A NEW GUIDE FOR IMPLEMENTING AND SCALING UP PROGRAMS TO REMOVE HUMAN RIGHTS-RELATED BARRIERS TO HIV SERVICES
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Download PDF In April 2020, the Global Fund, Frontline AIDS, and GIZ BACKUP Health – the three leading organizations in the fight against HIV/AIDS – partnered to publish a practical guide to implementing and scaling up programs to remove human rights-related barriers to HIV services. The Global Fund is a leading international financier of the response against HIV, tuberculosis (TB), and…
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Frontline Aids, the Global Fund Secretariat, and GIZ BACKUP Health collaborated on a guidance document for implementers
ABSTRACT Frontline AIDS published a guide to implementing and scaling up programs to remove human rights-related barriers to HIV services with support from GIZ BACKUP Health and the Global Fund. Although it is designed to address human rights-related barriers to HIV serves, it can be used to address human rights is other settings.
In April 2020, the Global Fund, Frontline AIDS, and GIZ BACKUP Health – the three leading organizations in the fight against HIV/AIDS – partnered to publish a practical guide to implementing and scaling up programs to remove human rights-related barriers to HIV services. The Global Fund is a leading international financier of the response against HIV, tuberculosis (TB), and malaria in over 100 countries. Frontline AIDS supports community organizations implementing HIV-related programs. GIZ BACKUP Health, an agency of the German Federal Ministry of Economic Cooperation and Development (BMZ), assists countries supported by the Global Fund in designing and managing their HIV, TB, and malaria programs.
The guide provides practical ways for HIV-program implementers to remove human rights-related barriers to HIV services, which hinder the response to the epidemic. Although the primary focus of the guide is to remove human rights-related barriers to HIV services, it can be used in programs to address barriers to other health conditions. The guide is divided into three modules, which are:
- understand human rights-related barriers to HIV services and the programs to remove them
- design programs to remove human rights-related barriers to HIV services
- deliver programs at scale to remove human rights-related barriers to HIV services.
Understand human rights-related barriers to HIV services and the programs to remove them
“I was fired from work when they found out I have HIV. Now, I have no money to travel to the health clinic,” says a person living with HIV (PLHIV). This quote illustrates one of the barriers that PLHIV face. When faced with stigmatization and human rights abuses, such as the risk of loss of employment, PLHIV may hide their status, fail to attend clinic appointments, or make decisions that are detrimental to themselves and those around them.
This module is divided into three areas, which are:
Understand human rights-related barriers to HIV services and the need to remove them
This section introduces the main human rights- and gender-related barriers that hinder the access and uptake of HIV services in most settings. These human rights- and gender-related barriers include:
- stigmatizing attitudes and discriminatory behaviors by healthcare workers against people living with HIV
- violations of the rights to confidentiality
- police violence and harassment with impunity
- denial of information
- criminalization of same-sex conduct and sex and sex work
- unlawful surveillance and arrest
- gender inequality
- forced and early marriage
- absence of protective laws and regulations
- denial of condoms in prisons
- violence including gender-based violence and intimate partner violence
- harmful and prohibitive laws, policies, and practices.
Human rights-related barriers contribute to the increase of HIV infections, especially among key and vulnerable populations. Key populations are individuals or groups who are at higher risk of contracting one of the three diseases (HIV, TB, and malaria) but have limited access to prevention and care, according to the Global Fund. HIV key populations include men who have sex with men (MSM), sex workers, transgender people, drug abusers, and those incarcerated. Vulnerable populations face certain situations that make them more at risk of contracting HIV. Vulnerable populations include adolescent girls and young women (AGYW), people with disabilities, migrants, refugees, and displaced people.
Understand the seven key programs that can reduce or remove human rights-related barriers to HIV services
This section illustrate in details the seven program areas for removing human rights-related barriers to HIV services, first developed by the Joint United Nations Program on HIV/AIDS (UNAIDS) in 2012. These are summarized in Figure 1 below.
Figure 1: The seven key program areas
Source: Guidance on implementing and scaling up programs to remove human rights-related barriers to HIV services
Understand your country context
This section is vital as it helps program implementers with the initial design of a response. Understanding the country context involves mapping the existing HIV-prevention strategies; identifying the barriers to access these services, as well as the individuals affected by those barriers; and determining the measures to overcome those challenges. Such steps are relevant for new programs.
Design programs to remove human rights-related barriers to HIV services
This module discusses how to design quality programs to reduce human rights-related barriers to services and improve access for “key and vulnerable populations.” It indicates the need for programs to be “gender-responsive”. In other words, the programs should reflect differentiated responses on risks and barriers to services experienced by men and women.
The guide provides several essential components that are important when designing comprehensive, sustainable, and impactful programs to remove human rights-related barriers to HIV services. The essential components are summarized in Figure 2 below:
Figure 2: The essential components for quality, comprehensive, and impactful programs
Source: Guidance on implementing and scaling up programs to remove human rights-related barriers to HIV services
The guide also provides the four steps to follow when designing programs to remove human rights-related barriers to HIV services. The first step is to map the process of change. This involves depicting the process of change due to interventions of the program and the indicators to measure success. The second step is to combine existing and complementary interventions, so as they mutually strengthen each other. The third step is to coordinate implementations for the programs to achieve and sustain the desired change. The fourth step is to select indicators and monitoring process to measure whether the programs are achieving the desired outcomes.
Deliver programs at scale to remove human rights-related barriers to HIV services
The guide stated that although programs to remove human rights-related barriers to HIV services existed, those programs were often small. A comprehensive program was never implemented at scale, over time, and strategically in any country.
Four key steps for scale-up
The guide takes program implementers through four key steps to scale up the delivery of programs to remove human rights-related barriers to HIV service. These four steps are:
- develop the scale-up plan
- develop the monitoring, evaluation, and learning plan
- cost the scale-up plan and mobilize resources
- implement the scale-up plan.
It is essential for implementers to use the guide as a source of innovation rather than a catalog of interventions to choose from.
While the details of this guide are specific to HIV programs, tips and lessons from this guide can be useful for many health-related programs, especially amid this COVID-19 pandemic, when increased human-rights related abuses have been observed.
Further reading
- The 2020 Frontline AIDS practical guide, “implementing and scaling up programs to remove human rights-related barriers to HIV services”, 23 April 2020
