Effective HIV & SRH Responses among Most at Risk Populations in Papua New Guinea Module 3: The Comprehensive Package of Programmes and Services for sex workers and their clients, MSM and transgender people

SESSION 1 A The Comprehensive Package of Programmes and Services for sex workers and their clients, MSM and transgender people INTRODUCTION TO THE COMPREHENSIVE PACKAGE OF PROGRAMMES AND SERVICES

 What is a Comprehensive Package of SRH & HIV Services for MARPs?  Why have a Comprehensive Package of Services?  Global Guidance Documents & Recommendations  Regional Guidance & Best Practice in Asia & Pacific  Introduction to The HIV and Sex Work Collection Overview

A Comprehensive Package of SRH & HIV Services for MARPs:  Defines a package of services that, if delivered to a target percentage of the sub-population, would halt the HIV epidemic and improve the sexual and reproductive health of MARPs A set of interventions that promotes attainment of the highest possible standard of sexual and reproductive health for MARPs Comprehensive Package of Services

A Comprehensive Package of Services provides a defined set of programmatic and service interventions that enable:  Rationale in Advocacy  Health Economics and Costing Opportunities  Strategic Planning & Health System Strengthening  Implementation of Best Practice  When implemented, improved access to Sexual and Reproductive Health and well-being for MARPs Comprehensive Package of Services

International Conference on Population and Development 1994  Equality and empowerment of women is a global priority  A woman’s ability to access SRHR is cornerstone of her empowerment. It is also the key to sustainable development.  Programme of Action to:  Provide universal access to family planning and SRHR  Deliver gender equality and empowerment of women  Address impacts of urbanization and migration  Support sustainable development and address environmental issues associated with population changes.  ICPD Beyond 2014 Review provides once in a generation chance to define what is required to deliver a more equal, more sustainable world for the 7 billion people who share it. Global Guidance

Numerous documents have been developed to provide global guidance on HIV prevention, treatment and care for sex workers, their clients, MSM and transgender people. Themes:  Increasing supportive environments  Empowerment  Economic opportunity  Access to services  Integrated response. These are teamed with calls for reduction in violence, gender inequity, stigma and discrimination. Global Guidance

 WHO, UNAIDS, UNFPA and NSWP (PEPFAR 2012) Prevention and Treatment of HIV and other Sexually Transmitted Infections for Sex Workers in Low and Middle Income Countries  UNAIDS (2012) Guidance Note on HIV and Sex Work  WHO, UNFPA, UNAIDS, NSWP, The World Bank (2013) Implementing Comprehensive HIV/STI Programmes with Sex Workers: Practical Approaches from Collaborative Interventions Global Guidance References to these documents and tools can be found in your Participant Manual

WHO, UNAIDS, UNFPA and NSWP (PEPFAR 2012) Prevention and Treatment of HIV and other Sexually Transmitted Infections for Sex Workers in Low and Middle Income Countries  Eight Evidence Based Recommendations  Four Good Practice Recommendations Global Guidance

Evidence Based Recommendations: 1.A package of interventions to enhance community empowerment among sex workers 2.Promoting correct and consistent condom use among sex workers and their clients 3.Offering periodic screening for asymptomatic STIs to female sex workers 4.As a short-term emergency measure, offering female sex workers in high prevalence settings, periodic presumptive treatment for asymptomatic STIs while comprehensive SRH services are being further developed Global Guidance

Evidence Based Recommendations: 5.Offering voluntary HIV testing and counselling to sex workers 6.Using the current WHO recommendations on the use of antiretroviral therapy for HIV positive general populations for sex workers 7.Using the current WHO recommendations on harm reduction for sex workers who inject drugs 8.Including sex workers as targets of catch-up HBV immunisation strategies in settings where infant immunisation has not reached full coverage. Global Guidance

Good Practice Recommendations: 1.All countries should work toward decriminalisation of sex work and elimination of the unjust application of non- criminal laws and regulations against sex workers 2.Government should establish antidiscrimination and other rights-respecting laws to protect against discrimination and violence, and other violations of rights faced by sex workers in order to realise their human rights and reduce their vulnerability to HIV infection and the impact of AIDS. Antidiscrimination laws and regulations should guarantee sex workers’ right to social, health and financial services Global Guidance

Good Practice Recommendations: 3.Health services should be made available, accessible and acceptable to sex workers based on the principles of avoidance of stigma, non-discrimination and the right to health 4.Violence against sex workers is a risk factor for HIV and must be prevented and addressed in partnership with sex workers and sex worker led organisations. Global Guidance

Group Check In: Global Recommendations To what extent have these recommendations been followed in your country?

