Sexual and Gender Minorities Baseline: The Situation in Guyana

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Material Information

Title:
Sexual and Gender Minorities Baseline: The Situation in Guyana
Physical Description:
56p ; Digital format PDF
Language:
English
Creator:
Magda Fiona Wills
Publisher:
UNDP Guyana
Place of Publication:
Guyana
Publication Date:

Subjects

Subjects / Keywords:
Caribbean Area, Guyana, sexual minorities, msm, transgender, gay, homosexual   ( lcsh )

Notes

Funding:
Support for the development of the technical infrastructure and partner training provided by the United States Department of Education TICFIA program.
General Note:
While the global response to HIV and AIDS has realized several successes in achieving universal access to prevention, care and treatment to date, challenges persist in ensuring equal access to these services for most at risk populations. The epidemiology of HIV reflects a stark disparity in access to prevention and treatment services for neglected most-at risk populations, such as men who have sex with men (MSM). World-wide, MSM often experience higher rates of HIV relative to the total population. The reasons for this dynamic are multi-faceted and include high risk behaviors, and cultural as well as structural barriers. For MSM in developing countries, for example, basic services for prevention and treatment of HIV infection have yet to reach the large majority of men. Homophobia and discrimination limit access of MSM to prevention services and markedly increase vulnerability, as do criminalization of same-sex behavior. Decriminalization of same-sex behavior is a structural intervention for prevention of HIV infection and has recently been embraced by a nonbinding statement from the United Nations (Beyrer C,Clin Infect Dis. 2010 May 15;50 Suppl 3:S108-13) In the Caribbean, all of the above mentioned barriers exist. In fact, recent evidence demonstrates that there is a correlation between the decriminalization of homosexuality and lower rates of HIV (UNAIDS). This correlation is attributed to improved access to services. Therefore, The United Nations Development Program (UNDP) has recently launched an initiative to address the current situation regarding men who have sex with men in Guyana where the HIV prevalence in this population is 19.4% in contrast to 1.8% in the total population. This rapid assessment has been commissioned to supplement two previous studies that were conducted in Guyana in informing the design of upcoming activities to support local capacity building to enhance access to services and respect for the human rights protections for MSM. Unfortunately, in Guyana, like much of the Caribbean, MSM tend to be a hard to reach population, perhaps due to elevated levels of stigma and discrimination and difficulty in accessing men who might participate in high risk same sex behaviors yet do not self-identify as an MSM. As a result, there is a relative paucity of data concerning the knowledge, attitudes and behaviors of this total population in Guyana. (i.e. those who self –identify and those who do not) The baseline report is organized as follows: the methodology is explained followed by the study limitations, the review (literature and desk). The report then proceeds with describing the reality of work and working with sexual and gender minorities in Guyana, the status quo and entry points. The main findings of the capacity assessment and focus groups are then discussed. Issues relating to the uniformed forces and health services providers are then presented followed by discussions and conclusions.

Record Information

Source Institution:
Caribbean IRN
Holding Location:
Caribbean IRN
Rights Management:
All rights reserved by the source institution.
System ID:
AA00000170:00001


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Prpae by Mr .M g aC il l









Content:

Acronym and Abbreviations............................... ........................................ 3

1.0 P re a m ble ................................................................................. 4
1.1 Introduction...................................... 4

1.2 Project Background..............................................5

1.3 Objective of the Consultancy ...................................... ...... ............................ .. 6

1.4 Scope of Consultant's Tasks ..................... ..... ........ ........ .... ............ .. .6

1.5 Outputs to be delivered................................ .... ........ ..........6

2.0 Methodological Framework ............... ... ...... ............... ............................7

2 .1 C a v e a ts ................................................... ........................... 8

3.0 Review (Literature and Desk) ...................................... .............. ... ....... ....9-14

4.0 Conceptualizing the Reality on Guyana ........................................ ...........................................15
4.1 Status Quo and Entry Point...................................... ............................................15
5.0 Capacities (main findings)....................................................................................................... 15-34
6.0 Focus Group (main findings) ................................................. ..............................................36-39
7 .0 U nifo rm F o rce s ............................................................................... ....... .............. ..............3 8 -3 9
8 .0 H ea lth S e rvices P provide rs................................................................................. ......................... 39
9.0 Validation Workshop............... ........... ................................................................. ... 40
10 .0 C o nclusio n ................................................................................... ...... ............. 4 1
11.0 Recommendation........................................................ ......................... ..... ....................42
12.0 References.......................................................................................... ..... ....................44-45
13.0 A ppe ndix .............................. ................. ............................................................ ... 46-56










Acronym and Abbreviation


AIDS Artiste in Direct Support
ART Anti-Retroviral Therapy
CBO Community-Based Organisation
FGD Focus Group Discussion
GAIS Guyana Aids Indicator Survey
GIPA Greater Involvement of People Living with HIV/AIDS
GFATM Global Fund to Fight AIDS, Tuberculosis, and Malaria
GUYBOW Guyana Rainbow Foundation
HIV Human Immuno Deficiency Virus
IDU Injection Drug User
IEC Information, Education, and Communications
LGBT Lesbian, Gay, Bisexual, Transgender
LAPOP Latin American Public Opinion Project
MARP Most-At-Risk Population (preferred term is now "key population")
MOHBSS Ministry of Health Behavioural Surveillance Survey
MSM Men who have Sex with Men
NGO Non-Governmental Organisation
OVC Orphans and Vulnerable Children
PEP Post-Exposure Prophylaxis
PICT Provider-Initiated Counseling and Testing
PLWHA People Living With HIV/AIDS
PLHIV Persons Living with HIV
SASOD Society Against Sexual Orientation Discrimination
SOGI Sexual Orientation and Gender Identity
STI Sexually Transmitted Infection
SW Sex Worker
TG Transgender
VCT Voluntary Counseling and Testing









Preamble


1.1 Introduction

While the global response to HIV and AIDS has realized several successes in achieving universal access to
prevention, care and treatment to date, challenges persist in ensuring equal access to these services for most at risk
populations. The epidemiology of HIV reflects a stark disparity in access to prevention and treatment services for
neglected most-at risk populations, such as men who have sex with men (MSM). World-wide, MSM often experience
higher rates of HIV relative to the total population. The reasons for this dynamic are multi-faceted and include high
risk behaviors, and cultural as well as structural barriers. For MSM in developing countries, for example, basic
services for prevention and treatment of HIV infection have yet to reach the large majority of men. Homophobia and
discrimination limit access of MSM to prevention services and markedly increase vulnerability, as do criminalization
of same-sex behavior. Decriminalization of same-sex behavior is a structural intervention for prevention of HIV
infection and has recently been embraced by a nonbinding statement from the United Nations (Beyrer C,Clin Infect
Dis. 2010 May 15;50 Suppl 3:S108-13)

In the Caribbean, all of the above mentioned barriers exist. In fact, recent evidence demonstrates that there is a
correlation between the decriminalization of homosexuality and lower rates of HIV (UNAIDS). This correlation is
attributed to improved access to services. Therefore, The United Nations Development Program (UNDP) has recently
launched an initiative to address the current situation regarding men who have sex with men in Guyana where the
HIV prevalence in this population is 19.4% in contrast to 1.8% in the total population.


This rapid assessment has been commissioned to supplement two previous studies that were conducted in Guyana
in informing the design of upcoming activities to support local capacity building to enhance access to services and
respect for the human rights protections for MSM. Unfortunately, in Guyana, like much of the Caribbean, MSM tend
to be a hard to reach population, perhaps due to elevated levels of stigma and discrimination and difficulty in
accessing men who might participate in high risk same sex behaviors yet do not self-identify as an MSM. As a
result, there is a relative paucity of data concerning the knowledge, attitudes and behaviors of this total population in
Guyana. (i.e. those who self -identify and those who do not)

The baseline report is organized as follows: the methodology is explained followed by the study limitations,
the review (literature and desk). The report then proceeds with describing the reality of work and working with
sexual and gender minorities in Guyana, the status quo and entry points. The main findings of the capacity
assessment and focus groups are then discussed. Issues relating to the uniformed forces and health services
providers are then presented followed by discussions and conclusions.









1.2 Project Background (justification)


Sexual and gender minorities face a significant burden of and vulnerability to HIV, partly as a result of
stigma and discrimination. This often results in many of them not accessing or receiving services for HIV
prevention, treatment, care and support. Among the most vulnerable are gay and other men who have sex
with men (MSM) and transgender people (BSS 2009). Although MSM have access to STI, HIV and AIDS
related services such as education/information, condoms, HIV testing and STI/HIV there are many
complaints about the quality of the services, in particular public health services.

One of the main human rights issues affecting sexual and gender minorities in Guyana is pervasive abuse
and harassment at the hands of police. As a result there is an urgent need for sensitivity training for police
on HIV and AIDs and human rights and vulnerability issues to enhance knowledge and understanding of
the rights and issues affecting sexual and gender minorities, especially MSM and gay and/or transvestite
sex workers on the streets.

Given the questionable quality of services for sexual and gender minorities, there is also an urgent need for
comprehensive peer and professional counselling services. Existing services, provided mostly by NGOs,
are not fully prepared to address the needs of sexual and gender minorities. These service providers can
benefit from sensitivity training. Further to that, local CBOs SASOD and GuyBow, are increasingly being
called on to provide peer-counselling services, as homophobia, stigma and discrimination drives sexual and
gender minorities away from services which are not community-run. Local CBOs also need to develop the
capacity to provide Voluntary Counselling and Testing (VCT) services to compliment current services.
Homophobic and transphobic attitudes also deter sexual and gender minorities from HIV testing. If services
are provided by their peer-run CBOs, many, who may not otherwise access vital HIV services, would seek
VCT services.

The project has 3 components to be lead by local partners with support from the Joint UN Team on AIDS:

1. Right based advocacy for policy makers, armed service providers, health service providers and
sexual minority groups;
2. A comprehensive counselling service programme for sexual and gender minorities;
3. Capacity building for NGOs serving sexual minority groups themselves.









1.3 Objective of the Consultancy:


The aim of this consultancy was gather baseline information on issues and challenges sexual and gender
minorities encounter that inhibit their use of essential health services, and actions that breach their human
rights to health services and protection from the uniformed services. A capacity needs assessment of the
CBOs that advocate for the rights of sexual and gender minorities was also conducted to ascertain the
gaps that need to be filled to enhance their abilities to implement their mandates. The gathering of this
baseline information was necessary for the development of evidence-based activities directed at mitigating
the stigma and discrimination sexual and gender minorities' face in Guyana.

It is also expected that the information gathered will help to invite the improved use of high-quality, HIV-
related services by sexual and gender minorities through the provision of evidence-informed competencies
of civil society organizations that work with sexual and gender minorities, as a means of championing
advocacy and supporting better quality and more easily accessible HIV-related services.

1.4 Scope of Consultant's Task:

The consultant is tasked with the following:

1. Conduct desk review and collect information available and materials which may have been
developed in Guyana on sexual and gender minorities and on promoting human rights.
2. Document best or effective practices on HIV, sexual and gender minorities from successful
programmes for the health and uniform services which may be adapted in Guyana.
3. Conduct a rapid assessment among health service providers on their attitudes to and behaviour
towards sexual and gender minorities, the availability, quality and access of services available to
them.
4. Conduct a rapid assessment among the uniformed services on their attitudes and behaviour
towards sexual and gender minorities.
5. Conduct rapid assessment among sexual and gender minorities, on their experiences with health
service providers and the uniformed services. (Police, Military and Prison staff)
6. Conduct HIV and rights based competencies needs assessment among sexual and gender
minorities and organizations working in this area.


1.5 Outputs to be delivered:

* Inception report detailing methodology for conducting reviews, surveys and general approach that will
be taken towards achieving the products of the consultancy;
* Rapid assessments conducted among target health service providers, uniformed services and sexual
and gender minorities on their attitudes to and behaviour towards sexual and gender minorities and
experiences with health service providers and the uniform services, respectively;
* Participate in validation workshop with key stakeholders on report findings;
* Full report on findings of reviews and rapid assessments, submitted.









2.0 Methodology:


The overall technique is to adapt a purposive methodology for collecting the information that will form the
basis of this report. Several methods were used to collect information from various target groups as
follows:


Information Generic Description of information Justification
Collection Method to be Collected

Literature Review Examine key concepts in the literature Literature and Desk Review
on sexual and gender minorities and synthesize the pertinent issues that
best practices in programmes to affect sexual and gender minorities.
support them. and the entry points for support.

Desk Review Take into account research on sexual
and gender minorities in Guyana

Focus groups To ascertain the norms, practices, The views of the beneficiaries are
issues and challenges of sexual and collected,. The technique also suites
gender minorities themselves regarding the sensitivity and in-depth nature of
In-depth-Interviews services and to ascertain group information required from sexual and
dynamics and idiosyncratic concerns, gender minorities to understand their
challenges, construct meaningful
Target CBO's heads, and specific engagement an recess strategies
SGM in rural areas where it is difficult
to mobilize these group.

Key informants At the level of the institution, the Collecting information from specialist,
policies under which they are guided, leaders, and key policy makers that
the direction given to operational staff. have responsibility for delivering
services that are necessary for all.

RapidlCapacity Determine institutional capacity of key Assess the institutional framework
Assessment entities to deliver essential health provisions or omission of that hinders
services and protection to sexual and the delivery of essential health
gender minorities. UNDP's capacity services and protection to sexual and
assessment framework will be used for gender minorities. This will also involve
this exercise. some degree of questioning the heads
of key agencies.









