In Peru, access to HIV treatment has improved in recent years, however, services are not always easy to access for all people who need them.  Notably, the HIV epidemic tends to be concentrated among key populations and socially disadvantaged sectors. One such vulnerable group is the approximately 1.1 million refugees and migrants from Venezuela living in Peru. There has been little known about the rates of HIV in this population and the number of people who may have interrupted medical treatment due to migration.

Like most countries, Peru’s health system has been hard hit by the COVID-19 pandemic. This has also impacted Peru’s HIV national response, threatening previous progress, and making it more difficult to ensure continuous access to HIV treatment.  The pandemic highlighted the fragilities of the Peruvian health system, which did not have the necessary capacity to contain the COVID-19 transmission of cases at the first level of care or sufficient hospital beds and specialists to manage and treat severe cases. Gaps remain in case surveillance, laboratory capacity, standardization of case management, and attention to other health priorities. And challenges remain in providing access to comprehensive HIV services for all, while tackling stigma and discrimination.

Approach

Using a health systems approach, LHSS provided technical assistance to the Government of Peru to:

• Improve the availability of comprehensive, high-quality HIV services for Venezuelan migrants in Peru and support planning for cross-border continuity of HIV care for migrants.
• Accelerate widespread and equitable access ‎to and delivery of safe and effective COVID-19 ‎vaccinations to reduce morbidity and mortality while strengthening health system capacity to prevent, detect, and respond to pandemic ‎threats.
• Strengthen care and support networks for LGBTQI+, migrants and nationals.
• Strengthen the MOH capacity to communicate appropriate MPOX information to vulnerable populations and respond to the MPOX emergency at the national and subnational levels.

Key Achievements

• LHSS worked with officials in Ayacucho and Huánuco regions to develop preparedness and response plans for future respiratory virus epidemics. The plans were presented by the Ministry of Health to all the health directorates, as a model for developing their own plans.
• LHSS supported UNAIDS, the HIV programs of Chile, Colombia, Ecuador, and Peru, and other stakeholders in developing a road map that would make it possible to share data and facilitate continuity of care for migrants with HIV along the migration route. 
• LHSS worked in close collaboration with the Directorate of Prevention and Control of HIVAIDS, Sexually Transmitted Diseases and Hepatitis (DPVIH) of the MOH, along with implementing partners, government officials, universities, and other stakeholders to draft and promote a bill that would allow migrants and refugees living with HIV or TB in Peru access to comprehensive health insurance (SIS). This law, once approved, will remove financial barriers currently preventing these vulnerable populations from accessing all the health services they need. 

• With the support of a grant from LHSS, the Universidad Peruana Cayetano Heredia created the Peruvian Observatory of Migration and Health (OPEMS), an online resource dedicated to the collection, systematization and dissemination of health data on migration. The site also provides a space for migrants to find information about organizations that can help them with specific issues. The Ministry of Health will continue to provide data to the Observatory, supporting its long-term sustainability.

• Working with the regional health directorates of La Libertad and Loreto and affected populations, LHSS helped the MOH develop regional-level guidance to strengthen capacity to respond to the MPOX epidemic.
• LHSS grantee, CONACCION worked with government to successfully co-develop and co-implement a communication campaign to prevent MPOX in high-risk populations, such as MSM and men living with HIV, including Venezuelan migrants. The campaign included the dissemination of MPOX prevention messages in Iquitos, La Libertad, and Lima, reaching nearly 600,000 people.
• LHSS grantee, PROMSEX, provided training for health personnel and community-based organizations to provide care to LGBTQI+ migrants and nationals in Lima, Piura, and Trujillo. They also strengthened community-based organizations’ support to LGBTQI+ migrants and non-migrants by linking them to health services, human rights protection services, attention to survivors of gender-based violence, and immigration services.

The LHSS activity in Peru was completed in October 2023.