HIV Policy and Advocacy Monitor

"Transgender people want more than a supportive document; we want the people's support. This will require more than just policy--it will require continuous advocacy efforts." -- Doi Nakpor

Doi Nakpor is the director of Sisters, a transgender-focused community-based organization in Thailand that has provided health, education, and support services to the transgender community in Pattaya, Thailand since 2004. Sisters employs social marketing outreach to reach members of this community, and offers them a friendly and supportive space. The organization also encourages preventive behaviors, including HIV testing and counseling and screening for other sexually transmitted infections.

Click here for the interview.

Policy Analysis

Rationale for WHO's New Position Calling for Prompt Reporting and Public Disclosure of Interventional Clinical Trial Results

PLOS Medicine

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001819

This article reviews the legal background leading to the World Health Organization's (WHO) new statement on public disclosure of clinical trial results, which reaffirms the ethical imperative of results reporting, and offers a range of ethical and economic arguments in its favor. The authors also detail the WHO's results-reporting process and review how it addresses existing gaps in reporting.

Generational Shift Threatens Global Progress Against HIV

Thomson Reuters Foundation

http://www.trust.org/item/20150413204125-tdx94/

Anick Dupuy's blog post examines increased sexual activity and limited sexual and reproductive health knowledge among youth, and the impact of these developments on the HIV epidemic. She also discusses how a transition in views of sex (from something personal to a commodity) has impacted the prevalence of risky youth behaviors, which will likely worsen with decreased funding for HIV education programs.

Analysis of the Social Feasibility of HIV and AIDS Programs in Kenya: Sociocultural Barriers and Facilitators and the Impact of Devolution

Health Policy Project

http://www.healthpolicyproject.com/index.cfm?id=publications&get=pubID&pubId=535

To inform development of Kenya's new AIDS Strategic Framework, the USAID- and PEPFAR-funded Health Policy Project examined social, cultural, and political barriers to and facilitators of policies intended to support the four pillars of HIV programming: prevention, treatment, care, and multisectoral mainstreaming. The analysis considers how barriers and facilitators impacted clients' experience of HIV programs under previous strategic plans, allowing for a social feasibility assessment of Kenya's HIV programs.

Redeployment: Opportunities to Control HIV and TB in Tanzania: Observations from Dar es Salaam, Mbeya and Zanzibar

Center for Global Health Policy

http://www.idsaglobalhealth.org/uploadedFiles/GlobalHealth/News/Tanzania%20Report%20High%20Res.pdf

In this report, the Center for Global Health Policy collects insights from a visit to Tanzania to see the impacts of U.S. investments on the HIV and tuberculosis epidemics and to discover prevention and treatment barriers. The latter include a healthcare facility shortage, a lack of trained healthcare workers and resources, inconsistent funding, and additional stigma- and funding-related barriers to service access for children living with HIV.

Resources: Models, Tools, and Research

Cost-effectiveness of Community-Based Strategies to Strengthen the Continuum of HIV Care in Rural South Africa: a Health Economic Modelling Analysis

The Lancet

http://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018%2815%2900016-8/fulltext

This study assessed the effect and cost-effectiveness of community-based home HIV testing and counselling (HTC) on population-level health. With enhanced linkage to care, community-based HTC can result in increased HIV testing coverage and treatment uptake. These approaches are considered very cost-effective, given that incremental cost-effectiveness ratios are less than 20 percent of South Africa's per capita gross domestic product.

Desk Review of HIV-related Policy Recommendations for Kazakhstan, Kyrgyz Republic, and Tajikistan (2007-2012)

Health Policy Project

http://www.healthpolicyproject.com/index.cfm?id=publications&get=pubID&pubId=205

In this September 2014 desk review, the USAID- and PEPFAR-funded Health Policy Project provides a detailed review of recent (2007-2012) assessment reports conducted in Kazakhstan, Kyrgyz Republic, and Tajikistan to serve as a resource for USAID and other groups interested in identifying priority HIV policy areas and recommendations.

CUREiculum

AVAC

http://www.avac.org/cureiculum

"CUREiculum is a suite of tools that provides simple, accessible information on HIV cure research, organizing into a systematic format for ongoing or issue-specific learning."

The Case for Addressing Gender and Power in Sexuality and HIV Education: A Comprehensive Review of Evaluation Studies

International Perspectives on Sexual and Reproductive Health

http://www.guttmacher.org/pubs/journals/4103115.html

In her review of 22 sexuality and HIV education interventions, Nicole Haberland determined that programs that addressed gender or power in sexuality were five times as likely to be effective as those that did not, suggesting that this inclusion should be a key characteristic of effective sexuality and HIV education programs.