2.1 Caveats:


It is difficult to ascertain the evidence contained in a report such as this one represents, because: (1) the
methodology is qualitative in nature; and (2) the population being investigated is not well defined or
documented. As a result the views and opinions reflected in this baseline are those sexual and gender
minorities who are willingly visible. Most of the information contained in secondary sources suffers the
same setback. Interactions with various groups working on issues of sexual and gender minorities, and
sexual and gender minorities themselves revealed both positive and negative experiences in dealing with
society, uniform forces, and health professionals. One therefore has to be careful not to generalize findings
and design blanket "evidence" based interventions without paying due attention to the specific nature and
dynamics of issues as it relates to location, group, agencies, and all other interactions in lending support to
sexual and gender minorities and groups or agencies working to support their causes. This revelation
makes it difficult therefore, to sanction on what a "baseline" such as this one can suggest. On the issue of
accuracy the only scientific reports that deal with any issue of sexual and gender minorities are the LAPOP
by Bynoe et al (2007), and the MoHBSS (2004). One deals with social tolerance of homosexuals in public
office and perceptions of discrimination, and the other reflects issues of HIV among MSM.



In summary, evidence exists in sufficient quality and scale to know that in Guyana, people are marginalized
due to sexual orientation and gender identity, and that these marginalized communities face
disproportionately high burdens of HIV and low access to health services. At the same time, more
research is needed, particularly social research using innovative sampling methods to document the full
range of subpopulations and their needs.









3.0 Review (Literature and Desk)


This review first clarifies who are deemed sexual and gender minorities and the behaviours which puts
them at risk of HIV. Secondly, it speaks to how HIV disproportionally affects sexual and gender minorities is
presented, followed by what has been the response (nationally or otherwise) to the preservation of sexual
and gender minorities' human rights. More specifically, within the context of this baseline, their access to
health care and protection by uniformed forces as it relates to their human rights is addressed. The review
concludes by highlighting effective and successful examples of international and, national best practice
programmes for working with sexual and gender minorities.

Before expounding on the aforementioned, it is important to note that there is an acute paucity of research
(secondary) material on issues and activities of sexual and gender minorities (Lesbian, Bisexual, Gay,
Transgender and Intersex (LBGTI) persons) in Guyana. In fact locally, sexual and gender minorities are
only covered in materials related to HIV, commonly in the section of the most-at-risk groups, or issues of
Men who have Sex with Men (MSM). Despite this, there is a growing number of sexual and gender
minorities according to Springer (2008), and Terborg (2006) in Guyana or more LBGTI "coming out of the
closet", i.e., tolerance and acceptance of LBGTI people are increasing in the English speaking Caribbean of
which Guyana is included. And, by right, issues that affect their humanity must be addressed as it would be
equally addressed for non-LBGT people. Actually Ban Ki-Moon has been quoted by UNAIDS (2009) on the
matter, "Not only is it unethical not to protect these groups; but it makes no sense from a health
perspective".

Sexual Orientation and Identity

Wilchins (2004) argued that sexuality has emerged as a central foundation for social identity, and that
'gayness' or homosexuality is a reflective contravention of gender. Therefore in the context of what this
baseline elucidates the definition1 developed by UNAIDS Action framework on Universal access for Men
who have sex with Men and Transgender people definition is adapted. It states that:

"The term 'men who have sex with men' describes those males who have sex with other males,
regardless of whether or not they have sex with women or have a personal or social identity
associated with that behaviour, such as being 'gay' or 'bisexual'.

"The term transgenderr people' refers primarily to transgender people whose initial given identity
was male or female, but who now identify as, or exhibit characteristics of, a gender different that
that originally assigned to them."


Locally in Guyana, focus group sessions with MSM reveal three main classifications. There are 'tops'
(those who are the penetrators), 'bottoms' (those who are the receivers) and versatile (those who would

1 The Global Fund defines sexual minorities as a phrase sometimes used to describe people who are not exclusively
heterosexual or who do not define themselves as male or female. Men who have sex with men include both gay-identifying and
non gay-identifying men.









penetrate as well as receive penetration). Beyond these three classifications there are also those who are
considered versatile tops and versatile bottoms.

Sexual Minorities and HIVin Guyana

Ministry of Health (2006) estimates the rate of HIV among MSM in Guyana at 18%, while the national rate
ranged from 1% to 4.9% during 1987 to 2006. The Ministry of Health Behavioural Surveillance Survey
(MoHBSS 2004) puts HIV/AIDS and STI among MSM at 21%. Surprisingly, the Guyana AIDS Indicators
Survey (GAIS 2005) makes no mention of MSM and their plight as it regards HIV (although youths were
covered).

Guyana's MDG Report (2007) suggested that expanded access to HIV prevention, treatment, care, and
support is potentially achievable by 2015. This is somewhat good news as the Ministry of Health (MoH
2006) showed that HIV is the number one cause of death in Guyana for individuals within their productive
age range (20-49). MSM in Guyana are at very high risk, with a population prevalence documented at
higher than 20%. Other populations with possible HIV prevalence of more than 1% are Miners, Loggers,
youth, women of childbearing age, and commercial sex workers).

Under reporting is presumed to be prevalent, and would be particularly so because of the stigma and
discrimination attached to people living with HIV (PLHIV). This would be even more difficult for MSM and
the wider LBGT community, who face some degree of stigma and discrimination because of their non-
normative sexualities or non-conforming genders.

Sexual and Gender Minorities and the Vexed Issues of Stigma, Discrimination, and Tolerance

Stigma and discrimination have been revealed as significant factors that impede the prevention of the
spread of HIV particularly among sexual and gender minorities specifically MSM. Stabroek News (2009
Nov. 9) reports that the Minister of Health Dr. Ramsammy recognized that stigma and discrimination is
affecting the Ministry's fight against the spread of HIV. As the report develops it was be revealed that
religious opposition, cultural traditions, and legal constraints form the basis for the discrimination that exists.

The GAIS (2005) has been useful in pointing out that there is low tolerance by adults for PLHIV. Bynoe et
al (2007) in assessing social tolerance with regard to non-discrimination based on sexual orientation in
Guyana, using multivariate regression analysis, found that such tolerance varied by geography (whether
urban/rural, size of area people lived in, and wealth). The study found that urban dwellers were more
socially tolerant, possibly due to the mix of cultures and lifestyles. Secondly, there is an inverse relationship
between area size and social tolerance regarding non-discrimination of individuals based on their sexual
orientation, i.e., the smaller the size of a community the less they are socially tolerant. Finally, wealth was
deemed a strong predicator of social tolerance. Further, the study showed comparatively that Guyana has
among the lowest level of social tolerance for homosexuals in public office in the Caribbean only
Jamaica, Honduras, and Haiti had lower levels of such social tolerance.

Additionally, there are other key behavioral risks for contracting and transmitting HIV among MSM. The
primary risk relates to the patterns of sexual practices. The MoHBSS (2005) explained that there is a high









rate of "partner change" and low condom use among MSM. UNAIDS (2008) indicated that male-to-female
transgender people have much higher rates of HIV infection than female-to-male transgender people. Even within the
wider Caribbean this obtains ibid referenced the Caribbean Commission on Health and Development
(CCHD 2005) as they showed evidence that HIV is most prevalent among men who have unprotected sex
with men. Continuing on the local situation the Terborg (2006) study revealed that 85%2 of MSM respondents
indicated they are at risk of contracting HIV primarily because of low condom use with main partner.

Sexual and Gender Minorities and Human Rights in Guyana

The UN's Living Human Rights in Guyana Report (2008) made it clear that "By adopting the Universal
Declaration of Human Rights, Guyana has agreed that its citizens will benefit from those basic rights that
every person, regardless of race, religion, gender, ethnicity, age or wealth, has the right to receive and
enjoy." The report further noted that "the interpretation of the fundamental rights provisions in the
constitution states that the court shall pay due regard to international law, international conventions and
charters bearing on human rights." However, in Guyana the legal right (s) and concomitant space for MSM
do not exist constitutionally, but is accommodated at various levels. In fact, the Laws of Guyana (Criminal
Laws (offenses)) Chapter 8:01 Section 351 to 353 states:

351 "Any male person who, in public or private, commits, or is a party to the commission, or
procures or attempts to procure the commission, by any male person, of any acts of gross
indecency with another male person shall be guilty of a misdemeanor and liable to
imprisonment for two years."

352 "Everyone who Attempts to commit buggery; or assaults any person with intent to
commit buggery; or being a male, indecently assaults any other male person, shall be guilty
of a felony and liable to imprisonment of ten years"

353 "Everyone who commits buggery, either with a human being or with any other living
creature, shall be guilty of felony and liable to imprisonment for life."

Cross dressing altogether, which is usually how transgender people express their non-conforming gender
identities is also outlawed within the Laws of Guyana Chapter 8:02, Section 153 sub-section xlvii states:

"being a man, in any public way or public place, for any improper purpose, appears in
female attire; or being a woman, in any public way or public place, for any improper
purpose, appears in male attire....".

On the issue of harassment the Terborg (2006) study found that 40% of the MSM experienced some form
of police harassment, and most MSM are of the view that Guyana is a homophobic society3 generally.

Religious opposition to outlaw discrimination against people based on their sexual orientation has been
very strong in Guyana. Large protests that erupted in 2001 and strong advocacy by the Guyana Council of

2 Terborg (2006) conducted nine focus groups sessions with 67 MSM of varied association.
3 Homophobia in Guyana has already been confirmed by Bynoe et al (2006), in the LAPOP based on low social tolerance, and
augmented by results of the GAIS (2005) which showed low adult tolerance for people living with HIV/AIDS.









Churches in 2003 are seen as reasons for the President not assenting to the Constitutional Amendment
No. 5 Bill #18, 2000 (see, Guyana Chronicle January 21, 2001, Stabroek News July 9, 2003 Guyana
Chronicle July 25, 2003; GINA, July 18, 2003).

Based on the focus groups discussions with MSM in Guyana, it was found that there is a cultural and ethnic
dimension to how receptive communities are to MSM. In predominantly black neighborhoods MSMs
complained of very low tolerance levels and are often met by assault, and taunts. Often times, MSM would
express their comfort with operating/living in East Indian communities.

Sexual and Gender Minorities and the National Response to HIV

In the context of the laws of Guyana it is not safe to assume that a national response to HIV guarantees by
any measure strategic intervention for the prevention and treatment of HIV through and among MSM.
However, MSM in Guyana are one of the most-at-risk groups and so the national strategy against HIV in
Guyana includes this group. There is strong evidence too that the Ministry of Health is willing to work with
MSM as they deliver health services to all Guyanese. Nevertheless, the challenge remains for a response
to target MSM because of the clandestine nature in which the group operates due to stigma and
discrimination based on sexual orientation which is then compounded if HIV positive.

Locally the Government and opposition supported a legislative response. There was unanimous
Parliamentary support in 2000 for outlawing discrimination based on sexual orientation in the Constitutional
Amendment No. 5 Bill #18. This marked a key national response at the political level. However, prior to the
elections of 2001 the President did not assent to the amendment and this lingers to date. On the policy
front Gable et al (2007) indicated that "the Guyana National Policy on HIV and AIDS emphasizes the rights
of "all HIV positive individuals, regardless of nationality, race, age, religion, disabilities, gender, sexual
orientation and socio-economic status . to the best quality of health care available without being
subjected to any form of discrimination."

More specific to the response to the HIV epidemic there has been international support for example,
Presidents Emergency Plan for AIDS Relief (PEPFAR), National AIDS Programme Secretariat (NAPS),
Guyana HIV/AIDS Reduction and Prevention Programme (GHARP). The Government of Guyana through
the Ministry of Health has also directed focus towards:

Strengthening national capacity for policy formation and Partnership/Multisectoral Response
Clinical and Diagnostic management and access to care, treatment, and support which includes
Access to ART
-VCT
-Home and Palliative Care (HPC)
Ols and STIs
Tuberculosis
Lab Support
Reducing risk and vulnerability to HIV infection
o Condoms and lubricant?
IEC/BCC
-MTCT
OVC
Strategic information









Surveillance and Research


Despite these efforts the evidence from secondary data shows that there is evidence of stigma and
discrimination in the health care system based on HIV status and more specifically, in some cases based
on sexual orientation. Nevertheless, at the more micro level (community and group) there is high demand
for health services among MSM as was revealed by Terborg (2006). Only 24% of the respondents in the
Terborg study never visited a health worker in 2005. The study further showed that there was a preference
for health visits to the Georgetown Public Hospital Corporation (GPHC) followed by the GUM4 and private
clinics respectively. However, the study found that most MSM preferred to use private health facilities,
especially "middle class" gays who are not comfortable with crowded facilities. Income would therefore
explain why most of the respondents visited GPHC. The study revealed that private facilities are deemed
more efficient because of relative positive attitudes of health workers and confidentiality.

In the next sub-section work executed and supported by donors, and development agencies, the NGO and
CSO community are developed.


International Best Practice for Sexual and Gender Minorities Programmes and Adaptation

At the level of policy initiatives in Latin America PAHO (2008) shows that: Argentina, Brazil, Colombia, Costa Rica,
Mexico, Nicaragua, and Peru have developed programmes and policies to reduce prejudice, stigma, and
discrimination against homosexuals, transsexuals, transvestites, and transgender individuals, as part of an effort to
prevent the spread of HIV.

