Part (1) Integrating HIV & STI Programs in LGBTIQQ, MSM, WSW, Sexuality, Gender, Orientation, Health and Wellness plans (Part 1)

You are an LGBT-Living with HIV or HPV, you have been asked to attend a Global Fund Planning meeting. This meeting is convened after realizing the umbrella organization which was identified to manage the funds did not have an inclusion plan.

Ask yourself, what would be the best parameters to frame your needs and therefore move toward problem solving.

The answer lies in:

Human rights:

Acceptability of services is a key aspect of effectiveness

Health literacy

Community empowerment

Three zero’s

Sexuality, Gender, Orientation and health

Guiding principles for implementing comprehensive HIV and STI programs

Several principles underlie the 2011 Recommendations and 2014 Key Populations Consolidated Guidelines and the operational guidance given in this publication. These principles are described in the 2014 Key Populations Consolidated Guidelines (pp.11–12). They may be summarized as follows:

Human rights: 

Protection of human rights for all members of each key population. Legislators and other government authorities should establish and enforce anti discrimination and protective laws, derived from international human-rights standards, in order to eliminate stigma, discrimination and violence faced by key population groups and to reduce their vulnerability to HIV. Access to quality health care is a human right. It includes the right to appropriate quality health care without discrimination. Health-care providers and institutions must serve beneficiaries based on the principles of medical ethics and the right to health. Health services should be accessible to all. HIV programmes and services can be effective only when they are acceptable and high quality and widely implemented. Poor quality and restricted access to services will limit the individual benefit and public-health impact of the recommendations contained in this guidance document. Access to justice is a major priority for key populations, due to high rates of contact with law enforcement services and the current illegality of their behaviours in many countries. Access to justice includes freedom from arbitrary arrest and detention, the right to a fair trial, freedom from torture and cruel, inhuman and degrading treatment and the right, including in prisons and other closed settings, to the highest attainable standard of health. The protection of human rights, including the rights to employment, housing and health care, for key populations it requires collaboration between healthcare and law-enforcement agencies, including those that manage prisons and other closed institutions. Detainment in closed settings should not impede the right to maintain dignity and health.

Acceptability of services is a key aspect of effectiveness:

Interventions to reduce the burden of HIV must be respectful, acceptable, appropriate and affordable to recipients in order to enlist their participation and ensure their retention in care. Services delivery must often employ appropriate models of service delivery with expertise in HIV. There is a need to build service capacity on both fronts. Services that are acceptable are more likely to be used in a regular and timely way. Consultation with organizations led by and including community outreach workers in service delivery are effective ways to work towards this goal. Mechanisms of regular and ongoing feedback from beneficiaries to service-providers will help inform and improve the acceptability of services.

Health literacy:

A lack  of sufficient health and treatment literacy, may hinder decision-making on HIV risk behaviours and their health-seeking behaviour. Health services should regularly and routinely provide accurate health and treatment information. At the same time health services should strengthen providers’ ability to prevent and to Integrate service provision: Multiple co-morbidities and poor social situations for example, HIV, viral hepatitis, tuberculosis, other infectious diseases and mental health conditions are often linked to stress associated with persistent social stigma and discrimination. Integrated services provide the opportunity for patient-centred prevention, care and treatment for the multitude of issues. In addition, integrated services facilitate better communication and care. When integration is not possible, strong links among health services should be established and maintained.

Community empowerment:

Community Empowerment means empowering and supporting self help groups to address for themselves the structural constraints to health, human rights and well-being that they face, and improve their access to services to reduce the risk of acquiring HIV. Community empowerment is an essential approach that underlies all the interventions and programme components described in this tool, and is inseparable from them. Community participation and leadership in the design, implementation, monitoring and evaluation of programmes are also essential. Participation and leadership help to build trust with those whom programmes are intended to serve, make programmes more comprehensive and more responsive to needs and create more enabling environments for HIV prevention.

Three zero’s:

Key population groups should be empowered to plan activities that lead to zero deaths by HIV; zero stigma; and zero discrimination. This will help align downstream plans with what is taking placing at the upstream.

Sexuality, Gender, Orientation and health:

These themes are recurring and affect the way key populations interact or seek social services in situations that are stigmatizing and discriminatory. Key populations should be empowered to examine and articulate the sexuality, gender, orientation and health needs with the goal for quality life and wellness.