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Transgender

HP+ More recent Transgender publications are available.

  • The Gender & Sexual Diversity Training was developed by the USAID- and PEPFAR-funded Health Policy Project, in coordination with a U.S. Government interagency team made up of members of the PEPFAR Key Populations Working Group and the PEPFAR Gender Technical Working Group. This version of the curriculum was developed specifically for PEPFAR staff and their country-level implementing partners to help country programs understand and address the needs of gender and sexual minority communities in the context of HIV programming, U.S. workplace policy on non-discrimination, and through a human rights lens.

  • In 2015, in order to examine the implications for key populations of reduced donor funding in Bangladesh and to provide guidance for future transitions, the USAID- and PEPFAR-funded Health Policy Project (HPP) conducted a desk review and 20 key informant interviews with civil society, local government, and international donors. The resulting case study offers lessons learned on how donors can ensure the resiliency of HIV programming for key populations while undergoing funding transitions.

  • In Barbados and Jamaica, the PEPFAR- and USAID-funded Health Policy Project (HPP) has delivered two-day stigma-reduction trainings to health facility staff. Adapted from a longer curriculum, the trainings comprehensively address stigma and discrimination by involving all health facility staff (including receptionists, pharmacists, nurses, and administration staff). HPP is also helping facility staff develop posted “codes of conduct” which outline the expectations for stigma-free services, regardless of HIV status, sexual orientation, or gender.

    The codes of conduct posters feature health facility staff photos and contact information for clients to report instances of discrimination. The codes of conduct are being rolled out across health facilities in Jamaica, Barbados, and other countries across the Caribbean.

  • The Blueprint for the Provision of Comprehensive Care for Trans People and Trans Communities in Asia and the Pacific (the Blueprint) is a document with far-reaching potential and applications in trans health and human rights in the region. The purpose of the Blueprint is to strengthen and enhance the policy-related, clinical, and public health responses for trans people in Asia and the Pacific. The primary audience for the Blueprint is health providers, policymakers and governments. The information within the Blueprint could also serve donors, bi- and multilateral organizations and trans and other civil society organizations.

    The Asia Pacific Transgender Network (APTN), the United Nations Development Programme (UNDP), and the USAID-funded Health Policy Project (HPP) collaboratively developed the Blueprint. This document is the third in a series of regional trans health Blueprints, and builds on what was produced in Latin America and the Caribbean by the Pan American Health Organization, the Regional Office of the World Health Organization for the Americas.

  • Condom and lubricant (C/L) programming is a critical element of an evidence-based HIV prevention package for sex workers (SW), men who have sex with men (MSM) and transgender (TG) people, populations bearing a disproportionate burden of HIV in Africa. Policy impacts lubricant availability and access.The USAID- and PEPFAR-funded Health Policy Project adapted the Policy Assessment and Inventory Decision Model methodology in Burkina Faso, Togo, and Kenya to assess policies that impact SW/MSM/ TG access to services, including C/L, against international standards and best practices. This poster presents the methods and results of the study, and was prepared for the 20th International AIDS Conference in July 2014.

  • Stigma and discrimination against people living with HIV (PLHIV) and key populations, such as sex workers and men who have sex with men, reduces access to critical services, adversely affects health outcomes, and undermines human rights. Legal services, however, are poorly resourced in low- and middle-income countries, and access is often limited to the wealthiest people.

    Drawing on lessons learned from other contexts, the Health Policy Project (HPP) collated international best practices, research on legal codes and systems in Ghana, and consultations with key stakeholders to determine approaches to monitoring discrimination. Using this information, the report the describes internet- and text message-based platforms for reporting HIV-related discrimination to the Commission on Human Rights and Administrative Justice (CHRAJ), providing a mechanism for civil society organizations to report cases to CHRAJ, track case progress, and use data on stigma and discrimination to guide future advocacy on HIV- and other related policies in Ghana.

  • As donor budgets for HIV have flat-lined, funding for HIV services and programming has decreased, particularly in countries with higher income status and concentrated HIV epidemics. To examine the impact of recent or ongoing PEPFAR funding transitions on key populations, the USAID- and PEPFAR-funded Health Policy Project (HPP) hosted a global consultation with key population civil society networks and developed case studies on PEPFAR’s transitions in four countries: Bangladesh, Botswana, China, and Guyana. The case studies offers lessons learned on how donors can ensure the resiliency of HIV programming for key populations while undergoing funding transitions.

    In addition, HPP developed the Readiness Assessment: Moving Toward a Country-led and –financed HIV Response for Key Populations. This guide is designed to assess the ability of a country’s stakeholders (including government, development partners, and civil society) to lead and sustain HIV epidemic control among key populations as donors transition to different levels and types of funding. The guide is a flexible tool that assesses readiness across four domains and focuses on the specific vulnerabilities of key populations.

