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Beyond the Gender Binary: Gender and Sexual Diversity Training on HIV

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Download the GSD Training Curriculum and Facilitation Guide

By Ryan Ubuntu Olson 

This piece was originally posted in the Linkages December 2016 newsletter (PDF).

Gender and sexual minorities (GSM) are treated unfairly in almost every society. Violence, stigma, and discrimination directly affect their health and interfere with access to health services, including HIV-related prevention, care, and treatment.

In 2014, the Health Policy Project (HPP), in coordination with a U.S. government interagency team, developed a training aimed at sensitizing staff of the President’s Emergency Plan for AIDS Relief (PEPFAR) and their implementing partners in 38 countries to issues pertaining to the health and rights of GSM.

GSM are a significant percentage of key populations at risk of acquiring HIV and, given the evolving climate around these issues, PEPFAR leadership believed that sensitizing their staff would help the agency reach its 90-90-90 goals. In response, the HPP team developed four modules to be delivered over the course of a working day. The training is provided from a rights-based perspective, but with humility, because we realize that there are myths, misconceptions, prejudices, and outright discrimination and violence facing GSM in all countries around the world, including our own.

The first module explores U.S. government policies related to gender and sexual diversity (GSD), as well as the instrumental part that gender roles play in driving actions and perceptions. The second module takes a deeper look at GSD concepts and terminology, especially as they apply to the workplace and PEPFAR programming. The third and most powerful module introduces participants to local GSM advocates and legal experts within their community, giving them the chance to explore GSD concepts in their own context. The final module then asks participants to apply their recently acquired knowledge to their PEPFAR work and to commit to proactively and meaningfully improving the impact they make in the lives of GSM.

A core pillar of the training is to expand beyond traditional, binary expectations of women and men in PEPFAR programming. As Sam Killerman explains in The Social Justice Advocate’s Handbook A Guide to Gender1 —on which much of the GSD training is based—“gender binary” is a rigid model of gender that classifies all people into one of two distinct gender archetypes. To illustrate how limiting a gender binary worldview is, the training draws upon participant experiences using four key concepts placed on a continuum—biological sex, gender expression, gender identity, and sexual orientation—because all people have these qualities, not just GSM.

By expanding the worldview of PEPFAR staff and implementing partners beyond a binary construction of gender, the training helps participants (1) move beyond the traditional ways gender has been applied to programmatic responses addressing the HIV epidemic for key populations and (2) build better programmatic solutions that address the health and rights of all people. The training also helps participants develop a broader knowledge base with which to support effective policies and robust policy advocacy efforts by civil society organizations and other key stakeholders. 

We delivered this training to a diverse range of PEPFAR staff and their implementing partners across language barriers, cultures, and other distinct variables. The power of the training has resonated with many people around the world. “The training helped clarify my role as USAID staff to make a change in the inclusion of GSM in programs. I gained knowledge of what to transfer to USAID implementers vis-à-vis that community,” said a participant from Mozambique. Research conducted on the training concluded that it produced sustained changes in attitudes about GSM and had an impact on both PEPFAR programming and conduct in the workplace. 

As a result, we can see the potential outcomes of this work. GSM, especially those represented within key populations, will be more thoughtfully targeted in PEPFAR’s HIV response, and we expect to see this lead to better health outcomes and contribute to the ultimate goal of ending the HIV epidemic. The training also helps deepen the understanding of how existing policies harm GSM and must be changed to create a policy landscape that affirms the health and rights of all people. This not only includes addressing laws criminalizing same-sex sexualities and gender nonconforming people, but also the numerous peripheral policies that determine access to health services, education, housing, and labor.

We can also see how expanding the conception of gender beyond traditional binary thinking can affect programmatic responses, whether working with key populations, women and girls, men and boys, or a combination of them all through gender synchronist approaches. These impacts can and will range from the enabling environments that govern programs to the very clinics where direct prevention, care, and treatment services are provided. This means that in some cases GSM will have unique interventions to fit their specific needs, and in other cases, programs that target broader populations will account for the diverse range of individuals they serve.

As the GSD trainings move forward under the Health Policy Plus (HP+) project, we will adapt the training in two significant ways. More PEPFAR staff will now be able to receive the training via a blended learning approach that combines an online component with in-person training. HP+ is also adapting the training to two different country contexts in Jamaica and Kenya using specific data points, anecdotes, and examples from those regions, ensuring that stakeholders in these countries are even more sensitized to GSD issues faced by minorities in their own country.

It’s been a privilege to deliver the gender and sexual diversity trainings to a wide variety of professionals around the world. After each session, I’m struck with how participants challenged their basic assumptions and their approaches to the PEPFAR programs they support and the policy environments in which they work. In the most recent training I co-facilitated at the headquarters of USAID’s Office of HIV and AIDS, one participant remarked, “I’ll work to remember that gender is not binary. We need to work to make sure that people of all gender identities, sexual orientations, and sexes are equally able to access our services.”

What this training ultimately demonstrates is that when we reexamine some of our most basic assumptions, powerful ways to reimagine meaningful responses to the HIV epidemic are not only possible, but found all around us.

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