take up the offer of provider- assisted referral because it requires disclosing their partners to providers, or for fear of stigma, discrimination or prosecution. Early experiences show social network-based approaches are feasible and effective Early implementation experiences show that social network-based HIV testing approaches are feasible to implement among key populations in various settings. The LINKAGES project is carrying out both provider-assisted referral and social network-based testing among men who have sex with men, female sex workers, transgender people and their partners in Democratic Republic of Congo, Haiti and Malawi. These approaches were operationalized through a range of strategies such as peer navigators and educators, outreach workers and by clients themselves using referral coupons and online, social media and mobile app-based platforms, which were particularly attractive for key populations. Voluntary provider-assisted referral and social network-based approaches proved feasible and acceptable among key population clients as well as their partners and contacts. These approaches were successful in identifying partners and contacts with HIV who were undiagnosed. For example: in Democratic Republic of Congo (October to December 2018), 99 contacts from 143 index clients were tested and 47 (48%) of those were diagnosed HIV-positive; in Haiti (April to December 2018), 369 contacts from 286 index clients were tested and 83 (22%) were diagnosed HIV-positive; and in Malawi (January to February 2019), 126 contacts were tested and 35 (25%) were diagnosed HIV- positive. Source: FHI 360/LINKAGES. 4 WHO recommends social network-based HIV testing approaches for key populations as part of partner services package4 For more information, contact: World Health Organization Department of HIV/AIDS 20, Avenue Appia 1211 Geneva 27 Switzerland E-mail: hiv-aids@who.int www.who.int/hiv WHO/CDS/HIV/19.32 © World Health Organization 2019 Some rights reserved. Licence: CC BY-NC-SA 3.0 IGO POLICY BRIEF HIV TESTING SERVICES • All members of key populations newly diagnosed with HIV can be offered voluntary partner services, including social network-based approaches where appropriate, at the time of diagnosis and periodically thereafter; clients’ willingness to accept partner services may change over time, or they may have new partners. • Consider whether it is beneficial to offer social network- based approaches for a limited duration (or waves) or on an ongoing basis. Social network-based approaches will be most effective when focused on networks of higher-risk people in key populations. Longer duration or more waves generally allow deeper penetration into these social networks and, thus, may identify more people with undiagnosed HIV, but they will need more resources. Ensure client safety. People with anxieties about a partner’s or social contact’s reaction to offer of HTS should be able and supported to decline partner services. People from key populations, particularly sex workers, often experience sexual violence and other abuse. Making sure that services are voluntary and informed is critical to avoid any adverse consequences. Women