‘More Than Just Lip Service: Scaling up sex work initiatives’ Making the Money Matter: Support for sex worker initiatives through the Global Fund for HIV, TB and Malaria Andy Seale, the Global Fund

Presentation Outline Round 8 and 9 Analysis Community Systems Strengthening Conclusions Global Fund Overview

Equity and the Global Fund Equitable access to services is fundamental to the mission of the Global Fund Priority will be given to ‘the most affected countries and communities, and to those countries most at risk’ and will include efforts to ‘eliminate stigmatization of and discrimination against those infected and affected by HIV/AIDS, especially for women, children and vulnerable groups’ The Framework Document of the Global Fund

Partnership Approach to Governance Donors Recipients ● Private Sector Private Foundations ● NGOs North ● NGOs South ● Communities living with the diseases ● WHO ● UNAIDS ● World Bank Civil Society Technical Partners Private Sector Public Sector (Governments) A partnership of stakeholders at the Board and in Country Coordinating Mechanisms

Global Fund Financing HIV/AIDS Grant Coverage (Rounds 1-9) OP/140709/2 140 countries US$ 10.8 billion (Approved Grant Amount) US$ 17.4 billion (Total Lifetime Budget)

Accessing Global Fund Resources In terms of being able to access or benefit from Global Fund grants, MSM, transgender people, and sex workers face serious challenges. They face limited access to decision-making or control in CCMs, principal recipient organizations, or sub-recipient organizations, and widespread inaction against social and structural barriers to the realization of health and rights. Even when (MSM/Sex workers and Trans communities) are nominal beneficiaries of Global Fund funding, there are consistent and extensive reports of funds not being allocated to appropriate interventions, a severe lack of services related to health and rights, and continued disregard for human rights. GF SOGI Strategy 2009 Early Analysis – Only 5-8% of HIV Prevention Spend Reaching Sex Workers Globally

Gender and SO/GI Strategies

Goal of Analysis Analyze Round 8 and 9 grant proposals, generating data on the strengths, deficiencies and possible technical support needs related to MSM, sex worker and transgender populations Approach  Population-specific: MSM, sex workers, transgender  Qualitative analysis: proposal form and work plan Sex Work and Global Fund Rounds 8 and 9

Areas of Analysis

Country Coordinating Mechanisms Increase in ‘representation’ of sex workers Round 8 funded proposals: none identified Round 9 funded proposals: 23 percent Working with = Representation? Pan-American Social Marketing Organization and United Belize Advocacy Movement are key organizations that work with MSM, sex worker and transgender populations respectively. Belize, Round 9 People representing key populations such as homosexuals, sex workers and intravenous drug users are represented on the CCM by NGOs and associations that intervene on their behalf. Togo, Round 9

MSM and Sex Worker Population and Prevalence Data Applicants funded in both Rounds 8 and 9 have more frequently included data in proposal forms related to population size and prevalence data estimations than planning activities related to collecting such data (MSM and Sex Worker combined) VariableRound 8Round 9 Population Data39% (n=12)60% (n=18) Population Activities10% (n=3)17% (n=5) Prevalence Data42% (n=13)67% (n=20) Prevalence Activities10% (n=3)

Thailand Example Undertake operational research studies: Selected operational research studies are proposed addressing salient issues in these activities. For all MARP populations, DDC will coordinate the following studies: 1)Estimation of MARP population sizes for these largely hidden and hard-to-reach populations using the "social network/scale up method" with technical support from UNAIDS and WHO. 2)Assessing sustainability of HIV prevention for MARPs: cost- effectiveness studies to determine best models. Thailand, Round 8, Funded

Service Delivery: Prevention and Treatment PreventionTreatment Round 8 Funded Proposals Any or all groups  71% (n=22) MSM  55% (n=17) Sex Workers  65% (n=20) Transgender  6% (n=2) Any or all groups  48% (n=15) MSM  39% (n=12) Sex Workers  42% (n=13) Transgender  3% (n=1) Round 9 Funded Proposals Any or all groups  80% (n=24) MSM  70% (n=21) Sex Workers  67% (n=20) Transgender  20% (n=6) Any or all groups  57% (n=17) MSM  53% (n=16) Sex Workers  37% (n=11) Transgender  17% (n=5)

Example: Lesotho Provide HIV prevention interventions for vulnerable groups. Five target groups (CSW, MSM, people with disabilities, herd boys and prison inmates) have been identified for an initial phase of outreach and support to individuals and groups with special needs within the general population.  Lesotho, Round 8 (Funded)

Care, Support, Stigma and Rights Promotion Care and SupportStigma/Rights Promotion Round 8 Funded Proposals Any or all groups  29% (n=9) MSM  26% (n=8) Sex Workers  23% (n=7) Transgender  3% (n=1) Any or all groups  13% (n=4) MSM  10% (n=3) Sex Workers  13% (n=4) Transgender  0% (n=0) Round 9 Funded Proposals Any or all groups  50% (n=15) MSM  47% (n=14) Sex Workers  33% (n=10) Transgender  20% (n=6) Any or all groups  43% (n=13) MSM  43% (n=13) Sex Workers  27% (n=8) Transgender  20% (n=6)

Example: Colombia One of the identified gaps pertains to the notion of “invisibility” and the exclusion of key groups and the risks to their rights. The promotion of meeting places and rights education are planned not only to make it possible for the key groups to meet and participate, but also to promote education for citizen involvement, political impact and reflection, HIV/AIDS education and the promotion of the Project’s activities.  Columbia, Round 9, Funded

Community System Strengthening Systematic partnership and network building at the local level Elements that support the core processes of community- based organizations Round 8 Funded Proposals Any or all groups  26% (n=6) MSM  13% (n=4) Sex Workers  26% (n=8) Transgender  0% (n=0) Any or all groups  3% (n=1) MSM  0% (n=0) Sex Workers  3% (n=1) Transgender  0% (n=0) Round 9 Funded Proposals Any or all groups  46% (n=14) MSM  43% (n=13) Sex Workers  27% (n=8) Transgender  20% (n=6) Any or all groups  17% (n=5) MSM  17% (n=5) Sex Workers  10% (n=3) Transgender  13% (n=4)

Community Systems Strengthening Board of the Global Fund - inclusion in proposals of measures for strengthening of community systems (CSS) Initiatives that contribute to the development and/or strengthening of community-based organizations to improve health outcomes – including LGBTI Enabling environment and advocacy Community networks, linkages, partnerships and coordination Resources and capacity building Community activities and service delivery Organizational and leadership strengthening Monitoring & Evaluation and Planning

Conclusions The evidence we currently have about ‘money spent’ suggests much more is needed to make the Global Fund work in relation to sex work (several early analyses indicating global investments of less than 5% of HIV prevention in total) Some regions/countries doing better than others – political will in-country is crucial Countries slightly increased commitments to sex worker focused funding between Round 8 and Round 9 in HIV proposals submitted to the Global Fund In Round 9 slightly more than half of the funded HIV proposals included prevalence related data on either MSM, transgender persons or male, female or transgender sex workers Round 10 looks promising – with the SOGI Strategy and emphasis on Community Systems Strengthening We need further research - Repeat Proposal Analysis will be published next year Investment analysis currently underway to look at ‘spend’ as well as activity area