  • Survey results in Dominica illustrated that key drivers of Stigma and Discrimination in health facilities (fear of HIV infection, negative attitudes and facility environment, including policy) are present across all levels of health facility staff, both medical and non-medical. HPP organized participatory analysis of the evidence and dissemination among health facility staff in order to promote reflection and to propel a sense of urgency to reduce stigma in the health setting. Baseline evidence provided a tool to motivate staff and policy makers to measurable improve services. Recommendations developed by the health care workers focus on a range of training suggestions including who, when, and how to strengthen capacity through training of health and auxiliary staff; and policy development strategies. They urged a call to action based on human rights and a professional obligation to provide equitable, quality services to all. The discussion and recommendations highlight the effectiveness of a participatory approach to data analysis to inform action. 

  • St. Kitts and Nevis is implementing an intervention package to achieve “stigma-free” HIV services. This brief summarizes the results from a survey of health facility staff to inform the intervention, and review of these data in a participatory workshop with health sector stakeholders. The National AIDS Programme is leading the implementation effort with technical support from the University of the West Indies (UWI) and the USAID- and PEPFAR-funded Health Policy Project (HPP). The package includes: a comprehensive survey of all health facility staff; training for health staff and NGO leaders on stigma reduction in health facilities; development of policies and facility Codes of Conduct to reduce HIV stigma; routine monitoring of stigma and discrimination; and where possible, tracking progress on treatment adherence and uptake of testing, treatment, and prevention. The package is part of a regional initiative led by the Pan Caribbean Partnership Against HIV/AIDS (PANCAP) and facilitated by HPP and UWI to apply a jointly agreed framework for effective stigma reduction in health facilities.

  • This two-day training was adapted from the USAID- and PEPFAR-funded Health Policy Project’s 2013 document, Understanding and Challenging HIV and Key Population Stigma and Discrimination: Caribbean Facilitator's Guide. The overall training objectives are

    1. To foster an understanding of how stigma and discrimination towards men who have sex with men and other key populations affects the HIV epidemic
    2. To increase understanding of the different identities of sexual minorities
    3. To increase understanding of how stigma and discrimination towards men who have sex with men impedes access to health services

  • In Jamaica, Woman Inc., with support from the Health Policy Project (HPP), implemented a pilot project to assess the feasibility of integrating screenings and referrals for gender-based violence (GBV) with clinical services for HIV and other sexually transmitted infections. The links between GBV and HIV are widely acknowledged, but relatively few people access services for GBV, especially women and key populations with high HIV burdens such as men who have sex with men and sex workers. The pilot project involved gender training for healthcare providers and community agencies, adaptation and implementation of a GBV screening tool, and mapping and strengthening of GBV referral systems. The findings, summarized in this brief, indicate that the pilot enhanced the capacity of HIV healthcare providers to improve access to GBV support services and better meet the needs of their patients, especially women and key populations.

  • Countries in West Africa (WA) have made significant progress in addressing the HIV epidemic. However, HIV prevalence among sex workers (SWs) and men who have sex with men (MSM) remains high, and data are unavailable for transgender (TG) populations. Services that meet the needs of SWs, MSM, and TG are often unavailable outside of major cities. Stigma and discrimination (S&D) against key populations impact service uptake and increase migration, making it harder to reach these populations. Policies—such as laws, national strategies, and operational procedures—impact service availability and uptake. To inform decisionmakers and improve access to HIV-related services for mobile SWs, MSM, and TG populations in West Africa, the USAID- and PEPFAR-funded Health Policy Project (HPP) conducted an analysis of key policies in countries along the Abidjan-Lagos corridor and Burkina Faso.

  • The PANCAP Stigma Framework was developed with assistance from the USAID- and PEPFAR-supported Health Policy Project in response to regional and national requests made to PANCAP for direction on responding to stigma and discrimination in the Caribbean. Stigma and discrimination continue to be key drivers of the Caribbean HIV epidemic and are major obstacles to effective responses. Their impact on Caribbean health and development is wide ranging. HPP provided technical and financial support for PANCAP partners with experience in reducing stigma and discrimination to review existing frameworks and Caribbean tools to inform the drafting of a comprehensive approach. A small group of technical experts from HPP drafted the initial framework to meet the needs of small countries, island states, and emerging nations. This framework has initially engaged and will serve to strengthen the capacity of national HIV programs to develop, implement, and monitor effective policies and programs, and to address HIV in a sustainable manner at the national level. The PANCAP Stigma Framework is built on three components, health and development, collective empowerment, and social justice and gender equality, which are crucial in addressing the Caribbean response to HIV-related stigma and discrimination. 

