LINKAGES ANGOLA Summary of Achievements January 2015–September 2019

The Linkages across the Continuum of HIV Services for Key Populations Affected by HIV (LINKAGES) project was implemented in Angola in partnership with civil society organizations (CSOs), government stakeholders, and key population (KP) individuals, with support from the U.S. Agency for International Development (USAID) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). The innovation of LINKAGES Angola was in developing tailored programming for each KP—female sex workers (FSWs), men who have sex with men (MSM), and transgender (trans) people—in recognition of the differentiated needs and preferences of each group in the country. KP members were involved in the creation and implementation of their own solutions to barriers to getting tested for HIV and initiating and adhering to antiretroviral therapy (ART). The project’s contributions to national guidance on legal rights pertaining to gender and sexual orientation have also paved the way for increased access to HIV services for KPs. CSO and government partners, too, have benefitted from project endeavors, particularly the development of mutually beneficial, collaborative relationships that will far outlast LINKAGES and have an enduring positive impact on KPs. This brief summarizes the significant achievements of the LINKAGES project in Angola.

KPs in Benguela province (which has the second Background largest city after Luanda) or Cabinda or Bié provinces, where 5.8% of pregnant women were found to be Since the inauguration of the Instituto Nacional HIV positive.4 da Luta contra a SIDA (The National Institute in the Fight against AIDS [INLS]) in 2004, national-level HIV- In 2015, the INLS partnered with LINKAGES Angola to: related data in Angola have been limited to surveillance • Map the prevalence of HIV and sexually transmitted in pregnant women and to modeled Spectrum data. infections (STIs) among KP members and estimate the Based on the first Demographic Health Survey (DHS) size of the KPs in five provinces through an IBBS study conducted in Angola in 2015, HIV prevalence for adults (ages 15–49) is 2.0%. Estimates indicate that • Build a robust service program to cover 53% (118,476) of people living with HIV (PLHIV) comprehensive prevention services, both at the need ART.1 community and facility levels

Until 2017, only limited national-level data were • Build the capacity of local CSOs and government to available on KPs in Angola. A 2011 integrated biological use data to inform KP programming and behavioral surveillance (IBBS) survey among LINKAGES Angola was implemented in Luanda province MSM in Luanda found an estimated HIV prevalence of January 2015–September 2019 and in Bié province 2 3.8% and an estimated population size of 6,236. May–September 2018 by Management Sciences for The prevalence of HIV among FSWs had only been Health (MSH) in partnership with 11 local CSOs and five studied in Cunene, a province bordering Namibia, grassroots groups. In Benguela province, parts of the where 8.5% of women engaging in transactional sex LINKAGES care model were also implemented from 3 were estimated to be living with HIV. No prevalence 2017 to 2019. Project activities aimed to help FSWs, or size estimation studies had been conducted among MSM, and trans women access the full continuum of 2

Members of the LGBTIQ and FSW community partners and LINKAGES Angola staff at the end-of-project event in Luanda, August 31, 2019

