20th International AIDS Conference - Melbourne, Australia


MOPE285 - Poster Exhibition

Breaking bad: policy impact on access to lubricant among sex workers, males who have sex with males, and transgender people in Burkina Faso, Togo, and Kenya

S.E. Duvall1, M. Maiga2, D. Mbote3, C. Compaore4, S. Anato5, A. Chen1, D. Adams1, R. Olson1, G. Chaold5, K. Beardsley1

1Health Policy Project, Futures Group GRM, Washington, DC, United States, 2Health Policy Project, Futures Group, West Africa, Accra, Ghana, 3Consultant, Nairobi, Kenya, 4Consultant, Ouagadougou, Burkina Faso, 5Consultant, Lome, Togo

Background: Condom and lubricant (C/L) programming is a critical element of an evidence-based HIV prevention package for sex workers (SW), men who have sex with men (MSM) and transgender (TG) people, populations bearing a disproportionate burden of HIV in Africa. Policy impacts lubricant availability and access.
Methods: The USAID- and PEPFAR-funded Health Policy Project adapted the Policy Assessment and Inventory Decision Model methodology in Burkina Faso, Togo, and Kenya to assess policies that impact SW/MSM/TG access to services, including C/L, against international standards and best practices. Over 100 policy documents were analyzed in each country. Key informant interviews assessed policy implementation.
Results: Policy analysis and key informant interviews in all three countries revealed frequent stockouts of free or affordable, single-dose lubricant and gaps in policies that would ensure SW/MSM/TG access. Analyses found that overarching policies for procurement and supply management (PSM) of medical supplies in all three countries generally follow best practices but fail to guarantee government funding for lubricant; do not address procurement, distribution, or reliable commodity forecasting of lubricant; and do not budget for lubricant PSM. Although recent HIV program policies in Kenya guarantee SW/MSM/TG access to lubricant, regardless of ability to pay, PSM policy in all three countries fails to do so. Moreover, HIV policies in Burkina Faso and Togo are silent regarding free lubricant for SW/MSM/TG. HIV and PSM policies in all three countries fail to provide mechanisms for SW/MSM/TG participation in selection of lubricant, potentially resulting in selection of products populations will not use. Kenya has begun piloting rollout of C/L distribution, supported by new HIV policy, but data regarding availability of and access to lubricant are still unavailable.
Conclusions: Although HIV policy in Kenya has significantly improved, PSM policies for procurement, distribution, forecasting, and budgeting for lubricant are needed in Burkina Faso, Togo, and Kenya to eliminate stockouts and ensure SW/MSM/TG access to free and/or affordable lubricant. Policies should also guarantee state funding of lubricant and engage populations in product selection. Rollout of this essential element of HIV prevention will remain precarious in all three countries unless these supportive policies are enacted and implemented.

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