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BACKGROUND: The USAID-funded Building Resilience project in the Dominican Republic aims to improve HIV detection and antiretroviral treatment adherence among Haitian migrants and their descendants, ultimately reducing viral load in these communities.
DESCRIPTION: Building Resilience project employs a family-focused service model to enhance the health of orphans and vulnerable children (OVC) by identifying HIV cases, promoting treatment adherence, and monitoring viral load. The target population faces challenges such as higher HIV prevalence, limited awareness, and access to antiretroviral treatment (ART), exacerbated poverty, lack of legal documentation leading to deportations, and restricted access to social protection programs.
LESSONS LEARNED: The project is contributing to the global 95-95-95 goal by ensuring that targeted children, adolescents, and caregivers knows their HIV status. From September 2021 to 2023, 12,913 beneficiaries were reached. Initially (September 2020), only 38% knew their HIV status. Through adjusted approaches and new strategies, by September 2023, 93% knew their HIV status.
Addressing complexities in raising HIV status awareness highlighted key lessons, emphasizing improving community volunteer effectiveness and sensitizing caregivers to their religious and cultural beliefs about HIV risk in children. Optimizing volunteer training, particularly in age-appropriate assessments, and redesigning the HIV Risk Assessment Tool were crucial in easing volunteers' discomfort with sensitive sex-related questions. Establishing trust through continuous training and fostering a psychological connection between volunteers and caregivers further enhanced volunteers' ability to assess HIV risk and facilitate necessary testing referrals.
Integrating cultural and religious sensitivities into HIV education, dispelling prevalent myths, and sensitizing caregivers, specifically addressing their limited acceptance of risk assessments for their children were crucial. By concentrating efforts on these areas, a more supportive and effective approach for conducting HIV risk assessments, referring for HIV testing, and ensuring completed referrals was implemented. This resulted in a significant improvement in the percentage of children in the program who knew their HIV status.
CONCLUSIONS: Culturally sensitive, comprehensive approaches are crucial for assessing HIV risk and delivering services to this vulnerable population. Effective communication, rapport-building, and targeted interventions are vital to engage 95% of people with HIV in knowing their serostatus. This involves raising awareness about the importance of HIV testing and ensuring broader access.