The following is a guest post from Ashley Gibbs and David Mbote who serve on Health Policy Plus (HP+), a USAID- and PEPFAR-funded project.
To reach the ambitious targets of the global HIV response, including universal treatment and viral suppression, we must first reach all populations with lifesaving HIV services. Unfortunately, HIV programming for gay and bisexual people, other men who have sex with men, and transgender individuals—among the populations most at-risk for HIV—are often undermined by stigma and discrimination. Homophobic and transphobic attitudes, which may provide justification for criminalization in some countries, are particularly damaging when held by policymakers, HIV program staff, and health service providers—the people responsible for creating and implementing HIV programming.
Significant evidence demonstrates that stigma against men who have sex with men, transgender women, and other gender and sexual minorities contributes to HIV epidemics. However, these populations are often not meaningfully included in national HIV responses and global policy dialogues. At the United Nations General Assembly High-Level Meeting on Ending AIDS in June 2016, a number of countries—some with large HIV epidemics — blocked the participation of 22 civil society groups that represent key populations and promote the human rights of gender and sexual minorities. The resulting Political Declaration therefore inadequately addresses the needs of these populations. The President of the International AIDS Society, Chris Beyrer, has called it “a setback for our global efforts to end AIDS.”
Within the USAID- and PEPFAR-funded Health Policy Plus project, we are fortunate to work toward mainstreaming expertise on gender and sexual diversity in the global HIV response. This builds on progress made under a predecessor project, the USAID- and PEPFAR-funded Health Policy Project (HPP). In coordination with a U.S. Government interagency team, HPP designed the Gender and Sexual Diversity (GSD) Training, which has helped PEPFAR staff and partners better understand and address the needs of gender and sexual minorities in the context of HIV programming around the globe.
In 2014–2015, the GSD training was implemented in 38 PEPFAR countries. We were pleasantly surprised by the overwhelming willingness by public health professionals to discuss sensitive topics. After the training in Rwanda, one participant remarked, “I had no idea that trainings like this exist. It’s great that someone was willing to start the conversation. Dialogue is always the beginning of change.” A participant from Namibia shared, “Before the panel [discussion], I had never met someone within the gay community and had never met anyone from an organization representing the LGBT community.”
HPP collected data on participants’ attitudes toward gender and sexual minorities before and after the training. We found that the one-day training produced statistically significant improvements in individuals’ attitudes toward this unique population. Qualitative and quantitative data collected 3–6 months after the training suggest that this attitude change was sustained over time.
Over half of the participants reported changes in their behavior as a result of the training, ranging from treating gender and sexual minorities with greater compassion on an individual basis to implementing new programming to benefit the individuals within this group. We anticipate that with a longer follow-up period, even greater stigma reduction will be measurable. Key results from our research were presented on Saturday in Durban, South Africa, at the Global Forum on MSM & HIV’s pre-conference to the International AIDS Conference: Action + Access: Rights and Demands of Gay and Bisexual Men in the Global HIV Response.
Reduced stigma against gender and sexual minorities is essential to continued progress in the HIV response. Without effectively reaching these marginalized groups, the UNAIDS 90-90-90 targets and other global development goals will be impossible to achieve. National and local policymakers, HIV programmers, and health service providers can all benefit from trainings to reduce stigma against gender and sexual minorities. A one-day training is a small investment when we consider the lives lost due to homophobia, biphobia, and transphobia.
Ashley Gibbs is a senior associate for health and David Mbote is a technical policy advisor at Palladium. Both serve on Health Policy Plus (HP+), a USAID- and PEPFAR-funded project.