2nd HIV Capacity Building Partners’ Forum Johannesburg, South Africa 19 – 21 March 2013

1. Strengthening Capacity of Stakeholders to Negotiate 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

2. MSM/TG/SW Services: Does the Policy Environment Matter? An adequate response to the HIV epidemic should focus prevention efforts on key populations among whom the majority of new HIV infections are likely to occur (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 are affected by policies, including laws, codes, directives and operational procedures.

3. MSM/TG/SW Services: Does the Policy Environment Matter? • Policies are laws, regulations, guidelines, operational procedures, statutes, etc. that should improve health outcomes and human rights environment • Good policies have significant benefits to country ownership • 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

4. 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

5. 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

6. HPP/AMSHeR Policy Decision Model [DM] The DM is designed as an in-depth policy resource for analysis of the legal, regulatory, and policy environment related to men who have sex with men (MSM), Transgender persons [TG], sex workers (SW) and prison populations to uncover gaps in policy and practical challenges to policy implementation beyond criminalization Methodology layers health policy unto international human rights frameworks in order to produce nuanced, systematic, multi-sectoral findings to inform incremental policy advocacy and near-term improvements to HIV services

7. HPP/AMSHeR Policy Decision Model [DM] Over 1,100 points of policy analysis that impact services for HIV, STI, sexual and reproductive health and rights Addresses coordination of national and sub-national frameworks; community partnership; decision-making; authorisation to provide services; consent for testing and treatment; privacy and confidentiality; stigma and discrimination; criminalization; gender-based violence; etc Methodology layers health policy unto international human rights frameworks in order to produce nuanced, systematic, multi-sectoral findings to inform incremental policy advocacy and near-term improvements to HIV services

8. Policy Issues - Healthcare • National provisions addressing access to healthcare • Disaggregated coverage and outcome reporting requirements to include MSM/TG/SW in strategic plans • Government policies that define roles NGOs • Agency oversight of health services (public health vs. law enforcement) • Process to obtain identity papers that allow access to healthcare services • Consent requirements • Protections from mandatory/compulsory interventions • Confidentiality/reporting regulations • Protections for providers from workplace infection exposure and legal liability • Codes of conduct for professional organizations

9. Policy Issues - Law • National discrimination protections/guaranteed human rights • Process to obtain identity papers • Registration of birth and sexes • Legal definitions (Loitering, public indecency, public scandal, etc) • Legal representation and access to justice • Guidelines on admissibility of evidence of criminalized identities/ behaviors (harm reduction materials, etc) • Practices that promote corruption • Crime reporting • Medical evidence • Use of International Law

10. Required Technical Skills • The DM is designed with a training component on data collection methods and assessment procedures • Skills 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]

11. DM Output – Burkina Faso Table 1 – Synopsis of Policy environment in Burkina Faso in relation to key populations Key findings

12. Acknowledgement The MSM/TG/SW Policy Decision Model was developed by African Men for Sexual Health and Rights [AMSHeR] and Health Policy Project [HPP], funded by the USAID