who disclose previous partner violence should be offered immediate first-line support by the health- care provider or another provider within the same health service or in another easily accessible service. Engage communities and raise awareness to support effective implementation of partner services including social network-based approaches. It is particularly important to empower key populations and ensure that they are educated about the potential benefits and cautions. Review and remove legal and policy barriers to safely implementing and scaling up partner services including social network-based approaches without fear of criminalization. Train and build the capacity of providers. Capacity- building should cover how to identify clients who would benefit from these services, how to engage with clients in discussion about partners and social contacts in non- judgemental ways, how to locate partners and social contacts and how to offer them voluntary HTS or to support clients in offering HTS, and how to facilitate mutual disclosure for couples. Providers will require training in minimizing the risk of harm and violence for clients and themselves, awareness of legal and policy issues, and documenting and reporting of partner service attempts and outcomes as part of routine programme monitoring. Monitor and evaluate partner services, including social network-based approaches, regularly to improve service delivery and optimize impact. This will require defining and collecting relevant indicators and developing a monitoring and evaluation plan. It is also important to monitor for social harms and, if unintended adverse outcomes are identified, to review and adjust programmes promptly. Ph ot o co ve r © P AT H/ Vu N go c Du ng
世卫组织建议将针对 重点人群的基于社交网络的 艾滋病毒检测方法作为一揽子 伙伴服务的一部分 2019年11月 政策简报 2 世卫组织建议将针对重点人群的基于社交网络的艾滋病毒检测方法作为一揽子伙伴服务的一部分 世界卫生组织（世卫组织）建议为所有艾滋病毒感 染者的性伙伴和注射吸毒伙伴提供自愿的艾滋病毒检测 服务。一个有效的方法是由服务提供者协助转诊，即一 个训练有素的服务提供者在征得艾滋病毒阳性客户同意 的情况下，向其伙伴提供自愿的艾滋病毒检测服务。服 务提供者协助转诊是一项安全有效的策略，有助于发现 更多的艾滋病毒感染者，并优先为容易感染艾滋病毒的 伙伴提供预防服务。 许多国家现在例行提供由服务提供者协助的转诊服 务。其在重点人群中的实施仍然受到一定的限制1。属 于重点人群的人往往不愿意向服务提供者透露其伙伴 的身份，因为他们害怕受到羞辱、歧视和缺乏保密性。 基于社交网络的艾滋病毒检测是一种让感染艾滋病 毒的重点人群的成员以及持续面临风险的艾滋病毒阴性 者的性伙伴和注射吸毒伙伴以及社会联系者接受自愿的 艾滋病毒检测服务的方法。通过消除人们对其保密性的 担忧并将服务范围扩大到社会联系人，基于社交网络的 艾滋病毒检测方法，能够提高重点人群对伙伴服务的 接受程度，从而覆盖更多可能没有进行艾滋病毒检测 1 重点人群是男男性行为者、注射毒品者、监狱或其它封闭环境中的人、性工作者 和变性人。 的人。世卫组织现在建议，可以向重点人群提供基于社 交网络的艾滋病毒检测方法。 基于社交网络的艾滋病毒检测方法的定义 社交网络是指由一系列共同的关系或行为联系 在一起的一群人，包括性伙伴和注射吸毒伙伴以及 社会联系人。 基于社交网络的艾滋病毒检测方法是艾滋病毒 伙伴服务的延伸：一个训练有素的服务提供者请艾 滋病毒感染者或持续面临风险的艾滋病毒阴性者鼓 励和邀请其性网络、注射吸毒网络或社交网络中的 人接受自愿的艾滋病毒检测服务。 对重点人群中实施的基于社交网络的艾滋 病毒检测方法进行系统审查的主要结果 为了给新指南提供信息，世卫组织委托进行了一项 系统审查，以评估基于社交网络的方法在重点人群中的 有效性。审查证据表明，这些方法： • 可能会增加艾滋病毒诊断，并发现更多艾滋病毒感染 者 • 可能会提高艾滋病毒伙伴服务的可接受性 • 实施是可行的 • 当把关注重点放在艾滋病毒高危人群上时，可以有效 利用资源 • 很少导致社会伤害或不良事件。 世卫组织建议，作为一揽子伙伴服务的一部分，可向重点人群提供基于社交网络 的艾滋病毒检测方法。 世卫组织的建议 新 可以将基于社交网络的方法对重点人群进行艾 滋病毒检测作为护理和预防综合方案的一部分。 （附条件推荐，极低质量证据）。 2016年世卫组织的建议 应当向艾滋病毒携带者提供自愿的由服务提供 者协助的转诊服务（通常称为协助伙伴通知），并 作为检测和护理综合方案的一部分。（强烈推荐， 中等质量证据）。 3就基于社交网络的方法而言，已经出现了几个可以 考虑的有希望的模式。其中包括： • 利用同龄人为艾滋病毒检测服务招募其网络中的重点 人群； • 艾滋病毒阳性和阴性客户向其伙伴和联系人分发艾滋 病毒自我检测套装； • 使用新的工具和技术，如数字和社交媒体、短信和其 它基于网络的平台，以接触社交网络，尤其是年轻的 重点人群； • 对伙伴服务和基于社交网络的方法采用匿名的方法来 保护机密性，特别是为了接触青少年和年轻重点人群 以及在重点人群遭受羞辱、歧视和刑事定罪的情况 下。 伙伴服务和基于社交网络的方法的操作注 意事项 确保保密性。在向重点人群提供伙伴服务（包括基 于社交网络的方法）时，尊重和保护客户及其伙伴的隐 私和保密性至关重要，尤其是在伙伴尚未相互披露其艾 滋病毒状况的情况下。 确保所有服务都是自愿的。每当提供伙伴服务和基 于社交网络的方法时，都必须确保客户了解其好处和注 意事项，并确保他们作出联系伙伴和社交网络中的其他 人的决定是出于自愿，而不是迫于压力。 提供差异化服务。可以调整包括基于社交网络的 方法在内的伙伴服务以适应当地的环境、背景和客户 偏好。 • 虽然应鼓励客户利用由服务提供者协助的转诊，因为 这非常有效，但他们应该有机会从所有现有的伙伴服 务选项中进行选择。他们可以为不同的伙伴选择不同 的方法，但也有拒绝的自由。 • 在可行并得到国家政策支持的情况下，可以向重点人 群中的艾滋病毒阳性和阴性成员提供基于社交网络的 方法。当客户由于需要向提供者披露其伙伴的身份或 担心受到污名化、歧视或起诉而不愿意接受由服务提 供者协助转诊的情况下，基于社交网络的检测方法尤 其有用。 早期经验表明，基于社交网络的方法是可行和有效的 早期实施经验表明，基于社交网络的艾滋病毒检测方法在各种环境的重点人群中实施是可行的。在刚果民 主共和国、海地和马拉维，LINKAGES项目正在男男性行为者、女性性工作者、变性人及其伴侣中进行由服务提 供者协助的转诊和基于社交网络的检测。这些方法通过一系列策略得以实施，如同辈引导者和教育工作者、外 联工作者，或者由客户自己利用转诊优惠券和在线、社交媒体和基于移动应用的平台实施，这些对重点人群特 别有吸引力。经证明，由服务提供者协助的自愿转诊和基于社交网络的方法在重点人群客户及其伙伴和联系人 中是可行和可接受的。这些方法成功地确定了未确诊的感染艾滋病毒的伙伴和联系人。例如：在刚果民主共和 国（2018年10月至12月），对143个索引客户的99名联系人进行了检测，其中47人（48%）被诊断为艾滋病毒阳 性；在海地（2018年4月至12月），对286个索引客户的369名联系人进行了检测，83人（22%）被诊断为艾滋病 毒阳性；在马拉维（2019年1月至2月），对126名联系人进行了检测，35人（25%）被诊断为艾滋病毒阳性。 资料来源：FHI 360/LINKAGES。 4 世卫组织建议将针对重点人群的基于社交网络的艾滋病毒检测方法作为一揽子伙伴服务的一部分4 • 所有新诊断为艾滋病毒感染者的重点人群成员都可以 在诊断时和诊断后定期获得自愿性的伙伴服务，包括 基于社交网络的方法（如适用）；客户接受伙伴服务 的意愿可能会随着时间的推移而改变，或者他们可能 会有新的伙伴。 • 考虑在有限的持续时间内（或波）或在持续的基础上 提供基于社交网络的方法是否有益。以社交网络为基 础的方法在关注重点人群中高风险群体的社交网络时 最为有效。更长的持续时间或更多的波通常使得可以 更深地渗透到这些社交网络中，因此可以发现更多未 确诊的艾滋病毒携带者，但是这需要更多的资源。 确保客户安全。担心伙伴或社会联系人对艾滋病毒 检测服务提议的反应的人应该能够拒绝伙伴服务并得到 支持。重点人群，尤其是性工作者，经常遭受性暴力和 其它虐待行为。确保服务是自愿和知情的对于避免任何 不良后果至关重要。卫生保健提供者或者同一卫生机构 或另一个方便前往的卫生机构的另一名卫生保健提供者 应向披露以前的伴侣暴力行为的妇女提供直接的一线 支持。 让社区参与进来并提高认识，以支持有效实施伙伴 服务，包括基于社交网络的方法。增强重点人群的权能 并确保他们了解可能的好处和注意事项尤为重要。 审查并消除法律和政策障碍，以便安全实施和扩大 包括基于社会网络的方法在内的伙伴服务，而不用担心 被定罪。 培训和建设服务提供者的能力。能力建设应包括如 何确定将从这些服务中受益的客户，如何以非审判的方 式与客户讨论其伙伴和社会联系人，如何找到伙伴和社 会联系人，如何向他们提供自愿的艾滋病毒检测服务或 支持客户提供艾滋病毒检测服务，以及如何促使夫妇之 间相互披露。服务提供者需要接受培训，以最大限度地 降低客户和自身遭受伤害和暴力侵害的风险，提高对法 律和政策问题的认识，记录并报告伙伴服务尝试和结 果，作为常规规划监测的一部分。 定期监测和评价伙伴服务，包括基于社交网络的方 法，以改善服务的提供并优化影响。这将需要确定和收 集相关指标，并制定监测和评价计划。同样重要的是， 要监测社会危害，如果发现意外的不良后果，要及时审 查和调整规划。 封 面 图 片 © P AT H/ Vu N go c Du ng 伙伴服务和基于社交网络的方法应始终是自愿 的。世卫组织不支持强制性或强迫的伙伴服务或 艾滋病毒检测服务。 要获得更多信息，请联系： World Health Organization Department of HIV/AIDS 20, Avenue Appia 1211 Geneva 27 Switzerland 电子邮件：hiv-aids@who.int www.who.int/hiv WHO/CDS/HIV/19.32 © 世界卫生组织2019 保留某些权利 许可：CC BY-NC-SA 3.0 IGO 政策简报 艾滋病毒检测服务
ДЛЯ КЛЮЧЕВЫХ ГРУПП НАСЕЛЕНИЯ ВОЗ РЕКОМЕНДУЕТ ПРИМЕНЯТЬ В РАМКАХ ПАКЕТОВ УСЛУГ ДЛЯ ПАРТНЕРОВ ВИЧ-ИНФИЦИРОВАННЫХ ЛИЦ ПОДХОДЫ, ОСНОВАННЫЕ НА ИСПОЛЬЗОВАНИИ СОЦИАЛЬНЫХ СЕТЕЙ НОЯБРЬ 2019 г. КРАТКИЙ ОБЗОР ПОЛИТИКИ 2 Для ключевых групп населения ВОЗ рекомендует применять в рамках пакетов услуг для партнеров ВИЧ-инфицированных лиц подходы, основанные на использовании социальных сетей Всемирная организация здравоохранения (ВОЗ) рекомендует предоставлять услуги по добровольному тестированию на ВИЧ (УТВ) для половых партнеров ВИЧ-инфицированных лиц, а также их партнеров, употребляющих инъекционные наркотики. Эффективным подходом является направление поставщиком услуг на тестирование, когда квалифицированный специалист предлагает услуги по добровольному тестированию на ВИЧ партнеру (или партнерам) ВИЧ-положительного клиента с его согласия. Направление поставщиком услуг на тестирование — это безопасная и эффективная стратегия для выявления