Effective HIV & SRH Responses among Most at Risk Populations in Papua New Guinea Module 3: The Comprehensive Package of Programmes and Services for sex workers and their clients, MSM and transgender people

SESSION 3 A Comprehensive Package of Services for MARPs IMPLEMENTATION

 Country or Provincial Adaptation of a Comprehensive Package  Implementing a Comprehensive Package of Services  Including in conflict and disaster response  Critical Enablers  Monitoring & Evaluation Overview

Based on the principles of universal access, all elements of the comprehensive package must be:  Physically accessible  Affordable  Equitable and non-discriminatory  Non-rationed. MARPs are entitled to full protection of all human rights including the right to non-discrimination, security of person, privacy, protection from violence, equality before the law and the highest attainable standard of health. Comprehensive Package of Services Principles

HIV and SRH services should be available to MARPs regardless of:  Age (no minimum age requirements)  Gender, sexual orientation or sexual behaviour  Citizenship, nationality, ethnicity or religious convictions  Employment status (informal or illegal sex work)  Confinement to a particular facility or setting including imprisonment, military service, institutionalisation or other  Health insurance or residential documentation status. Comprehensive Package of Services Principles

Country or Provincial Level Analysis of each Key Element: Is this intervention available in your context? What is the quality of this intervention? What policy changes or shifts could strengthen this intervention? What additional capacity building could strengthen this intervention? What additional monitoring or evaluation could strengthen this intervention? What are immediate next steps required to assure this intervention is available, at acceptable quality? Comprehensive Package of Services Country or Provincial Adaptation

Process:  Analysis of Key Elements  Adopt policy that describes a comprehensive package of HIV services to be available for sex workers nationally  Update clinical protocols, as necessary  Develop training modules & distribute educational materials to providers, as necessary  Develop monitoring procedures  Adapt a national M&E framework to measure short, medium and long term indicators for outputs and outcomes. Comprehensive Package of Services Country or Provincial Adaptation

Process:  Analysis of Key Elements within programme  Explore programme related critical enablers that support or provide barriers to key elements  Explore external critical enablers that support or provide barriers to key elements (mitigate, advocate)  Develop strategy towards Comprehensive Package  Reorient programmes and create links to broader services  Build capacity of staff – training and education  Monitoring & Evaluation Programme Framework  Community empowerment at centre of process Comprehensive Package of Services Programme Adaptation

GROUP ACTIVITY Participants to think through the process of Country or Provincial Adaptation for a Comprehensive Package of Services for MARPs –Who would lead the process? –Who would be the key internal players? –Who would be the key stakeholders? –Factors to be considered? Repeat the process for Programme Level Adaptation Comprehensive Package of Services Adaptation

Comprehensive Package of Services In Disaster & Conflict Response CHAPTER TWO MINIMUM INITIAL SERVICE PACKAGE “A series of actions needed to respond to the reproductive health needs of populations in the early phase of a refugee situation … there are some aspects of reproductive health that must also be addressed in this initial phase to reduce mortality and morbidity, particularly among women”

Objectives of the MISP:  To identify an organisation and individual to facilitate the coordination and implementation of the MISP  Prevent and manage the consequences of sexual violence  Reduce HIV transmission  Prevent excess neonatal and maternal morbidity & mortality  Plan for the provision of comprehensive reproductive health services, integrated into Primary Health Care as the situation permits. Comprehensive Package of Services In Disaster & Conflict Response

SMALL GROUP ACTIVITY Participants to divide into small groups Each small group to read through the Disaster Scenario Discuss the provided questions in small groups Share ideas and discussion points from small groups with whole training group

Comprehensive Package of Services In Disaster & Conflict Response SMALL GROUP ACTIVITY What is the immediate impact on sex workers in this disaster? Is there a difference between natural disasters & conflict? How does the MISP apply to this scenario? Who potentially would or could lead implementation of the MISP? Are MISP SRH services likely to be accessed by sex workers? Why or Why Not? Which of the MISP services should be prioritised to reach sex workers? What are the longer term impacts on sex workers and sex work following disasters? Are there ways of promoting sex worker access to MISP services?