HIV prevention, testing, care, and treatment services Highlights (Figure 1). Working with CSOs, Provincial Health Departments, and the INLS, the project sought both • Generated critical data to inform programming through the to achieve epidemic control and promote structural PLACE biobehavioral study of HIV and STIs, which found that 36% of FSWs, 56% of MSM, and 55% of trans women knew changes in society. their HIV status; 17% of FSWs, 34% of MSM, and 55% of trans women were on ART; and 100% of FSWs and MSM and From May to August 2018, LINKAGES partnered 0% of trans women on ART were virally suppressed. with local CSO FOJASSIDA and the Provincial Health Office in Bié to bring a minimum package of HIV and • Developed distinct, tailored interventions for each KP group to STI services to FSWs in rural areas and communities meet their needs and preferences: FSW peer educators were surrounded by military brigades. Similarly, in Benguela trained to provide HIV testing and counseling; the enhanced peer outreach approach was used successfully to reach MSM province, the LINKAGES model was implemented in Luanda province and FSWs in Bié province; and a trans by Organização de Interação Comunitaria (OIC), woman activist started monthly gatherings at a community a subpartner of the United Nations Development center where two nurses provided prevention and testing Program (UNDP) under the Global Fund to Fight AIDS, services to trans women. Tuberculosis and Malaria (Global Fund). • Fourteen CSO and community group partners established effective referral pathways to more than 21 public health facilities in Luanda province for initiating KPs living with HIV on treatment. Biobehavioral Study of HIV • Led the development of a community health information and STIs among KPs system to enable CSOs to follow clients along the continuum of services, which was adopted at the national level. The From October 2016 to June 2017, LINKAGES’ civil system also led to the adoption of national community society partner, Domuns Custodius, LDA – Tchikos, HIV monitoring indicators that include KPs and risk under the leadership of INLS and with technical disaggregations. assistance from the University of North Carolina at • Contributed to the update of national STI guidelines and Chapel Hill, conducted a biobehavioral study of HIV and home-based cared manual for people living with HIV, and to other STIs using the Priorities of Local AIDS Control the development of Know-Your-Rights manual on Angola’s Efforts (PLACE) method among KPs in five provinces legal framework regarding gender identity, sex work, and sexual orientation. of Angola: Luanda, Bié, Benguela, Cabinda, and Cunene. This was the first time HIV and STIs among KPs had 3

Figure 1. Angola Provinces where the LINKAGES KP service Partnerships model was implemented: Luanda and Bié (USAID) and Benguela (Global Fund) LINKAGES Angola collaborated with the following groups to improve the access and quality of HIV-related services for KPs.

CSOs: • ANASO • Associação Solidaridade Cristã & • Associaçao Angolana Ajuda Mútua Angolana (ASCAM) Para o Bem-Estar da • Centro de Apoio aos Jóvens (CAJ) LUANDA Familia (ANGOBEFA) • Cuidados da Infância (CI) • Associação Beneficente • Domuns Custodius, LDA – Cristã (ABC) Tchikos • Associação de Mulheres • Forum Juvenil de Apoio a Saúde e Vivendo com VIH e SIDA, Prevenção da SIDA (FOJASSIDA) BENGUELA BIÉ MWENHO • Organização de Integração • Associação LGBTIQ IRIS Comunitária (OIC)

Grassroot Groups: • Arquivo de Identidade • H Maiúsculo Angolano (AIA) • Mulheres Abençoadas • Movimento Eu Sou Trans • Mulheres de Coração

been assessed. HIV prevalence was found to be 8% among FSWs, 2% among MSM, and 9% among trans Service Delivery Impact women. The study also found that the majority of people who tested positive for HIV were not aware Over the life of the project, CSO partners collectively of their status, explaining why so few were on ART. improved their ability to identify new HIV cases every Thirty‑six percent of FSWs, 56% of MSM, and 55% of year. When compared to the estimated number of trans women knew their HIV status. Of the FSWs with HIV-positive cases found by the PLACE study in 2017, HIV, only 17% were on ART, but all had a suppressed on average, LINKAGES and its partners identified 74% viral load. Of the MSM with HIV, 34% were on ART of the total cases among FSWs, 69% of estimated and all had suppressed viral load. The sample of trans cases among MSM, and 16% of the total estimated women with HIV was very small, but 55% were on ART cases among trans women (Figure 2). and none had viral load suppressed. Individuals diagnosed with HIV were linked to a peer navigator (PN)—a person living with HIV who supported them from the moment they learned their HIV status Key Programmatic Elements through the phases of acceptance, successful initiation on ART, and maintenance—to ensure they did not abandon LINKAGES Angola’s efforts to reach KP members treatment. PNs were staff members of partner CSO employed a community-based model with teams MWENHO. They provided support to 2,024 out of 2,237 comprised of outreach workers and HIV counselors. HIV-positive KP individuals in Luanda province. Overall, Initially, the teams used similar strategies across all 58% of clients living with HIV who had a PN initiated ART three KPs. However, as the project evolved, the model upon their first medical consultation, while only 24% who was tailored for each group according to their particular came to the first consultation unattended did so. needs and preferences (see Table 1). 4

