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People Living With HIV

HP+ More recent People Living With HIV 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.

  • Based on the UTETEZI Project curriculum, Advocacy for Improved Access to Services for MSM: A Workshop Curriculum for a Multi-Stakeholder Policy Advocacy Project, this advocacy for policy change guide is designed for use by MSM (men who have sex with men) groups, community-based organizations (CBOs), civil society organizations (CSOs), and individuals working in HIV and MSM health to help them advocate regionally, nationally, and locally for improved HIV and health-related MSM policies. In particular, this guide can serve as an important tool for CSOs working on MSM issues in hostile legal environments.

  • 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 USAID-funded Health Policy Project (HPP) formed a study team to estimate the unit costs associated with a minimum package of HIV services for female sex workers (FSWs) and men who have sex with men (MSM).

    To support the use of the analysis and cost data presented in the final study, the HPP study team also identified the need to develop a companion user guide to provide policymakers and program planners with a practical, stepwise approach to using data for decision making and evidence-based HIV programs, services, and policies, that address the needs of people living with HIV (PLHIV), MSM, and FSWs in Côte d’Ivoire.

    Using a stepwise approach with accompanying tables and worksheets, the guide first explains the importance of calculating average costs using data analysis presented in the larger study. Next, it explains how to determine and use program reach to estimate annual unit costs for HIV programs. Finally, the reader is shown how to project programmatic and national annual costs for FSWs and MSM. 

    The guide is available in English and French.

  • 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.

  • The government of Cote d'Ivoire is committed to the fight to gain control and turn the tide of the HIV epidemic. Striving to offer the best standard of HIV treatment, the country aims to adopt the new 90-90-90 target. The country also plans to roll out “test and offer” for the general population in the near future and begin piloting Option B+ for pregnant women in 2015. Such an intense scale-up of HIV treatment services will require intensified coordination to mobilize resources and effectively target those funds for treatment scale-up and sustainability.

    The aim of this cost-outcome analysis study was to estimate the cost of HIV treatment scale-up and the impact of such an expansion by estimating the cost of treatment for one person per year for adults, children, and pregnant women. Currently, limited data exist around the unit cost of HIV treatment in Cote d’Ivoire. To inform policy decisions on how best to finance scale-up of treatment with the limited resources available, understanding the outcome of HIV treatment—and the levers for improving the chances of successful treatment—is critical.

    The study found that the cost of the full year of treatment expected by following the national treatment guideline would be CFA142,431 (US$288) for adults, CFA217,603 (US$440) for children, CFA85,063 (US$172) for PMTCT Option B, and CFA 151,827 (US$207) for PMTCT Option B+. A total investment of approximately CFA147 billion (US$297 million) is required over the next five years, leading up to the year 2020, to achieve the 90-90-90 target and a 100 percent roll-out of the Option B+ approach for the prevention of mother-to-child transmission (PMTCT). This investment will save more than 35,000 lives and prevent more than 6,000 children from becoming infected via PMTCT compared to the status quo, in which treatment coverage increases at the historical pace.

  • The Sub-Saharan Africa MSM Engagement (SAME) Tool was developed based on literature reviews and expert/technical inputs from the USAID- and PEPFAR-funded Health Policy Project (HPP), the Johns Hopkins School of Public Health, amfAR, African Men for Sexual Health and Rights (AMSHeR), and USAID. In collaboration with eight leading MSM organizations—one each from Rwanda, Malawi, Togo, Mozambique, Zambia, Tanzania, Ghana, and Cameroon—HPP and AMSHeR piloted the tool from April to June 2013, in both English and French. This poster summarizes the pilot study, and was presented at the 20th International AIDS Conference in July 2014.

  • 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.