Adapted verbatim from PAHO (2008)

* "The City of Buenos Aires passed a resolution in 2007 requiring healthcare providers and other employees of city
health clinics to refer to transsexuals, transvestites, and transgender people according to their self-assigned gender
and name.
* Nicaragua's National Assembly in 2007 repealed Article 204 of the Penal Code, which outlawed sexual relations
between people of the same sex.
* Peru's Ministry of Health launched a communication campaign in 2007 aimed at reducing discrimination against
sexual minorities (see poster above).
* Colombia has launched a new communication strategy aimed at reducing barriers to access to HIV prevention and
treatment services for members of sexual minorities.
* Brazil has launched a new National Plan of Action against the HIV Epidemic among Homosexuals and Transsexuals,
to improve sexual minorities' access to health and education. It will be implemented by special teams in each of
Brazil's 27 states.
* Costa Rican President Oscar Arias in March issued an executive decree designating May 17 as National Day against
Homophobia. The decree calls on public institutions to promote actions aimed at eradicating stigma and
discrimination against sexual minorities.
* Mexico's Ministry of Health is developing a guide to raise awareness among health providers and government
officials of the importance of nondiscrimination on the basis of sex, race, religion, and sexual orientation. It will be
distributed before the 17th International AIDS Conference, scheduled for Mexico City in August."





4 This is now called the National Care and Treatment Centre









Identifying champions in various sectors has been suggested by UNAIDS (2008) as useful at the policy
level.

There are local best practice for which MSM appreciate, these are:

AIDS model has been to work with other well establish organizations with gay friendly services, e.g.,
GRPA. Additional they blend a downstream and upstream approach. Downstream, they are on the ground
reaching out to the MSM communities.

FACTS uses a model of establishing and building decentralized support groups, building key partnerships
and relationships with community members, businesses, and the uniform services. This sensitizes the
communities, reduces stigma and discrimination and encourages MSM to use available health services.
Additionally, like GRPA, FACTS builds its team of staff around work in the fields. In fact, outreach has been
the basis of success for FACTS and GRPA in targeting the MSM communities. FACTS' strength lies in the
life it builds for the MSM socially and economically.

GRPA model for working with sexual and gender minorities to provide access to health care has been an
approach of seek and find. The organization usually sends workers in the field to mobilize the most-at-risk
groups (MSM included). In some cases they pay the MSM to be tested. GRPA workers also escort MSM to
their testing facilities with their permission. This is followed by confidence building and establishing a
network so that other MSM are encouraged. MSM in the focus groups sessions, especially sex workers
pointed to GRPA as a safe space in which health services can be accessed for sexual and gender
minorities.

GUYBOW has a unique model of building capacity to empower MSM through counseling, information
sharing, and referrals to GRPA.

SASOD works more at the policy level by advocating, lobbying and providing technical inputs for legislative
changes so that discrimination based on sexual orientation and gender identity can be outlawed.

Most of the aforementioned NGOs/CSOs have established networks among themselves to deliver better
services to MSM. Some of their activities overlap but individually they offer unique inputs into working with
sexual and gender minorities to prevent the spread of HIV. It should be noted that local NGOs/CSOs have
the experience, training and know-how to work generally with MSM but their work needs to be supported by
efforts at the policy and legislative levels for it to be sustainable. In the section that assesses the capacities
of existing NGOs/CSOs their idiosyncratic needs and deficiencies will be highlighted.

At the operational level Springer (2008) has produced a manual locally on some of the perquisite training
for health-care service providers working with LGBT people.









4.0 Contextualizing the Reality in Guyana


4.1 Status Quo and Entry Point

The MSM community proved difficult to reach and work with as they are battling with the challenge of stigma and
discrimination from the general populace. The MSM reached for the purpose of the baseline were the ones who said
that they were comfortable with themselves and were in no way interested in how others perceived them. Because
of this it was not uncommon for them to express the view that they had experienced minimal to no discrimination.
Self preservation was noted as crucial for perseverance. The operation of the MSM community is clandestine
because of the stigma and discrimination attached to it and there is some difficulty getting an accurate account of the
depth and array of issues they face. Like Terborg's study, reaching the MSM community had to be done through
gate keepers.

If MSM are going to be supported, one needs to work at the grass-roots level. It was found that much of the MSM
community (particularly sex workers) are out of touch with information on how to get help and make informed
decisions. To reach this sub-group one has to seek and find through 'gate keepers' in most cases.

Davis (2006) memo found that historically (in the USA) sexual and gender minorities have not been catered for, and
when they were it was done in a very limited way, focusing on their mental health predominantly. Mental health has
been, the entry point because sociologically, and in some cases religiously the view was that LBGT had many
emotional issues or was just simply mentally ill. While there may very well be valid justifications for supporting LBGT
mental health because of risks of suicide, and emotional anxieties based on abuse, molestation etc, there are other
arguments which suggests that some of their behaviour is genetic.

In Guyana the practice has been for CSOs and NGOs working with MSM and transgender persons to focus
on HIV, with the exception of SASOD whose goals include advocating for the repeal of laws that criminalize
same-sex intimacy and non-conforming gender expression, and Artiste in Direct Support (AIDS) who
historically, fought for the rights of gays. This has been the strategy because MSM are outlawed by dated
legislation which has not been revised. Consequently, the entry point for support to MSM and transgender
people has been work that is HIV related.



5.0 Capacities (main findings)

The capacity assessment was designed to ascertain the strengths and weaknesses of NGOs/CSOs that
work with sexual and gender minorities, especially their ability to offer VCT services. The methodology
used for conducting the capacity assessment encompass the design of an instrument based on UNDP's
capacity assessment framework and CSO assessment, through face to face interviews with organizational
heads or designate.

A scale (ranging 1 through 5) was developed to assess the capacity of each NGO/CSO. [1=Little or no
evidence of relevant capacity (merely congregate based on similar interests and issues); 2= Some evidence
(coordinate SGM activities internal or externally); 3= Average (coordinate and advocate having the human capacity);
4=Above average (human and some physical capacity advocacy); 5= Capacities present to sustainably execute
tasks]













# of Staff* Services offered


2009


2009


existence


2009


Counseling, capacity building,
referrals, awareness sessions.


NA intervention and support, Legal
assistance and representation,
Advocacy, etc

26+10V HIV education, OVCs, home based
care, inter alia

8 Phone, internet and peer counseling,
condom and flyer distribution, support
groups for targeted populations,
outreach activities for targeted
populations



4 Counseling, distribution of
condoms, educate FSW, MSM,
also deal with OVC (this
component is not funded)


Guybow


SASOD



FACTS


AIDS





GRPA

United
Bricklayers



U and Me


HIV counseling, feeding of the
elderly


20yrs+


7yrs



10yrs


18yrs


3yrs


9yrs


Not available


G$1-4m



G$28M
(5%CS)

G$1-25M


Not available


Founder funds
from overseas


Note: *V represents volunteer staff; *CS represents cost sharing. SASOD has no full-time staff, only project staff and consultants.


2+50V


NGO/CSO Region


Duration in Annual budget*,




















oranzai ons were' engaged in bilin capacity and so hav evove int stog niie ocsn
on issue afetn M and corintn thei work wit maysaehlesfo pialrsls

Mot, rgniai on a r e ai deene nt (depending I on fudn of [ donors) and assclhir

ineedne sa etsujcie I atfrthsraiatosbig udd twa etta
eve touh hee assoe leibliy n orultig bjctve, ftn ims hee s oomuh ha










With the exception of AIDS, GuyBow and SASOD whose work started with a clear focus on sexual and gender
minorities, MSM in particular, most of the NGOs/CSOs sprung up out of a need to work on issues of HIV as funding
was available to work with at-risk groups. Some organizations were engaged in building capacity and so have
evolved into strong entities focusing on issues affecting MSM and coordinating their work with many stakeholders for
optimal results. Most organizations are aid dependent (depending on funding from donors) and as such their
independence is at best subjective. In fact for those organizations being funded, it was felt that even though there
was some flexibility in formulating objectives, often times there is too much that has to be tailored to suit donor
agencies' mandates.

It is important to note that many of the NGOs/CSOs indicated capacity strengths primarily on the premise of human
capital (capacity) they have, and not the other complementary capacities (equipment, financial resources, physical
space in some case, and training in VCT).

Capacity to engage stakeholders, and build partnerships: All organizations lauded the fact that they were highly
competent and had the necessary capacity to engage stakeholders and build partnerships, as it was currently being
done. However, there seems to be more of a network building between some gay-friendly uniform force operatives as
this is usually a difficult partnership to build and maintain since the uniform forces function to uphold the law, which
criminalizes various facets of non-normative sexualities and non-conforming genders..

Three organizations are confident that they have capacity to articulate their mandate and policy positions (SASOD,
FACTS, and AIDS), see table 1. In cases of AIDS and SASOD this is consistent with how and why these
organizations were established, their history of advocacy at the policy level and in debates, and their presence on the
issues as they have evolved over time. FACTS has its organizational strengths (work less in the policy arena), which
has proven to be a concrete mechanism for building the partnerships they have and for expanding as rapidly as they
did in covering HIV and related work in general. GuyBow feels that it can improve on articulating its mandate, while
GRPA has had a long and positive track record in the work they do, and have indicated above average capacity to
articulate their mandate. 'U and Me' was formulated by a Guyanese in the Diaspora and so the current management
is not of the view that capacity exists for the articulation of their mandate.



Table 1: Does the organization have the capacity to articulate its mandate and policy positions?
Count

Does the organization have the capacity to articulate its mandate and
policy positions? Total
Above Sustain
Some Average average capabilities to
evidence evidence evidence execute tasks Missing
NGO or Artist in Direct Support
CSO 0 0 0 1 0 1
Assessed
FACTS 0 0 0 1 0 1
GRPA 0 0 1 0 0 1
GuyBow 0 1 0 0 0 1
SASOD 0 0 0 1 0 1
U and Me 1 0 0 0 0 1
United Brick Layers 0 0 0 0 1 1
Total 1 1 1 3 1 7














In spite of the aforementioned all NGOs/CSOs are of the view that capacity exists within their organization to assert
leadership through knowledge on the issues that affect sexual and gender minorities (see table 2). In table 3 GRPA,
and GuyBow, have above average capacity to manage domestic and external relations with stakeholders, while
SASOD and FACTS indicated sustained capacity to do this. The others indicated average capacity on this issue.


Table 2: Does the organization have the capacity to assert leadership through
affect sexual and gender minorities?
Count


Does the organization have the capacity
to assert leadership through knowledge
of the issues that affect sexual and
gender minorities? Total

Sustain
Above average capabilities to
evidence execute tasks
NGO or Artist in Direct Support
CSO 1 0 1
Assessed
FACTS 0 1 1
GRPA 1 0 1
GuyBow 1 0 1
SASOD 0 1 1
U and Me 1 0 1
United Brick Layers 1 0 1
Total 5 2 7


Table 3: Does the organization have the capacity to manage relations with domestic and external
stakeholders inclusively and constructively on issues of SGM?
Count
Does the organization have the capacity to
manage relations with domestic and
external stakeholders inclusively and
constructively on issues of SGM? Total
Above Sustain
Average average capabilities to
evidence evidence execute tasks
NGO or Artist in Direct Support
CSO 1 0 0 1
Assessed
FACTS 0 0 1 1
GRPA 0 1 0 1
GuyBow 0 1 0 1
SASOD 0 0 1 1
U and Me 1 0 0 1
United Brick Layers 0 1 0 1
Total 2 3 2 7


knowledge of the issues that











Most of the organizations have indicated the capacity to build and manage partnerships among relevant stakeholders
(uniform services, NGO's, Health services, Judiciary, Legal aid) exist (see table 4). This is primarily the case because
these are key agencies with which they interface on a regular basis. In many cases too they have to form informal
partnerships with these organizations to address issues that may, often affect these groups.

As it relates to the capacity to articulate desired outcomes and benefits of collaboration and to motivate diverse
groups of stakeholders (in table 5), most organizations are of the view that this is done. In fact United Brick layers,
SASOD, and FACTS indicated sustained capacities to do this, GRPA, GuyBow, and U and Me above average, and
AIDS average.

Table 4: Does the organization have the capacity to build and manage partnerships among relevant
stakeholders (uniform services, NGO's, Health services, Judiciary, Legal aid)?
Count
Does the organization have the capacity to build
and manage partnerships among relevant
stakeholders (uniform services, NGO's, Health
services, Judiciary, Legal aid)? Total

Sustain capabilities
Above average evidence to execute tasks
NGO or Artist in Direct Support
CSO 1 0 1
Assessed
FACTS 1 0 1
GRPA 1 0 1
GuyBow 1 0 1
SASOD 0 1 1
U and Me 1 0 1
United Brick Layers 0 1 1
Total 5 2 7


Table 5: Does the organization have the capacity to articulate desired outcomes and benefits of collaboration
to motivate diverse groups of stakeholders?
Count
Does the organization have the capacity to
articulate desired outcomes and benefits of
collaboration; to motivate diverse groups of
stakeholders? Total

Above Sustain
Average average capabilities to
evidence evidence execute tasks
NGO or Artist in Direct Support
CSO 1 0 0 1
Assessed
FACTS 0 0 1 1
GRPA 0 1 0 1
GuyBow 0 1 0 1
SASOD 0 0 1 1
U and Me 0 1 0 1
United Brick Layers 0 0 1 1
Total 1 3 3 7













Information sharing, public awareness and education on sexual and gender minorities are strengths that all of the
organizations have, at above average level (see table 6).

