NATIONAL LGBTI FRAMEWORK SANAC LGBTI TECHNICAL WORKING GROUP #DURBAN 20/09/2018

CONTEXT Increase focus on behaviour change and prevention Increase focus on youth and young women Increase focus on key populations Sex Workers LGBTI PWID Prison Inmates Increase focus on human rights Increase focus on stigma and discrimination 20/09/2018

HIV and STI Risk Transgender global data: Trans* women are 49 times more likely to acquire HIV than other adults of reproductive age1 28% Trans* women in the US are living with HIV2 WSW in South Africa demonstrate higher burden of STIs and HIV than expected3 National MSM prevalence estimate 28% 5 HSRC, 2013 Marang MSM study, UNAIDS (2014) Gap Report, Page 91 Herbst et al, 2008. Estimating HIV prevalence and risk behaviours of TG persons in the United States: a systematic review Policy Brief, June 2015, Claiming the human right to health for WSW through South Africa’s National Strategic Plans on HIV and STI UCSF, 2015 triangulation report

LGBTI reached (2015) Funder Period Prevention services/training/ outreach HCT PEPFAR 12 months 32 000 28 000 Global Fund 67 000 37 000 99 000 65 000  

Goal of LGBTI Framework The goal of the South African National LGBTI HIV Framework is to provide consolidated guidance to reverse the burden of disease from HIV, STIs and TB and to promote a rights- and evidence-based environment for LGBTI communities in South Africa

Objectives To reduce HIV, STI and TB among LGBTI in line with the 90-90-90 treatment targets To empower LGBTI populations through a peer-led programme that will strengthen community networks and LGBTI organisations to address the social and economic factors To reduce internalised and external stigma, discrimination against LGBTI and offer harm reduction support To implement effective mechanisms to deal with human rights abuses and violence, sensitisation, legal literacy and paralegal support To establish an ethical- and evidence-based evaluation plan for the delivery of acceptable, accessible, appropriate and available services

Guiding Principles LGBTI community led and aligned with: National plans and national & global objectives Rights based Evidence informed Multi-sectoral Incorporating health, social and human development and rights based Leadership and accountability Effective management, coordination and monitoring

Draft LGBTI HIV framework 5-year targets Population Target Prevention MSM 200 000 Trans* 5 000* WSW and tbd* Intersex * No PSE available

Comprehensive Approach Peer / Community Led Packages Health Empowerment Psychosocial Human rights Evaluation Output Coverage, access to healthcare Skills building, opportunity Counselling, harm reduction, sensitisation Policies, legal literacy M&E framework Outcome Reduced HIV/STI/TB incidence Networks, careers Decreased violence and stigma Human rights framework Research data / PSE Impact Reduced morbidity & mortality Empowered LGBTI Improved well-being Protected human rights Evidence-informed plan and rollout

Evaluation and Research evidence LGBTI CARE CASCADE Access to health Violence Mental health Stigma Discrimination Legal access Substance use Economic opportunity Evaluation and Research evidence

Packages of Care Health Empowerment Psychosocial Evaluation Monitor violence Confront discrimination Counselling Mental Health Harm reduction Support groups Friendly services Evaluation Human rights LGBTI led Community networks Campaigns, IEC Safe spaces CBO capacity Skills building Employment Peer-led outreach Clinics Prevention: condoms & lube, HTS, PrEP, PEP Care & treatment: UTT, STI/TB, SRH, Retention in care Monitoring & Evaluation Evidence base Mapping / Population size estimations Operations research Surveillance Stigma index Confidentiality Legal literacy Access to legal support Law reform Protective policies Sensitive law enforcement

Core Package: Health Care Lesbian & Bisexual women Gay & Bisexual men Trans* men & women Generate demand Peer outreach Condoms and lube HTS & PEP PrEP, UTT, TB/STI, SRH Lab & diagnostics Adherence Retention Linkage Integration Viral hepatitis Rectal care and treatment MMC Condoms, lube, dam ART Family planning PAP smears PMTCT PrEP, UTT PAP smears, PMTCT, FP Trans clinical services Hormone therapy Reassignment surgery PEER / COMMUNITY LED

Core Package: Health Care Lesbian & Bisexual women Gay & Bisexual men Trans* men & women Generate demand Peer outreach Condoms and lube HTS & PEP PrEP & UTT TB/STI, SRH Lab & diagnostics Adherence Retention Linkage Integration Viral hepatitis Rectal care and treatment MMC Condoms, lube, dam ART Family planning PAP smears PMTCT PAP smears, PMTCT, FP Trans clinical services Hormone therapy Reassignment surgery PEER / COMMUNITY LED

Core Package: Empowerment Lesbian & Bisexual women Gay & Bisexual men Trans* men & women Personal development Skills building Employment Economic empowerment Standardised IEC Campaigns Outreach Community networks CBO capacity Safe spaces Employment / economic empowerment Safe space PEER / COMMUNITY LED

Core Package: Psychosocial Support Lesbian & Bisexual women Gay & Bisexual men Trans* men & women Mental health services Counselling & care Peer support groups and networks Stigma / discrimination Violence / verbal assault Counselling support Harm reduction PEER / COMMUNITY LED

Core Package: Human Rights Lesbian & Bisexual women Gay & Bisexual men Trans* men & women Confidentiality Supportive legislation and policies Law reform Legal literacy and services Sensitisation of law enforcement, HCW, social workers Access to legal support PEER / COMMUNITY LED

Core Package: Evaluation Lesbian & Bisexual women Gay & Bisexual men Transgender men & women Mapping Population Size Estimations Sero-surveillance IBBS Social and structural drivers Stigma index Operations research Impact evaluation PEER / COMMUNITY LED

Next Steps Further consultation: Finalise Plan Public comment on SANAC website Sector consultation Finalise Plan Adopt at SANAC Committees Official launch of National LGBTI Plan Full Implementation by 1 September 2016

Thank you

Bibliography South African National AIDS Council. National Strategic Plan on HIV, STIs and TB, 2012-2016 Pretoria: SANAC 2011 OUT!, 2006. Levels of empowerment among LGBT people in KZN https://www.teachforamerica.org/top-stories/infographic-top-5-worrisome-stats-about-growing-lgbt UNAIDS (2014) Gap Report, Page 91 Herbst et al, 2008. Estimating HIV prevalence and risk behaviours of TG persons in the United States: a systematic review Policy Brief, June 2015, Claiming the human right to health for WSW through South Africa’s National Strategic Plans on HIV and STI University of California SF. Report of the South African men-who-have-sex-with-men Data Triangulation Project San Francisco UCSF. Global Health Sciences 2015. McIntyre J, Jobson, G., Struthers, H., De Swardt, G., Rebe, K. . Rapid Assessment of HIV Prevention, Care and Treatment Programming for MSM in South Africa: Assessment Report Johannesburg ANOVA Health Institute 2013 Available from: http://www.anovahealth.co.za. World Health Organization. Prevention and Treatment of HIV and Other Sexually Transmitted Infections among Men who have Sex with Men and Transgender People Geneva WHO 2011. Available from: http://www.who.int/hiv/pub/guidelines/msm_guidelines2011/en/. World Health Organization. Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations Geneva WHO; 2014. Available from: http://www.who.int/hiv/pub/toolkits/keypopulations/en/. Lane T, Osmand T, Marr A, Shade SB, Dunkle K, Sandfort T, et al. The Mpumalanga Men's Study (MPMS): results of a baseline biological and behavioral HIV surveillance survey in two MSM communities in South Africa. PloS one. 2014;9(11):e111063. PubMed PMID: 25401785. Pubmed Central PMCID: 4234301.