  • Stigma and discrimination (S&D) confronting people living with HIV and key populations violate people’s rights and can adversely affect HIV prevention, care, and treatment. However, standardized approaches for quantifying and responding to health facility S&D have been unavailable. The USAID- and PEPFAR-funded Health Policy Project led a collaborative global effort to review, prioritize, adapt, and synthesize existing measures and programmatic tools. This effort involved researchers, trainers, other experts, and stakeholders. The resulting stigma-reduction package supports a comprehensive, research-to-action response in health facilities. This poster, presented at the 20th International AIDS Conference in Melbourne, Australia, in July 2014, describes the development of the stigma-reduction package and framework.

  • The USAID- and PEPFAR-funded Health Policy Project (HPP) in Kenya helped the Ministry of Health (MOH) secure an allocation of KSh 2.9 billion (approximately US$30 million) in the 2015/16 national budget to purchase HIV commodities and other strategic health commodities. Of this, US$21 to 23 million will go to purchase antiretroviral drugs (ARVs) and HIV testing kits. The remainder will supplement the purchase of malaria and tuberculosis commodities. HPP also helped secure the reinstatement of a line item for an annual allocation for HIV commodities in future national budgets. HPP is also working with private sector pharmacies and hospitals to stock ARVs that can be accessed by those who can afford them. As part of this initiative, the Kenya Medical Supplies Authority has already earmarked ARVs for 10,000 patients to help trigger sales. Innovative efforts, like increasing ARV sales in the commercial sector, can further enhance the sustainability of Kenya’s HIV program and increase access to ARVs and HIV services for those who cannot afford private care.

  • 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.  

  • A new study released by the Health Policy Project, examines the experience of stigma and discrimination among male and female sex workers and how these experiences affect sex workers’ utilization of health services. Measuring the prevalence of four types of stigma: anticipated, witnessed/heard, experienced, and internalized; the study revealed that over 80 percent of male sex workers and over 70 percent of female sex workers avoided or delayed needed health services in the year preceding the survey. This and other findings provide critical evidence for the need to address stigma and discrimination to both improve health outcomes of and control the HIV among the key populations most affected by HIV.

  • 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.

  • At the request of the USAID Mission in Malawi, the USAID-funded Health Policy Project (HPP) undertook a comprehensive facility-based assessment to ascertain the extent to which FP services have been integrated into HIV services in Malawi through different integration models and across various types of facilities (public and non-profit private). The study was also designed to examine how the reproductive rights of people living with HIV (PLHIV) are being respected and addressed through approaches such as PIFP and access to method choice. Finally, the study aimed to identify any systems-level barriers to integration and provide practical recommendations for the Ministry of Health (MOH) and other stakeholders to improve FP-HIV integrated services in Malawi.

  • The HIV epidemic in Ukraine is severe and concentrated: it is estimated that there were 211,800–237,000 HIV-positive individuals in the country in 2013. Once dominated by infections among people who inject drugs (PWID), the adult HIV incidence in Ukraine is increasing among other key populations and the national prevention strategy must adapt. These populations include female sex workers (FSWs), clients and casual partners of FSWs, and men who have sex with men (MSM), among others. In this context, the USAID- and PEPFAR-funded Health Policy Project partnered with the State Service of Ukraine on HIV/AIDS and the Institute for Economy and Forecasting to analyze the cost and effectiveness of HIV prevention from 2014–2018. Conducted in July 2013, the analysis aimed to inform the National AIDS Programme (NAP) 2014–2018. This poster was presented at the 20th International AIDS Conference in Melbourne, Australia.

  • Saving Mothers, Giving Life (SMGL) is five-year public-private partnership aiming to drastically reduce maternal mortality in sub-Saharan Africa. As part of the proof of concept, the USAID- and PEPFAR-funded Health Policy Project conducted an expenditure analysis to identify what additional expenditures were made to reduce maternal mortality in the eight SMGL pilot districts in Uganda and Zambia. The overall study findings showed that investments in infrastructure, transportation, training for healthcare workers, and demand creation for facility-based deliveries led to maternal mortality decreases in both countries in one year—30 percent in one, 35 percent in the other. HPP's expenditure analyses complement these evaluations, and help to inform budgeting and planning for scale-up of the district strengthening model.