In table 7, four organizations seem to have established norms for collaboration for trust building (AIDS, FACTS,
United Brick Layers and GRPA). 'U and Me' indicated average capacity to do this while GuyBow and SASOD are
above average.


Table 6: Does the organization have the capacity to facilitate open communication by sharing information,
create awareness, and educate the public of SGM?
Count
Does the organization have the
capacity to facilitate open
communication by sharing
information, create awareness, and
educate the public of SM? Total

Sustain
Above average capabilities to
evidence execute tasks
NGO or Artist in Direct Support
CSO 0 1 1
Assessed
FACTS 0 1 1
GRPA 1 0 1
GuyBow 1 0 1
SASOD 0 1 1
U and Me 1 0 1
United Brick Layers 0 1 1
Total 3 4 7


Table 7: Does the organization have the capacity to build trust with its partners through establishing norms
of collaboration and sustaining them?
Count
Does the organization have the capacity to
build trust with its partners through
establishing norms of collaboration and
sustaining them? Total
Above Sustain
Average average capabilities to
evidence evidence execute tasks
NGO or Artist in Direct Support
CSO 0 0 1 1
Assessed
FACTS 0 0 1 1
GRPA 0 0 1 1
GuyBow 0 1 0 1
SASOD 0 1 0 1
U and Me 1 0 0 1
United Brick Layers 0 0 1 1
Total 1 2 4 7












Despite discriminatory laws pertaining to sexual orientation, rights based advocacy is an issue all the NGOs/CSOs
work on in various forms and at various levels. Some work at the community and household level offering support to
sexual and gender minorities, others work on advocacy at the policy level. Generally, legal constraints do not make it
easy for these organizations to optimize their approaches to work with sexual and gender minorities. Most of the
NGOs/CSOs work with sexual minorities as a subset of their work on HIV. The evidence has shown that only in the
case of AIDS and SASOD were the focus firmly on sexual and gender minorities, MSM in particular. Today both
organizations continue this work. SASOD continues to focus on advocacy for repealing laws that outlaw cross-
dressing and same-sex intimacy.

Table 8, shows that FACTS, GRPA, United Brick Layers, and SASOD have sustained capacities to promote rights
respected approaches for the support and protection of sexual and gender minorities among key stakeholders. To a
lesser extent U and Me (which is above average), and GuyBow do not seem to have evidence of such as they felt too
much is mandated by donors.


Table 8: Does the organization get the space to promote rights respected approaches for the support and
protection of SGM with its partners and other key stakeholders?
Count
Does the organization get the space to promote rights
respected approaches for the support and protection of
SGM with its partners and other key stakeholders? Total
Above Sustain
Some average capabilities to
evidence evidence execute tasks Missing
NGO or Artist in Direct Support
CSO 0 0 0 1 1
Assessed
FACTS 0 0 1 0 1
GRPA 0 0 1 0 1
GuyBow 1 0 0 0 1
SASOD 0 0 1 0 1
U and Me 0 1 0 0 1
United Brick Layers 0 0 1 0 1
Total 1 1 4 1 7



Mobilizing resources is essential to the prosperity, sustainability, and general function of the NGOs/CSOs. In table 9,
all but two organizations indicated sustained capacities to mobilize resource (FACTS, and AIDS).


Table 9: Does the organization have the capacity to mobilize resources?
Count

Does the organization have the capacity to
mobilize resources? Total
Above Sustain
Average average capabilities to
evidence evidence execute tasks


NGO or
CSO
Assessed


Artist in Direct Support


FACTS










GRPA 0 0 1 1
GuyBow 0 0 1 1
SASOD 0 0 1 1
U and Me 0 0 1 1
United Brick Layers 0 0 1 1
Total 1 1 5 7











Three organizations (GRPA, GuyBow, and United Brick Layers) indicated full knowledge of donors' funding priorities
and policies concerning sexual and gender minorities and related programmes, see table 10.

In table 11, United Brick Layers and GRPA are the only two organizations who fully believe that there are forums at
which they can address issues affecting sexual and gender minorities. SASOD is of the view that on average this is
the case while GuyBow and FACT are a little more optimistic; U and Me do not share the same level of optimism as
the others.

Table 10: Does your organization have comprehensive knowledge of donors' funding priorities and policies
with regards to SGM and related programmes?
Count

Does your organization have comprehensive knowledge
of donors' funding priorities and policies with regards to
SM and related programmes? Total
Little or no
evidence of Above Sustain
relevant Average average capabilities to
capacity evidence evidence execute tasks
NGO or Artist in Direct Support
CSO 0 0 1 0 1
Assessed
FACTS 0 1 0 0 1
GRPA 0 0 0 1 1
GuyBow 0 0 0 1 1
SASOD 0 0 1 0 1
U and Me 1 0 0 0 1
United Brick Layers 0 0 0 1 1
Total 1 1 2 3 7


Table 11: Does the organization have a forum at which there is an outlet for addressing the issues and
concern of SGM with its partners and key stakeholders?
Count

Does the organization have a forum at which there is an outlet for
addressing the issues and concern of SGM with its partners and key
stakeholders? Total
Little or no
evidence of Above Sustain
relevant Average average capabilities to
capacity evidence evidence execute tasks Missing
NGO or Artist in Direct Support
CSO 0 0 0 0 1 1
Assessed
FACTS 0 0 1 0 0 1
GRPA 0 0 0 1 0 1
GuyBow 0 0 1 0 0 1
SASOD 0 1 0 0 0 1
U and Me 1 0 0 0 0 1
United Brick Layers 0 0 0 1 0 1
Total 1 1 2 2 1 7











Opinions on the authorities capacity to negotiate with donors about increasing transparency, predictability, and
volatility of support, in table 12, shows that only one organization feels there is limited capacity of this, all else is at or
above average. One organization is of the view that the president has lots of experience in doing this. However, as
indicated earlier only three organizations grew out of a focus on sexual and gender minorities, while others focus
were HIV and AIDS under which they supported or supports at risk groups which includes MSM and transgender
persons. .

Table 12: Do authorities have the capacity to negotiate with donors about increasing transparency and
predictability and reducing volatility?
Count


Do authorities have the capacity to negotiate with donors about
increasing transparency and predictability and reducing volatility? Total
Little or no
evidence of Above Sustain
relevant Average average capabilities to
capacity evidence evidence execute tasks Missing
NGO or Artist in Direct Support
CSO 0 1 0 0 0 1
Assessed
FACTS 0 0 0 0 1 1
GRPA 0 0 0 1 0 1
GuyBow 1 0 0 0 0 1
SASOD 0 1 0 0 0 1
U and Me 0 0 1 0 0 1
United Brick Layers 0 0 0 1 0 1
Total 1 2 1 2 1 7



Most organizations indicated (above average or sustained) capabilities to monitor and track internal processes, and
outcomes related capacity development, see table 13. In fact, most of the organizations core staff benefits from
training programmes, exposure to conferences on issues affecting sexual and gender minorities, etc., support offered
by donors. By extension too, organizations benefit from knowledge and skills that they also pass on to wider
audiences.


Table 13: Does the organization have the capacity to monitor and track internal processes, and outcomes
related to obtain donors support for capacity development initiatives?
Count

Does the organization have the capacity to
monitor and track internal processes, and
outcomes related to obtain donors support
for capacity development initiatives? Total


Above Sustain
Average average capabilities to
evidence evidence execute tasks


NGO or
CSO
Assessed


Artist in Direct Support


FACTS
GRPA
GuyBow

















The organizations identified specific challenges they face in advancing their work on dealing with issues sexual and
gender minorities encounter. One such challenge is that of apprehension by some faith based organization in giving
national support for the advancement of the rights of sexual and gender minorities. There are persons in the faith
based community who are not openly critical of the rights sexual and gender minorities should enjoy. Another
challenge revealed is that of unpredictability of funding for programmes. Thirdly, support is shortcoming to build
capacity of sexual and gender minorities to empower them. Fourthly, some organizations mentioned insufficient tools
(lubricants, MSM condoms, etc.) to promote safer sexual relations.

In responding about capacities to overcome the challenges faced, the organizations had varying responses. Some
organizations indicated that they do not have sufficient resources to respond to the challenges. This include tools
(financial and/or materials) to reach the needs of beneficiaries. Others indicated they can supply information needed
to address the constraints, noting that they do not necessarily have the answers and alternative solution (s). Table 15
represents the organizations views on their capacity to respond to their challenges.

Table 14: What specific challenges the organization face in interacting with relevant partners/stakeholders
that affects results?
Count
What specific challenges the organization
face in interacting with relevant
partners/stakeholders that affects results? Total
Little or no
evidence of Sustain
relevant Average capabilities to
capacity evidence execute tasks
NGO or CSO FACTS
0 1 0 1
Assessed
GRPA 0 0 1 1
United Brick Layers 1 0 0 1
Total 1 1 1 3


Table 15: Does the organization have the capacity to respond to the needs of the audience it initiate internal
and external communication strategies in order to be responsive to stakeholders?
Count
Does the organization have the capacity to respond to the needs of the
audience it initiate internal and external communication strategies in
order to be responsive to stakeholders? Total
Above Sustain
Some Average average capabilities to
evidence evidence evidence execute tasks Missing_


NGO or
CSO
Assessed


Artist in Direct Support


FACTS
GRPA
GuyBow
SASOD
U and Me










United Brick Layers 0 0 0 1 0 1
Total 1 1 1 3 1 7











Capacity for using research and evidence in decision making (assessing situations): In the context of research
and analysis, SASOD, GUYBOW, AIDS, and GRPA have these capacities. The other NGOs/CSOs investigated had
monitoring and tracking plans which created data and information as evidence for forward planning and
programming; agencies supporting some of the programmes of a few NGOs/CBOs would conduct analysis of the
data and information these agencies collected. As a result this they saw as not empowering and have implications for
ownership, because they need to build their own capacities to conduct same analysis.

Most of the organizations have average and above capabilities to collect information or access to and capacity for the
use of disaggregated data on sexual and gender minorities, see table 16. However, this primarily relates to the
sexual and gender minorities the organizations work with, and over the years, the network they have fostered, built
and expanded in reaching out to a wide cross-section of sexual and gender minorities in Guyana. In table 17
capacities to use and disseminate information are all above average for the organizations interviewed.

Table 16: Does the organization collect or have access to and capacity for use of disaggregated
data/information on SM and their key concerns?
Count
Does the organization collect or have access to and
capacity for use of disaggregated data/information on
SGM and their key concerns? Total
Little or no
evidence of Above Sustain
relevant Average average capabilities to
capacity evidence evidence execute tasks
NGO or Artist in Direct Support
CSO 0 0 1 0 1
Assessed
FACTS 0 1 0 0 1
GRPA 0 0 0 1 1
GuyBow 0 0 1 0 1
SASOD 0 0 0 1 1
U and Me 1 0 0 0 1
United Brick Layers 0 0 1 0 1
Total 1 1 3 2 7


Table 17: Does the organization's staff have the capacity to use and disseminate datalinformation?
Count
Does the organization's staff have the
capacity to use and disseminate
data/information? Total

Above
average Sustain capabilities
evidence to execute tasks
NGO or Artist in Direct Support
CSO 1 0 1
Assessed
FACTS 1 0 1
GRPA 0 1 1
GuyBow 1 0 1
SASOD 0 1 1
United Brick Layers 0 1 1
Total 3 3 6














Staff development through training, workshops is common among the organizations assessed (with the exception of
FACTS who feels there is need for strengthening in data analysis), see table 18. However, there is still the view that
training is deficient in data analysis, in some cases data collection processes. Strengths in capacity of many of the
organizations assessed are rooted strongly in their ability to manage projects, and budgets, see table 19. This does
not suggest proficiency in project management in general. Experience gained in this area is related to how long most
of the groups are in existence and the capacity they have built over the years in working with various donors
providing opportunities for training, and technical assistance. Consequently, most organizations rate highly their
ability to coordinate, manage projects and execute budgets.

Table 18: Does the organization offer staff development to strengthen capacity for advocacy, analysis etc?
How often?
Count
Does the organization offer staff
development to strengthen capacity for
advocacy, analysis etc? How often? Total
Above Sustain
Some average capabilities to
evidence evidence execute tasks
NGO or Artist in Direct Support
CSO 0 1 0 1
Assessed
FACTS 1 0 0 1
GRPA 0 0 1 1
GuyBow 0 1 0 1
SASOD 0 1 0 1
U and Me 0 1 0 1
United Brick Layers 0 0 1 1
Total 1 4 2 7


Table 19: Does the organization build staff capacity to coordinate projects, manage
Count


budgets etc?


Does the organization build staff
capacity to coordinate projects, manage
budgets etc? Total

Sustain
Above average capabilities to
evidence execute tasks
NGO or Artist in Direct Support
CSO 1 0 1
Assessed
FACTS 0 1 1
GRPA 0 1 1
GuyBow 1 0 1
SASOD 0 1 1
U and Me 1 0 1
United Brick Layers 0 1 1
Total 3 4 7











The organizations that work with sexual and gender minorities have taken a commitment to do so and have
recognized the importance and continued need to work from a rights based-perspective. Most of the organizations
would like to see MSM for example, treated equally and as such do not like the idea of making the distinction
between a gay person and another person. Consequently, the work they do is done with respect for all. The results
in table 20 should all be interpreted as organizations working within the precepts of rights for all. Table 21 reveals
that all of the organizations keep updates on issues affecting sexual and gender minorities, be it local or international.

