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POSITIVE HEALTH, DIGNITY and PREVENTION a Policy Framework FOREWORD

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POSITIVE HEALTH, DIGNITY and PREVENTION a Policy Framework FOREWORD POSITIVE HEALTH, DIGNITY AND PREVENTION A POLICY FRAMEWORK FOREWORD Positive Health, Dignity and Prevention highlights the importance of placing the person living with HIV at the centre of managing their health and wellbeing. Among other things, this Framework takes us beyond the more limited concept of ’positive prevention’ which focuses only on people living with HIV ’preventing’ the transmission of HIV. In contrast, Positive Health, Dignity and Prevention stresses the importance of addressing prevention and treatment simultaneously and holistically. It also emphasises the leadership roles of people living with HIV in responding to policy and legal barriers within the socio-cultural and legal contexts in which they live, and in driving the agenda forward toward better health and dignity. Whilst acknowledging current work in the area of ‘positive prevention’ this Framework helps inform and expand on this work and provides further policy guidance in terms of understanding how to enhance and nurture the leadership of people living with HIV, as they define and guide existing programmes that allow them to live in dignity, maintain or improve their health, and make choices that have beneficial results for themselves and their partners, families, and communities. It will also ensure that people living with HIV feel they have ownership of the programmes and services that are focused towards them. In considering the ongoing challenge of HIV prevention, people living with HIV should be recognised as a part of the solution—not a part of the ‘problem’. The public health and human rights goal of preventing new HIV infections can only be achieved when the human, sexual, and reproductive rights of people living with HIV are protected and supported; when the broader health and dignity needs of people living with HIV are met; and when access to timely and uninterrupted treatment and care encourages greater uptake of confidential voluntary counselling and testing. These important goals can be achieved with broad stakeholder commitment to this Framework. We hope that Positive Health, Dignity and Prevention will shape how governments, policymakers, programmers and international agencies work with people living with HIV: moving away from treating people living with HIV as passive targets of prevention messages towards recognising them as active participants in the global HIV response. Kevin Moody Michel Sidibé International Coordinator and CEO, GNP+ UNAIDS Executive Director POSITIVE HEALTH, DIGNITY AND PREVENTION A POLICY FRAMEWORK 2 CONTENTS Foreword 2 Executive Summary 4 Background 7 HIV prevention and people living with HIV 7 A new framework for hiv prevention by people living with HIV 8 A new name for a new framework 9 Who is this framework for? 9 Guiding 11 Principles 11 Values 13 Goalscomponents, elements and linkages 19 Empowerment 19 Gender equality 19 Health promotion and access 19 Human rights 19 Preventing new infections 19 Sexual and reproductive health and rights 19 Social and economic support 19 Hot topics: Three challenges and opportunities 25 Stalling on universal access 25 State-supported stigma and discrimination 27 Treatment as prevention 29 Building evidence and progress and outcomes 33 The importance of meaningfully involving people living with HIV 33 Building evidence 33 Measuring impact, progress and outcomes 37 Moving forward 39 Appendix 1: Framework development background 44 Appendix 2: Further reading 45 Acronyms 46 Acknowledgements 47 POSITIVE HEALTH, DIGNITY AND PREVENTION A POLICY FRAMEWORK 3 EXECUTIVE SUMMARY The primary goals of Positive Health, Dignity and Attaining the goal of Positive Health, Dignity and Prevention are to improve the dignity, quality, and length Prevention specifically requires promoting and affirming of life of people living with HIV; which, if achieved will, in the empowerment of people living with HIV through the turn, have a beneficial impact on their partners, families, following objectives: and communities, including reducing the likelihood of new infections. • Increasing access to, and understanding of, evidence-informed, human-rights-based policies and Positive Health, Dignity and Prevention is not just a new programmes that support individuals living with HIV to name for the concept of HIV prevention for and by people make choices that address their needs and allow them living with HIV, formerly known as ‘positive prevention’. to live healthy lives free from stigma and discrimination. Rather, Positive Health, Dignity and Prevention is built on a broader basis that includes improving and maintaining • Scaling up and supporting existing HIV counselling, the dignity of the individual