The document discusses a policy decision model to assess the policy environment for HIV services for key populations such as men who have sex with men, transgender people, and sex workers. The model conducts an in-depth analysis of over 1,100 policy points across health, law, and other sectors to identify gaps and challenges. It layers this analysis on human rights frameworks to inform advocacy and service improvements. The model also includes methodology, required technical skills, and provides an example output analyzing Burkina Faso's policy environment.

1. Strengthening Capacity of Stakeholders to
Negotiate the Complex Policy Environment
for MSM/TG/SW Services
2nd HIV Capacity Building Partners’ Forum
Johannesburg, South Africa
19 – 21 March 2013
African Men for Sexual Health and Rights [AMSHeR]
www.amsher.net

2.  An adequate response to the HIV epidemic should
focus prevention efforts on key populations among
whom the majority of new HIV infections are likely to
occur (Wilson and Challa 2009. Sarkar, Menser et al.
2009. UNAIDS 2007).
 Availability, accessibility and adequacy of prevention,
care and treatment services for MSM/TG/SW are
affected by policies, including laws, codes, directives
and operational procedures.
MSM/TG/SW Services: Does the
Policy Environment Matter?

3.  Policies are laws, regulations, guidelines, operational
procedures, statutes, etc. that should improve health
outcomes and human rights environment
 Good policies have significant benefits to country
ownership
• Give authority and provide legitimacy and
permission
• Provide stability and consistency
• Shape practice and programs
• Inform and teach
• Create consensus and provide a framework for
collaboration
MSM/TG/SW Services: Does the
Policy Environment Matter?

4. Multi-sectoral policies that impact services or exposure to
high-risk environments
 Direct impact on health
 HIV, STI, Primary Care, etc
 Indirect impact on health
 Gender, Education, etc
 Environments that MSM interact with because of criminalized
status
 Police [Law Enforcement], Prison, Judiciary, etc
 Environments where MSM/TG/SW behaviors take place
 Labour, Commerce/Transportation, Immigration/Migration,
Prison, Military/Uniformed Services, etc
Importance of multi-level assessment
of policies

5.  National/local/operational
 Legislation—Parliament
 National Strategic Plans and Policies—Executive Branch
 Regulations—Line Ministries and Departments
 Local authority by-laws
 Case Law—Legal precedent and judicial findings
 Guidelines and Protocols—Professional associations,
international organizations such as WHO
 Operational Plans—local implementation details
 Institutional SOP and client management systems
Importance of multi-level assessment
of policies

6.  The DM is designed as an in-depth policy resource for
analysis of the legal, regulatory, and policy
environment related to men who have sex with men
(MSM), Transgender persons [TG], sex workers (SW)
and prison populations to uncover gaps in policy and
practical challenges to policy implementation beyond
criminalization
 Methodology layers health policy unto international
human rights frameworks in order to produce
nuanced, systematic, multi-sectoral findings to inform
incremental policy advocacy and near-term
improvements to HIV services
HPP/AMSHeR
Policy Decision Model [DM]

7.  Over 1,100 points of policy analysis that impact services for
HIV, STI, sexual and reproductive health and rights
 Addresses coordination of national and sub-national
frameworks; community partnership; decision-making;
authorisation to provide services; consent for testing and
treatment; privacy and confidentiality; stigma and
discrimination; criminalization; gender-based violence; etc
 Methodology layers health policy unto international
human rights frameworks in order to produce nuanced,
systematic, multi-sectoral findings to inform incremental
policy advocacy and near-term improvements to HIV
services
HPP/AMSHeR
Policy Decision Model [DM]

8. Policy Issues - Healthcare
 National provisions addressing
access to healthcare
 Disaggregated coverage and
outcome reporting
requirements to include
MSM/TG/SW in strategic plans
 Government policies that
define roles NGOs
 Agency oversight of health
services (public health vs. law
enforcement)
 Process to obtain identity
papers that allow access to
healthcare services
 Consent requirements
 Protections from
mandatory/compulsory
interventions
 Confidentiality/reporting
regulations
 Protections for providers from
workplace infection exposure
and legal liability
 Codes of conduct for
professional organizations

9. Policy Issues - Law
 National discrimination
protections/guaranteed
human rights
 Process to obtain identity
papers
 Registration of birth and
sexes
 Legal definitions (Loitering,
public indecency, public
scandal, etc)
 Legal representation and
access to justice
 Guidelines on admissibility
of evidence of criminalized
identities/ behaviors (harm
reduction materials, etc)
 Practices that promote
corruption
 Crime reporting
 Medical evidence
 Use of International Law

10.  The DM is designed with a training component on
data collection methods and assessment procedures
 Skills required for the assessment teams include -
 HIV field research specialist
 Public health specialist/advisor
 A lawyer, experience on key populations
 Key populations technical advisor
 Sociologist, experienced in key population research
 2 Research assistants [MSM/SW]
Required Technical Skills

11.  Table 1 – Synopsis of Policy environment in Burkina
Faso in relation to key populations
 Key findings
DM Output – Burkina Faso

12. Acknowledgement
The MSM/TG/SW Policy Decision Model was
developed by African Men for Sexual Health and
Rights [AMSHeR] and Health Policy Project [HPP],
funded by the USAID