PULSE Initiative Update

Dear PULSE Stakeholder,

With APCOM’s PULSE initiative passing a series of important milestones, we’d like to give you an update about how this key project is progressing.

Overview

The PULSE initiative is a three-year research, advocacy and capacity building project aimed at improving HIV education and services targeting young men who have sex with men (MSM) in the greater Mekong region of South East Asia. The project is led by Asia Pacific community network APCOM in partnership with community organisations, researchers and health authorities in Cambodia, Myanmar, Lao, Thailand and Vietnam. The project is funded by French 5% Initiative on AIDS, Tuberculosis and Malaria implemented by Expertise France under Ministry of Foreign Affairs oversight. APCOM’s country partners for the project are KHANA (Cambodia), LaoPHA (Lao PDR), MYS (Myanmar), RSAT (Thailand) and VNMSMTG (Vietnam).

Background

HIV is a rising threat to the health of men who have sex with men (MSM) right across Asia, with MSM on track to account for more than half of the 300,000 new HIV transmissions per year that researchers expect to occur in the region by 2020. Young MSM between the ages of 15 and 24 account for tens of thousands of these new cases every year. The estimated prevalence of HIV in young MSM under 25 years of age in Cambodia, Laos PDR, Myanmar, Thailand and Vietnam is 0.6%, 0.9%, 4.6%, 11% and 10% respectively. Young MSM are particularly vulnerable to HIV with low levels of HIV education, condom use and HIV testing. Many young MSM also have limited access to HIV services and increased opportunities for sex through online dating. However, the full picture about young MSM and HIV in Asia remains unclear due to a lack of recent and high quality epidemiological and behavioural data for young MSM. Also, young people are increasingly living their lives online but long-established data sets used by HIV researchers don’t capture this new reality. All these factors limit the effectiveness of HIV responses targeting young MSM in Southeast Asia, especially programmes using digital communications.

Program Goals

The overarching goal of the PULSE initiative is to contribute in reducing HIV risk behaviours and prevent the escalating HIV epidemic among the young MSM population in the sub-region, by:

• developing and successfully implementing a multi-year survey to collect new epidemiological and behavioural data on young MSM aged 15-24 years old across four (4) countries in the greater Mekong sub-region (Cambodia, Lao PDR, Thailand and Vietnam).
  
  
• using the survey findings to improve the HIV response for young MSM by developing evidence-based advocacy priorities for country partners and APCOM, informing policies and programs at the regional and national level, and providing evidence to key international stakeholders, such as the Country Coordinating Mechanisms and Global Fund for future programs for young MSM.
  
  
• building the capacity of community organisations in the Greater Mekong sub-region, particularly to collect research evidence and use it effectively in their advocacy, policies and programs.

Program Objectives

The specific objectives are to:

• Conduct a 3-wave epidemiological and behavioural survey among young MSMs aged 15-24 living in in Cambodia, Lao PDR, Thailand, and Vietnam. The surveys will:
  
  
  • characterize the population of young MSM aged 15-24 who will be recruited through the survey in Cambodia, Lao PDR, Thailand and Vietnam; and estimate the prevalence of HIV in this population;
    
    
  • describe the situation and needs of young MSM in terms of HIV prevention, HIV testing, uptake of PEP and PrEP, and HIV treatment; this includes characterizing the HIV treatment cascade in the context of the participating countries;
    
    
  • identify factors and contexts that potentially shape young MSM condom use, testing for STIs and contribute to effective management of HIV among HIV positive participants; including factors relating to homophobia and HIV stigma;
    
    
  • identify potential differences between countries in selected core indicators of condom use, HIV testing, uptake of PEP and PrEP, HIV prevalence and HIV treatment
    
    
  • if changes are observed over time, to monitor potential trends in selected core indicators of condom use, HIV testing, uptake of PEP and PrEP, HIV prevalence and HIV treatment.
    
    
  • to derive recommendations in terms of priority actions targeting young MSMs in 4 Greater Mekong countries (Cambodia, Lao PDR, Thailand and Vietnam) and overall.
    
    
• Fill in the strategic information gaps of the epidemiological and behavioural data of young MSM aged 15-24 using the Internet in Cambodia, Lao PDR, Thailand, and Vietnam, including among those who live outside urban centres;
  
  
• Increase awareness of Civil Society, Country Coordinating Mechanisms (CCM), Global Fund Country Teams and Ministries of Health in Cambodia, Lao PDR, Myanmar, Thailand and Vietnam on the different specific needs of young MSM aged 15-24 in relation to:
  • HIV prevention, testing, treatment, care, and support;
  • New and innovative approaches in reaching young MSM
    
    
• Conduct a rapid assessment with the country partners and strengthen their capacity utilizing a capacity development plan in the following areas:
  • Governance
  • Program and Finance
  • Advocacy Capacity
  • Membership
  • Strategic Information, especially in relation to the results of the research
  • New and innovative prevention approaches
  • Human rights and legal environments

Recent Achievements

APCOM, in collaboration with our country partners, has made substantial progress in implementing PULSE over the last 12 months:

• Wave 1 of the PULSE survey launched on 30 March 2018 in Cambodia, Lao PDR and Thailand. The survey closed on 31 May 2018. In total, 2865 young MSM completed the survey: 1477 in Thailand, 769 in Cambodia and 619 in Lao PDR. Data analysis is underway. The survey was widely promoted by APCOM (in English) and Country partners (in local languages) through social media (e.g. Facebook, private and public chat groups), dating apps, online influencers and ‘offline’ community events.
  
