The Arise program
Enhancing HIV prevention programs for at-risk populations
For every two people beginning antiretroviral treatment for HIV/AIDS worldwide, another five people become newly infected. In this context, experts agree that turning the tide against the global burden of HIV/AIDS must continue to emphasize prevention. Prevention interventions, ranging from educational and health services to introducing new technologies, need to be tailored to local settings and needs, address the complex, underlying issues that lead to risk, build on existing evidence—and importantly—must be cost-effective to ensure their sustainability.
Under a $17 million grant from the Department of Foreign Affairs, Trade and Development Canada, PATH is providing technical and financial support to six HIV-prevention projects that are using innovative, cost-effective strategies to address the needs of most-at-risk populations. These vulnerable groups include female sex workers (FSW), HIV-positive pregnant women, sero-discordant couples, women living with HIV, men having sex with men (MSM), and injecting drug users (IDUs).
Through these projects, we aim to reach nearly one hundred thousand people and help avert new HIV infections among thousands of individuals by September 2014. So far, Arise projects have trained thousands of health care workers and affiliates, provided HIV counseling and testing services to more than 200,000 people, and reached nearly an equal number of people with a range of prevention services including access to clean needles and syringes, contraceptive methods, male and female condoms, prevention of mother-to-child transmission (PMTCT) services, help lines, and referrals to opioid substitution therapy, rehabilitation, tuberculosis, antiretroviral therapy (ART), and sexually transmitted infection (STI) treatment centers.
Across each project, we emphasize:
- Most-at-risk populations. We focus on implementing and expanding HIV-prevention services to people in low-income countries who would not otherwise be reached.
- Cost-effective interventions. Each project costs less than US$500 per infection averted; assessments will measure the cost-effectiveness of services provided.
- Rigorous results tracking. We are using operations research, and including key outcomes such as HIV incidence or persistent condom use, to understand and evaluate the impact of interventions.
- Impact evaluations. Projects will generate key lessons to inform future HIV-prevention strategies.
- Lessons learned. A key component of our work is synthesizing and disseminating lessons, best practices, and recommendations.
India: improving health seeking behavior among men who have sex with men
To decrease HIV risk behaviors and improve health seeking behaviors among hard to reach MSM in India, PATH is working with FHI 360, Humsafar Trust, and local community-based organizations to enact mobile health technology-based interventions, including a dedicated help line staffed by trained counselors to provide counseling on correct and consistent condom use, promote HIV testing, answer questions, and provide referrals to integrated counseling and testing centers, as well as a hierarchical text messaging system to provide information and education about HIV/AIDS and provide answers to frequently asked questions.
India: reaching injecting drug users
In New Delhi, PATH is working with the Population Council and Sahara Centre for Residential Care and Rehabilitation to expand HIV prevention services and reduce risky injection and sexual behaviors among injecting drug users and their sexual and injection partners. Interventions include training outreach workers and peer educators and providing comprehensive HIV-prevention services.
Senegal: promoting behavior change among female sex workers
In the Dakar region, PATH is collaborating with Université Cheikh Anta Diop (UCAD), AIDS Africa Watch (AWA), and Westat Inc. to reduce the spread of HIV and other STIs within the context of sex work. Activities include using behavior change communication and other strategies among female sex workers and their partners, as well as promoting risk reduction in sex work hot spots such as bars.
Uganda: addressing unmet need for family planning among HIV-positive women
In northern and eastern Uganda, we are working with Pathfinder International and the National Coalition of Women Living with AIDS to address unmet need for contraception among HIV‑positive women.
The project promotes dual-method contraception, using condoms, and other methods to avoid unplanned pregnancy and prevent the spread of HIV and other STIs. Community and clinic-based health workers receive training on family planning, and women receive integrated family planning and PMTCT services.
Zambia: expanding couples HIV counseling and testing
To prevent HIV infections among couples in the Copperbelt mining region, we have engaged Emory University’s Rwanda Zambia HIV Research Group (ZEHRP) to expand couples HIV counseling and testing (CVCT), encourage risk reduction, refer HIV-positive clients to clinics for antiretroviral therapy, and promote CVCT at the government and community levels. The success and continued expansion of the project’s CVCT strategy has led to its incorporation into the Zambian government’s national HIV/AIDS policy.
Zimbabwe: reducing mother-to-child transmission of HIV
In Mashonaland Central Province, PATH is collaborating with the Population Council and the Zimbabwe AIDS Prevention Project to reduce mother-to-child transmission of HIV among women seeking antenatal care in seven districts. Interventions include community sensitization and mobilization for PMTCT; training, support, and capacity-building to implement the World Health Organization’s 2010 recommended PMTCT protocols in health facilities; and early infant diagnosis of HIV.
For more information on Arise, please read our factsheet.