The SWIT Implementing Comprehensive HIV/STI Programmes with Sex Workers: Practical Approaches from Collaborative Interventions WHO, UNFPA, UNAIDS, NSWP, The World Bank (2013)  Provides practical advice, tools, guidelines and case studies for implementation of HIV and STI programmes for and with sex workers  Based on recommendations of WHO, UNAIDS, UNFPA and NSWP guidance document. Global Guidance

The SWIT The SWIT contains the following 6 chapters: 1.Community Empowerment 2.Addressing Violence against Sex Workers 3.Community-led Services 4.Condom and Lubricant Programming 5.Clinical and Support Services 6.Programme Management and Organizational Capacity- Building

The SWIT  Within each chapter key elements are explored in detail  These elements are shown here for Chapter 1 Community Empowerment Global Guidance

UNFPA, UNAIDS & APNSW (2012) HIV & Sex Work Collection Regional Experience & Good Practice

“There is considerable experience in this region about what works in delivering HIV prevention, treatment and care programmes” (UNFPA, UNAIDS & APNSW, 2012, p6) Regional Experience & Good Practice The HIV and Sex Work Collection

The purpose of the HIV and Sex Work Collection is to:  Document and share programming and advocacy experience  Provide detailed case studies that illustrate the ways in which programmes and advocacy interventions were designed and delivered to elements of a comprehensive response  Identify lessons learned, gaps, challenges and key considerations for strengthening and scaling up comprehensive and effective responses in the region Regional Experience & Good Practice

“A wealth of analysis exists on the nature and extent of HIV epidemics in Asia and the Pacific in the context of sex work. These have highlighted the progress and the challenges that must be tackled to realise the targets to which governments have committed, to bring an end to AIDS” (UNFPA, UNAIDS & APNSW, 2012, p4) Regional Experience & Good Practice The HIV and Sex Work Collection

It is a valuable resource:  For programming managers, implementers and service providers  To guide policy makers and development partners in planning and allocating resources for strengthening and scaling up effective interventions  To advance advocacy efforts for a comprehensive response that focuses on evidence and rights based interventions. Regional Experience & Good Practice

The HIV and Sex Work Collection  Presents eleven key elements of a comprehensive response to HIV in the context of sex work  Strategic Investment demands the address of social enablers and enabling policies  Document presented in two sections:  Part 1: Key lessons learned, gaps and challenges in delivering and scaling up evidence and rights based responses in the Asia-Pacific region  Part 2: Presents 11 detailed case studies on HIV and sex work interventions Regional Experience & Good Practice

ORGANISATIONFOCUSCOUNTRY Targeted Outreach Programme (TOP PSI) Scaling up an integrated approach to SRH and HIV prevention, testing, treatment and care Myanmar Dark BlueHIV prevention, treatment and care for male and transgender sex workers China Service Workers in Group (SWING) Sex worker organisational development; partnerships with police to foster law enforcement practices that protect rights and support effective HIV programming Thailand Lily Women’s Wellness Centre HIV prevention, treatment and care for ‘low fee’ sex workers China Regional Experience & Good Practice The HIV and Sex Work Collection

ORGANISATIONFOCUSCOUNTRY Veshya Anyay Mukti Parishad (VAMP) Plus Improving access to HIV testing, treatment and care for sex workers living with HIV India USHA Cooperative/Durbar Mahila Samanwaya Committee (DMSC) Economic empowerment: financial cooperative – savings and loans India Durjoy Nari Sangha (Durjoy) Preventing and addressing violence against sex workers Bangladesh Blue Diamond Society (BDS) Advocacy and leadership development for law reform, programmes for legal education and legal services for MSM and TG communities Nepal Regional Experience & Good Practice The HIV and Sex Work Collection

ORGANISATIONFOCUSCOUNTRY Ashodaya AcademyCommunity to community capacity building for sex worker-led HIV interventions India EMPOWERMeeting the needs of migrant sex workers: integrating HIV within holistic education programming; advocacy for labour rights and reform of laws and law enforcement practices Fiji Survival Advocacy Network Fiji (SAN Fiji) Addressing stigma and discrimination, improving access to health services Fiji Regional Experience & Good Practice The HIV and Sex Work Collection

SMALL GROUP ACTIVITY Small Groups to discuss their knowledge of organisations or programmes in their area working with sex workers. Each small group to decide on one organisation or programme and present back to the group: Who runs the programme? Who the programme works with? What has worked? The outcomes of the programme for sex workers? Regional Experience & Good Practice