дополнительных случаев ВИЧ-инфекции и определения приоритетных услуг по профилактике для партнеров ВИЧ-инфицированных лиц, которые подвержены риску заражения. Во многих странах уже сейчас врачи выдают такие направления на постоянной основе. Тем не менее, в ключевых группах населения реализация этого подхода все еще ограничена1. Лица, входящие в ключевые группы, часто неохотно указывают своих партнеров врачам из-за боязни стигматизации, дискриминации и отсутствия конфиденциальности. Использование соцсетей для тестирования на ВИЧ — это подход, обеспечивающий вовлечение в добровольное тестирование на ВИЧ половых партнеров, партнеров, употребляющих инъекционные наркотики, и социальных контактов представителей ключевой группы населения с ВИЧ-инфекцией, а также тех, кто ВИЧ- отрицателен, но подвержен постоянному риску заражения. Подходы к тестированию на ВИЧ с использованием социальных сетей, направленные на решение проблем конфиденциальности и расширение охвата через социальные контакты, могут повысить уровень приемлемости услуг для партнеров среди ключевых групп и, таким образом, охватить больше людей, у которых нет иной возможности пройти тестирование на ВИЧ. В настоящее время ВОЗ рекомендует использовать социальные сети в рамках подхода к тестированию на ВИЧ для ключевых групп населения. Определение подходов к тестированию на ВИЧ с использованием социальных сетей Социальная сеть — это группа людей, связанных общим набором взаимоотношений или моделью поведения, которая включает в себя половых партнеров и знакомых, употребляющих инъекционные наркотики, а также социальные контакты. Подходы к тестированию на ВИЧ с использованием социальных сетей представляют собой расширение услуг для партнеров ВИЧ-инфицированных лиц: квалифицированный специалист рекомендует ВИЧ инфицированным и лицам с отрицательным ВИЧ статусом, но постоянно подверженным риску заражения, пригласить своих половых партнеров, знакомых, употребляющих инъекционные наркотики, а также социальные контакты к участию в добровольном тестировании на ВИЧ. Основные выводы систематического обзора подходов к тестированию на ВИЧ с использованием социальных сетей среди ключевых групп населения Для информирования о новых рекомендациях ВОЗ поручила провести систематический обзор для оценки эффективности подходов с использованием социальных сетей среди ключевых групп населения. Полученные данные показали, что эти подходы: • могут увеличить число положительных диагнозов ВИЧ и выявить дополнительное количество ВИЧ-инфицированных; • могут повысить уровень приемлемости услуг тестирования среди партнеров ВИЧ-инфицированных; • реально осуществимы; • могут обеспечить эффективное использование ресурсов, если они будут ориентированы на людей с постоянным высоким риском инфицирования ВИЧ; • редко приводят к социальному вреду или нежелательным явлениям. Появилось несколько многообещающих моделей для подходов с использованием социальных сетей, которые можно принять к рассмотрению. Они включают: • использование лиц одного круга для привлечения ключевых групп населения через социальные сети, чтобы они могли воспользоваться УТВ; В случае ключевых групп населения ВОЗ рекомендует применять в рамках пакетов