An innovative new programme shows the power of South-to-South learning — and how facilitated self-assessment can unlock new data and insights to help countries reduce HIV infections. ‍

“I’m worried,” admits a representative from Uganda.

It’s February, and dozens of national health officials, United Nations agencies representatives, activists and international donor officials from nearly a dozen African countries have joined a late afternoon Zoom call.

As the webinar’s presentations continue, the chatbox has come alive, and the official from East Africa has a burning question.

“I get very concerned about key populations who get on pre-exposure prophylaxis (PrEP),” she admits, typing her comment into the box. “What if they forget all about using condoms to prevent other sexually transmitted infections?”

In 2017, the Global HIV Prevention Coalition (GPC) was launched to kick start the world’s HIV prevention efforts. More than 30 countries are part of the coalition, and some member countries, such as South Africa, Eswatini and Zimbabwe, have seen recent declines in new HIV infections, according to the coalition’s 2020 progress report.

Still, less than half of sex workers and only about a third of men who have sex with men (MSM), transgender people, and people who inject drugs — these groups are known as key populations — in GPC countries have regular access to HIV services, including PrEP. In the vast majority of GPC African member states, these populations are also criminalised — making it even more difficult for HIV programmes to reach these groups with services.

Today, representatives from 10 GPC countries are sharing how they have increased access to condoms — and reached marginalised and sometimes criminalised people with the HIV prevention services they need the most.

Back on the webinar, a top Nigerian health official has just finished presenting on the country’s progress improving condom procurement when he spots the question from Uganda.

“PrEP, for us, is offered with specific advice about the need for continuous, consistent and correct use of condoms,” he offers. ‍

Within seconds, the Ugandan official responds: “Thanks, Nigeria, for emphasis on condoms in the intervention. Great work!”

‍

‍A facilitated, experiential learning experience

Since the 1990s, countries in the Global South have increasingly looked to learn lessons from one another in hopes of leapfrogging shared challenges.

In 2020, Genesis Analytics teamed up with the University of Manitoba to begin a small proof of concept project called the South-to-South Learning Network in hopes of doing just that for condom and key population HIV prevention programming in 10 GPC African member countries, namely: Ghana, Kenya, Malawi, Mozambique, Nigeria, South Africa, Tanzania, Uganda, Zambia, Zimbabwe.

With funding from the Bill & Melinda Gates Foundation, the South-to-South Learning Network began by supporting countries to become the first to pioneer UNAIDS’ new HIV Prevention Self-Assessment Tools (PSATs). The team then mapped PSAT results to pair countries together based on strengths and weaknesses in structured peer-to-peer learning opportunities, such as regional webinars, virtual study tours and thematic link and learn sessions. Tailored, facilitated, and deliberate activities such as these within the network enabled countries to share experiences and lessons while forming new cross-continental relationships.

During the network’s first year, it has already:

• Demonstrated proof of concept;
• Shaped key population policies in Uganda and Nigeria;
• Informed national funding applications to the Global Fund to AIDS, TB and Malaria in several countries;
• Fed into national strategic plan (NSP) catch-up plans in South Africa;
• Led to targeted requests for technical assistance in response to demonstrated gaps.

‍

Each one, teach one: Pioneering link and learn sessions

Once the team had mapped PSAT results, countries were then offered the chance to participate in “link and learn sessions.” During these small gatherings, countries shared real-life learnings and challenges, such as how to drive demand for condoms or plan and conduct an integrated bio-behavioural survey for key populations.

Ghana, for example, was invited to host a link and learn session for countries such as Zimbabwe detailing how Ghana has been able to integrate human rights programming for key populations into its response despite a criminalised environment. In 2020, at least 90% of female sex workers and men who have sex with men in Ghana had been tested for HIV, officials revealed in the May 2021 link and learn session.

From Zimbabwe, Senior Technical Specialist for Key Populations at the National AIDS Council, Humphrey Ndondo, was listening.

“We have lived for a long time in a space where there is a denial that key populations exist," said Ndondo, congratulating Ghanaian colleagues on their efforts to encourage key populations to report human rights violations. “You are miles ahead of a lot of countries within the region … in that you already have a human rights strategy."

Kenya also hosted a link and learn session to share its successes in differentiated HIV service delivery that, for instance, provides HIV prevention and care to sex workers through specialised after-hour and weekend clinics.

For those in Nigeria, the webinar provided practical solutions for longstanding problems.

“One of [our] key challenges is having robust monitoring tools that can track different models of differentiated HIV service delivery,” said the Society for Family Health in Nigeria’s Deputy Chief of Party Dr. David Olusegun Oyedeji. “This is something that we are relying on Kenya for: to look at their tools and modify it for the country.”

For many participants, sessions facilitated by the South-to-South Learning Network team were the first time they had connected with their counterparts in neighbouring countries.

‍

Facilitation and high-level buy-in incentivised participation — even amid competing demands

The GPC’s convening power was essential in obtaining initial buy-in from countries. Once the process was underway, dedicated and deliberate facilitation — alongside technical assistance — by our teams ensured that the network maintained momentum. Countries often reported that the access the network provided to, for instance, high-level representatives from donors and UN agencies particularly worked to incentivise participation.

Each country in the network was also led by a team of 10 champions, nominated by countries and provided with clear terms of reference by our teams. Champions represented a broad constituency and included representatives from government, national AIDS councils, UN agencies and civil society networks. Many countries also chose to have a representative from either the Global Fund or the President's Emergency Plan for AIDS Relief (PEPFAR).

Although coordinating the schedules of these diverse champions could be tricky at times, the South-to-South Learning Network team found high-level champions were essential to driving the process.

“You cannot underestimate the importance of investing in building strong foundations and relationships within and between South-to-South Learning Network country teams if you want to achieve real long-term change and impact,” Genesis Analytics’ South-to-South Learning Network Project Director Kerry Mangold explained.

Today, many of these champions, and participating bodies, continue to support the network — and see the value of expanding the project.

“I cannot emphasise enough the need to nurture [this kind of] culture of learning and sharing,” argued Global Coordinator HIV/AIDS, Sexual and Reproductive Health at the United Nations Population Fund Elizabeth Benomar at a recent network meeting. “We really need to continue to learn from each other and take advantage of the opportunity that the South-to-South Learning Network initiative brings to catalyse a scale-up of our programmes.”

Interested in learning more about this project? Contact Kerry Mangold, South-South Learning Network Programme Director, at KerryM@genesis-analytics.com ‍