Technical Bulletin Compendium: HIV Prevention and Treatment Strategies for MSM

Intended as a primer for MSM advocates and service providers, this series covers key interventions and frameworks that have been central to the current global dialogues on HIV prevention, treatment and care. Topics were identified and prioritized based on results of the MSMGF’s 2010 Global Men’s Health and Rights study (GMHR), which surveyed more than 5,000 MSM worldwide regarding access to and knowledge of the current spectrum of HIV prevention strategies. Each bulletin was developed utilizing a balanced approach, highlighting both the benefits and challenges of a given intervention based on existing evidence.

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The Global HIV Epidemics among Sex Workers

Since the beginning of the epidemic sex workers have experienced a heightened burden of HIV. Unfortunately, sex workers’ HIV and health-related risks and rights have often gone unattended and global resource allocation related to HIV prevention, treatment and care has not been based on rigorous analysis in terms of the evidence related to sex work and HIV. To inform an equitable, effective, and sustainable response to HIV which promotes and protects the human rights of sex workers, the following questions were addressed in this analysis, focusing largely on female sex workers from lower and middle income countries:

What is the global burden of HIV among sex workers? How do sex worker HIV burdens compare to the general population? How does this vary by region?
How does the policy and social context shape sex workers’ HIV risk across geographic settings? How does this context influence the provision and coverage of HIV services?
To what extent can comprehensive HIV prevention at-scale among sex workers modify HIV transmission dynamics among sex workers and the general population?
What are the most cost-effective HIV prevention, treatment, and care interventions in the context of sex work? What combinations of services are most cost-effective?
Given this evidence, what are the implications for allocative efficiency in HIV prevention programs?
How does violence against sex workers affect their health and human rights and HIV transmission dynamics among sex workers and the general population across settings?
What has been the role of sex worker leadership in promoting the human rights of and reducing the burden of and risks for HIV infection among sex workers across contexts?

Consultation of Sex Workers (PICO Questions) and Report

The World Health Organization (WHO) is developing guidelines for evidence-based interventions for the prevention and treatment of HIV and other sexually transmitted infections (STIs) in low- and middle-income countries. As a global partner to the WHO in this process, the Global Network of Sex Work Projects oversaw a civil society consultation of sex workers commissioned by the WHO to gather feedback on proposed guidelines. This report contains the findings from that consultation and was submitted to the WHO.

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‘SWIT’ – Implementing Comprehensive HIV/STI Programs with Sex Workers (Policy Brief)

This tool, commonly abbreviated as ‘SWIT,’ is the product of collaboration among sex workers, service providers, researchers, government officials, and NGOs from around the world. Its development was guided by WHO, UNFPA, UNAIDS, NSWP, the World Bank, and development partners from the US, including the Bill & Melinda Gates Foundation. The purpose of this tool is to describe approaches and principles to building programmes. Guidance is provided on how to implement the recommended health-care interventions for HIV prevention, treatment and care, how to manage programmes, and how to build the capacity of sex worker organizations. Throughout the document are case examples from programmes around the world, highlighting specific aspects related to sex worker programming that have worked well in their contexts. These case examples illustrate how an issue or challenge has been addressed, and to inspire ideas about approaches that could work in the reader’s own context.

The full-text document is also available.

Year of publication:

2013

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Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach

These consolidated guidelines provide guidance on the diagnosis of HIV infection, the care of people living with HIV, and the use of antiretroviral (ARV) drugs for treating and preventing HIV infection. They are structured along the continuum of HIV testing, care and treatment. Behavioural, structural and biomedical interventions that do not involve the use of ARV drugs are not covered in these guidelines. The 2013 consolidation process combines and harmonizes recommendations from a range of WHO guidelines and other documents, including the 2010 guidelines on using antiretroviral therapy (ART) for HIV infection in adults and adolescents, in infants and children, and for treating pregnant women living with HIV and preventing HIV infection in infants. Comprehensive guidance is now provided on using ARV drugs across age groups and populations of adults, pregnant and breastfeeding women, adolescents, children and key populations. The guidelines also aim to consolidate and update clinical, service delivery, and programmatic guidance.

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Verdict on a Virus: Public Health, Human Rights and Criminal Law

This document is intended for anyone who wants to know more about the criminalization of HIV transmission or exposure and the related health, human rights, and legal implications. It can help you to become more familiar with the latest laws, legal support, and other services relating to HIV in your country or region. The 10 key questions in this guide provide a snapshot of case studies and opinions from around the world; they ask and answer the key questions about the criminalization of HIV transmission and exposure – what it is and why it is an increasingly important issue now; and what are the human dimensions in terms of health, stigma, human rights, the law, and the experiences of people living with HIV. This guide provides resources and information to:

Support legal advocacy and social mobilization in countries that criminalize HIV transmission or exposure in order to repeal or reform these laws;
Consolidate arguments and document why the criminalization of HIV transmission or exposure is not an effective approach for promoting public health;
Catalyse national and international activism to prevent future laws on criminalization being enacted or applied; and
Support people living with HIV to become more familiar with legal issues and their rights.

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Preventing HIV and Unintended Pregnancies: Strategic Framework 2011 – 2015

This strategic framework supports the ‘Global Plan Towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive’. It offers guidance for preventing HIV infections and unintended pregnancies – both essential strategies for improving maternal and child health, and eliminating new paediatric HIV infections. The framework should be used in conjunction with other related guidance that together address all four prongs of eliminating mother-to-child transmission of HIV. This document focuses on strengthening rights-based polices and programming within health services and the community.

Advancing HIV Justice: A progress report of achievements and challenges in global advocacy against HIV criminalisation

Many laws criminalising HIV non-disclosure, exposure and transmission were put in place due to ignorance about how HIV is transmitted and what sort of harm it causes. Fear of HIV and discrimination against people living with HIV are almost palpable in many of these laws and in the sentences that result from prosecution. This document scans the current situation, the good developments and the bad; details the many initiatives by independent experts, governments, the United Nations and civil society; describes the latest research and its findings in terms of prosecutions and convictions and the social impact of these on the HIV response and people’s behaviour. Most importantly, it powerfully demonstrates that civil society advocacy on this issue is not only alive – it goes from strength to strength.

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