In February 2015, the Office of the U.S. Global AIDS Coordinator (OGAC) publicly released its PEPFAR Country/Regional Operational Plan (COP/ROP) 2015 Guidance. This 268-page document outlines key changes in how OGAC will allocate funds in coming years, including recommendations for engaging civil society in PEPFAR funding decisions at country and regional levels. On February 20th, OGAC convened a webinar presentation (with audio) for UNAIDS and civil society organizations to provide an overview of the new guidance. In the webinar, OGAC emphasized the need to coordinate civil society engagement with the Global Fund, national governments, bilateral donors, UNAIDS, and others. This includes the suggestion that countries use their concept note to the Global Fund to make specific recommendations to PEPFAR country teams for civil society engagement, where applicable.
These changes to the PEPFAR COP process present both significant opportunities and potential challenges for advocates, service providers, and community members working to advance the health and human rights of men who have sex with men (MSM) and other key populations in the global HIV response. This community update highlights these opportunities and challenges to inform meaningful action by activists and organizations in the many countries and regionswhere PEPFAR operates.
PEPFAR COP 2015 and Prioritization of Key Populations
The PEPFAR COP 2015 Guidance emphasizes that a new prioritization of resources for epidemic control will focus on locations and populations with the highest burden of disease, with a goal of assisting host country governments to reach 80% coverage of people living with HIV in these locations and populations by September 2017. To make these prioritization decisions, PEPFAR country teams will regularly collect and analyze demographic and epidemiological data to divide program activities geographically and by site into “core, near-core, and non-core,” with core activities receiving funding priority. Of particular relevance to civil society, the Guidance requires PEFPAR country and regional teams to collect data on HIV prevalence and population size estimations among MSM, female sex workers, and people who inject drugs, if and when it is safe to do so.
In addition, the 2015 COP Guidance outlines three key areas for achieving PEPFAR’s human rights agenda: 1) Reducing stigma and discrimination in HIV service delivery/health care settings; 2) Ensuring that data for decision-making is gathered to optimize patient care; and 3) Supporting patient rights and access to quality services. To meet these goals, required actions for PEPFAR country teams include a.) conducting non-discrimination trainings; b.) preparing a Legal Environment Assessment of laws, regulations, and policies that support or hinder the epidemic response; and c.) submitting a two-page assessment of country processes to report stigma/discrimination and violations of patient rights affecting access to services.
For background on PEPFAR’s “5 agendas,” which includes PEPFAR’s epidemic control and human rights agendas, please see the PEPFAR Blueprint: Creating an AIDS-Free Generation document issued by OGAC in 2012, as well as a Community Update conducted by the MSMGF on the implications of the Blueprint for MSM.
Increasing Civil Society Engagement
The PEPFAR COP 2015 Guidance includes new requirements for increasing civil society engagement in the development of each Country Operational Plan. These include four steps required of each PEPFAR country team in the COP planning process: 1) Development of a civil society COP engagement plan; 2) Convening engagement meetings between PEPFAR teams and civil society organizations; 3) Solicitation of written feedback from civil society organizations to PEPFAR teams; and 4) Submission of written feedback back to civil society organizations. The guidance stresses that civil society consultations should occur through a formal structure on a quarterly basis, that a diverse range of civil society organizations including representatives of key populations should be included, and that PEPFAR teams are required to submit civil society recommendations and country team feedback as part of their COP submission.
Call to Action
The Global Forum on MSM & HIV (MSMGF) commends OGAC for its vision and leadership in making policy changes to increase civil society engagement and pursue a human rights agenda through the PEFPAR COP development process. The MSMGF furthermore calls on OGAC to assure that key populations are meaningfully included in civil society consultations and that sufficient funding is allocated to act upon civil society recommendations made in each country and region where PEPFAR operates.
Specifically, the MSMGF calls for OGAC to:
a. Ensure that MSM and other key populations continue to be prioritized for programming within all PEPFAR recipient countries, irrespective the availability of data. Unavailability of reliable data should not preclude the provision of acceptable, accessible, affordable and safe programs for MSM and other key populations.
b. As PEPFAR allocations are re-prioritized, provide sufficient funding for each PEPFAR country to ensure data collection on MSM and other key populations is conducted in close consultation with members of those communities, and in a manner that protects the safety and confidentiality of research participants supplying data.
c. Commit to securing country buy-in in the COP development process for MSM- and key population-focused work.
d. Ensure that community-, MSM-, and other key population-led program representatives are meaningfully included in civil society consultations and that these consultations are both transparent and substantive.
e. Commit to adequate allocation of funds, particularly to smaller, community-, MSM-, key population-led organizations, to meet targets and goals proposed by members of MSM and key population communities in the COP development process.
How to Get Involved
The MSMGF encourages advocates, service providers, and community members of key populations in PEPFAR countries to engage meaningfully in civil society consultations for the PEPFAR COP 2015 development process. As COP submission deadlines are rapidly approaching in April and May 2015, these consultations are likely to be held in the coming weeks. OGAC has highlighted and the MSMGF re-affirms several ways for activists and organizations to play a key role in the development of PEPFAR Country Operational Plans:
1. Contact PEPFAR country teams via your local U.S. Embassy and request information on the specific schedule for civil society engagement meetings in the COP 2015 planning process. Note that OGAC has assigned PEPFAR country teams a COP 2015 submission deadline of either April 3rd or May 1st. As these are both very near-term dates, we emphasize the urgent importance of making contact as soon as possible to confirm specific schedules for civil society consultations in your country.
2. Contact civil society networks, coalitions, and coordination platforms working to develop consolidated recommendations for PEPFAR country teams. This is of particular importance to ensure that concerns of MSM and other key populations are included. Where relevant, one potential approach is to use recently submitted Global Fund concept notes to inform the PEPFAR COP.
3. Provide written requests to PEPFAR country teams for information and data relevant to key populations to be included in the COP submission.
The MSMGF will continue to provide additional information on how to engage with the PEPFAR COP 2015 process as we receive it in the coming weeks and months. We also urge you to report to us any problems or obstacles you may experience, which we can document and report to our contacts at OGAC and with PEPFAR country teams. Please write to the MSMGF’s Senior Policy Advisor Nadia Rafif at firstname.lastname@example.org with any questions or problems you may have.
A downloadable PDF version of this guidance is available on the MSMGF website at http://www.msmgf.org/files/msmgf/documents/PEPFAR%20COP%202015%20Community%20Update_March%202015.pdf.