Welcome to the Publication Archives of USAID-funded Health Policy Projects.

Browse Health Policy Project (2010-2016) Materials

↑ top


Files will load from www.healthpolicyproject.com.

List entries are alphabetical by title and contain the title, abstract, and then the filename which is hyperlinked and will open in a new browser window. Most files are PDFs. There may be multiple files per abstract.

People who Inject Drugs

HP+ More recent People who Inject Drugs publications are available.

  • 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.

  • There is considerable uncertainty surrounding key population size and HIV prevalence estimates in Tanzania. To address this data gap, the USAID- and PEPFAR-funded Health Policy Project (HPP), the Ministry of Health and Social Welfare, and the Tanzania Commission for AIDS held a one-day workshop in Dar es Salaam in April 2014 to discuss and reach consensus among key stakeholders on key population estimates for mainland Tanzania. A Delphi method was used to seek consensus on the estimated size of and HIV prevalence among the three key populations in Tanzania: female sex workers, men who have sex with men, and people who use/inject drugs. The workshop processes and outcomes are summarized in this report. 

  • 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.

  • Effectively capturing and reporting discrimination data can help an organization or government administration gauge the level of discrimination in a country and ensure effective responses. However, there is currently no standard design for a discrimination monitoring and reporting system. In this report, the Health Policy Project brings together known international best practices; research on relevant, existing legal codes and systems in Ukraine; and information from consultations with key stakeholders to determine priorities and approaches for monitoring discrimination. The project also documents a process for defining the scope and scale of a potential system, which both incorporates these best practices as well as considers local needs, resources, and policy environments. The report serves as the beginning of a conversation on monitoring, reporting, and resolving cases of discrimination for vulnerable populations.

  • HPP received funding to work in three countries in the Central Asia Region (CAR)—Kazakhstan, Kyrgyz Republic, and Tajikistan—to support and strengthen collaboration and coordination between nongovernmental organizations (NGOs) and governments working together to identify linkages and referral protocols for HIV-related health and social services. This desk review and analysis is intended to provide a detailed review of recently published assessment reports (2007–2012) conducted in Kazakhstan, Kyrgyz Republic, and Tajikistan to serve as a resource for USAID (CAR) and other groups interested in identifying priority HIV policy areas.

  • This brochure provides an overview of a web-based platform that civil society organizations in Ghana can use to report cases of discrimination to the country's Commission on Human Rights and Administrative Justice (CHRAJ). The system, developed with support from the USAID- and PEPFAR-funded Health Policy Project, links civil society to CHRAJ through case tracking, follow-up, and data reporting. The brochure provides information on why someone would submit a complaint, how to submit a complaint, and how to follow up on a complaint. It is meant solely for informational purposes. Step-by-step guidance on how to use the system is provided by the Discrimination Reporting System User Guide.

  • The Discrimination Reporting System User Guide outlines how civil society organizations in Ghana can use a web-based platform to report cases of discrimination to the country's Commission on Human Rights and Administrative Justice (CHRAJ). The system, developed with the support of the USAID- and PEPFAR-funded Health Policy Project, links civil society to CHRAJ through case tracking, follow-up, and data reporting. The user guide provides civil society organizations with a visual description of how to navigate the online system, submit complaints on behalf of clients, track the progress of complaints, and generate reports. It will be distributed to civil society organizations in Ghana that support people living with HIV and key populations.

  • 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.

  • The Harm Reduction Expenditure Tracking Tool assesses total and unit expenditure in-country over two fiscal years for needle and syringe exchange programs (NSPs) and opioid substitution therapy (OST). The user guide provides step-by-step instructions for using this Excel-based tool. 

    The USAID- and PEPFAR-funded Health Policy Project (HPP), in collaboration with the Eurasian Harm Reduction Network (EHRN), developed the Harm Reduction Expenditure Tracking Tool. The tool was created for use by civil society groups to advocate for increased funding for harm reduction as HIV prevention in Eastern Europe and Central Asia. The tool and user guide are available in English and Russian.

  • This Harm Reduction Funding Gap Tool shows the difference in financial resource needs and commitments by year for needle and syringe exchange programs (NSP) and opioid substitution therapy (OST) programs. The user guide provides step-by-step instructions for using this Excel-based tool.

    The USAID- and PEPFAR-funded Health Policy Project (HPP), in collaboration with the Eurasian Harm Reduction Network (EHRN), developed the harm reduction funding gap tool. The tool was created for use by civil society groups to advocate for increased funding for harm reduction as HIV prevention in Eastern Europe and Central Asia. The tool and user guide are available in English and Russian.

