1. Effective HIV & SRH Responses among Key Populations in Myanmar Module 2: The Core Package for Prevention of HIV amongst Key Populations in Myanmar

2. Session 1 The Core Package for Prevention of HIV amongst Key Populations in Myanmar Global and National Guidance on HIV and Sexual & Reproductive Health

3.  Global Guidelines for HIV and SRH among Key Populations.  Regional Documents for HIV and SRH among Key Populations.  National Guidelines: A Core Package for Prevention of HIV Amongst Key Populations in Myanmar. Overview

4. Gaps, Strengths and Challenges for HIV & SRH Programming in Myanmar 3. National 2. Regional 1. Global

5. A Comprehensive Package of SRH & HIV Services for KPs:  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 Key Populations. A set of interventions that promotes attainment of the highest possible standard of sexual and reproductive health for key populations Comprehensive Package of Services

6. 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

7. WHO, UNAIDS, UNDP, UNFPA and UNODC (2014) HIV Prevention, Diagnosis, Treatment and Care for Key Populations. Consolidated Guidelines. Brings together existing WHO guidance on five key populations:  MSM  PWID  People in Prisons & other closed settings  Sex Workers  Transgender People Consolidated Guidelines

8. Between 40% and 50% of all new HIV infections occur among people from key populations and their immediate partners globally – it’s even higher in the Asia Pacific region and in Myanmar.

9. The Consolidated Guidelines aim to: 1.Provide comprehensive package of evidence-based HIV related recommendations for key populations. 2.Increase awareness of the needs of, and issues important to key populations. 3.Improve access to, uptake and coverage of effective and acceptable services. 4.Catalyse greater national and global commitment to adequate funding and services. Consolidated Guidelines

10. The Comprehensive Package Essential Health Sector Interventions: 1.HIV prevention – condoms and lubricant, PrEP (new), PEP 2.Harm reduction interventions for substance use (NSP, OST) 3.HIV testing and counselling 4.HIV treatment and care 5.Sexual and reproductive health interventions 6.Prevention and management of co-infections and other co-morbidities, including viral hepatitis, TB and mental health conditions Consolidated Guidelines

11. The Comprehensive Package: Essential Strategies for an Enabling Environment 1.Supportive legislation, policy and financial commitment 2.Addressing stigma and discrimination 3.Community empowerment 4.Addressing violence against people from key populations Consolidated Guidelines

12. HIV Prevention Recommendations: 1.Correct and consistent use of condoms and condom compatible lubricants for all key populations. 2.Among MSM, PreP is a NEW RECOMMENDATION as an additional HIV prevention choice within comprehensive HIV prevention. 3.For serodiscordant couples, daily oral PreP is a NEW RECOMMENDATION for HIV negative partners. 4.PEP should be available voluntarily for key populations on a voluntary basis post possible exposure to HIV. 5.Voluntary medical male circumcision recommended for prevention of heterosexually acquired HIV in men, in settings with hyperendemic and generalised HIV epidemics. Consolidated Guidelines

13. Harm Reduction Recommendations: 1.All people from key populations who inject drugs should have access to sterile injecting equipment through needle and syringe programmes 2.All people from key populations who are opioid dependent should be offered access to opioid substitution therapy 3.All people from key populations with harmful alcohol or other substance use should have access to evidence-based interventions, including brief psychological interventions 4.A NEW RECOMMENDATION is that people likely to witness opioid overdose should have access to naloxone and be instructed in its use for emergency overdose. Consolidated Guidelines

14. HIV Testing and Counselling (HTC) Recommendations: 1.Voluntary HTC should be routinely offered to all KPs both in the community and in clinical settings. Community-based HIV testing and counselling for key populations, linked to prevention, care and treatment services, is recommended, in addition to provider-initiated testing and counselling. Consolidated Guidelines

15. HIV Treatment and Care Recommendations: 1.Key populations living with HIV should have the same access to ART and to ART management as other populations. 2.All pregnant women from key populations should have the same access to services for prevention of mother-to-child transmission of HIV (PMTCT) and follow the same recommendations as women in other populations. Consolidated Guidelines