Table 20: Does the organization build staff capacity on rights respected professional approaches for SGM?
Count
Does the organization build staff
capacity on rights respected
professional approaches for SGM? Total
Little or no
evidence of
relevant Sustain capabilities to
capacity execute tasks
NGO or Artist in Direct Support
CSO 1 0 1
Assessed
FACTS 0 1 1
GRPA 0 1 1
SASOD 0 1 1
United Brick Layers 0 1 1
Total 1 4 5

Table 21: Does the organization keep updates of SGM issues locally and otherwise, and acquire
data/information on those issues?
Count
Does the organization keep
updates of SGM issues
locally and otherwise, and
acquire data/information on
those issues? Total


Above Sustain
average capabilities to
evidence execute tasks
NGO or Artist in Direct Support
CSO 0 1 1
Assessed
FACTS 0 1 1
GRPA 0 1 1
GuyBow 1 0 1
SASOD 0 1 1
United Brick Layers 0 1 1
Total 1 5 6











Capacity for budget management and project implementation: All of the organizations indicated they
possess the capacity for budget planning and project implementation. However, only organizations that are receiving
donor funding are compelled to build and maintain such capacity, and can adequately do so if the need arise.
Currently FACTS, AIDS, GUYBOW, GRPA, and United Bricklayers receive funding for which they have this capacity
for monitoring and financial reporting.

All of the organizations indicated that they have the capacity to manage financial resources appropriately in the
implementation of programme and delivery of services, see table 22. This is the case because most funding agencies
offer training to these organizations in this regard. Additionally, these organizations are monitored often, and have to
meet funding agencies criteria of financial management before qualifying for support. Further, service delivery are
monitored too as it is the basis for programming. Hence, it is no surprise, in table 23, that all the organizations
indicated sustained capacities to track how resources are being spent and disbursed. In fact, as per project all
organizations have record and general bookkeeping practices.

Table 22: Does the organization have the capacity to manage financial resources appropriately in the
implementation of programmes and delivery of services?
Count
Does the organization have the
capacity to manage financial
resources appropriately in the
implementation of programmes
and delivery of services? Total
Sustain capabilities to execute
tasks
NGO or Artist in Direct Support
CSO 1 1
Assessed
FACTS 1 1
GRPA 1 1
GuyBow 1 1
SASOD 1 1
U and Me 1 1
United Brick Layers 1 1
Total 7 7

Table 23: Does the organization have the capacity to track whether resources are being spent for what they
are intended for, i.e. are there proper business processes, book keeping etc in place?
Count
Does the organization have the capacity to
track whether resources are being spent for
what they are intended for, i.e. are there proper
business processes, book keeping etc in place? Total
Sustain capabilities to execute tasks
NGO or Artist in Direct Support
CSO 1 1
Assessed
FACTS 1 1
GRPA 1 1
GuyBow 1 1
SASOD 1 1
U and Me 1 1
United Brick Layers 1 1
Total 7 7











Due to the continuous training, monitoring and strict guidelines on financial management under which the
organizations receive support, table 24, shows sustained capacities to design appropriate tools for effective financial
management. In most cases donors/supporters provide the tools for such management. With specific reference to
capacity to use and analyze data to improve business processes, most organizations collect such information for
lessons learnt, determining results and the effectiveness and impact of such, and future programming. It is
noteworthy that some organizations expressed key interest in being part of the analysis or building capacity for such.

Table 24: Does the organization have the capacity to use and design appropriate analytical tools to
undertake effective financial management?
Count
Does the organization have the capacity
to use and design appropriate analytical
tools to undertake effective financial
management? Total

Sustain capabilities to execute tasks
NGO or Artist in Direct Support
CSO 1 1
Assessed
FACTS 1 1
GRPA 1 1
GuyBow 1 1
SASOD 1 1
U and Me 1 1
United Brick Layers 1 1
Total 7 7


Table 25: Does the organization have the capacity to use and analyze data to improve business processes?
Count
Does the organization have
the capacity o use and
analyze data to improve
business processes? Total

Above Sustain
average capabilities to
evidence execute tasks
NGO or Artist in Direct Support
CSO 0 1 1
Assessed
FACTS 0 1 1
GRPA 0 1 1
GuyBow 0 1 1
SASOD 1 0 1
U and Me 1 0 1
United Brick Layers 0 1 1
Total 2 5 7











Capacity to offer HIV related and prevention services to sexual and gender minorities: Responses here were
mixed. On the one hand, SASOD was not interested in working on individual behaviour change and so most of what
was asked in this section did not apply to them. On the other hand some NGOs/CSOs possessed the human
capacity to offer HIV related support and prevention services to sexual and gender minorities. Deficiencies exist
primarily because of a lack of equipment, in some cases, limited contingent of staff and in others, physical space.
SASOD indicated that they are not interested in offering VCT but remain committed to the policy advocacy. GuyBow
showed little or no capacity to offer VCT, while FACTS has the human skills to conduct VCT, but no equipment. 'U
and Me' has the trained personnel and physical space to offer VCT but lack the equipment to do so. GRPA is the
only entity with sustained capacity to offer VCT services as they have been doing so for many years. The
aforementioned is illustrated in the organizations responses in table 26 and 27.

Table 26: Does the organization have the capacity (trained staff with competencies, equipment, etc) to offer
VCT to SGM?
Count

Does the organization have the capacity (trained staff with
competencies, equipment, etc) to offer VCT to SGM? Total
Little or no
evidence of Sustain
relevant Average capabilities to Not
capacity evidence execute tasks Missing Applicable
NGO or Artist in Direct Support
CSO 0 0 0 1 0 1
Assessed
FACTS 0 1 0 0 0 1
GRPA 0 0 1 0 0 1
GuyBow 1 0 0 0 0 1
SASOD 0 0 0 0 1 1
U and Me 0 0 1 0 0 1
United Brick Layers 0 0 1 0 0 1
Total 1 1 3 1 1 7


Table 27: Does the organization have the physical capacity (office, and other space) to effectively provide
VCT services?
Count

Does the organization have the physical capacity (office,
and other space) to effectively provide VCT services? Total
Little or no
evidence of Sustain
relevant capabilities to Not
capacity execute tasks Missing Applicable
NGO or Artist in Direct Support
CSO 0 0 1 0 1
Assessed
FACTS 0 1 0 0 1
GRPA 0 1 0 0 1
GuyBow 1 0 0 0 1
SASOD 0 0 0 1 1
U and Me 0 1 0 0 1
United Brick Layers 0 1 0 0 1
Total 1 4 1 1 7











Outreach capacity is a critical component of reaching sexual and gender minorities, particularly in presence of
discrimination based on HIV status, sexual orientation and gender identity. A large component of FACTS' and
GRPA's programmes is outreach. U and Me has the capacity to conduct outreach as measured by the largest
component of volunteers, but there is no evidence other NGOs/CBOs in their current programmes have similar
capacity. GuyBow emphasized that the capacity for outreach is very limited, see table 28.

Table 29, shows that all the organizations have capacity to build the partnership or play a role in a stakeholder willing
to offer VCT for sexual and gender minorities, as most of them would have had experience with various funding
agencies in this regard.

Table 28: Does the organization have the capacity to do outreach as it regards VCT for SGM?
Count
Does the organization have the capacity to do outreach as it regards
VCT for SM? Total
Little or no
evidence of Sustain
relevant Average capabilities to Not
capacity evidence execute tasks Missing Applicable
NGO or Artist in Direct Support
CSO 0 0 0 1 0 1
Assessed
FACTS 0 0 1 0 0 1
GRPA 0 0 1 0 0 1
GuyBow 1 0 0 0 0 1
SASOD 0 0 0 0 1 1
U and Me 0 0 1 0 0 1
United Brick Layers 0 1 0 0 0 1
Total 1 1 3 1 1 7


Table 29: Does the organization have the capacity to build the partnership or play a
group that is willing to offer VCT for SGM?
Count


role in a stakeholder


Does the organization have the capacity to
build the partnership or play a role in a
stakeholder group that is willing to offer
VCT for SGM? Total

Above Sustain
average capabilities to Not
evidence execute tasks Applicable
NGO or Artist in Direct Support
CSO 0 1 0 1
Assessed
FACTS 0 1 0 1
GRPA 0 1 0 1
GuyBow 0 1 0 1
SASOD 0 0 1 1
U and Me 1 0 0 1
United Brick Layers 0 1 0 1
Total 1 5 1 7











All the organizations indicated a capacity to collect information on their services and clients, see table 30. However,
not all the organization have the capacity to analyze information collected or are involved in the analysis of the data
collected and as such this mitigates against data analytical capabilities in general.

Table 30: Does the organization have the mechanism for collecting administrative data on the services
offered and clients served to make further evidence based decision, recognized emerging issues and require
adjustment of services offered etc?
Count
Does the organization have the mechanism for
collecting administrative data on the services
offered and clients served to make further
evidence based decision, recognized emerging
issues and require adjustment of services offered
etc? Total
Sustain capabilities to execute
tasks Not Applicable
NGO or Artist in Direct Support
CSO 1 0 1
Assessed
FACTS 1 0 1
GRPA 1 0 1
GuyBow 1 0 1
SASOD 0 1 1
U and Me 1 0 1
United Brick Layers 1 0 1
Total 6 1 7


Consistent with the information revealed in table 29 all organizations assessed indicated that they have the capacity
to establish networks among national institutions and agencies that are responsible for VCT. In fact, the modality in
which most of the NGOs/CSOs operate is through partnership and networking with national and international
institutions to solicit support for beneficiaries.

Table 31: Does the organization have the capacity to establish a network among national institutions and
agencies that are responsible for VCT?
Count
Does the organization have the capacity to
establish a network among national institutions
and agencies that are responsible for VCT? Total
Sustain capabilities to execute Not
tasks Applicable
NGO or Artist in Direct Support
CSO 1 0 1
Assessed
FACTS 1 0 1
GRPA 1 0 1
GuyBow 1 0 1
SASOD 0 1 1
U and Me 1 0 1
United Brick Layers 1 0 1
Total 6 1 7









6.0 Focus Groups (main findings)


Group characteristics

The consultant conducted 10 focus group sessions distributed across regions 4, 6 and 10; in regions 2 and
7 members of the MSM community are mostly closeted gays and preferred to remain anonymous. The
group sizes ranged from 7 to 13. Combined, the age range of respondents were 20 through 58 years old of
varied ethnicity mainly east Indians and blacks. Most of the respondents in the rural communities visited
only completed primary schooling. Similarly, those referred to as "anti-man" in the urban areas, primary
schooling.
Commonalities

Most of the MSM community socialized among themselves, particularly those who are open about
their sexual orientation. Others, for survival, suppressed their identities and function within all
circles of the society. Nevertheless, there is the occasional gay pageantry, and gay friendly spaces
(in some rural and urban communities). Online is becoming one of the most regular meeting and
safe spaces for MSM.

Most groups revealed that there is so much emphasis on HIV that there is an implicit neglect of
information on other STIs.

Most persons who faced open discrimination based on their sexual orientation, gender identity and
expression indicated that abuse (physical and verbal) came mainly from teenage boys and young
men.

HIV and related health services (privately and publicly) are available, but access varied based on
knowledge, and receptiveness of health workers, level and scope o outreach programmes.


Differences

The level of stigma and discrimination, based on the focus group discussions and research
material reviewed, varied widely across and within regions investigated, perceivably by ethnicity,
education level, openness of sexuality, and religious beliefs. Age did not seem to be a factor
influencing stigma and discrimination. The level of accuracy and concomitant weight that can be
leveraged by such evidence to make generalized pronouncements may be questionable.

On the one hand, focus group discussions in region 10 revealed that MSM were discriminated
against by members of the community. In fact, some revealed that their homes were stoned,
another recounted to being shot by a pellet gun from a group in front of a bank where two
security guards were present and did nothing. These stories were never officially reported to
the police, but the same group also indicated that they had no problem with the police. This
revealed that lack of confidence that their matters would be treated equally, or simply lack
confidence in the services offered. On the other hand, in region 6, it was revealed that a more
receptive community in some parts. With this type of evidence there is inclination of cultural
differences in how receptive a community is towards MSM.










Even though there is opposition by religious groups towards promoting rights of sexual and gender
minorities, in some communities, as revealed in the focus groups conducted, MSM attend and are
active members in church.

Cross-cutting

In all the sessions FGD participants shared that there exists some form of support for the MSMs.
This support can be internally which most often has shown itself to be, MSM "looking out for each
other". External to this MSM are supported directly or indirectly by some CSO/NGO. However,
some MSM are not familiar with the existing services of CSOs/NGOs which have implications for
access. Often NGOs/CSOs who recognize this implement outreach programmes. The limitation
within these established relationships and networks are the result of resources which affect the
scope of work an NGO/CSO can do. In some cases fragmentation can affect the coordination and
collaborative efforts of these groups working for the same cause. This may result since among
MSM their own group dynamics affect these outcomes.

MSM who are open about their sexual orientation revealed that they are not discriminated against
in terms of seeking and finding employment, but they do not seek out jobs. This reflects implicit
discomfort that is the likely result of discrimination perceived or real.

With reference to police, some groups revealed relations while others did not. However, what was
clear is that gay friendly police existed and would often tolerate LBGTI and heed their concerns
and issues. Support in some cases were revealed to be based on "bribes" for protection, or in the
cases of those who are sex workers, to be allowed to conduct "business".