Table 1. Tailored interventions for KPs in Angola Key Population Interventions

Female • Regular microplanning to identify hot spots in underserved areas sex workers • HIV prevention including condom and lubricant distribution at hot spots • Provision of HIV testing at hot spots through a mobile clinic with a three-member team (i.e., a peer educator, HIV counselor, and peer navigator) • Gender-based violence services integrated into the minimum HIV service package offered at hot spots • Presumptive treatment of chlamydia and gonorrhea at hot spots

Men who have • Enhanced peer outreach approach (EPOA) sex with men • Online peer educator outreach • Microplanning to identify hot spots, including hosting one-time events like parties • Social network mapping to identify high risk networks • Syndromic treatment of chlamydia and gonorrhea at EPOA sites

Transgender • Mobilization of trans women by a trans activist to attend monthly informal gatherings, where nurses women provided on-site HIV prevention and testing services • Syndromic treatment of chlamydia and gonorrhea at monthly meeting site

Figure 2 Coverage of HIV-positive KP individuals against IBBS PLACE study estimate of HIV-positive cases, Luanda (September 2015–September 2019)

Figure 2. Coverage of HIV-positive KP individuals against IBBS PLACE study estimate of HIV-positive cases, Luanda (September 2015–September 2019)

3,000 2,542 2,500 overage o 74% coverage all s omined 2,000 IBBS HIV+ Size estimate Diagnosed in FY19 1,500 895 Diagnosed in FY18 69% Number of KP individuals coverage 16% Diagnosed before FY18 1,000 coverage

691 462 500 93 272 25 166 14 290 59 4 0 FS MSM Trans eople

5

By close of project, LINKAGES had increased the number of CSOs and community groups it worked with Technical Highlights from three in 2015 to 15 in 2019. In total, the service delivery partners reached 58,901 KP individuals with the Female Sex Workers minimum HIV prevention and testing package, 78% of whom agreed to test for HIV, resulting in an overall case- Prior to LINKAGES, the first interventions for FSWs detection rate of 5%. Of the 2,237 clients diagnosed entailed sharing HIV prevention messages and providing with HIV, 81% initiated ART at 21 government-run health condoms and lubricants at hot spots. FSWs were facilities in Luanda and Bié provinces (Figure 3). referred to health facilities for HIV testing, but typically, only a few women would show up to get tested. In an Together, partners worked on making structural effort to not lose any clients, peer educators requested changes to the policy environment for KPs. LINKAGES to train them as HIV counselors to provide In partnership with the LGBTIQ groups H Maiusculo HIV testing themselves at the hot spots. LINKAGES then and Movimento Eu Sou Trans, LINKAGES trained worked with INLS to train and certify the new counselors. more than 550 staff at these facilities to build their Over time, FSWs who were peer educators were given capacity to offer comprehensive and KP-friendly HIV the possibility to become certified as counselors as well, services. In addition, in partnership with Global Fund, thus increasing their professional qualifications. LINKAGES sensitized more than 600 police chiefs and officers in Luanda province on the needs and rights of Microplanning sessions were conducted to analyze KPs under Angolan and international law, as well as on GPS data to identify hot spots in underserved areas, the relationship between GBV and HIV, as part of the including those with the proper conditions for testing project’s efforts to reduce the perpetration of stigma, (e.g., confidential rooms, support from the hot spot discrimination, and violence against KP members. owner). These planning sessions helped the team make the best use of the few mobile clinics available.