  • Local Capacity Initiative Facilitated Discussion and Capacity Assessment Tool: Facilitator's Manual The purpose of this manual, prepared by Advancing Partners & Communities with support from the Health Policy Project, is to help determine technical assistance needs and to conduct an assessment of an organization’s policy, advocacy, and organizational systems capacity. The assessment consists of a facilitated self-assessment as well as optional stakeholder interviews. The tool is divided into five major sections (LCI outcome areas); four of these areas focus on critical elements for advocacy and one focuses on overall organizational capacity. Additionally, there are in-depth domains associated with each larger outcome, which can be used to further review capacity.

    Policy Advocacy Rapid Assessment Tool for CSOs This tool is used to facilitate an overarching conversation with small to medium sized CSO regarding policy advocacy capacity and priorities. The tool addresses six major topics and seven cross cutting themes related to policy advocacy. Findings identified by this conversation can be used to design capacity development strategies.

  • 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.

  • For people living with and affected by HIV, stigma and discrimination within health facilities are serious barriers to healthcare access and engagement. Researchers have documented numerous instances worldwide of people living with HIV receiving substandard care or being deterred from seeking care. Although progress has been made in training and other interventions to reduce HIV-related stigma in healthcare facilities, these programs have not been institutionalized as routine practice or implemented on a large scale. Moreover, the tools for measuring stigma tend to be lengthy and time-consuming to administer, thus infeasible for use in facilities.

    To address these issues, an international team of researchers developed and piloted a brief, globally standardized questionnaire for measuring stigma and discrimination in health facilities. This tool can help facilitate routine monitoring of HIV-related stigma as well as the expansion and improvement of programming and policies at the health-facility level.

    Based on the pilot's findings, two final questionnaires are now available: a brief version for program evaluation and a comprehensive version for research purposes. Each questionnaire can be used for high-prevalence or low-prevalence settings.

  • 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 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. 

  • 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 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.

  • This handout provides an overview of the Positive Health, Dignity and Prevention (PHDP) Curriculum created by the Jamaican Network of Seropositives (JN+)—with support from the Jamaican Ministry of Health’s National HIV/STI Program (GIPA Unit) and the USAID- and PEPFAR-funded Health Policy Project. The curriculum aims to promote personal health and advocate for high-quality health services for people living with HIV (PLHIV). Although it was developed in Jamaica, the curriculum offers a promising, practical tool to help strengthen PLHIV leadership and advocacy to advance PHDP in the region and globally, and to enhance health systems and health outcomes across prevention, care, and treatment.

  • The Jamaican Network of Seropositives (JN+)—with support from the Jamaican Ministry of Health’s National HIV/STI Program (GIPA Unit) and the USAID- and PEPFAR-funded Health Policy Project—created a capacity-building curriculum led by people living with HIV (PLHIV). The curriculum aims to implement and advocate for Positive Health, Dignity, and Prevention (PHDP) and promote community leadership at the country level.

    PHDP—a global policy framework authored by the Global Network of People Living with HIV (GNP+) and UNAIDS in 2011—advances a holistic framework for PLHIV to manage their health, advocate for high-quality HIV services, and prevent onward HIV transmission. PHDP provides a concrete framework and road map that is especially relevant to meeting current global and national care and treatment goals for HIV—and to making “combination prevention” a reality.

  • Like many sub-Saharan African countries, Kenya is exploring the adoption of the World Health Organization Option B+ strategy as the standard of care for its program to prevent mother-to-child transmission of HIV. The Health Policy Project (HPP) was invited by the National AIDS and STI Control Programme (NASCOP) to help conduct a cost-effectiveness analysis of scaling up Option B+ versus other strategies. Results of the analysis suggest that implementing a scale-up of Option B+ will avert infant and adult infections but at a significant additional cost. Kenya should consider these results to assess whether Option B+ is affordable given the available resources.

  • 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.

  • 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.