Typical barriers to implementation of a comprehensive package for MARPs include:  Unsupportive national policy  Lack of adequate funding  Restrictive criteria for eligibility for services  Stigma and discrimination  Law enforcement harassment  Cost of services to users  Poor geographic distribution of services  Limited hours of operation  Limited technical capacity including comprehensive sexual history assessment and STI management. Critical Enablers

Group Check In: Country & Programme Level Barriers Which barriers to implementation of a Comprehensive Package of Services for MARPs exist at country level? Which barriers to implementation of a Comprehensive Package of Services for MARPs exist at programme and local level? Critical Enablers

A significant barrier to access of services by MARPs remains stigma and discrimination. This may be perceived or real, from health workers and the greater community. As a result, or fear of, of stigma and discrimination, MARPs may be reluctant to disclose sexual activity and request STI screens or physical examinations even when they do present to services. Critical Enablers

All key elements of a Comprehensive Package should be acknowledged within an M&E Framework and streamlined into standardised reporting mechanisms (disaggregated to MARPs), which supports one national reporting system. Comprehensive Packages, especially when agreed at national level, provide basis for sound data collection under a ‘one national system’ Monitoring & Evaluation

1.Community mobilisation –Number of sex workers engaged in self-organised networks –Number of sex worker-led organisations and networks operating under a constitution and recognised board –Percentage of sex workers engaged in self-organised networks promoting correct and consistent STI and HIV messages (IBBS) 2.Peer outreach –Number of sex workers engaged as peer educators –Number of sex workers reached with HIV & SRH prevention programmes & reach regularity (disaggregated to type of outreach services) 3.Male & female condoms and water-based lubricants –Number of male and female condoms distributed to sex workers and their clients –Percentage of sex workers reported the use of a condom with most recent client (IBBS) Monitoring & Evaluation

4.Access to full range of SRH services –Number of sex workers attending SRH services (disaggregated) –Number of sex workers using dual method contraception –Number of sex workers living with HIV on ART –Number of sex workers who report an abortion in last 12 months (IBBS) 5.Access to alcohol and drug-related harm reduction –Number of sex workers trained on alcohol harm reduction –Percentage of sex workers who inject drugs (IBBS) –Percentage of sex worker who inject drugs that access a needle-syringe programme at least once per month (IBBS) –Percentage of sex workers who inject drugs receiving consistent and monitored OST (IBBS) 6.HIV voluntary testing and counselling –Number of sex workers who received an HIV test and know their results –Percentage of sex workers who received an HIV test in the past year and know their results (IBBS) Monitoring & Evaluation

7.Access to HIV treatment, care and support –Number of sex workers living with HIV and receiving ARV therapy –Percentage of sex workers who are living with HIV (IBBS) –Percentage of sex workers living with HIV and receiving ARV therapy 8.Preventing and address violence –Number of sex workers trained in violence prevention –Number of sex workers who attend legal services for matters pertaining to violence –Percentage of sex workers who report violence within work environment during past year (IBBS) 9.Prevent and respond to stigma and discrimination –Number of health service staff trained on stigma and discrimination –Number of sex workers who report stigma and discrimination as a barrier to HIV or SRH service access during past year (IBBS) Monitoring & Evaluation

10.Economic empowerment –Number of sex workers enrolled in income generating and microcredit programmes 11.Advocacy and leadership building –Number of sex workers trained in advocacy –Number of sex workers trained in leadership –Number of sex workers who reported participation in formal advocacy process during past year (IBBS) Data collection should allow disaggregation of indicators to gender (male, female and transgender), age, service and geographical location to aid in accurate analysis of coverage with results used to improve reach and access by sex workers across the spectrum of HIV and SRH services. Monitoring & Evaluation

A Comprehensive Package of Services for MARPs

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