GBV was also addressed in the tailored FSW model, through a partnership between USAID and Global Figure 3. Figure 3. Total number of KPs reached, tested, Fund, working through their principal recipient, Total numandber oflinked KPs re actoh eARTd, tes tined, Luanda and linke dprovince to ART in L uanda province September 2015–September 2019 UNDP. Beginning in 2017, the partners integrated (September 2015–September 2019) GBV services into the minimum HIV service package delivered at hot spots. For example, outreach teams 58,901 60,000 promoted awareness of types of violence and provided basic psychosocial support, such as active listening and documentation of incidents, for FSWs who 45,760 reported violence. The women were then referred to the bimonthly FSW support group Blessed Women 40,000 (Mulheres Abençoadas), which was formed as part of KPs the USAID/Global Fund partnership with LINKAGES. 5% overall LINKAGES-trained CSO partner ASCAM also provided HIV case- detection rate 20,000 “ I always followed HIV testing on the 81% ART sidelines, watching carefully how initiation rate it was performed on the women I 2,237 1,810 referred. I always wanted to test. Total KPs Total KPs Total KPs who Total KPs Now I can. ” reached with tested tested positive initiated prevention for HIV for HIV into ART package Delfina da Costa, FSW peer educator, now trained as HTC counselor 6 Figure 4. Trends in HIV testing and case finding among FSWs in Luanda province, Year 1–Year 4 (October 2015–September 2019)

Figure 4. Trends in HIV testing and case finding among FSWs in Luanda province, Year 1–Year 4 (October 2015–September 2019)

18000 7.0% 16400 15841 16000 15420 14661 6.0% 14000 5.0% 12000 5.8% 9555 4.7% 4.0% 10000 3.4% 3.0% FSWs 8000 3.0% 6000 5693 6411 2.0% 4000 2926 1.0% 2000 691 895 100 190 0 0.0% FY16 FY17 FY18 FY19 Fisal ears Members of the FSW empowerment group Blessed Women KP_PREV HTS HTS_POS Case-Detection Rate psychosocial support to 314 cases of violence disclosed by FSWs during the project. Figure 5. ART initiation for FSWs in Luanda province by year Testing uptake among FSWs increased steadily over the life of project in Luanda, reaching 94% by Year 4. Figure 5. ART initiation for FSWs in Luanda In total, 2,021 FSWs were diagnosed as living with HIV province by year in Luanda province over the life of the project, of whom 80% initiated ART (Figures 4 and 5). In partnership 2000 90.0% with provincial health offices and community partners 1876 1800 80.7% 80.0% OIC and FOJASSIDA, LINKAGES Angola diagnosed 79.3% an additional 115 FSWs in Bié and Benguela, of whom 1600 1513 70.0% 1400 83% initiated ART. 60.0% 60.3% 1200 981 50.0% Men Who Have Sex with Men FSWs 1000 778 40.0% 800 38.0% To reach MSM, LINKAGES Angola initially applied the 30.0% same HIV prevention and testing strategy at hot spots 600 20.0% as used for FSWs, but with less success. Although the 400 290 175 men reached tended to accept testing, the case-finding 200 100 10.0% 38 rate was low (1% from 2017 to early 2018), indicating 0 0.0% that the program was not reaching MSM at greatest risk. FY16 FY17 FY18 FY19 As a result, LINKAGES switched to the EPOA,5 which Fisal ears entailed the use of MSM peer mobilizers to reach hidden HTS_POS TX_NEW ART Initiation Rate and higher-risk MSM networks. Mobilizers referred friends, sexual partners, and acquaintances to come to a designated health facility (an EPOA site) and receive HIV prevention and testing services. MSM clients could, in turn, become mobilizers and bring in new peers, reaching to craft more effective behavior-change messages for deeper and deeper into networks. The program was able clients. The quality of peer-to-peer and provider-to- to significantly expand service coverage. In addition to client interactions improved due to the training of staff providing monetary incentives for referrals, EPOA also on how to screen for risky behavior and how to apply provides tools to peer educators and health care providers motivational interviewing techniques to build rapport with 7

FFigureigure 6. C o6.nt Contributionribution to total H toIV ctotalases fo HIVund ( ncases=93) a mfoundong M S(n=93)M in Ang amongola by m etMSMhod use ind ,Angola Q1–Q4 FY by19 method used, Q1–Q4 FY19

