Meaningful involvement of key affected populations in the HIV response. Dr. Steave Nemande AMSHeR Evolve, Cameroon

Definitions What is GIPA? It is not a project or programme. It is a principle that aims to realize the rights and responsibilities of people living with HIV, including their right to self-determination and participation in decision-making processes that affect their lives. In these efforts, GIPA also aims to enhance the quality and effectiveness of the AIDS response.

Cont. Who are KAPs? The term ‘key populations’ or ‘key affected populations at higher risk of HIV exposure’ refers to those most likely to be exposed to HIV or to transmit it – their involvement is critical to an effective response to the epidemic (they are key to the epidemic and key to the response). In all countries, key populations include people living with HIV. In most settings, men who have sex with men, transgender persons, people who inject drugs, sex workers and their clients, and seronegative partners in serodiscordant couples are at higher risk of HIV exposure to HIV than other people.

Pyramid of involvement of PLWHAS DECISION MAKERS: PLHIVare actively involved in decision- making processes or policy-making bodies, and their inputs are valued equally with all the other members of these bodies. EXPERTS: PLHIV are recognized as important sources of information, knowledge and skills who participate – on the same level as other professionals – in the design, implementation and monitoring and evaluation of interventions. IMPLEMENTERS: PLHIV carry out key community level interventions e.g. as caregivers, peer educators or outreach workers.

Cont. SPEAKERS: PLHIV are often used as spokespersons in campaigns to change behaviors, or are brought into conferences or meetings to “share their views” but seldomly given the opportunity to participate. CONTRIBUTORS: activities involve PLHIV only marginally, generally when the PLHIV is already well-known. For example, using an pop star living with HIV on a poster, or having relatives of someone who has recently died of AIDS to speak about that person at public events. TARGET AUDIENCES: activities are aimed at or conducted for PLHIV, or address them en masse rather than as individuals.

Now how have key affected populations been involved in the HIV response in Africa? The case of MSM.

Target audience MSM are a target audience of HIV programmes since the early This started mainly with HIV organizations providing them with information and preventive material, or doing research to assess their needs (Senegal, Kenya). -- As a result, first evidence of MSM being vulnerable to HIV and STI became available to strengthen interventions. -- Yet there are few targeted services dealing with stigma, discrimination, violence, substance abuse, mental health concerns, and other health care needs. -- Where they exist, their competence in relation to the needs of MSM have not been thoroughly evaluated.

Contributors No celebrity has actually come out as a gay person on the African continent yet.

Speakers Many African LGBTI activists are actively advocating for the respect of the rights of their peers, including their rights to health. Some of them have come out as gay men (Cameroon, Uganda, Nigeria, South Africa, etc.) or as HIV positive gay men (Namibia, Nigeria, Côte d’Ivoire) -- This was crucial in the face of the denial of same-sex sexuality in Africa -- This has facilitated the visibility of MSM and consideration of MSM issues accross the continent and internationnally. --Unfortunately, some have had to flee their countries and to seek refuge in Europe, US, South Africa, or other countries.

Implementers & Experts Due to the growing number of AIDS-related deaths in the early 2000, local LGBTI HIV activists began a working to ensure access to services and care to their communities. In most African countries, there is some form of organizing to ensure access to these services by MSM Community centers offering targeted health-related services to MSM were opened accross the continent (Cameroon, Côte d’Ivoire, Kenya, Morocco, South Africa). There is a growing number of sub-regional and regional initiatives to strengthen country based interventions (eg. Afri Minorites, AMSHeR)

Decision makers There are very few open MSM participating in decision- making or policy-making bodies in Africa. The Country Coordinating Mechanism is actually the only space provided (Cameroon, Namibia, Senegal) at country level. They face many challenges in their work : -- Weakness of the CCM in ensuring its role of supervisor and controller -- Criminalization of same-sex practices. -- Poor knowledge of MSM issues or hostility from other CCM members. -- Weak support from other civil society representatives. -- No participation in the design of the MSM component of the national programme.

Successes Many LGBTI/MSM-led organizations are providing services to their communities accross Africa. Community centers offerring specific health related services (Cameroon, Côte d’Ivoire, Kenya, Morocco, South Africa). There is an existing network of MSM-led organizations called AMSHeR – African Men for Sexual and Health Rights. A Committee for the protection of the rights of PLHIV and those most at risk (including MSM) is now active within the African Commission on Human and Peoples’ Rights.

Challenges Engaging governments on a rights-based approach in the fight against HIV, especially in countries where same-sex practices are criminalized. -- Decriminalization -- Policy changes -- Fighting stigma and discrimination Reaching out to hidden/invisible MSM or scaling up and sustaining interventions. -- Rural settings and places where there are no LGBT organizations -- Providers competent in dealing with MSM issues -- Purchasement of lubricant and other specific material for prevention

Cont. Developping taylored programmes targetting young MSM, MSM living with HIV, MSM who trade sex, women who have sex with women (WSW), transgender and intersex people. Mobilizing resources and capacity for a more effective HIV response. Building a real and strong leadership of MSM on country, subregional, and regional levels.

Thank you! Merci! Amesegnalew!