  • Maternal deaths and infant HIV infections continue despite improved regimens for maternal health and prevention of mother-to-child transmission (PMTCT) and increases in PMTCT services. Service uptake and retention drop off significantly at each step in the PMTCT cascade. Key social factors limiting the successful completion of the cascade are stigma and discrimination. The Health Policy Project conducted a comprehensive literature review to examine the current evidence on stigma and discrimination and their negative impact on PMTCT, as well as the potential benefits of integrating PMTCT into antenatal care (ANC) and maternal, neonatal, and child health (MNCH) services.

    Substantial evidence indicates that stigma and discrimination affect (1) initial use of ANC services, (2) uptake of HIV testing during ANC, (3) initial participation in programs for PMTCT and HIV care, (4) use of skilled delivery services, (5) adherence to recommended infant feeding practices, (6) participation in early infant diagnosis, and (7) retention in and adherence to these programs during and after pregnancy.

    It will be impossible to reduce HIV-related maternal mortality without lowering the barriers of stigma and discrimination. Integrating maternal health and HIV services may not be enough to overcome social barriers that keep women, partners, and infants from fully accessing health services. Alongside important modifications to make clinical services more effective, convenient, and accessible for pregnant women and families; PMTCT, maternal, neonatal, and child health services must address HIV-related stigma and discrimination.

  • 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 past decade, PEPFAR has committed significant technical and financial resources to the fight against HIV, working with local partners in target countries to promote prevention programs, increase the number of patients receiving ART, and strengthen national coordination and monitoring of programs. As donor funding stagnates and developing economies grow, it is critical to identify long-term, sustainable sources of domestic funding for HIV to maintain and build upon the successes achieved by low- and middle-income-countries in partnership with PEPFAR.

    As part of PEPFAR’s Sustainable Financing Initiative to increase domestic resource for HIV, HPP created a baseline assessment of the current state of HIV financing in Uganda against which future achievements in domestic resource mobilization can be measured. The assessment analyzes current resource commitments against projected need, estimates future domestic resource needs, and examines efficiency and equity in the use of funds.

  • In the past decade, the President’s Emergency Plan for AIDS Relief (PEPFAR) has committed significant technical and financial resources to the fight against HIV, working with local partners in target countries to promote prevention programs, increase the number of patients receiving antiretroviral therapy (ART), and strengthen national coordination and monitoring of programs. As donor funding stagnates and developing economies grow, it is critical to identify long-term, sustainable sources of domestic funding for HIV to maintain and build upon the successes achieved by low- and middle-income-countries in partnership with PEPFAR.

    As part of PEPFAR’s Sustainable Financing Initiative to increase domestic resource for HIV, the Health Policy Project (HPP) has created a baseline assessment of the current state of HIV financing in Zambia against which future achievements in domestic resource mobilization can be measured. The assessment analyzes current resource commitments from all sources, both domestic and external, against projected resource need under UNAIDS’ 90-90-90 target, to determine future need for new domestic resources in each country, as well examines efficiency and equity in the use of funds, with the goal of maximizing the impact of financial commitments.

  • Stigma and discrimination (S&D) in health facilities undermines HIV prevention, care, and treatment and negatively impacts health. Reducing S&D requires understanding the prevalence of its drivers and manifestations to shape a tailored response. The St. Kitts and Nevis National AIDS Program (NAP), with support from the USAID- and PEPFAR-funded Health Policy Project (HPP) and the University of the West Indies (UWI), collected data as a first step in creating a comprehensive S&D-reduction program. This poster, presented at the 20th International AIDS Conference in Melbourne, Australia, in July 2014, summarizes the results of the data collection.

  • This study, conducted by the USAID- and PEPFAR-funded Health Policy Project (HPP), assessed the costs and benefits of different prevention of mother-to-child transmission of HIV (PMTCT) treatment options (baseline treatment as currently offered, Option B, and Option B+). It is intended to inform the scale-up of PMTCT services in Nigeria’s 13 high-burden states, which account for 70 percent of the mother-to-child transmission burden.

