Boksburg Communiqué Report on SRHR and HIV/AIDS Services for Key Populations In ESA

We, the delegates to the Regional Policy Dialogue on Integrated Sexual and Reproductive Health and Rights and HIV Services for Key Populations in ESA, including His Excellency the former president of the Republic of Mozambique, Joaquim Chissano, former heads of state and governments from ESA, the African Union Commission, national AIDS co-ordinating agencies, international co-operating partners, the United Nations Joint Programme on HIV and AIDS, development partners and key populations, gathered in Boksburg, Johannesburg, South Africa, from 2 – 3 April, 2014:

Recognising the urgent need to address the sexual and reproductive health and rights (SRHR) and needs of key populations in eastern and southern Africa;

Concerned that violations against key populations undermine their basic rights and wellbeing as enshrined in the Universal Declaration of Human Rights (1948);

Concerned that the voices of key populations are silent or overlooked in making policy decisions about their health, wellbeing and development; inadequate evidence exists to inform interventions, policies and laws that reflect the SRH service needs of key populations;

Aware of the urgent need to develop policy that addresses the SRH and HIV service concerns of key populations in the post 2015 development agenda;

Noting the economic cost and development impact of stigma, discrimination and exclusion of key populations from mainstream public health interventions;

Convinced of the need to stop human rights violations experienced by different key populations in the region;

And determined to scale up access to and uptake of quality, integrated SRH and HIV information and services by key populations;

Deeply alarmed about:

• High rates of HIV infections in Africa – particularly in the ESA region, gender-based violence and poor SRH outcomes among key populations;
• Limited involvement of key populations in design and implementation of HIV and SRHR information and programmes;
• Lack of a conducive policy environment to support access to and uptake of SRH and HIV information and services by key populations;
• Continued isolation, discrimination, persecution, rejection and violence against key populations;
• Gross violations of human rights of key populations and continued criminalisation, founded on prejudice, hate and blackmail.

Recommending that:

Generally,

• Public health issues be depoliticised;
• Based on data drawn from the principles of Know Your Epidemic – Know Your Response the definition of key populations be harmonised within country contexts;
• Disaggregated data for key populations (by age, equity dimensions, sex, sexual orientation, gender identity, sexual orientation, ethnicity) be collected to inform policy and programmes;
• Greater investment in SRH policy and services to reduce the HIV and SRH burdens faced by key populations.

And specifically recommend the following for various key population groups:

For people living with HIV:

• The implementation of the Positive Health, Dignity and Prevention policy framework at country level;
• Monitoring of human rights violations experienced by people living with HIV;
• Meaningful involvement of people living with HIV in the design, conceptualisation, implementation, monitoring and evaluation of all policies and programmes that affect their lives.

For lesbian, gay, bisexual, transgender and intersex (LGBTI) people:

• Country policies should recognise and address the  needs of LGBTI populations using a fundamental human rights approach;
• Develop and adopt minimum SRH service packages that address the needs of LGBTI populations;
• Continued and systematic advocacy against criminalisation laws, guidelines, policies and constitutions;
• Continued sensitisation of all key stakeholders using an evidence-based approach.

For sex workers:

• Decriminalise all laws and policies against sex work;
• Policy implementation to be done through a multi-sectoral approach;
• Recognise sex work as a legitimate form of work, using the human rights approach;
• Provision of integrated life skills, entrepreneurship training, HIV and SRH services that reach the most marginalised sex workers;
• Engaging political, religious and traditional leaders to play a pro-active role in protecting sex workers.

For persons with disabilities:

• Domesticate the Convention on the Rights of Persons with Disabilities, and other declarations and commitments on people with disabilities;
• Service delivery models should mainstream the needs of people with disabilities;
• Meaningful involvement of people with disabilities in policy formulation and implementation.

For young people:

• Accountability of national governments towards the ESA ministerial commitment and other regional and international commitments on SRHR and Comprehensive Sexuality Education;
• Comprehensive sexuality education for young people, including young people who identify with different key populations (PLHIV, sex workers, LGBTI people, people with disabilities);
• Deliver youth friendly services that adequately address young people’s health and social needs;
• Conduct comprehensive operational research and data analysis of laws and policies to understand how they impact on the SRHR of adolescents and young people.

We pledge to:

• Take concrete measures to work with key populations, African Union Commission, East African Community, Southern African Development Community (SADC), governments, development partners, civil society and communities to ensure policies address the SRHR needs and concerns of key populations in ESA and promote their access to sexual and reproductive health services and commodities that respond to HIV and other SRHR elements;
• Establish a supportive environment for policy to be operationalised across the region.

Thus done and agreed on this 3^rd day of April, 2014, by the delegates to the Tweet@ble Regional Policy Dialogue on Integrated Sexual and Reproductive Health and Rights and HIV Services for Key Populations in ESA.