услуг для партнеров ВИЧ-инфицированных лиц подходы, основанные на использовании социальных сетей. Рекомендации ВОЗ НОВАЯ В случае ключевых групп населения ВОЗ рекомендует применять в рамках комплексного пакета услуг для партнеров ВИЧ-инфицированных лиц подходы, основанные на использовании социальных сетей (условная рекомендация, доказательства очень низкого качества). Рекомендации ВОЗ 2016 г. Направление поставщиком услуг на добровольное тестирование (часто называемое уведомлением партнера) должно предлагаться ВИЧ-инфицированным как часть комплексного пакета тестирования и лечения (строгая рекомендация, доказательства среднего качества). 3• распространение наборов для самотестирования на ВИЧ ВИЧ-положительными и ВИЧ-отрицательными клиентами среди своих партнеров и контактов; • использование новых инструментов и технологий, таких как цифровые и общественные СМИ, мессенджеры и другие веб-платформы, для доступа к социальным сетям, особенно для представителей ключевых групп молодежи; • применение анонимных методов предоставления услуг партнерам ВИЧ-инфицированных лиц и подходов с использованием социальных сетей для защиты конфиденциальности, особенно для охвата подростков и представителей ключевых групп молодежи, а также в условиях, когда ключевые группы населения подвергаются стигматизации, дискриминации и криминализации. Операционные рекомендации по предоставлению услуг партнерам ВИЧ инфицированных лиц и подходам с использованием социальных сетей Обеспечивать конфиденциальность. Очень важно уважать и защищать конфиденциальность и неприкосновенность частной жизни клиентов и их партнеров при предоставлении услуг партнерам ВИЧ-инфицированных лиц, включая подходы с использованием социальных сетей для ключевых групп населения, особенно когда партнеры еще не раскрыли друг другу свой ВИЧ- статус. Предоставлять услуги на добровольной основе. Всякий раз, когда предлагаются услуги партнерам ВИЧ-инфицированных лиц и подходы с использованием социальных сетей, важно информировать клиента об их пользе и мерах предосторожности и обеспечить, чтобы его решения о контактах с партнерами и другими людьми из социальных сетей были добровольными, а не принятыми под давлением. Дифференцировать услуги. Предоставление услуг партнерам ВИЧ инфицированных лиц и подходы с использованием социальных сетей могут быть адаптированы к местным условиям и предпочтениям клиентов. • Несмотря на то, что клиентам необходимо рекомендовать пользоваться направлениями на тестирование от поставщиков услуг, поскольку у этого подхода высокая эффективность, клиенты должны иметь возможность выбирать из всех доступных вариантов услуг для партнеров. Клиенты могут выбирать разные методы для разных партнеров, но также могут отказаться от этих услуг. Предшествующий опыт показывает, что подходы с использованием социальных сетей осуществимы и эффективны Предшествующий опыт реализации показывает, что подходы к тестированию на ВИЧ с использованием социальных сетей можно реализовать среди ключевых групп населения в различных условиях. В Демократической Республике Конго, Гаити и Малави в рамках проекта LINKAGES осуществляется направление на тестирование и тестирование с использованием