  • At the request of the Ghana AIDS Commission and other in-country stakeholders, the Health Policy Project (HPP) updated an analysis of the effects of various funding scenarios on program impact and HIV incidence and coverage. The project used the Goals Model to develop these scenarios, which were based on new fiscal realities and provided stakeholders with information to revise a proposal to the Global Fund to Fight AIDS, Malaria and Tuberculosis. HPP’s Goals Model helps countries respond to the HIV epidemic by showing how the amount and allocation of funding is related to the achievement of national goals, such as the reduction in HIV prevalence and expansion of care and support. The information from this analysis will continue to guide ongoing decision making and planning in Ghana regarding the country's HIV treatment, care, and support programs.

  • 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.

  • Developed by the USAID- and PEPFAR-funded Health Policy Project, this guide is a training tool that provides a standard for stigma reduction. It is a resource for facilitators seeking to train participants to reduce HIV and key population stigma and discrimination, and for leaders of community dialogue and policy development in this area. The guide has been piloted in the Caribbean and other settings and can be readily adapted for other contexts.

  • The response to HIV and AIDS is an integral component of efforts to improve social and economic conditions in Ghana and Côte d’Ivoire. Available data suggest that HIV prevalence rates among key populations, particularly female sex workers (FSWs) and men who have sex with men (MSM), are several times higher than the national averages for both countries. These groups also face additional barriers to social acceptance and access to services, compared with the general population. Accordingly, Ghana and Côte d’Ivoire each completed a Strategic Framework to guide interventions and service delivery specifically for key populations. The frameworks propose a package of services that includes HIV prevention; HIV treatment, care, and support; and psychosocial support and legal services. This brief describes the costing analysis conducted by HPP and in-country stakeholders to provide country-specific costing data on key populations to provide an evidence base for policy-making processes.

  • As part of its overall effort to promote evidence-based policies, decision making, planning, and advocacy, the Health Policy Project has worked with the Ghana AIDS Commission (GAC) and other important  stakeholders to conduct a costing study of services to key populations in Ghana (males who have sex with males and female sex workers). This will ensure that Ghana has country-specific costing data available. The study team collected information from service providers at eight purposively selected facilities and from program managers at the regional and central levels. The costing data are now being used to update Ghana's Goals Model and for planning, budgeting, and decision-making purposes (e.g, in conjunction with the development of Global Fund proposals and development of operational plans and budgets). In addition, one of the purposes of analyzing unit costs is to understand what is driving costs and identify areas where there is potential to gain efficiencies and reduce costs without negative impacts on quality.

    The report does not include specific operational details on how each of these different levels may use study results for their individual planning, budgeting and resource mobilization, and/or allocation purposes. The accompanying Estimating the Unit Costs of Providing Key HIV Services to Female Sex Workers and Males Who Have Sex with Males in Ghana: A Data Use Guide summarizes key findings from the study and provides specific details on how study results may be best used to inform the evidence base for the Ghana HIV program.

  • As part of its overall effort to promote evidence-based policies, decision making, and planning and advocacy, the Health Policy Project has worked with the Ghana AIDS Commission (GAC) and other important stakeholders to conduct a costing study of services to prevent mother-to-child transmission of HIV. This will ensure that Ghana has country-specific costing data available. The study selected 14 sites within the country, including teaching, regional, and district hospitals providing PMTCT services. To understand differences in services being delivered at the community level, the study included three community-based health planning service sites and three maternity home sites. The study team interviewed two programmatic and finance staff at the 14 sites and central-level program managers and financial officers during data collection. The costing data are now being used to update Ghana's Goals Model and for planning, budgeting, and decision-making purposes (e.g., in conjunction with the development of Global Fund proposals).

    The report does not include specific operational details on how each of these different levels may use study results for their individual planning, budgeting and resource mobilization, and/or allocation purposes. The accompanying Estimating the Unit Costs of Providing HIV Prevention of Mother-to-Child Transmission Services in Ghana: A Data Use Guide summarizes key findings from the study and provides specific details on how study results may be best used to inform the evidence base for the Ghana PMTCT program.