Abstract
BackgroundIn Lebanon, HIV is concentrated in both native and refugee communities of men who have sex with men (MSM). For over 10 years, the National AIDS Program (NAP) has offered HIV voluntary counselling and testing through a partnership with nongovernmental organizations (NGOs). In 2018, implementation of HIV self-tests (HIVST) was introduced, and this self-care intervention has been further scaled up during the coronavirus disease 2019 (COVID-19) pandemic. This paper (1) describes the effectiveness of implementing HIVST in Lebanon, and (2) discusses how the success of HIVST implementation has been reflected during the COVID-19 pandemic.MethodsThe NAP conducted a series of workshops (July–November 2018) to introduce HIVST services for healthcare workers working at different NGOs. The workshops highlighted that HIVST would be distributed for free, that it would be confidential and voluntary, and that participants were encouraged to notify the NGOs of their results, which would be kept strictly confidential. NGOs collected data anonymously and confidentially from beneficiaries (age, consistency of condom use and HIV testing history), who were asked to call back with the results of their HIVST. At the NAP, data were combined, aggregated and analysed.ResultsIn 2019, the NGOs distributed 1103/1380 (79.9%) HIVST kits to their beneficiaries. The NGOs collected feedback on 111 kit results, of which two were HIV-positive. Feedback about HIVST results from beneficiaries was low (111/1103) due to noncompliance of beneficiaries and the lack of human and financial resources in the NGOs. From January through May 2020, a total of 625/780 HIVST kits (80.1%) were distributed. This period was divided into pre-COVID-19 and during COVID-19. The follow-up with the beneficiaries during COVID-19 was much improved because of the absence of on-site activities, shifting more efforts towards HIVST (449/625). There have been no reports of social harm related to HIVST.ConclusionHIVST implementation in Lebanon serves as an example of introducing a self-care intervention as part of a community-led effort. In order to maintain HIVST services at the same improved level, reorganization of care is needed within each NGO following the adaptation process due to COVID-19, along with continuous monitoring and evaluation of HIVST reported data.
Highlights
In Lebanon, HIV is concentrated in both native and refugee communities of men who have sex with men (MSM)
According to the National AIDS Program (NAP), there were an estimated 2570 people living with HIV (PLHIV) in Lebanon in 2019, and the HIV epidemic was Maatouk et al Health Res Policy Sys 2021, 19(Suppl 1):50 concentrated in men who have sex with men (MSM) [1]
In mid-2018, the NAP conducted a series of workshops to introduce HIV self-tests (HIVST) services, which included presenting the scientific evidence of the test, providing IEC material and HIVST hands-on support to different Healthcare workers (HCWs) working in nongovernmental organizations (NGOs)
Summary
In Lebanon, HIV is concentrated in both native and refugee communities of men who have sex with men (MSM). Social contexts include habits and norms regarding sexual orientation and/or HIV-positive serostatus, including among families, friends, and cultural, religious and health institutions, which lead to the exclusion of MSM in HIV prevention, education and employment, and in healthier long-term relationships [2]. This has been supported by previous papers on Lebanese MSM, where men in relationships were much more likely to have been tested for HIV [3]. In local and foreign MSM communities, HIV prevalence was 12% and 3%, respectively, and knowledge of key HIV-related information (testing, prevention, treatment and services) was 8.7% and 6.3%, respectively [1]
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