социальных сетей для мужчин, имеющих половые контакты с мужчинами, работников секс-индустрии, трансгендеров и их партнеров. Эти подходы были реализованы с помощью целого ряда стратегий, таких как привлечение сверстников из одного круга общения и наставников, соцработников и самих клиентов при использовании бланков направлений, социальных сетей, интернет-платформ и мобильных приложений, которые являются наиболее привлекательными для ключевых групп населения. Подходы, основанные на направлении поставщиком услуг на добровольное тестирование и использовании социальных сетей, оказались осуществимыми и приемлемыми как среди ключевых групп населения, так и среди их партнеров и контактов. Эти подходы были успешными в выявлении партнеров и контактов ВИЧ- инфицированных лиц, которые не проходили тестирование. Например: в Демократической Республике Конго (с октября по декабрь 2018 г.) прошли тестирование на ВИЧ 99 контактов от 143 клиентов, и у 47 (48%) из них был поставлен положительный диагноз; в Гаити (с апреля по декабрь 2018 г.) прошли тестирование на ВИЧ 369 контактов от 286 клиентов, и у 83 (22%) из них был поставлен положительный диагноз; и в Малави (с января по февраль 2019 г.) прошло тестирование на ВИЧ 126 контактов, и у 35 (25%) из них был поставлен положительный диагноз. Источник: FHI 360/LINKAGES. Предоставление услуг партнерам ВИЧ-инфицированных лиц и применение подходов с использованием социальных сетей всегда должны осуществляться на добровольной основе. ВОЗ не поддерживает обязательное или принудительное предоставление услуг партнерам ВИЧ-инфицированных лиц или УТВ. 4 Для ключевых групп населения ВОЗ рекомендует применять в рамках пакетов услуг для партнеров ВИЧ-инфицированных лиц подходы, основанные на использовании социальных сетей4 Для получения дополнительной информации обращайтесь по адресу: Всемирная организация здравоохранения Департамент по ВИЧ/СПИДу 20, Avenue Appia 1211 Женева 27 Швейцария E-mail: hiv-aids@who.int www.who.int/hiv WHO/CDS/HIV/19.32 © World Health Organization 2019 Некоторые права защищены. Лицензия: CC BY-NC-SA 3.0 IGO КРАТКИЙ ОБЗОР ПОЛИТИКИ УСЛУГИ ТЕСТИРОВАНИЯ НА ВИЧ • Подходы с использованием социальных сетей могут быть предложены как ВИЧ-положительным, так и ВИЧ отрицательным представителям ключевых групп населения при наличии возможности, а также когда это поддерживается национальной политикой. Подходы с использованием социальных сетей могут быть особенно полезны в тех случаях, когда клиенты из ключевых групп населения неохотно принимают предложение воспользоваться направлением от поставщика услуг для партнера из-за того, что это требует раскрытия поставщику услуг информации о партнерах, или из-за страха стигматизации, дискриминации или преследования. • Всем представителям ключевых групп населения с недавно установленным диагнозом ВИЧ-инфекция во время диагностики и периодически после нее могут быть предложены добровольные услуги для их партнеров, в том числе в соответствующих случаях подходы с использованием социальных сетей. Готовность клиентов воспользоваться такими услугами со временем может измениться, или у них могут появиться новые партнеры. • Необходимо определить целесообразность