Needs

MSM revealed the need for gay friendly medical personnel.
There is a need for attention and information on STIs other than HIV.
There is a need for the scaling up of outreach programmes for MSM, as it seems to be one of the
most effective ways of reaching out to the community.
There is a need to change attitudes and behaviour towards LBGT people. This is a very long term
goal but can be initiated through legislation that decriminalizes cross-dressing, and abuse fuelled
by discrimination based on non-normative sexuality..


7.0 Uniform Forces

Based on focus groups with sexual and gender minorities, reports pointed to the leniency of the uniformed
forces in dealing with the MSM community, while in some of the secondary literature and on the account of
some NGOs/CSOs the situation has been mixed. In most cases, MSM claimed to have a good relationship
with the police. In fact, some of the mobilization of MSM groups for this study was done by police who
seem to have easy access to this group. There is clear evidence that MSM are often threatened within the









community by the general populace. They further indicated that if threatened; they were quite comfortable
with making reports to the police though this did not seem to be a common practice. For openly gay and
bisexual men, the research enquired if they had to assume the role of a heterosexual to get attention the
response was, across the board, "Dem done know we" meaning that the police was aware of their
sexual identity.

Upon discussions with a few police it was stated that in training, members of the force are taught basic
human rights. More specifically, they are taught that all persons should be respected regardless of their
race, class, gender and sexual orientation. However, the police must uphold the local law; this coupled
with, pressure from the LBGTI community for a repeal of those laws and opposition to the repulsion of
those laws by strong religious groups puts the police in a precarious position. Technically, only in the
presence of strong evidence and until conviction can one be subjected to punishment of the law.
Consequently, if a criminal offence is alleged ones human rights must be upheld. The space exists for
punishment of abuse in the laws of Guyana, and Guyana is a signatory to the main UN treaties which
guarantee and protect human rights. Therefore, until such time as a conviction there must be respect for
ones human rights, access to health care, protection etc for all Guyanese. In some of the consultations held
under this study, it was revealed that there is a police management procedure plan which encompasses
training and procedures for dealing with sexual and gender minorities. While the researcher has not seen
this plan, if it exists, there is room for UNDP to support this initiative.

In the case of the prisons services, known MSM are separated from the general heterosexual environment
as they are termed a security risk as well as deemed at risk. If found in same sex acts, prisoners are taken
before the court for buggery. Condoms are not allowed in prisons, however there is a VCT site, but its level
of functionality is unknown.

In the army, VCT and other medical services exist, however on the issue of sexual and gender minorities
the modus operandi is "don't ask, don't tell," although there is no indication of an official policy.
Additionally, the army does not have a mandate (other than in high crime wave situations) to deal with the
civilian population.



8.0 Health Services Providers


Access to health care as revealed earlier is subjected to a few factors which can be addressed.
Perception of health care workers is mixed, but there was a clear need for medical workers
sensitive to the needs of sexual and gender minorities.
The quality of health care and issues related to service delivery such as waiting time, variety and availability
of drugs etc, often affects sexual and gender minorities. These constraints also affect general users of
health care in Guyana and are not unique to sexual and gender minorities.









9.0 Validation Workshop (required Interventions identified by NGOs/CSOs)


A workshop was held with NGOs/CSOs which primarily working with sexual and gender minorities.
Specifically, break-out sessions covering 3 general areas Health Service Providers, Uniform Forces and
Capacity Building- delineated on key findings of the report, and formulated collective actions that are
deemed useful as next steps. Through the use of advocacy tools the groups identified the following:

On Health Service Providers

Training of health service providers:

Training had specific connotations and required focus on key areas, these are:
Promotion of a better understanding of the diversities of sexual practices/behavior of MSM;
A need for more attention to risk reduction and not the behaviour of clients or their sexual lifestyle;
Promotion of a gay-friendly environment, which they felt should mean: No preaching or imposition
of religious beliefs; No judging of behavior or lifestyle just be neutral/professional; Be courteous
and respectful at all times; Maintain privacy/confidentiality at all times.
Finally, there is a need for a special unit created for people who experience discrimination by
health service providers based on sexual identification. At this unit, people should be able to report
incidents and seek and obtain recourse.


On Uniform Forces

-Sensitization (sexual and gender minorities, magistracy, Police, and prison officers); Equal
employment policies (similar to HIV in the work place policy possible collaboration with ILO);
Rights and responsibilities of LBGTI people; and Prison reform.

Unfairness in terms of the treatment meted out to many MSM, especially by the some policemen and
prison staff needs to be rectified through some form of code of conduct. The fear expressed is that
when put before the court, the magistracy is hardly ever sympathetic towards sexual and gender
minorities. MSM are not the only ones who suffer this faith, but they were nonetheless especially
vulnerable. It was stated that the law itself and all its inequities created an environment for criminality.


On Capacity Building

There are specific needs for strengthening capacity of the NGOs/CSOs, these were highlighted as:

Proposal Preparation









- Financial Management

- Resource Mobilization

- Project Management

- Monitoring and Evaluation









10.0 Conclusion


1. A review was conducted to collect available information and materials developed in Guyana on sexual
and gender minorities and concomitant human rights. It was found that there is an acute deficiency in
information available on sexual and gender minorities. Most of what existed focused on MSM as an at-risk
group of the contraction and spread of HIV. It was found that key sensitivities, such as stigma and
discrimination, religious/cultural beliefs, and the existing legislative framework, can somewhat explain the
challenges that LGBTI people face. This reinforces the strong dual approach need to confront the
challenges policy and legislative advocacy, and function/operational work at the grass-roots levels to
bring immediate support for health and other services required. A communication strategy with a heavy
element of outreach, and sensitized medical practitioners are critical too.

2. Best practices for programmes that support sexual and gender minorities were highlighted within the
region (Latin America) and locally by a few NGOs/CSOs. Most of the programmes recognized the need for
policy, legislative and attitudinal changes which are easily adaptable to Guyana, but this has not been the
case. In fact, there are examples of parliamentary support for legislative changes in Guyana but this has
been met with protest and lack of assent. Other support is fragmented and needs to be more coordinated
for the purpose of educating on the needs, from a human rights perspective, of sexual and gender
minorities. There are some local models of work that can be enhanced to serve the sexual and gender
minorities, once additional capacities are built and resources are made available.

3. There were both negative and positive responses from health services providers and uniformed forces in
the response and interactions with sexual and gender minorities. Sexual and gender minorities face the
same challenges in accessing available health services as others, except in cases where individuals are
discriminated against because of their HIV status, sexual orientation and/or gender identity.
Notwithstanding, more work is needed to liberate the rights, further, of sexual and gender minorities, as this
is deemed a catalyst for the comfort needed for individuals to come forward in the fight against HIV.

4. Finally a needs assessment on capacities to offer VCT revealed that NGOs/CSOs covered under this
investigation has had the experience, knowledge, passion and commitment in working with at- risk groups,
for example, sex workers, MSM, among others. A platform exists therefore for the work to continue once
the necessary and sufficient support is available.









10.0 Recommendations


1. Train and build capacity of uniformed services

Support police management procedure plan on areas where it purports to deal with sexual and
gender minorities;

Support prison officers training, and strengthen VCT site in prisons, where they exist;

2. Train and build capacity of community-based organizations

Build capacity of some NGO/CSO Functional Support and Other Strengthening for VCT Support,
despite some MSM having a preference for public health facilities;

Strengthen capacity for Policy and Advocacy among NGOs/CSOs who focus on these areas;


There is a need for the scaling up of outreach programmes for MSM, as it seems to be one of the
most effective ways of reaching out to the community;


3. Train and build capacity of health service providers

Support initiatives of public and private health agency to sensitize medical personnel on how to
work with MSMs;

There is a need for attention and information on STIs other than HIV, such as viral hepatitis, rectal
gonorrhea and syphilis.


4. Champion principles of universal human rights


There is a need to change attitudes and behaviour towards LBGTI people. This is very long term
but can be initiated through legislation that decriminalizes cross-dressing, and abuse fuelled by
discrimination based on non-normative sexualities.









Reference:

Gable L et al. (2007). Legal aspects of HIV/AIDS: a guide for law and policy reform. Washington DC, World
Bank.

Douglas, C. (2008), "Homosexuality in the Caribbean-Crawling out of the Closet, Maryzoon Press ISBN-13 978-976-
630-495-9

Davis, M., (2006), "Exclusion to Inclusion of Sexual and Gender Minorities in Behavioural Health Services", mimeo


The Global Fund, (2008), "Fact Sheet: Sexual Minorities in the context of the HIV epidemic" Global Fact Sheet
Series", 6 of 6, 15 September, 2008.

Terborg, Julia (2006), "Study on perception and behaviour regarding HIV/AIDS prevention and care among female
sex workers and men who have sex with men in Georgetown Guyana", PAHO and CSIH, Georgetown 2006.

Springer, Dereck (2008), "Youth Friendly Services Training Manual: A facilitator's guide for training health care
providers to deliver optimal care to Lesbian Gay, Bisexual, and Transgendered people", Youth Friendly Adolescent
Health Unit, Ministry of Health Guyana, 2008.

Ministry of Health Behaviour Surveillance Survey 2005, conducted by Family Health International in collaboration with
Guyana Responsible Parenthood Association and the Ministry of Health. Ministry of Health Guyana 2005.

Ministry of Health (2006), "Statistical Bulletin", Ministry of Health Statistics Unit, 2006.

Guyana Aids Indicators Survey 2005, GRPA and ORC Marco, Ministry of Health 2006.

Guyana MDG Report 2007, UNDP Guyana: http://www.undp.org.gy/documents/bk/MDG Guyana Report2007.pdf

The Yogyakarta Principles (2007), "Principles on the application of international Human Rights Law in relation to
sexual orientation and gender identity", Yogyakarta, Indonesia, 2007. www.yoqyakartaprincples.org

The Laws of Guyana 1973, Vol. 2, Criminal Offences Act Chapter 8:01 part 5, title 25, section 351 through 353; -
Chapter 8:02 part 5 title 12 section 153 xlvii.

Guyana Chronicle January 21, 2001,

Guyana Chronicle July 25, 2003

GINA, July 18, 2003.

Bynoe, M. et al (2007), "The Political Culture of Democracy in Guyana 2006", a joint University of Guyana, Vanderbilt
University study, http://sitemason.vanderbilt.edullapoplGUYANABACK

Stabroek news (2009), "Stigma, discrimination still affecting HIV fight" Posted By lana Seales On November 24,
2009.









Living Human Rights on Guyana "Dignity and Justice for all in Guyana", UN Country Team Guyana, 2008.
http://www.undp.org.gy/documents/bk/Human Rights booklet.pdf

Guyana Constitutional Amendment No. 2, Bill No. 9, 2003.

Constitutional Amendment No. 5 Bill #18, 2000.

Wilchins, Riki (2004), "Queer theory, gender theory: An instant primer" Alyson publication LA, first edition, 2004.

PAHO (2008), "Health and Human Rights: PAHO Countries tackle homophobia", The News Letter of Pan American
Health Organization, 2008.









Appendix:

Appendix A

Field Reconnaissance

Visits were carried out in several regions: 2, 4, 6, 7 and 10.

Institutions involved in Capacity Assessment

1. SASOD, GUYBO and Artiste in Direct Support, FACTS, United Brisk layers, U and Me
2. Impromptu IDIs, Army, Prisons, Police Force

Agencies, Library and Documentation centers consulted

3. Ministry of Human Services
4. Parliament
5. CARICOM library
6. Ministry of Health policies in relation to sexual minors
7. Legal Affairs and Bar Association
8. University of Guyana
9. National library
10. UNICEF
11. UNAIDS
12. UNFPA



Meetings held:

Meeting with NGOs Guybow, SASOD, AIDS, UNDP










Appendix B


UNITED NATIONS DEVELOPMENT PROGRAMME

Guyana Country Office

Terms of Reference


I. Project Details


Name of Project:


Job Title:


HIV Sexual Minorities Project

Consultant HIV Sexual Minorities


Pre-Classified Grade:


Purpose:


Provide Consultancy


Duration of Consultancy:


2 Months


II. Background


Sexual minorities face a significant burden of and vulnerability to HIV as a result of stigma and discrimination. This often results in
many of them not accessing or receiving services to help in HIV prevention, treatment, care and support. Among the most
vulnerable are men who have sex with men (MSM) and transgendered people. Although MSM have access to STI, HIV and ADIS
related services such as knowledge, condoms, early treatment of STI, and HIV testing, there are many complaints about the quality
of the services, in particular public health services.



One of the main human rights issues affecting sexual minorities in Guyana is pervasive abuse and harassment at the hands of
police. There is an urgent need for sensitivity training for police on HIV human rights and AIDS vulnerability issues to enhance their
knowledge and understanding of the rights and issues affecting sexual minorities, especially MSM and gay and/or transvestite sex
workers on the streets.



Given the sub-standard quality of services for sexual minorities, there is also an urgent need for comprehensive peer and
professional counselling services. Existing services, provided mostly by NGOs, are not fully prepared to address the needs of
sexual minorities. These service providers can benefit from sensitivity training. Further to that, local CBOs SASOD and GuyBow,
are increasingly being called on to provide peer-counselling services, as homophobia, stigma and discrimination drives sexual










minorities away from services which are not community-run. As a corollary to counselling, local CBOs also need to develop the
capacity to provide Voluntary Counselling and Testing (VCT) services. Anti-gay attitudes also deter sexual minorities from HIV
testing. If services are provided by their peer-run CBOs, many, who may not otherwise access vital HIV services, would seek VCT
services.