2% 100% 17% 17% 20% 22% 19% 20% 27% 24% 33% 30% Walk-in PN* 80% 38% 50% 17% Walk-in EPOA site 20% 33% 13% 18% Hot Spot 60% 33% 13% GO 25% 33% 40% EPOA 40% 80% 81% 22% 67% 60% 55% * Walk-in PN: when the PN 50% 50% 48% at a large ART hospital 20% 38% screened all walk-in 33% 30% 22% patients for KP status and risk. 0% Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Overall

patients, making clients more likely to come back Figure 7. Trends in HIV testing and case finding among MSM in Figure 8. ART initiation for MSM in Luanda province by year for regular checkups and refer their sexual partners FigureLuanda p r7.ov Trendsince, Year in1–Y HIVear 4 (testingOctober 201 and5– Scaseeptem findingber 2019) and contacts. among MSM in Luanda province, Year 1–Year 4 EPOA was the largest contributor to HIV case finding (October 2015–September 2019) among MSM during Year 4 at 48%. Importantly, 24% 350 90.0% of the positive cases identified came to test at the 318 4500 4193 8.0% 79.6% 83.3% 7.1% 80.0% EPOA site as walk-ins (Figure 6)—patients who had 300 4000 3860 7.0% 69.5% already tested with the program at least once, tested 3651 6.6% 265 70.0% 3500 negative then, and returned on their own from 6.0% 250 225 60.0% several months to one year later to retest. MSM 3000 4.8% 5.0% 200 179 50.0% 2500 4.5%

EPOA was complemented by the work of online 4.0% MSM 2000 1883 150 40.0% peer educators who maintained professional 37.5% 3.0% 1500 1407 30.0% profiles on Facebook and reached out to other MSM 1191 100 890 2.0% online to offer HIV and STI services at the EPOA 1000 59 20.0% 6 50 41 site. The “Going Online” approach focused on 500 1.0% 10.0% 226 166 16 techniques to develop rapport with MSM clients in 16 43 93 6 0 0.0% 0 0.0% a private and confidential virtual space and then to FY16 FY17 FY18 FY19 FY16 FY17 FY18 FY19 successfully transfer that rapport to the EPOA peer Fisal ears Fisal ears educator and/or nurse in an offline space. The first HTS_POS TX_NEW ART Initiation Rate three months of implementing the online approach KP_PREV HTS HTS_POS Case-Detection Rate resulted in a 17% HIV case-finding rate, compared to 8% overall for the EPOA strategy. During the project, MSM had an average case-finding rate of 4%, 83% of whom initiated ART (Figures 7 and 8). 8

Figure 7. Trends in HIV testing and case finding among MSM in Figure 8. ART initiation for MSM in Luanda province by year Luanda province, Year 1–Year 4 (October 2015–September 2019) Figure 9. Trends in HIV testing and case finding among trans women in Luanda province, Year 1–Year 4 (October 2015–September 2019) Figure 8. ART initiation for MSM in Luanda Figure 9. Trends in HIV testing and case finding province by year among trans women in Luanda province, Year 1–Year 4 (October 2015–September 2019)

350 90.0% 318 4500 4193 8.0% 79.6% 83.3% 160 66.7% 70.0% 7.1% 80.0% 147 4000 3860 300 69.5% 7.0% 140 3651 6.6% 265 70.0% 60.0% 3500 6.0% 250 225 120 51.0% 60.0% 50.0% MSM 3000 4.8% 5.0% 200 179 50.0% 100 2500 4.5% 36.8% 40.0% 4.0% MSM 78 2000 1883 150 40.0% 80

37.5% TG 1407 3.0% 60 30.0% 1500 30.0% 60 1191 100 54 49 2.0% 1000 890 20.0% 20.0% 59 40 2.6% 38 50 41 500 1.0% 10.0% 24 25 226 166 16 10.0% 16 43 93 6 20 14 0 0.0% 0 0.0% 3 2 2 FY16 FY17 FY18 FY19 FY16 FY17 FY18 FY19 0 0.0% Fisal ears Fisal ears FY16 FY17 FY18 FY19 Fisal ears KP_PREV HTS HTS_POS Case-Detection Rate HTS_POS TX_NEW ART Initiation Rate KP_PREV HTS HTS_POS Case-Detection Rate

