How A CHEKUP II Wellness Center Supports Key Populations in their Safety and Wellness Journey in Kabwe, Zambia

This story was first published by our partner, John Snow Health Zambia (JSH). It features the work of the JSI and JSH partnership under the USAID-funded Controlling HIV Epidemic for Key and Underserved Populations, which is creating greater access to HIV prevention among populations at highest risk in Zambia.

We have seen MSM face discrimination, we know FSW who have been arrested for idle standing and many afraid to report crimes against them because of the laws surrounding their work. We understand that there are transgender individuals in our community who are never heard. All of these experiences contribute to the fear that key populations face in accessing health services,” Jeffries Ngosa explains.

Inequalities are undermining our response to HIV and AIDS. Marginalization of key populations, including men who have sex with men (MSM), female sex workers (FSW), and transgender individuals, is contributing to the inequity in protection, treatment access, and viral suppression that these individuals face. Unsupportive policy environments and harmful gender norms play a central role.

In Kabwe, Zambia these factors are compounded by the closeness of its community. “Our community is small and presenting at a health clinic where your auntie or your brother may work to receive services… this may prevent you from wanting to go, or, at least, may prevent you from being open in discussing the risks you face in your life,” Bright Teri elaborates.

Ngosa and Teri are leading an effort in Kabwe to change the way care is offered to key populations. The KP Wellness Center, established in Kabwe through the USAID CHEKUP II project, implemented by JSH, is one of 7 centers in development across the nation devoted to working with FSW, MSM, transgender individuals, and other key populations in order, not just to meet their health service needs, but to offer safety and wellness in a welcoming space.

The minimum package offered at these centers includes biomedical, behavioral, and structural interventions. Biomedical services offered include HIV testing services, family planning, STI testing and treatment, condom distribution, PrEP, linkage to ART, COVID-19 counseling and vaccination, and gender-based and intimate partner violence case management. Non-clinical interventions include social asset-building interventions that focus on improved mental health and well-being and economic strengthening interventions.

These services, in large part, harness the networks that the KPs themselves have built and leverage peer-to-peer models. Ngosa explains “When an individual walks into this location, they are presented with choices. We first ask ‘who would you feel most comfortable speaking with today?’ And as we go through counseling it’s not our job to tell people what to do or what not to do. It’s our job to help them understand risks and practice self-care.”

Ngosa and Teri have been offering services to KPs in the area for several years and were approached by JSH leaders to build this wellness center from scratch. They started, in October 2022, by finding a location – one that would present enough space for group activities while also being proximal to the central business district and easily accessed by public transport.

Once a location was selected, mobilizing KPs and building trust in discreet and comprehensive services was the next and more challenging step. Discretion hasn’t always been a guarantee for KPs when accessing health services and discrimination has always been a risk. Building a safe space across those shared experiences is an area where Ngosa and Teri and others focus on continuously growing.

What helps” Ngosa, who has been a KP peer mentor for nearly 7 years, elaborated “is that I am a member of the KP population myself, and the relationships built as a peer mentor over the years allowed us to reach out to individuals we already knew and worked with. Those individuals told others and so on.” This project became a necessary continuation of the work Ngosa and Teri had been able to offer this community.

Localized expertise, flexible scheduling, and social networking to ensure this predominantly younger population is involved (most KPs in this area are between ages of 18 and 30) has helped drive community mobilization. “Another valuable avenue has been working with CSOs like Thitandtizane and other health centers to help get the word out about our offerings” added Ngosa. Since operationalizing the center in early December 2022, 96 KPs have (as of the end of January 2023) accessed services through this wellness center.

“I’d love to see us attending at least 95% of our KPs. There are still people here feeling isolated. We know there are more transgender clients we could be supporting, for instance. We know that we need to constantly evolve and use dynamic strategies to reach this goal,” says Teri.

Ngosa continues “I want to see viral load reduction in our HIV-positive populations… We are starting to see more MSM who previously didn’t have confidence in the health system coming here to treat STIs. PrEP access numbers are high and condom distribution is, too.”

What does the end game ultimately look like? “A FSW we worked with recently received financial counseling through our SBCC approach. She has been able to save income. The result of this counseling and changes made placed her in a position where she doesn’t have to accept a partner requesting to not use a condom. She can negotiate and prioritize her safety in these negotiations. This is what we want for our clients: to achieve stability and safety, you can reduce and mitigate risks.”