The project has 3 components to be lead by local partners with support from Joint UN Team on AIDS:

4. Right based advocacy for policy makers, armed service providers, health service providers and sexual minority groups.
5. Comprehensive counselling services programme for sexual minorities
6. Capacity building for sexual minority supporting NGOs and sexual minority groups themselves


III. Objective


To reduce stigma and discrimination directed to sexual minorities in Guyana and to improve the use of high-quality, HIV-related
services by sexual minorities through the provision of evidence-informed competencies of civil society organizations that work with
sexual minorities to take the lead in advocating for and supporting good quality and easily accessible HIV-related services


IV. Specific Duties and Responsibilities


The Consultant will be engaged in the following:



1. Conduct desk review and collect information available and materials which may have been developed in Guyana on
sexual minorities and on promoting human rights.


2. Document HIV sexual Minorities best or effective practices from successful programmes for the health and uniform
services, on the issue of sexual minorities, which may be adapted in Guyana.


3. Conduct rapid assessment among health service providers on their attitudes to and behaviour towards sexual minorities,
the availability, quality and access of services available to them.


4. Conduct rapid assessment among the uniform services on their attitudes to and behaviour towards sexual minorities.


5. Conduct rapid assessment among sexual minorities, on their experiences with health service providers and the uniform
services. (Police, Military and Prison staff)

6. Conduct HIV and rights based competencies needs assessment among sexual minorities and organizations working in










this area.


V. Key Outputs


* Inception report detailing methodology for conducting reviews and Surveys and general approach that will be taken towards
achieving the products of the consultancy;
* Rapid assessments conducted among target health service providers, uniform services and Sexual Minorities on their
attitudes to and behaviour towards sexual minorities and experiences with health service providers and the uniform services,
respectively;
* Host validation workshop with key stakeholders;
* Full report on findings of reviews and rapid assessments, submitted.


VI. Required skills and experience


* 5-7 years experience in HIV related research and analysis;
* Excellent proven ability to asses and analyse qualitative and quantitative data;
* Post graduate qualifications in the social sciences;
* Ability to develop and present electronically generated analytical data;
* Capacity to work closely with minority groups


VII. Schedule


Subject Date Venue Time

Methodology generated and submitted for review

Commence desk and web reviews

Commence Rapid assessment

Conduct validation workshop

Submit final report


Appendix C
Instruments:









Rapid/Capacity Assessment Instrument


For the purpose of the capacity assessment UNDP's capacity assessment framework5 (illustrated below) is
adapted. More specifically, the focus is on engaging the key stakeholders, and conducting an assessment
after which a response will be formulated and validated by the workshop.


I( S
TtIchliseth
ElKpacity

^^^development


Step 2: Assess
capacity assets
and needs
(individual and
organizational)






jI "l ),,h "


The assessment component which is the focus of this instrument delves into the functional and technical
capacity.














Tools:


5 See UNDP capacity assessment practice note, 2008.












Mandate:


Services offered:

Partnerships:

Duration in existence:

Staff evolution:

Task evolution:

Annual budget evolution (income versus expenditure):


Yes


Comments


Have the objectives of your organization -I
been defined and are they clearly formulated
to treat the needs of SM?


Have the objectives been developed together -I
with all relevant stakeholders (including those
delivering services to SM)?



scalel=Little or no
evidence of relevant capacity
(merely congregate based on
similar interests and issues)
2= Some evidence
(coordinate SM activities
internal or externally) Comments (the why of the responses
Questions 3= Average (coordinate and on the scale is documented in this
advocate having the human COlumn)
capacity)
4=Above average (human and
some physical capacity
advocacy)
5= Capacities present to
sustainably execute tasks

Does the organization have the capacity to
articulate its mandate and policy positions












Does the organization have the capacity to
assert leadership through knowledge of the
issues that affect sexual minorities?

Does the organization have the capacity to
manage relations with domestic and external
stakeholders inclusively and constructively on 1
issues of SM?

Does the organization have the capacity to
build and manage partnerships among
relevant stakeholders (uniform services,
NGOs, Health services, Judiciary, Legal aid). 1 2345

Does the organization have the capacity to
articulate desired outcomes and benefits of
collaboration; to motivate diverse groups of
stakeholders?

Does the organization have the capacity to
facilitate open communication by sharing 1
information, create awareness, and educate 4
the public of SM?

Does the organization have the capacity to
build trust with its partners through
establishing norms of collaboration and
sustaining them?

Does the organization get the space to
promote rights respected approaches for the
support and protection of SM with its partners 4
and other key stakeholders?

Does the organization have the capacity to
mobilize resources?
12 34 5









Does your organization have comprehensive
knowledge of donors' funding priorities and
policies with regards to SM and related
programmes?


1 2 3 4 5


Does the organization have a forum at which
there is an outlet for addressing the issues 12
and concern of SM with its partners and key 12 3 4 5
stakeholders?

Do authorities have the capacity to negotiate
with donors about increasing transparency
and predictability and reducing volatility?1 2 3 4 5

Does the organization have the capacity to
monitor and track internal processes, and
outcomes related to obtain donors support for1 2 3 4 5
capacity development initiatives?

What specific challenges the organization
face in interacting with relevant
partners/stakeholders that affects results?

Does the organization have the capacity to
respond to the needs of the audience it
initiate internal and external communication
strategies in order to be responsive to
stakeholders?


scale Comments

Does the organization collect or have access
to and capacity for use of disaggregated
data/information on SM and their key 1 23 45
concerns?



Does the organization's staff have the
capacity to use and disseminate









data/information?

Does the organization offer staff development
to strengthen capacity for advocacy, analysis,
etc? How often?

Does the organization build staff capacity to
coordinate projects, manage budgets etc?


Does the organization build staff capacity on
rights respected professional approaches for 1 2345
SM?

Does the organization keep updates of SM
issues locally and otherwise, and acquire
data/information on those issues?


scale Comments

Does the organization have the capacity to
manage financial resources appropriately in
the implementation of programmes and 4
delivery of services?

Does the organization have the capacity to
track whether resources are being spent for
what they are intended for, i.e. are there
proper business processes, book keeping etc
in place?


Does the organization have the capacity to
use and design appropriate analytical tools to
undertake effective financial management?

Does the organization have the capacity to
use and analyze data to improve business
processes?










scale Comments


Does the organization have capacity (trained
staff with competencies, equipment, etc) to
offer VCT to SM?


1 I2 3 45


Does the organization have the physical
capacity (office, and other space) to
effectively provide VCT services?1 2 3 4 5

Does the organization have the capacity to
do outreach as it regards VCT for SM?


Doe the organization have the capacity to
build the partnership or play a role in a
stakeholder group that is willing to offer VCT 1 2 3 4 5
for SM?

Does the organization have any mechanism
for collecting administrative data on the 1 2
services offered and clients served to make 1 2 3 4 5
further evidence based decision, recognized
emerging issues and require adjustment of
services offered etc?

Does the organization have the capacity to
establish a network among national
institutions and agencies that are responsible 1 2 3 4 5
for VCT?









Appendix D
These are the areas of questioning for the IDI's, Snowball, and FGDs.

Basic information (testing acceptance/integration etc)

Age:

Race:

Education:

Rural/Urban:

Forms of recreation/socialization:

Support Groups/Organization:

Shortcomings:

How can group/organization further support you?

What type of sexual and gender minorities exists?

How would you define discrimination?

Forms of violent discrimination

Forms of non violent discrimination


Health Care:

Access to health care
Perception of health care workers
Quality health care
Scope adequacy of services offered


Protection (Rights-based):

Social protection

Interaction with religious organizations
Interaction with other groups (sports, educational, etc.)









Economics protection

Interaction with employers, employees
Interaction within job market

Security (legal rights, physical protection, Abuse)

Physical protection
Interaction with discipline forces (police, army, and prison)
Abuse




Full Text

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Sexual and Gender Minorities Baseline: The Situation in Guyana HIV Sexual Minorities Project SGM Report 20 10 Prepared by: Mrs. Magda Wills

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2 Content: Acronym and Abbreviations .3 1.0 Preamble 4 1.1 4 1.2 Project Background 5 1.3 Objective of the Consultancy 6 1.4 6 1.5 6 2.0 Methodological Framework 7 2.1 8 3.0 9 14 4.0 Conceptualizing the Reality on Guyana .................................................................................. ........15 4. 1 Status Quo and Entry Point .................................................................................................15 5.0 Capacities (main findings)................................................................................................. .......... 15 34 6.0 Focus Group (main findings) ................................................................................................. .. ...3 6 3 9 7.0 Uniform Forces .......................................................................................................................... 38 39 8.0 Health Services Providers................................................................................. .................. .............3 9 9.0 Validation Workshop ................................................................................................................... 40 10.0 1 1 1 .0 Recommendation...................... ....................................................................................................... 4 2 1 2 .0 References................................................................................................................... ............... 4 4 4 5 13 .0 Appendix..................................................................................................................... ................ 4 6 5 6

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3 Acronym and Abbreviation AIDS Artiste in Direct Support ART Anti Retroviral Therapy CBO Community Based Organisation FGD Focus Group Discussion GAIS Guyana Aids Indicator Survey GIPA Greater Involvement of People Living with HIV/AIDS GFATM Global Fund to Fight AIDS, Tuberculosis, and Malaria GUYBOW Guyana Rainbow Foundation HIV H um an Immuno Deficiency Virus IDU Injection Drug User IEC Information, Education, and Communications L GB T Lesbian, Gay, Bisexual, Transgender LAPOP Latin American Public Opinion Project MARP Most At MOHBSS Ministry of Health Behavioural Surveillance Survey MSM Men who have Sex with Men NGO Non Governmental Organisation OVC Orphans and Vulnerable Children PEP Post Exposure Prophylaxis PICT Provider Initiated Counseling and Testing PLW HA People Living With HIV/AIDS PLHIV Persons Living with HIV SASOD Society Against Sexual Orientation Discrimination SOGI Sexual Orientation and Gender Identity STI Sexually Transmitted Infection SW Sex Worker TG Transgender VCT Voluntary Counseling and Testing

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4 Preamble 1.1 Introduction While the global response to HIV and AIDS has realized several successes in achieving universal access to prevention, care and treatment to date, challenges persist in ensuring equal access to these services for most at risk populations. The epidemiology of HIV reflects a stark disparity in access to prevention and treatment services for neglected most at risk populations, such as men who have sex with men (MSM). World wide, MSM often experience hig her rates of HIV relative to the total population. The reasons for this dynamic are multi faceted and include high risk behaviors, and cultural as well as structural barriers. For MSM in developing countries, for example, basic services for prevention and treatment of HIV infection have yet to reach the large majority of men. Homophobia and discrimination limit access of MSM to prevention services and markedly increase vulnerability, as do criminalization of same sex behavior. Decriminalization of same sex behavior is a structural intervention for prevention of HIV infection and has recently been embraced by a nonbinding statement from the United Nations (Beyrer C,Clin Infect Dis. 2010 May 15;50 Suppl 3:S108 13) In the Caribbean, all of the above mentioned barriers exist. In fact, recent evidence demonstrates that there is a correlation between the decriminalization of homosexuality and lower rates of HIV (UNAIDS). This correlation is attributed to improved access to services. Therefore, The United Nation s Development Program (UNDP) has recently launched an initiative to address the current situation regarding men who have sex with men in Guyana where the HIV prevalence in this population is 19.4% in contrast to 1.8% in the total population. This rapid a ssessment has been commissioned to supplement two previous studies that were conducted in Guyana in informing the design of upcoming activities to support local capacity building to enhance access to services and respect for the human rights protections fo r MSM. Unfortunately, in Guyana like much of the Caribbean, MSM tend to be a hard to reach population, perhaps due to elevated levels of stigma and discrimination and difficulty in accessing men who might participate in high risk same sex behaviors yet do not self identify as an MSM. As a result, there is a relative paucity of data concerning the knowledge, attitudes and behaviors of this total population in Guyana. (i.e. those who self identify and those who do not) The baseline report is organized a s follows: the m ethodolog y is explained followed by the study limitations, the review (literature and desk). The report then proceeds with describing the r eality of work and working with sexual and gender minorities i n Guyana the s tatus quo and e ntry p oint s. The main findings of the capacity assessment and focus groups are then discussed. Issues relating to the uniform ed forces and health services providers are then presented followed by discussions and conclusions.