  • Males who have sex with males (MSM), transgender (TG) people, and sex workers (SWs) are at higher risk for HIV transmission than other individuals, even in generalized epidemics. Structural and policy issues have created barriers for MSM/TG/SW in seeking services and adopting individual and community harm reduction strategies. The Policy Analysis and Advocacy Decision Model for HIV-Related Services: Males Who Have Sex with Males, Transgender People, and Sex Workers, published by the Health Policy Project and AMSHeR (African Men for Sexual Health and Rights) with support from USAID and PEPFAR, is a collection of tools that helps users assess and address policy barriers that restrict access to HIV-related services for MSM/TG/SW. In 2012 and 2013, the Decision Model was applied in Burkina Faso and Togo. This brief presents the Decision Model and key policy findings.

  • The Policy Analysis and Advocacy Decision Model for Services for Key Populations in Kenya provides stakeholders—including policy makers, service providers, and advocates—with tools to assess and advocate policies that govern accessibility and sustainability of services for key populations (men who have sex with men, sex workers, people who inject drugs, and transgender people). By comparing existing Kenyan policies to the global normative guidelines and best practices, the model reveals gaps and challenges in implementation. This document, prepared by the USAID and PEPFAR-funded Health Policy Project for the National AIDS Control Council of the Ministry of Health, analyzes more than 120 policy and program documents related to HIV and key populations.  It also makes policy recommendations for enhanced service scale-up and uptake by key populations in Kenya. 

  • This USAID-funded assessment, conducted in Togo, is the second country application of the Health Policy Project (HPP) and African Men for Sexual Health and Rights (AMSHeR) Policy Analysis and Advocacy Decision Model for HIV-Related Services: Males Who Have Sex with Males, Transgender People, and Sex Workers (Beardsley et al., 2013). The current application of the Decision Model in Togo complements the pilot application conducted in 2012 in Burkina Faso. It was designed as an in-depth policy analysis of the legal, regulatory, and policy environment related to sex workers (SW), men who have sex with men (MSM), and prison populations in Togo to uncover gaps in policy and practical challenges to policy implementation. Beginning in June 2013, the HPP principal investigator, a legal expert from AMSHeR, and a team of local consultants conducted a document review and assessment. The team collected an inventory of 116 source policy and program documents and previous policy and program research related to HIV and/or key populations. Upon completion of the inventory, the team conducted 21 key informant interviews to examine the policy environment and assess dissemination and implementation of current policies, particularly gaps in dissemination and implementation that pose barriers to service access for key populations. The HPP policy analysis and key informant interviews confirmed that positive changes related to HIV prevention, care, and treatment are occurring in Togo. Initial steps are being taken to develop policies that recognize key populations and aim to improve access to services for them. Significant opportunities exist to further progress, including the USAID-funded Regional Project for the Prevention and Care of HIV/AIDS in West Africa (PACTE-VIH) and open support from the president of Togo and the permanent secretary for the National AIDS Council. However, critical gaps in policy, dissemination, and implementation remain and are highlighted in this report.

    Read the brief on this topic.

  • Over the past five years, the USAID- and PEPFAR-funded Health Policy Project (HPP) has worked in collaboration with global and country-level institutions to advance understanding and approaches to measuring and addressing HIV-related stigma. At the global level, HPP led efforts to review, prioritize, adapt, test, and synthesize existing measures and programmatic tools for stigma reduction in health facilities. This resulted in the development of a comprehensive package for “stigma free” health facilities (HPP, 2015). The package was piloted in several Caribbean countries,2 and offers a complete response to S&D in health facilities—from research to action. Its total facility approach targets all health facility staff, from doctors to cleaning staff.

    In an effort to facilitate further scale-up and refinement of these successful approaches, HPP convened an expert meeting in Washington, DC on June 3, 2015 to discuss and strategize a way forward to scale up S&D reduction efforts in health facilities. These discussions yielded valuable insights and recommendations, which are presented in this brief.

  • Stigma and discrimination (S&D) remain critical barriers to achieving HIV prevention, care, and treatment targets, including zero new HIV infections and zero AIDS-related deaths. In Jamaica and elsewhere in the Caribbean, S&D falls hardest on key populations, including men who have sex with men (MSM) and sex workers (SW) and undermines access to testing and treatment.

    The Key Population Challenge Fund (KPCF) project aimed to improve the quality of and access to stigma-free HIV testing and counseling (HTC) services for key populations. Through this initiative, the Health Policy Projected (HPP) implemented a stigma-reduction toolkit for facility-based healthcare providers. Project outcomes included cultivating an enabling environment for key populations and the development of facility-level codes of conduct.

  • In the Caribbean, transgender persons are disproportionately affected by HIV. Moreover, high levels of stigma and discrimination create significant barriers and make it difficult for them to access the health care services they need. Most clinicians in this region also do not receive any training on transgender health or broader issues of sexuality and diversity, further limiting availability of transgender-friendly services.

    In response, HPP has developed a training manual for healthcare workers in Jamaica, Barbados, and the Dominican Republic to strengthen their capacity to provide high-quality, stigma-free health services for transgender persons. This brief highlights key content from each of the chapters contained in the manual.