Transgender Women

Similar to the situation with MSM, LINKAGES provided Figure 10. ART initiation for trans women in Luanda province by year trans women with HIV prevention and testing services at hot spots and met with little success. By 2018, uptake of testing was only 12%, possibly because test- takers felt they were at high risk of being identified as HIV positive in the hot spot setting. 50 120.0% 43 After consultations between LINKAGES and trans 45 100.0% 74.4% 100.0% community leaders, a trans activist proposed to mobilize 40 her peers, both by phone and through home visits, to 35 75.0% 32 80.0% attend informal gatherings at a community center on 30 66.7% a monthly basis. The gatherings became a safe space 25 60.0% where they could discuss issues affecting their lives TG 20 18 beyond HIV, such as hormones, sex work, and gender 40.0% 15 12 identity. The meetings were attended by two nurses 10 who provided on-site HIV prevention (i.e., condoms, 20.0% 4 3 lubricant) and testing services. HIV testing uptake 5 2 2 climbed to 75%. The trust the nurses built with trans 0 0.0% FY16 FY17 FY18 FY19 women proved critical to increasing testing. The monthly Fisal ears group—which its members eventually named Women at Heart (Mulheres do Coração)—is recognized by the HTS_POS TX_NEW ART Initiation Rate most salient LGBTIQ organizations in Angola. During the LINKAGES Angola project, the average positivity rate for trans women was 39%, 74% of whom initiated ART Yuca Pimenta, trans activist who came up with the idea to mobilize (Figures 9 and 10). other trans women to monthly gatherings. Figure 9. Trends in HIV testing and case finding among trans women in Luanda province, Year 1–Year 4 (October 2015–September 2019)

160 66.7% 70.0% 147 140 60.0%

120 51.0% 50.0% 100 36.8% 40.0% 78 80 TG 60 30.0% 60 54 49 20.0% 40 2.6% 38 24 25 20 14 10.0% 3 2 2 0 0.0% FY16 FY17 FY18 FY19 Fisal ears KP_PREV HTS HTS_POS Case-Detection Rate

9

Figure 10. ART initiation for trans women in Luanda province by year

Figure 10. ART initiation for trans women in Policy Impact Luanda province by year LINKAGES Angola helped transform the health system and policy environment to be more inclusive of and 50 120.0% responsive to KPs. The following achievements were 43 45 100.0% 74.4% made at the policy level: 100.0% 40 35 75.0% 32 80.0% Strengthened the Contribution of CSO Data to the 30 66.7% Health Information System 25 60.0%

TG • LINKAGES led the development of a community 20 18 40.0% health information system (HIS) that was adopted 15 12 at the national level for use by CSOs. The HIS allows 10 20.0% clients, including KP HIV clients, tuberculosis-HIV 4 5 2 2 3 co-infected clients, and mother-child pairs, to be 0 0.0% followed along the continuum of services through FY16 FY17 FY18 FY19 the use of a unique identifier code for each client. Fisal ears A dynamic tool, it can be used by any organization HTS_POS TX_NEW ART Initiation Rate that provides community-level HIV services, enabling CSOs to provide evidence of their contributions to overall national HIV targets. The INLS uses aggregated data from the HIS to inform policy and proposals for funding, while the Ministry of Health, INLS, and ANASO (the national association of HIV “ I worked as a peer educator with nongovernmental organizations) are promoting the HIS for use in civil society moving forward. LINKAGES between 2016 and 2017, as a staff of Cuidados da Infancia CSO • LINKAGES also led the effort to develop a list of partner. My role was mobilizing other community service indicators, including those disaggregated by risk behavior and KP type, on which trans women to HIV prevention and all national and international CSO partners should testing services offered at hot spots. report, and obtained approval from the INLS for these But few of my peers accepted the indicators. All CSOs and NGOs delivering HIV-related services in the community are required to screen for services. They were afraid of a breach in risk (i.e., do you have sex with men, women, or both) confidentiality, and they did not want to and must also include FSWs, MSM, and trans people know about HIV. So LINKAGES sought in their data disaggregation during reporting. out my opinion. We talked a lot about Contributed to National Guidelines how we could get to them. I then had the idea of convening an empowerment • Following the 2017 PLACE study estimates, in 2018, the INLS updated the national STI guidelines to adopt group of trans women and mobilizing the World Health Organization’s recommendation them by doing home visits and phone to offer presumptive periodic treatment (PPT) of calls, Facebook. LINKAGES listened. chlamydia and gonorrhea to FSWs and routinely test them for syphilis as part of its standard of care. They paid attention to me. ” • LINKAGES led the development of a pocket-size Yuka Pimenta, trans peer educator and manual on Angola’s legal framework regarding founder of the trans women support group gender identity, sex work, and sexual orientation. Women at Heart Contributors included the Ministry of the Interior (police), the National AIDS Program, KP-led groups 10

and organizations, and a local legal counsel firm. Six thousand copies have been printed and distributed. Linkages across the • The national home-based care manual for people living with HIV and AIDS was updated to include messages Continuum of HIV Services on Undetectable = Untransmittable (U=U) and the peer for Key Populations Affected navigation model. by HIV (LINKAGES)

Formalized and Recognized Community-Based HIV Testing is a global cooperative agreement funded • LINKAGES worked with the INLS to ensure that by USAID through PEPFAR. Led by FHI 360 individuals trained as peer educators, lay HIV counselors, with partners Pact, IntraHealth International, or peer navigators received certification from the government to provide HIV-related services. and the University of North Carolina at

• CSOs are also now included in national HIV proficiency Chapel Hill, LINKAGES has worked in more testing supervision as a testing delivery point, alongside than 30 countries since 2014 to reduce health facilities. The relationship between CSOs and HIV transmission among key populations — health facilities for referral of patients previously tested in a community setting was formalized. sex workers, men who have sex with men, transgender people, and people who inject LINKAGES Legacy in Angola drugs — and to improve their enrollment and retention in care. After establishing the prevalence of HIV and STIs among KPs in Angola, LINKAGES Angola made significant strides toward reaching and connecting KP individuals to services that met their needs. It did so through its flexibility and use of innovative strategies and approaches that created a more enabling environment for service provision and uptake. Future progress toward HIV goals now rests with Angola’s government leaders and capable local CSOs.

This report is made possible by the generous support of the American people through USAID and PEPFAR through the terms of cooperative agreement #AID-OAA-A-14-00045. The contents are the responsibility of the LINKAGES project and do not necessarily reflect the views of USAID, PEPFAR, or the United States Government.

Suggested citation: LINKAGES. LINKAGES Angola: Summary of Achievements January 2015–September 2019. Durham (NC): FHI 360; 2019.

1 Ministério da Saúde (MINSA), Instituto Nacional de Luta contra a SIDA (INLS). V plano estratégico nacional de resposta às ITS-VIH/SIDA e hepatites virais 2015–2018: “zero é a nossa meta.” Luanda, Angola: MINSA, INLS; 2014.

2 Kendall C, Kerr LR, Mota RM, Cavalcante S, Macena RH, Chen S, et al. Population size, HIV, and behavior among MSM in Luanda, Angola: challenges and findings in the first ever HIV and syphilis biological and behavioral survey. J Acquir Immune Defic Syndr. 2014;66:544‑51.

3 Pinho A, Bastos FI, Sampaio CAM, Fernandes EC, Bertoni N, Albuquerque E, et al. Estudo de vigilância comportamental e serológica do VIH e sífilis (BSS) entre mulheres jovens envolvidas em sexo transaccional na zona da fronteira entre Angola e Namíbia. Luanda, Angola: Instituto Nacional de Saude Publica de Angola, Instituto Nacional da Luta contra Sida (INLS), FIOCRUZ, CDC; 2011.

4 Ministerio da Saúde-Instituto Nacional de Luta Contra a Sida (INLS). Relatório de progresso da resposta global à SIDA (GARPR, 2014) República de Angola. Luanda: Instituto; 2014.

5 For more information about EPOA, please see the LINKAGES Enhanced Peer Outreach Approach Implementation Guide.

6 For more information about online approaches, please see the LINKAGES document, Going Online to Accelerate the Impact of HIV Programs.