This is the abstract presentation of Dr Harjyot Khosa, which was made as part of the 12th session of 10th Asia Pacific Conference on Reproductive and Sexual Health and Rights (#APCRSHR10) Virtual. This session was held in lead up to #WorldAIDSDay and #16DaysofActivism against sexual and other forms of gender-based violence, on the theme of "HIV/AIDS and sexual and reproductive health and rights (SRHR) in Asia and the Pacific". Chair: Jennifer Butler, Director, UNFPA Pacific Sub Regional office based in Fiji Plenary Speaker: Eamonn Murphy, Regional Director, UNAIDS, Asia and the Pacific | “Solidarity and Accountability: HIV, SRHR and the COVID response” Abstract Presenters: ------------------------- * Jude Tayaben | Successes, Pitfalls, and Moving Forward: Adivayan Youth Health Center- A school-based program addressing Adolescent Sexuality, and Reproductive Health Issues in Benguet, Philippines * Samreen, Manisha Dhakal | Integrating transgender health into HIV and SRHR programming in Indonesia, Nepal, Thailand and Vietnam * Harjyot Khosa | Stigma, sex work and non-disclosure to health care providers: Exploring dynamics of anal sex through community led monitoring to bridge gaps in HIV care continuum services * Angela Kelly Hanku, Agnes K. Mek | I can, I want, I will and Young & Positive: Two visual method projects with young women living with HIV in Papua New Guinea For more information on the session, please visit www.bit.ly/apcrshr10virtual12 Official conference website: www.apcrshr10cambodia.org Thanks

1. Stigma, sex work and non-disclosure to health care
providers: Exploring dynamics of anal sex through
community led monitoring to bridge gaps in HIV care
continuum services
Dr Harjyot Khosa
Asia Pacific Conference on Reproductive and Sexual
Health and Rights (APCRSHR10)

2. Community score card
Community score card is an approach to increase the engagement of the community
in improving HIV service delivery.
Local Problems – Local Solutions
Build capacity of community on awareness creation, demand generation, advocacy,
service delivery, process of monitoring and accountability, facilitate implementation,
planning and decision-making, management of services, peer learning and teaching.
One of the recommendations of mid-term appraisal of NACP-IV was to strengthen the
community feedback mechanism. Community scorecard is an approach to receive
systematic feedback from the community and service providers. This is to increase the
engagement of the community in improving the quality of HIV service delivery.

3. Using the Community Score Card as tool to interface KPs, TI
programme and Health Care Services
• A community score card is developed
among KP, TI and Service Provider
• Participatory in nature and process,
scoring is developed on a range of
issues from attitudes to actual delivery
of services
• Scores are mutually agreed upon, how
to get better scores in futures paves the
way to develop a plan
• Empowering process for both KP
communities and service providers
• Sustainable mechanism to monitor
and record change in quality and
efficiency of services over a period of
time

4. Key features
• The community score card has a set of seven core indicators and sub-indicators.
• The community and health care providers conducts the scoring separately and
individual group arrive at a consensus score
• An interface meeting between the community and the HCPs is conducted where the
scores provided by the HCPs and the community is reviewed. An action plan is
developed with concrete action steps for improving the service delivery, based on
the discussions.
• This exercise is repeated on a quarterly basis, to review the progress on action
taken and develop the action plan for the next quarter.
• Community score card will be implemented by DAPCU, SACS/TSU PO and
facilitated by TI Project Manager.
• SACS will have the overall responsibility to monitor the implementation of community
scorecard system.
Revamped and Revised Elements of Targeted Intervention for, HIV Prevention
and Care Continuum among Core Population

5. The Framework

6. 6
KP experience
Poor / Absent Service/
Denial
Consolidate collective
community
experience into a
score card
Share Score Card
with Providers
Action Plan for improved
service delivery – provider
and community
responsibilities outlined
New Experience of
service delivery
Consolidate New
collective community
experience into a new
score card

7. Interface meeting
The interface meeting brings together both community members and
service providers (facility staff) to discuss the results of the scorecards.
During this facilitated discussion a mutually agreed reform agenda and
action plan is developed.
KP community
Score card
Health input
tracking form
Interface
Meeting
Review the Action Plan
Completed By:
Facility Staff (providers)
&
KP Community Members

8. Implementation experience: 72 score cards were developed engaging 1526 KPs and 466
Service providers, Nirantar, CDC/ PEPFAR

9. Advocacy Tracker
 STI issues are seldom discussed
No one EXAMINED ANAL STIs
 CD4 testing machine is there but the testing is not done regularly
 No IEC material available for KPs on HIV/AIDS – prevention or treatment
 Lubes are not available in TIs
 Lack of awareness about HIV bill
 Separate room is not available for counseling
 KPs are made to wait longer than others
169 issues out of 230
resolved till date!
Head of hospital, health care
providers, TI functionaries and
communities developed and
resolved action points during
the INTERFACE MEETINGS!

10. Challenges
At the Programme/ Macro level
• Health system involvement
• Time bound programme
• Both parties believe in the developmental nature of the process, otherwise
it can become an opportunity for preparing a list of complaints or a
confrontation, or tokenism
• Jointly accepted set of parameters for monitoring –Quality of Care
standards, treatment protocols, programme guidelines
At the Implementation /Micro level
• Orientation and capacity building of targeted intervention team.
• Programme flexibility to incorporate new suggestions
• Get providers ready to listen – not dismiss
• Manage community relationship with providers – avoid ‘blaming’
• Follow up

11. HCP are the frontline to service delivery to women who have sex, however
are yet not prepared socially and have internal moral conflicts to treat
anal STIs. Considering that community monitoring is imperative to
broaden HIV service reach, engaging KPs to facilitate better health,
improve access to health care and overcome stigma, discrimination.

12. Thank you!