  
• Mapping of online actors and venues popular with young MSM in each respective country was completed in late 2017. This provided critical information for the promotion of the survey in each country.
  
  
• Pilot testing of the survey tool was conducted with young MSM in Cambodia, Lao PDR, Thailand and Vietnam in February - March 2018. Pilot testing provided valuable feedback on the survey, validated the online mapping and provided insight into the most appropriate incentives for participation.
  
  
• The summary protocol, survey tool, consent form, and focus group discussion guide were finalised and project approval was obtained in Cambodia, Lao PDR, Vietnam and Thailand. Myanmar received preliminary approval from Ministry of Health and Sports in August 2018, allowing for submission to a national ethics committee.
  
  
• The 2nd Regional Community Advisory Group (CAG) was successfully held in November 2017 during APCOM’s RRRAP summit, bringing together country and technical partners to discuss the implementation of PULSE, review the draft survey and workshop difficulties. In country inception (or consultation) meetings were also held in Myanmar (Yangon in December 2017), Lao PDR (Vientiane in January 2018) and Cambodia (Phnom Penh in November 2018). In Vietnam, this meeting was conducted as a series of stakeholder meetings in Ho Chi Minh City and Hanoi, as the product did not have formal approval through VUSTA.
  
  
• APCOM held official stakeholder meetings with 24 organisations in Cambodia, Lao PDR, Myanmar and Vietnam, with additional stakeholder meetings in-country by country partners. In addition, APCOM has had conversations to start collaborations with UNAIDS, Youth Lead and UNICEF, for example for the 3rd CAG.
  
  
  
  
• Several formal and informal capacity building activities were held. For example:
  • capacity assessments were conducted for all five country partners using APCOM’s Rapid Assessment Apparatus (RapApp).
    
    
  • sub-recipients attended APCOM’s RRRAP summit, a capacity strengthening and knowledge sharing event.
    
    
  • the 3rd Regional CAG meeting was held in June 2018, co-sponsored by UNICEF, to build the capacity of the country partners and young MSM to understand and use data for evidence-informed advocacy. The meeting also included pre-planning for the next waves of the survey, by drawing out the lessons learned from implementation to date.
    
    
  • in-country activities including trainings on financial management and reporting, effective communication, advocacy and online platforms.
    
    
  • APCOM provided significant technical assistance in-person and remotely across, for example, reporting, financial management, research approvals, pilot testing, promotions and data collection.
    
    

• Agreements with sub-recipients were finalised for years 1 (1 May 2017-30 April 2018) and 2 (1 May 2018 – 31 March 2019) in the last year. Agreements for year 3 will be negotiated in early 2019. A new Agreement with Myanmar Youth Stars for a reduced scope of work is pending the confirmation of reprogramming.
  
  
• The inaugural Scientific Advisory Committee (SAC) Meeting was held in August 2018. The SAC is intended to help ensure the scientific rigour of the research component by providing a “brain’s trust” of experts from the Greater Mekong sub-region. The work of the SAC complements the Community Advisory Group / Coordinating Advisory Group (CAG), which has broader representation from community and key stakeholders to support the overall conduct of the project.

Major Upcoming PULSE Activities

• Analysis of the data is in progress and preliminary results will be presented to key stakeholders on the national and regional level. These meetings are anticipated to be held across the region in the coming months.
• We anticipate the next wave of the survey will begin at the end of the year in the 4 countries.
  
  

Lessons Learned

• The data on participation and completion in the online survey demonstrates the acceptability and feasibility of the online-only survey format to sample young MSM, particularly in Lao PDR and Cambodia where online surveys have not been used extensively (in contrast to Thailand and Vietnam). It has further demonstrated the capacity of community based organisations to conduct research.
  
  
• The experience in promoting the survey to this group of young MSM in this first wave has provided crucial information on effective promotions and engagement strategies and has significantly strengthened the capacity of our country partners to effectively promote the survey in subsequent rounds. Indeed, as the survey was open for 9 weeks and as participation was monitored weekly, we were able to proactively improve the promotion strategy. Whilst online dating apps were cited as a venue popular with young MSM, and while the responses in terms of click throughs were high, dating app advertising did not appear to translate to survey completion. In contrast, offline advertising in Cambodia and Lao PDR was quite effective, and social media influencers were incredibly effective in Thailand. We aim to use this information to improve the subsequent waves of the survey and wave 1 of the survey in Vietnam.
  
  
• Engagement from government and other key stakeholders has been positive to date. Indeed, while there was initially skepticism of the online only format Lao PDR (and other countries) expressed during the inception and stakeholder meetings in January 2018, during offline promotion events in April 2018 CHAS was keen to learn from the online format with a view to improving their own data collection (e.g. IBBS).
  
  
• The improvements in the capacity of sub-recipients across reporting, financial management, project management, preparing for, understanding and conducting research, and promotions and communications, has been significant over all. For example, sub-recipients led the approvals processes in their respective countries. This was a new activity and skill for most of the sub-recipients and also APCOM. APCOM provided significant technical assistance to support our partners. While the approvals may have taken longer than anticipated they contributed to ownership and understanding of the project, and capacity to take on similar projects in the future.
  
  

Links

PULSE Program Promotional Brochure

PULSE Program Launch Media Release

PULSE Survey Launch Media Release

Please let me if you have any questions of concerns in relation to our PULSE programme.

Kind regards

Midnight Poonkasetwattana

APCOM Executive Director

+66 853 605 200 | [email protected]

Skype: midnight.poonkasetwatana