Context

The fight against HIV is no picnic. In many countries, stigmatization, marginalization, homophobia, gender-based violence and patriarchal constraints are real obstacles to HIV/AIDS services. The nature of the health services offered, and the populations targeted, sometimes entails serious security risks not only for the service providers, but also for the program beneficiaries.

In this regard, the 2020-2022 Technical Review Panel (TRP) Observations Report on Grant Round 6 (NFM3) noted that there is incomplete or insufficient prioritization of person-centred prevention approaches and service packages targeting underserved populations (e.g., there is a need for greater attention to confidentiality and security concerns in highly stigmatized environments and for online interventions).

In fact, the impact of this is felt at different levels. There is a direct impact on the people who work or volunteer for the programs, and to whom the programs have a responsibility. The organizations that deliver the programs, which are often small and community-led, are also seriously affected. Safety and security issues affect their effectiveness and sustainability. Below is an overview of the different impacts and consequences that can result from a lack of programme security.

In other words, the quality of programs offering services to key populations (KPs) is in part linked to the safety of the workers, volunteers and implementing organizations. One is intimately dependent on the other. It is with this in mind that the Global Fund has made the safety of its programs one of its major concerns. At the heart of its Global Fund Strategy 2023-2028 is the following statement: "We will also redouble our efforts with regard to human rights in crisis situations and strengthen our support for initiatives to ensure the safety of clients and providers of HIV services supported by the Global Fund".

In the same vein, the Global Fund's 2023-2025 HIV Information Note stresses that programme security considerations are important. Specifically, it notes that assessment, prevention and response activities involve security risks and including program activities to assess, prevent and respond to security-related risks faced by KPs is key to optimizing Global Fund investments since “these risks can undermine program reach and cause harm to key populations and those delivering services to them” (p.17).

More specifically, the Note states that: “Collecting data on key populations can pose significant personal and privacy-related risks to key populations and young people. Accordingly, data should be collected in ways that do no harm, that is, data collection and storage that protects privacy and confidentiality, ensures informed consent, and minimizes all security risks” (p.5).

Rather than being an accessory, peripheral or secondary issue, program safety must be the subject of early, essential and particular attention. Because, as we said, the optimization of Global Fund investments and the success of the fight against HIV depend on it.

Guidelines and tools for strengthening KP program safety supported by the Global Fund

These measures are mere indications or suggestions, since what is valid or applicable in context X may need to be adapted or may not apply in context Y.  The following table summarizes the measures that organizations can take to ensure the security of their programs and those responsible for implementing them.

More specifically, here are five tools to facilitate the integration of safety into programmes.

Source: Initiative and tool supported and developed by the Global Fund's Community, Rights and Gender Department, in collaboration with FHI 360 and the Civil Society Institute for Health, West and Central Africa.

Tool 1: Safety incident log

Ensures that programmes have a concrete record of the incidents and harm that concern them. This is Important for five main reasons:

1. Ensures that those affected receive the necessary support;
2. Highlights trends and vulnerable areas;
3. Helps demonstrate the impact of safety risks to key stakeholders;
4. Allows information to be shared with other vulnerable organizations; and
5. Helps prevent and respond to other events.

Tool 2: Self-assessment of safety strategies

Enables organizations to assess their strengths and weaknesses and identify priorities for improvement.

Safety areas assessed in the self-assessment:

1. Influencing the public's perception of the project;
2. Cultivating and raising awareness among external allies;
3. Document damage for monitoring and advocacy;
4. Develop functional, institutionalized safety protocols, including for emergencies;
5. Ensuring the security of data and communications;
6. Protect physical premises (e.g., offices); and
7. Ensuring the safety of workers during proximity activities.

Tool 3: Threats, risks and vulnerability assessment

Understand in detail where risks come from and how to reduce them:

1. Helps organizations gain a better (holistic) understanding of the nature of the threats they face;

1. Useful when examining incidents in the safety log;
2. Helps ensure that safety plans are well adapted to the challenges in question;
3. Allows you to operate with a clear understanding of the real risks and their underlying causes;
4. Allows you to discuss the acceptable level of risk; and
5. Recognize the different vulnerabilities and abilities of each worker when planning for safety.

Tool 4: The safety plan

A basic framework for identifying actions to improve the safety of the program's various activities:

1. Broad and specific application - while some safety measures will contribute to improving the safety of the organization or programme as a whole, others are specific to a given activity;
2. Carried out on an ad hoc basis - It is likely to be carried out several times within an organization - once per activity; and
3. Dynamic - Safety plans must be dynamic and updated as the situation changes.

Tool 5: Incorporating safety into funding applications

Practical advice for including programme safety in Global Fund grants:

1. Provides advice on how and where to integrate safety-related activities and costs into Global Fund reprogramming and funding requests;
2. Taking safety into account may require resources, as it may involve changes in the way organizations operate;
3. These resources and costs are eligible for support from the Global Fund; and
4. Helps create a safe working environment that also promotes mental health.

To sum up, we stress that making the safety of programs and their implementers a priority and devoting sufficient resources to them are essential if HIV is to be beaten or, in other words, if lives are to be saved.