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

2. 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

3. 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, 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

4. 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

5. 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

6. Objectives
To reduce HIV, STI and TB among LGBTI in line with the 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

7. 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

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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. Thank you

20. Bibliography
South African National AIDS Council. National Strategic Plan on HIV, STIs and TB, Pretoria: SANAC 2011
OUT!, Levels of empowerment among LGBT people in KZN
UNAIDS (2014) Gap Report, Page 91
Herbst et al, 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:
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 Available from:
World Health Organization. Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations Geneva WHO; Available from:
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):e PubMed PMID: Pubmed Central PMCID: