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Strengthening Capacity of Stakeholders toNegotiate the Complex Policy Environment for MSM/TG/SW Services 2nd HIV Capacity Building Partners’ Forum Johannesburg, South Africa 19 – 21 March 2013 African Men for Sexual Health and Rights [AMSHeR] www.amsher.net
MSM/TG/SW Services: Does the Policy Environment Matter?An adequate response to the HIV epidemic shouldfocus prevention efforts on key populations amongwhom the majority of new HIV infections are likely tooccur (Wilson and Challa 2009. Sarkar, Menser et al.2009. UNAIDS 2007).Availability, accessibility and adequacy of prevention,care and treatment services for MSM/TG/SW areaffected by policies, including laws, codes, directivesand operational procedures.
MSM/TG/SW Services: Does the Policy Environment Matter?Policies are laws, regulations, guidelines, operationalprocedures, statutes, etc. that should improve healthoutcomes and human rights environmentGood policies have significant benefits to countryownership • Give authority and provide legitimacy and permission • Provide stability and consistency • Shape practice and programs • Inform and teach • Create consensus and provide a framework for collaboration
Importance of multi-level assessment of policies Multi-sectoral policies that impact services or exposure to high-risk environments Direct impact on health HIV, STI, Primary Care, etc Indirect impact on health Gender, Education, etc Environments that MSM interact with because of criminalized status Police [Law Enforcement], Prison, Judiciary, etc Environments where MSM/TG/SW behaviors take place Labour, Commerce/Transportation, Immigration/Migration, Prison, Military/Uniformed Services, etc
Importance of multi-level assessment of policies National/local/operational Legislation—Parliament National Strategic Plans and Policies—Executive Branch Regulations—Line Ministries and Departments Local authority by-laws Case Law—Legal precedent and judicial findings Guidelines and Protocols—Professional associations, international organizations such as WHO Operational Plans—local implementation details Institutional SOP and client management systems
HPP/AMSHeR Policy Decision Model [DM]The DM is designed as an in-depth policy resource foranalysis of the legal, regulatory, and policyenvironment related to men who have sex with men(MSM), Transgender persons [TG], sex workers (SW)and prison populations to uncover gaps in policy andpractical challenges to policy implementation beyondcriminalizationMethodology layers health policy unto internationalhuman rights frameworks in order to producenuanced, systematic, multi-sectoral findings to informincremental policy advocacy and near-termimprovements to HIV services
HPP/AMSHeR Policy Decision Model [DM]Over 1,100 points of policy analysis that impact services forHIV, STI, sexual and reproductive health and rightsAddresses coordination of national and sub-nationalframeworks; community partnership; decision-making;authorisation to provide services; consent for testing andtreatment; privacy and confidentiality; stigma anddiscrimination; criminalization; gender-based violence; etcMethodology layers health policy unto internationalhuman rights frameworks in order to produce nuanced,systematic, multi-sectoral findings to inform incrementalpolicy advocacy and near-term improvements to HIVservices
Policy Issues - HealthcareNational provisions addressing Consent requirementsaccess to healthcare Protections fromDisaggregated coverage and mandatory/compulsoryoutcome reporting interventionsrequirements to includeMSM/TG/SW in strategic plans Confidentiality/reporting regulationsGovernment policies thatdefine roles NGOs Protections for providers from workplace infection exposureAgency oversight of health and legal liabilityservices (public health vs. lawenforcement) Codes of conduct for professional organizationsProcess to obtain identitypapers that allow access tohealthcare services
Policy Issues - LawNational discriminationprotections/guaranteed Guidelines on admissibilityhuman rights of evidence of criminalized identities/ behaviors (harmProcess to obtain identity reduction materials, etc)papers Practices that promoteRegistration of birth and corruptionsexes Crime reportingLegal definitions (Loitering,public indecency, public Medical evidencescandal, etc)Legal representation and Use of International Lawaccess to justice
Required Technical SkillsThe DM is designed with a training component ondata collection methods and assessment proceduresSkills required for the assessment teams include - HIV field research specialist Public health specialist/advisor A lawyer, experience on key populations Key populations technical advisor Sociologist, experienced in key population research 2 Research assistants [MSM/SW]
DM Output – Burkina FasoTable 1 – Synopsis of Policy environment in BurkinaFaso in relation to key populationsKey findings
AcknowledgementThe MSM/TG/SW Policy Decision Model wasdeveloped by African Men for Sexual Health andRights [AMSHeR] and Health Policy Project [HPP],funded by the USAID