  • This Harm Reduction Unit Costing Tool estimates the in-country unit cost per client per year for opioid substitution therapy (OST) and needle and syringe exchange (NSP) services. The user guide provides step-by-step instructions for using this Excel-based tool.

    The USAID- and PEPFAR-funded Health Policy Project (HPP), in collaboration with the Eurasian Harm Reduction Network (EHRN), developed the harm reduction unit costing tool. The tool was created for use by civil society groups to advocate for increased funding for harm reduction as HIV prevention in Eastern Europe and Central Asia. The tool and user guide are available in English and Russian.

  • 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

  • Discrimination against people living with HIV and key populations is a common and challenging problem. A year ago, the Commission on Human Rights and Administrative Justice (CHRAJ) in Ghana launched a web-based system to provide a simple way for reporting HIV- and key population–related discrimination with help from the USAID and PEPFAR-supported Health Policy Project (HPP). This brief describes the outcomes of the discrimination reporting system after one year and ways forward. 

    Click here to read a blog on HPP's work on the CHRAJ stigma and discrimination reporting portal.  

  • Once dominated by infections among people who inject drugs, the adult HIV incidence in Ukraine is increasing among other key populations and the national prevention strategy must adapt. In this context, the USAID-supported Health Policy Project (HPP) partnered with State Service of Ukraine on HIV/AIDS and Other Socially Dangerous Diseases, and the Institute for Economy and Forecasting of the National Academy of Sciences of Ukraine in July 2013 to analyze the cost and effectiveness of HIV prevention over 2014–2018. The analysis aimed to inform the National AIDS Programme (NAP) 2014–2018. HPP applied the Goals mathematical model to examine the effects of scaling up treatment, harm reduction, and other behavioral interventions on incidence, and developed an Excel-based model to estimate the implementation cost. Recent Ukraine-specific epidemiological, behavioral, demographic, and cost data were obtained from the Ministry of Health and other secondary sources. Results suggest that the NAP with universal access targets for prevention is the most cost-effective prevention strategy. This suggests additional investment in Ukraine would be rational and could save lives. Non-renewal of Global Fund support for key prevention interventions in Ukraine would substantially weaken the efficiency and effectiveness of its HIV response and requires an urgent resource mobilization strategy.  

  • Through this case study, the USAID- and PEPFAR-funded Health Policy Project (HPP) seeks to share Thailand’s experience implementing the AIDS Zero Portal (AZP) and its initial impact at the national and provincial levels. The AZP offers a potential model for other countries looking to institutionalize and leverage information systems as part of their routine monitoring and evaluation, strategic planning, and resource allocation efforts.

  • The number of new HIV infections in Eastern Europe and Central Asia (EECA) continues to grow, with people who inject drugs (PWID) and their sexual partners disproportionately affected by the epidemic. To address this challenge, the Eurasian Harm Reduction Network (EHRN), with support from the USAID- and PEPFAR-funded Health Policy Project (HPP), developed a suite of easy-to-use, Excel-based tools, available in Russian and English. Civil society organizations advocating harm reduction services can use them to estimate past expenditure levels, future resource needs, and potential funding gaps using local costs of services and products. This brief introduces these tools. 

  • The Policy Analysis and Advocacy Decision Model for Services for People Who Inject Drugs (PWID) is a collection of tools designed by the USAID-funded Health Policy Project and the Eurasian Harm Reduction Network to help stakeholders create an inventory of country policies, analyze these policies against international best practices and human rights frameworks, assess policy implementation, and create a strategic advocacy plan. The primary goal of the model is to identify the policies that most directly affect access to and sustainability of key PWID services and the needs and opportunities for policy advocacy that will improve access to services, even while larger, long-term human rights policies remain deficient.

    The Decision Model is intended for global application but includes special attention to the policy issues facing Eastern Europe and Central Asia. Stakeholders can use the tools to identify restrictive, poorly written, and absent policies that impact the access to and sustainability of key services for PWID including HIV counseling and testing, antiretroviral therapy, hepatitis and tuberculosis services, opioid substitution therapy, and needle and syringe programs. These services are analyzed within the settings of community-based programs, pre-trial detention, prison, and institutions that have custody of minors. The policy areas under consideration are extensive, with more than 1,300 policy points for analysis. Policy areas include service coordination; data use and decisionmaking; participation of PWID in decisionmaking, service delivery and evaluation; consent; personal data; stigma and discrimination; criminal sanctions; gender-based violence; human rights; procurement and supply management; eligibility; funding; and service delivery protocols.

    A companion decision model geared specifically toward males who have sex with males, transgender people, and sex workers (Policy Analysis and Advocacy Decision Model for HIV-Related Services: Males Who Have Sex with Males, Transgender People, and Sex Workers) is also available. 

  • 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 poster presents the results of a study on measuring HIV stigma among all levels of health facility staff. A tool developed by international program implementing agencies, university and non-university based researchers, the global network of people living with HIV (GNP+), and UNAIDS was field-tested to refine it and create a brief questionnaire that can be used s a standalone survey or a module in a broader HIV survey for health facility staff. The poster was presented by staff of the USAID- and PEPFAR-funded Health Policy Project at the 17th International Conference on AIDS and STIs in Africa in December 2013, in Cape Town, South Africa.

  • 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.

  • Ukraine has one of the fastest growing HIV epidemics in the world, and the number of HIV cases diagnosed in the country has doubled since 2001 (UNAIDS, 2010). Ukraine’s epidemic remains concentrated among most-at-risk populations (MARPs)—with over 80 percent of reported HIV cases occurring in these groups (PEPFAR, 2010). In this context, the Health Policy Project evaluated the degree to which an enabling policy framework for HIV exists in Ukraine, with a focus on HIV prevention among MARPs. The project interviewed 72 key informants regarding the policy environment and policy dissemination and implementation at the national and subnational levels. This assessment findings indicate a strong enabling environment, but one that has gaps and barriers, such as lack of operational guidelines to support the implementation of HIV laws and regulations. Building on the joint U.S. and Ukraine Governments’ Partnership Framework, the findings reveal new possibilities for developing effective mechanisms to support the implementation and enforcement of HIV-related regulations in Ukraine.

  • Ukraine has one of the fastest growing HIV epidemics in the world, and the number of HIV cases diagnosed in the country has doubled since 2001 (UNAIDS, 2010). Ukraine’s epidemic remains concentrated among most-at-risk populations (MARPs)—with over 80 percent of reported HIV cases occurring in these groups (PEPFAR, 2010). In this context, the Health Policy Project evaluated the degree to which an enabling policy framework for HIV exists in Ukraine, with a focus on HIV prevention among MARPs. The project interviewed 72 key informants regarding the policy environment and policy dissemination and implementation at the national and subnational levels. This assessment findings indicate a strong enabling environment, but one that has gaps and barriers, such as lack of operational guidelines to support the implementation of HIV laws and regulations. Building on the joint U.S. and Ukraine Governments’ Partnership Framework, the findings reveal new possibilities for developing effective mechanisms to support the implementation and enforcement of HIV-related regulations in Ukraine.

  • Ukraine has one of the fastest growing HIV epidemics in the world, and the number of HIV cases diagnosed in the country has doubled since 2001 (UNAIDS, 2010). Ukraine’s epidemic remains concentrated among most-at-risk populations (MARPs)—with over 80 percent of reported HIV cases occurring in these groups (PEPFAR, 2010). In this context, the Health Policy Project conducted an assessment to evaluate the degree to which an enabling policy framework for HIV exists in Ukraine, with an emphasis on HIV prevention among MARPs. The project carried out 72 key informant interviews regarding the policy environment and policy dissemination and implementation at the national and subnational levels. This report summarizes the assessment findings, which indicate a strong enabling environment but one that has gaps and barriers related to policy implementation and operational guidelines. Also see the Annex Addendum for more information.

  • Ukraine has one of the fastest growing HIV epidemics in the world, and the number of HIV cases diagnosed in the country has doubled since 2001 (UNAIDS, 2010). Ukraine’s epidemic remains concentrated among most-at-risk populations (MARPs)—with over 80 percent of reported HIV cases occurring in these groups (PEPFAR, 2010). In this context, the Health Policy Project conducted an assessment to evaluate the degree to which an enabling policy framework for HIV exists in Ukraine, with an emphasis on HIV prevention among MARPs. The project carried out 72 key informant interviews regarding the policy environment and policy dissemination and implementation at the national and subnational levels. This report summarizes the assessment findings, which indicate a strong enabling environment but one that has gaps and barriers related to policy implementation and operational guidelines. Also see the Annex Addendum for more information.