KP Focused

MARPS’ goal is to facilitate access to testing and referral for other clinical and screening services to most at risk populations across Botswana including sex workers, truck drivers, construction workers, as well as men who have sex with men (MSM).

To date, the majority of HIV services in Botswana, including those offered by Tebelopele have targeted the general population rather than specific populations such as MARPs. The national prevention strategy highlights the need to expand services to vulnerable and at risk populations. The Government of Botswana and BOTUSA supported a needs assessment of sex worker risks and needs conducted by ITECH which highlighted the vulnerabilities of sex workers and lack of adequate information and services.

Program Description

1. Direct Services by Tebelopele

Tebelopele will work in several centres to provide improved services for MARPs, initially focusing on sex workers and populations involved in transactional sex. Activities include:

Outreach into areas with known sex worker populations (e.g. border area of Kasane). Tebelopele will utilize other successful outreach techniques such as Ghanzi’s tea and Moon Light testing outreach programme.
Adjusted hours of operation to offer moonlight or night-time and early morning testing services on outreach.
Condom distribution and counselling on STI risks. The current counselling protocol and intake sheet includes screening questions for STI signs and symptoms – this will continue to be emphasized and clients at greater risk will be given information as well as referrals to STI treatment and screening
Tebelopele counsellors working at centres with a higher likelihood of MARP outreach will be trained to provide MARP friendly services based on other successful regional programs in Africa
The specific Goal of the Project was to minimize the risk associated with high risk construction worker populations, targeting the estimated 19415 people in affected communities and construction workers, with prevention interventions, based on an initial community health profile, anchoring intensified HIV/AIDS testing by experienced Tebelopele counselors.

2. Referrals and Linkages to other services

Recognizing that Tebelopele is not a provider of clinical treatment and other screening services, Tebelopele has always relied on linkages and referrals with other organizations to ensure Tebelopele clients are able to access the full spectrum of services to prevent, care, treat and support HIV. In some parts of the country there are higher rates of non-Batswana sex workers (e.g. Kasane, where a number of sex workers are from Zambia and Zimbabwe), Tebelopele will work with clinics to ensure these vulnerable populations have access to services. Below are brief descriptions of

Regular and ongoing communications with the DMSACs, police and civil authorities about Tebelopele’s activities with MARPs to ensure the authorities are aware of our efforts and understand the public health importance of working with MARPs to reduce the community’s overall vulnerability to HIV.
Referral to clinics with information about STI signs and symptoms from clients to facilitate treatment according to the Government of Botswana’s guidelines of syndromic STI management. In addition to referrals for individual clients, lead counsellors will also communicate with clinic staff to ensure that referrals and services are effectively streamlined.
Advocacy with ACHAP and clinics to support and facilitate STI screening and treatment of all sex workers including those from Zimbabwe and Zambia. The government supports free access to treatment for STIs for anyone in Botswana, regardless of their status, but if they are not ill with a public health condition their screening and treatment support is not covered. Tebelopele will advocate with ACHAP that at ACHAP supported clinics (especially Kasane) those MARP populations who test with Tebelopele and assent to having signs or symptoms of STIs will be referred and their STIs will be treated. Tebelopele will work with the clinic and the community to ensure there is awareness of these services which are already available.
Training for referring clinics. Tebelopele will invite nurses and counsellors from clinics to which Tebelopele refers STI and MARP clients to attend the aforementioned MARP-friendly services training.