living with HIV, to support and testing, care, support, treatment, and prevention enhance that individual’s physical, mental, emotional and programmes that are community owned and led, sexual health, and which, in turn, among other benefits, and increasing access to rights-based health services creates an enabling environment that will reduce the including sexual and reproductive health. likelihood of new HIV infections. • Scaling-up and supporting literacy programmes in Positive Health, Dignity and Prevention encompasses the health, treatment, prevention, human rights and the full range of health and social-justice issues for people living law, and ensuring that human rights are promoted with HIV, and espouses the fundamental principles that and implemented through relevant programmes and responsibility for HIV prevention should be shared, and protections. that policies and programmes for people living with HIV should be designed and implemented with the meaningful • Ensuring that undiagnosed and diagnosed people, involvement of people living with HIV. along with their partners and communities, are included in HIV prevention programmes that highlight shared By linking together the social, health, and prevention needs responsibilities regardless of known or perceived HIV of the individual living with HIV within a human-rights status and have opportunities for, rather than barriers framework, Positive Health, Dignity and Prevention results to, empowering themselves and their sexual partner(s). in a more efficient use of resources, with outcomes more responsive to the needs of people living with HIV and more • Scaling up and supporting social capital programmes beneficial for their partners, families, and communities. that focus on community-driven, sustainable responses This Framework is the first step towards operationalising to HIV by investing in community development, Positive Health, Dignity and Prevention. It should be seen networking, capacity-building, and resources for as a living document that adapts to the evolving needs of people living with HIV organizations and networks. people living with HIV and the policies and programmes that serve them. Operationalising Positive Health, Dignity and Prevention is not about creating new programmes, except where basic programmes currently do not exist. Rather, it is about using this new framework to create linkages among existing programmes and also taking them to scale, so that they are more efficient and more responsive to the needs of people living with HIV. POSITIVE4 HEALTH, DIGNITY AND PREVENTION A POLICY FRAMEWORK POSITIVE HEALTH, DIGNITY AND PREVENTION4 Individual programmatic elements will inevitably differ from 4 POLICY DIALOGUE setting to setting, as local needs and resources dictate, but To agree on priority areas for implementation, fall under eight major component headings. including linkages between existing programmes, and to understand gaps in current policies relating to HIV - EMPOWERMENT prevention for people living with HIV. - GENDER EQUALITY 5 PLANNING - HEALTH PROMOTION AND ACCESS To prepare for standard operational guidelines for - HUMAN RIGHTS Positive Health, Dignity and Prevention. - PREVENTING NEW INFECTIONS 6 IMPLEMENTATION - SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS To develop standard operational guidelines for Positive - SOCIAL AND ECONOMIC SUPPORT Health, Dignity and Prevention. - MEASURING IMPACT 7 INTEGRATION Nine action areas are recommended to move forward with To integrate standard operational guidelines into the development of operational guidelines for Positive national strategic frameworks, resources, plans, Health, Dignity and Prevention, with specific roles and policies, and monitoring and evaluation systems. responsibilities for GNP+, other networks of people living with HIV, civil society, the public and private sectors, the 8 MONITORING AND EVALUATION Joint United Nations Programme on HIV/AIDS (UNAIDS) To develop monitoring and evaluation indicators Secretariat and Cosponsors and donor agencies. for implementation of Positive Health, Dignity and Prevention, including programme linkages; policy 1 ADVOCACY development; effectiveness in reducing new infections; To increase the meaningful and broad-based and individual and population health outcomes. mobilisation of people living with HIV in HIV prevention efforts and increase the capacity of organizations and 9 ADAPTATION AND IMPROVEMENT networks of people living with HIV at global, regional, To adapt the Framework and operational guidelines in and country levels to participate as full, equal, and light of new findings from monitoring and evaluation as essential partners in the planning, implementation, the epidemic changes, more evidence accumulates, and monitoring, and evaluation of Positive Health, Dignity other changes occur (e.g. new prevention technologies,
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