16. Prevention and Management of Coinfections and Co-morbidities Recommendations: 1.Key populations should have the same access to TB prevention, screening and treatment services as other populations at risk of or living with HIV 2.Key populations should have the same access to Hepatitis B and C prevention, screening and treatment services as other populations at risk of or living with HIV 3.Routine screening and management of mental health disorders (depression and psychosocial stress) should be provided for people from key populations living with HIV order to optimise health outcomes and improve adherence to ART. Consolidated Guidelines

17. Sexual and Reproductive Health Recommendations: 1.Screening, diagnosis and treatment of STIs should be offered routinely as part of comprehensive HIV prevention and care for key populations. 2.People from key populations, including those living with HIV, should be able to experience full, pleasurable sex lives and have access to a range of reproductive options. 3.Abortion laws and services should protect the health and human rights of all women, including those from key populations. 4.It is important to offer cervical cancer screening to all women from key populations. 5.It is important that all women from key populations have the same support and access to services related to conception and pregnancy care, as women from other populations. Consolidated Guidelines

18. Critical Enablers: 1.Laws, policies and practices should be reviewed and revised to work toward decriminalisation of behaviours and other unjust applications of civil law and regulations. 2.Countries should work towards implementing and enforcing antidiscrimination and protective laws, derived from human rights standards, to eliminate stigma, discrimination and violence. 3.Health services available and acceptable to key populations. 4.Programmes work toward implementing a package of interventions for community empowerment among key populations. 5.Violence against people from key populations should be prevented in partnership with key population led organisations. Monitor violence and establish redress mechanisms. Consolidated Guidelines

19. Global Guidance Group Check In: Global Recommendations Which of the five key populations are relevant to Myanmar context? To what extent have the global recommendations been implemented in Myanmar? Which key population groups receive adequate coverage in prevention, treatment and care programming? What can be learned where key population groups receive inadequate coverage in prevention, treatment and care programming?

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

21. “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

22. 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

23. 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

24. 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

25. NAP Global Progress Report, Myanmar identified challenges:  Health Systems Strengthening – health personnel, task shifting, capacity of NAP and Township teams.  Legal and policy frameworks – national laws impede HIV responses (MTR NSP), stigma and discrimination, new technical WG on Human Rights and Gender (MTR NSP).  Financial Resource gaps – 45% expenditure gap on HIV, spending on prevention declined.  Community Systems Strengthening – government acknowledges the important contribution of NGOs, capacity building needed for local NGOs, continuity in planning of prevention resources, ART funding model and sources. National Guidance: 2014 HIV Progress Report, Myanmar

26. National AIDS Control Programme, Department of Health, Ministry of Health Myanmar (October 2014) Core Package for Prevention of HIV Amongst Key Populations in Myanmar.  Five Elements for the Prevention of HIV Amongst Key Populations in Myanmar  Three Cross Cutting Issues plus Integration Recommendations National Guidelines: A Core Package for Key Populations

27. 5 Elements for the Prevention of HIV Amongst Key Populations: Condom Access & Use outlines the essential elements of condom access and use. Integration issues include entry points to services and programming within closed settings. Drug-Related Harm Reduction Services primarily focuses upon injection drug use with non-sterile equipment. Integration with HIV and SRH services is highlighted as is creating demand for Harm Reduction. HIV Counselling and Testing Services emphasises HCT as an entry point to HIV prevention and continuum of care services, promoting the need to ‘know your HIV status’ and minimising barriers to HCT service access. National Guidelines: A Core Package for Key Populations

28. Sexually Transmitted Infection Diagnosis and Treatment Services emphasises STI services for KPs and PLHIV as well as varied sites for STI service delivery. STI services are an entry point to HIV testing treatment, care and support. Monitoring and Evaluation includes tracking client service use with Unique Identified Codes (UIC) as well as measuring quality of service, integrated into the National M&E Plan. Cross Cutting Issues: Entry Points to HIV, SRH, HR Services Peer Outreach. Referral Systems Essential elements for an enabling environment (stigma and discrimination, legal and policy environment, coordination). National Guidelines: A Core Package for Key Populations

30. Group Check In: Myanmar National Guidelines What needs to be done to reach the level of coverage outlined in the Core Package for Myanmar?

31. Where to from here? Tomorrow we will:  Work in small groups to identify strengths, gaps and challenges in implementing the elements of the Core Package  Discuss strengths, gaps and challenges in the large group to share potential solutions  Present more global and regional guidance on good practice across the Core Package for prevention of HIV in Myanmar. National Guidelines