Advocacy

HIV and the General Election -- What We Should Be Talking About

National AIDS Trust and HIV Scotland

http://www.nat.org.uk/Media-and-Blog/Press-Releases/2015/April/HIV_and_the_general_election.aspx

The National AIDS Trust and HIV Scotland call on the new UK government to commit to five key priorities that will reduce HIV transmission and improve the lives of people living with HIV across the UK: retain existing protections, introduce compulsory sex and relationships education, make HIV prevention a national public health priority, end HIV stigma in the National Health Service and social care, and ensure support to people affected by HIV-related sickness or disability.

Interview with Doi Nakpor

HIV Policy and Advocacy Monitor: Tell us about Sisters' mission and its work.

Our mission at Sisters is to promote sexual health and human rights for transgender women in Pattaya, Thailand. Sisters has a drop-in center where women can receive health services, as well as an outreach team to reach women throughout the city. Of the 5,000 transgender women estimated to live in Pattaya, Sisters reaches 2,300. This estimation is derived from our work over the last 10 years, but the population is very mobile, with higher numbers during the tourist season. Due to police harassment, the political climate in Thailand surrounding transgender women, and decreasing tourism, the population may be in decline.

HIV Policy and Advocacy Monitor: What are the main policy priorities in Thailand for you and your organization?

I think the first issue for Sisters is achievement of gender recognition for transgender people. As the minority of a minority (among the broader LGBTI community), transgender women experience employment difficulties, limited reproductive and sexual health information, lower incomes, limited access to social welfare, and harassment from the police. In order to truly improve the quality of life for this community, Sisters needs to look beyond HIV to ensure that our work addresses these difficult conditions. However, even when the gender recognition law is in place, our society as a whole must learn to recognize our gender, be more accepting, and realize that trans rights are human rights. Transgender people want more than a supportive document; we want the people's support. This will require more than just policy--it will require continuous advocacy efforts.

HIV Policy and Advocacy Monitor: What are some of Sisters' policy and advocacy activities?

We partner with the Thailand Asia Regional Office of the CDC (Thai CDC) to estimate HIV prevalence among transgender people. In recognition of our work, Thai CDC invited us to stakeholder meetings to develop a sexual and reproductive health guideline for transgender people, where we advocated for more comprehensive sexual healthcare for this population. While Thailand already has a national HIV guideline developed by the Ministry of Public Health, we need more comprehensive guidelines that address HIV in tandem with other health issues relevant to transgender women, including reproductive health. Sisters is currently developing these guidelines in cooperation with Thai CDC and the Red Cross.

Sisters also conducts human rights work. In cooperation with the Thai Transgender Alliance, we promote equal rights for trans people in Thailand. In Pattaya, which has one of the highest populations of transgender women, Sisters supports the Alliance's gender recognition advocacy project. Sisters also provided input and development support to the Alliance's recently released legal review of gender recognition and assessment of the current gender situation in Thailand.

HIV Policy and Advocacy Monitor: What led you to become involved in policy and advocacy work?

Because I am trans, I have seen and experienced many of the problems faced by my community. It's about more than work for me; it's about life. When our efforts succeed, I benefit as a member of the community, but the entire transgender community benefits as well. I have faced discrimination daily and have struggled to enter the workforce. As one of two transgender siblings, I struggle to talk to my parents about being trans and the issues I face. These experiences are not unique to me, so what Sisters does is not about work--it's about life.

HIV Policy and Advocacy Monitor: How is social marketing an important strategy in the response to HIV?

Social marketing is important in getting the transgender community's attention. While we have a strong condom distribution project, the distribution of safe sex commodities to transgender sex workers is not sufficient to change their behavior--that's where social marketing comes in. Incorporating social marketing in our programs helps us analyze a product, determine the best way to draw attention to it from members of the transgender community, and then link it to HIV prevention. For example, we provide beauty services (e.g., facial massages, lessons on make-up use) to transgender women, using the time to introduce them to the center and its services, and to discuss HIV prevention. We are currently holding a promotion for members who get tested at the center with their partner, offering them a gift bag with body lotion and additional beauty products.

The USAID- and PEPFAR-funded Health Policy Project's HIV Policy and Advocacy Monitor is a monthly newsletter focusing on the advancement, development, and analysis of policies, advocacy campaigns and organizations, and policy-related data to inform the response to HIV and AIDS at the global, national, and local levels. It includes news items, resources, advocacy reports, and innovative policy analyses on a wide range of topics such as treatment, key populations issues, gender, and financing for HIV policies and programs.

If you would like to suggest an item for inclusion in the next issue, please send it to: [email protected].

About the Health Policy Project

The Health Policy Project is a five-year cooperative agreement funded by the United States Agency for International Development (USAID) under Cooperative Agreement No. AID-OAA-A-10-00067, beginning September 30, 2010. The project's HIV-related activities are supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). It is implemented by Futures Group, in collaboration with Plan International USA, Avenir Health (formerly Futures Institute), Partners in Population and Development Africa Regional Office (PPD ARO), Population Reference Bureau (PRB), RTI International, and the White Ribbon Alliance for Safe Motherhood (WRA).