применения подходов, основанных на использовании социальных сетей, на ограниченный период (или по волнообразному графику) или на постоянной основе. Подходы с использованием социальных сетей будут наиболее эффективными, когда они сосредоточены на сообществах людей с повышенным риском в ключевых группах населения. Большая продолжительность или большее число «волн», как правило, позволяют глубже проникнуть в эти социальные сети и, таким образом, могут выявить больше ВИЧ-инфицированных, но эти варианты требуют больше ресурсов. Обеспечить безопасность клиента. Людям, обеспокоенным реакцией партнера или социального контакта на предложение воспользоваться УТВ, нужно обеспечить поддержку и возможность отказаться от услуг для их партнеров. Люди из ключевых групп населения, особенно работники секс-индустрии, часто подвергаются сексуальному и другим видам насилия. Обеспечение добровольного и информированного предоставления услуг имеет решающее значение для предотвращения любых неблагоприятных последствий. Женщинам, которые раскрывают информацию о предыдущем насилии со стороны партнера, должна быть оказана немедленная первичная поддержка со стороны врача или иного работника в рамках медицинского или другого доступного вида обслуживания. Привлекать сообщества и повышать осведомленность для поддержки эффективного внедрения услуг для партнеров ВИЧ инфицированных лиц, включая подходы с использованием социальных сетей. Это имеет особенно важное значение для расширения возможностей ключевых групп населения и информирования их о потенциальной пользе и мерах предосторожности. Проверить наличие и устранить правовые и политические барьеры для безопасного внедрения и расширения услуг для партнеров ВИЧ-инфицированных лиц, включая подходы с использованием социальных сетей, не опасаясь криминализации. Обучать и наращивать потенциал врачей и прочих медицинских работников. Наращивание потенциала должно охватывать методы выявления клиентов, которым могли бы быть полезны эти услуги, методы вовлечения клиентов в непредвзятое обсуждение партнеров и социальных контактов, методы поиска партнеров и социальных контактов и предложения им услуг по добровольному тестированию на ВИЧ или оказания поддержки клиентам в предложении УТВ, а также методы содействия взаимному раскрытию информации для пар. Поставщики услуг должны быть иметь понимание правовых и политических аспектов, и им потребуется обучение по минимизации риска причинения вреда для клиентов и их самих, а также документированию и отчетности по попыткам и результатам предоставления услуг для партнеров ВИЧ инфицированных лиц в рамках обычного мониторинга программ. Регулярно проводить мониторинг и оценку предоставления услуг для партнеров ВИЧ-инфицированных лиц, в том числе использования подходов на основе социальных сетей, для улучшения качества предоставления услуг и оптимизации воздействия. Это потребует определения и сбора соответствующих показателей и разработки плана мониторинга и оценки. Также важно отслеживать риск социального вреда и, в случае выявления непреднамеренных неблагоприятных последствий, оперативно пересматривать и корректировать программы. Фо то гр аф ия н а о бл ож ке © PA TH /V u N go c D un g