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5 1.2 Project Background (justificatio n) S exual and gender minorities face a significant burden of and vulnerability to HIV partly as a result of stigma and discrimination. This often results in many of them not accessing or receiving services for HIV prevention, treatment, care and support. Among the most vulnerable are gay and other men who have sex with men (MSM) and transgender people (BSS 2009) Although MSM have access to STI, HIV and A I DS related services such as education/information condo ms, HIV testing and STI/HIV t here are many complaints about the quality of the services, in particular public health services. One of the main human rights issues affecting sexual and gender minorities in Guyana is pervasive abuse and harassment at the hands of police. As a result t here is an urgent need for sensitivity training for police on HIV and AIDs and human rights and vulnerability issues to enhance knowledge and understanding of the rights and issues affecting sexual and gender minorities, especially MSM and gay and/or transvestite sex workers on the streets. Given the questionable quality of services for sexual and gender minorities, there is also an urgent need for comprehensive p eer and professional counselling services. Existing services, provided mostly by NGOs, are not fully prepared to address the needs of sexual and gender minorities. These service providers can benefit from sensitivity training. Further to that, local CBOs SASOD and GuyBow, are increasingly being called on to provide peer counselling services, as homophobia, stigma and discrimination drives sexual and gender minorities away from services which are not community run. L ocal CBOs also need to develop the capac ity to provide Voluntary Counselling and Testing (VCT) services to compliment current services Homophobic and transphobic attitudes also deter sexual and gender minorities from HIV testing. If services are provided by their peer run CBOs, many, who may not otherwise access vital HIV services, would seek VCT services. The project has 3 components to be lead by local partners with support from the Joint UN Team on AIDS: 1. Right based advocacy for policy makers, armed service providers, health service providers and sexual minority groups ; 2. A c om prehensive counselling service programme for sexual and gender minorities ; 3. Capa city building for NGOs serving sexual minority groups themselves

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6 1.3 Objective of the Consultancy : The aim of this consultancy w as gather baseline information on issues and challenges sexual and gender minorities encounter that inhibit their use of essential health services, and actions that breach their human rights to health services and protection from the uniformed services. A capacity needs assessment of the CBOs that advocate for the rights of sex ual and gender minorities w as also conducted to ascertain the gaps that need to be filled to enhance their abilities to implement their mandate s The gathering of this baseline information was necessary for the development of evidence based activities dir ected at mitigating the stigma and discrimination sexual and gender face in Guyana. It is also expected that the information gathered will help to invite the improved use of high quality, HIV related services by sexual and gender minorities th rough the provision of evidence informed competencies of civil society organizations that work with sexual and gender minorities, as a means of championing advocacy and supporting better quality and more easily accessible HIV related services. 1.4 Scope of The consultant is tasked with the following : 1. Conduct desk review and collect information available and materials which may have been developed in Guyana on sexual and gender minorities and on promoting human rights. 2. Document best or effective practices on HIV sexual and gender m inorities from successful programmes for the health and uniform services which may be adapted in Guyana. 3. Conduct a rapid assessment among health service providers on their attitudes to and behaviour towards s exual and gender minorities, the availability, quality and access of services available to them. 4. Conduct a rapid assessment among the uniform ed services on their attitudes and behaviour towards sexual and gender minorities. 5. Conduct rapid assessment among sexual and gender minorities, on their experiences with health service providers and the uniform ed services. (Police, Military and Prison staff) 6. Conduct HIV and rights based competencies needs assessment among sexual and gender minorities and organization s working in this area. 1.5 Outputs to be delivered : Inception report detailing methodology for conducting reviews s urveys and general approach that will be taken towards achieving the products of the consultancy; Rapid assessments conducted among target health service providers, uniform ed services and s exual and gender m inorities on their attitudes to and behaviour towards sexual and gender minorities and experiences with health service providers and the uniform s ervices, respectively; Participate in validation workshop with key stakeholders on report findings ; Full report on findings of reviews and rapid assessments, submitted.

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7 2.0 Methodology: The overall technique is to adapt a purposive methodology for colle cting the information that will form the basis of this report. S everal methods were used to collect information from various target groups as follows: Information Collection Method Generic Description of information to be Collected Justification Literature Review Examine key concepts in the literature on sexual and gender minorities and best practices in programmes to support them. Literature and Desk Review synthes ize the pertinent issues that affect s exual and gender m inorities a nd the entry po ints for support. Desk Review T ake into ac count research on sexual and gender minorities in Guyana Focus groups In depth Interviews To ascertain the norms practices, issues and challenges of sexual and gender minorities themselves regarding services and to ascertain group dynamics and idiosyncratic concerns. Target S G M in rural areas where it is difficult to mobilize these group The views of the beneficiaries are collected ,. The technique also suite s the sensitivity and in depth nature of information required from sexual and gender minorities to understand their challenges construct meaningful engagement and redress strategies. Key informants At the level of the institution, the policies under which they are guided, the direction given to operational staff Collecting information from specialist, leaders, and key policy makers that have responsibility for delivering services that are necessary for all Rapid/Capacity Assessment Determine inst itutional capacity of key entities to deliver essential health services and protection to sexual and gender assessment framework will be used for this exercise. A ssess the institutional framework provisions or omission of that h inders the delivery of essential health services and protection to sexual and gender minorities. This will also involve some degree of questioning the h eads of key agencies.

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8 2.1 Caveats: It is difficult to ascertain the evidence contained in a report such as this one represents, because: (1) the methodology is qualitative in nature; and (2) the population being investigated is not well defined or documented As a result the views and opini ons reflected in this baseline are those sexual and gender minorities who are willingly visible Most of the information contained in secondary sources suffers the same setback. Interactions with various groups working on issues of sexual and gender minori ties, and sexual and gender minorities themselves revealed both positive and negative experiences in dealing with society, uniform forces, and health professionals. One therefore has to be careful not to generalize findings sed interventions without paying due attention to the specific nature and dynamics of issues as it relates to location, group, agencies, and all other interactions in lending support to sexual and gender minorities and groups or agencies working to support their causes. This revelation accuracy the only scientific reports that deal with any issue of sexual and gender minorities are the LAPOP by Byno e et al (2007), and the MoHBSS ( 2004). One deal s with social tolerance of homosexuals in public office and perceptions of discrimination, and the other reflects issues of HIV among MSM. In summary, evidence exists in sufficient quality and scale to know that in Guyana, people are marginalized due to sexual orientation and gender identity, and that these marginalized communities face disproportionately high burdens of HIV and low access to health services. At the same time, more research is needed, parti cularly social research using innovative sampling methods to document the full range of subpopulations and their needs.

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9 3.0 Review (Literature and Desk) This review first clarifies who are deemed sexual and gender minorities and the behaviour s which puts them at risk of HIV. Secondly, it speaks to how HIV disproportionally affects sexual and gender minorities is presented followed by what has been the response (nationally or otherwise) to the preservation of sexual and gender health care and protection by uniform ed forces as it relates to their human rights is addressed The review concludes by highlighting effective and successf ul examples of international and national best practice programmes for working with sexual and gender minorities. Before expounding on the aforementioned, it is important to note that there is an acute paucity of research (secondary) material on issues a nd activities of sexual and gender minorities (Lesbian, Bisexual, Gay, Transgender and Intersex (LBGT I ) persons ) in Guyana. In fact locally, sexual and gender minorities are only covered in materials related to HIV, commonly in the section of the most at r isk groups, or issues of Men who have S ex with M en (MSM) Despite this, there is a growing number of sexual and gender minorities according to Springer (2008), and Terborg (2006) in Guyana or more LBGT I coming out of the closet acceptance of LBGT I people are increasing in the English speaking Caribbean of which Guyana is included. And, by right, issues that affect their humanity must be addressed as it would be equally addressed for non LBGT people. Actually Ban Ki Moon has been quoted by UNAIDS (2009) on the unethical not to protect these groups; but it makes no sense from a health Sexual Orientation and I dentity Wilchins (2004) argued that sexuality has emerged as a central f oundation for social identity, and that gayness or homosexuality is a reflective contravention of gender. Therefore in the context of what this baseline elucidates the definition 1 developed by UNAIDS Action framework on Universal access for Men who have sex with M en and Transgender people d efinition is adapted. It states that: regardless of whether or not they have sex with women or have a personal or social identity was male or female but who now identify as or exhibit characteristics of, a gender different that that originally assigned to them Locally in Guyana, focus group sessions with MSM reveal three main classifications. The r e are tops (those who are the penetrators), bottoms (those who are the receivers) and versatile (those who would 1 The Global Fund defines sexual minorities as a phrase sometimes used to describe people who are not exclusively heterosexual or who do not define themselves as male or female. Men who have sex with men include both gay identifying and non gay identifying men.

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10 penetrate as well as receive penetration ). Beyond these three classifications there are also those who are considered versatile tops and versatile bottoms. Sexual Minorities and HIV in Guyana M inistry of Health (2006) estimates the rate of HIV among MSM in Guyana at 18%, while the national rate ranged from 1% to 4.9% during 1987 to 2006. The Ministry of Health Behavioural Surveillance Survey ( MoH BSS 2004) puts HIV/AIDS and STI among MSM at 21%. Surprisingly, the Guyana AIDS Indi cators Survey (GAIS 2005) makes no mention of MSM and their plight as it regards HIV ( although youths were covered). expanded access to HIV prevention, treatment, care, and support is potentially achievable by 201 5. This is somewhat good news as the Ministry of Health (MoH 2006) showed that HIV is the number one cause of death in Guyana for individuals within their productive age range (20 49). MSM in Guyana are at very high risk, with a population prevalence docum ented at higher than 20%. O ther population s with possible HIV prevalence of more than 1% are Miners, Loggers, youth, women of childbearing age, and commercial sex workers). Under reporting is presumed to be prevalent, and would be particularly so because of the stigma and discrimination attached to people living with HIV (PLHIV) This would be even more difficult for MSM and the wider LBGT community, who face some degree of stigma and discrimination because of their non normative sexualities or non confo rming genders Sexual and Gender Minorities and the V exed I ssues of Stigma, Discrimination, and T olerance Stigma and discrimination ha ve been revealed as significant factors that impede the prevention of the spread of HIV particularly among sexual and gender minorities speci fic ally MSM. Stabroek N ews (2009 Nov. 9) reports that the Minister of Health Dr. Ramsammy recognized that stigma and discrimination is the spread of HIV. As the report develops it w as be re vealed that religious opposition, cultural traditions, and legal constraints form the basis for the discrimination that exists. The GAIS (2005) has been useful in pointing out that there is low tolerance by adults for PLHIV. Bynoe et al (2007) in assessi ng social tolerance with regard to non discrimination based on sexual orientation in Guyana, using multivariate regression analysis, found that such tolerance varied by geography (whether urban/rural, size of area people lived in, and wealth). The study fo und that urban dwellers were more socially tolerant, possibly due to the mix of cultures and lifestyles. Secondly, there is an inverse relationship between area size and social tolerance regarding non discrimination of individuals based on their sexual ori entation, i.e., the smaller the size of a community the less they are socially tolerant. Finally, wealth was deemed a strong predicator of social tolerance. Further, the study showed comparatively that Guyana has among the lowest level of social tolerance for homosexuals in public office in the Caribbean only Jamaica, Honduras, and Haiti had lower levels of such social tolerance. Additionally, there are other key behavioural risks for contracting and transmitting HIV among MSM. The primary risk relates to the patterns of sexual practices. The MoHBSS (2005) explained that there is a high

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11 UNAIDS (2008) indicated that male to female transgender people have much higher rates of HIV infection than femal e to male transgender people Even within the wider Caribbean this obtains ibid referenced the Caribbean Commission on Health and Development (CCHD 2005) as they showed evidence that HIV is most prevalent among men who have unprotected sex with men. Continuing on the local situation t he Terborg (2006) study revealed that 85% 2 of MSM respond ents indicated they are at risk of contracting HIV primarily because of low condom use with main partner Sexual and Gender M inorities and H uman R ights in Guyana The Living Human Rights in Guyana Report (2008) made it By adopting the Universal Declaration of Human Rights, Guyana has agreed that its citizens will benefit from those basic rights that every person, regardless of race, religion, gender, ethnicity, age or wealth, has the right to receive and enjoy. The report further noted of the fundamental rights provisions in th e constitution states that the court shall pay due regard to international law, international conventions and However, i n Guyana the legal right (s) and concomitant space for MSM do not exist constitutionally, but is accommodate d at various levels. In fact, the Laws of Guyana (Criminal Laws (offenses)) Chapter 8: 01 Section 351 to 353 states : 351 procures or attempts to procure the commission, by any male person, of any acts of gross indecency with another male person shall be guilty of a misdemeanor and liable to Attempts to commit buggery; or assaults any person with intent to commit buggery; or being a male, indecently assaults any other male person, shall be guilty s buggery, either with a human being or with any other living Cross dressing altogether, which is usually how transgender people express their non conforming gender identities is al so outlawed within the Laws of Guyana Chapter 8:02, Section 153 sub section x1vii states: female attire; or being a woman, in any public way or public place, for any imp roper On the issue of harassment the Terborg (2006) study found that 40% of the MSM experienced some form of police harassment, and most MSM are of the view that Guyana is a homophobic society 3 generally Religious opp osition to outlaw discrimination against people based on their sexual orientation has been very strong in Guyana. Large protests that erupted in 200 1 and strong advocacy by the Guyana Council of 2 Terborg (2006) conducted nine focus groups sessions with 67 MSM of varied association. 3 Homophobia in Guyana has already been confirmed by Bynoe et al (2006), in the LAPOP based on low social tolerance, and augmented by results of the GAIS (2005) which showed low adult tolerance for people living with HIV/AIDS.

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12 Churches in 2003 are seen as reasons for the President not as senting to the Constitutional Amendment No. 5 Bill #18, 2000 ( see, Guyana Chronicle January 21, 2001, Stabroek News July 9, 2003 Guyana Chronicle July 25, 2003; GINA, July 18, 2003 ) Based on the focus groups discussions with MSM in Guyana, it was found that there is a c ultural and ethnic dimension to how receptive communities are to MSM. In predominantly black neighborhoods MSMs complained of very low tolerance levels and are often met by assault, and taunts. Often times MSM would express their comfort with operating/living in East Indian communities. Sexual and Gender M inorities and the N ational R esponse to HIV In the context of the laws of Guyana it is not safe to assume that a national response to HIV guarantees by any measure strategic intervention for the prevention and treatment of HIV through and among MSM. However, MSM in Guyana are one of the most at risk groups and so the national strategy against HIV in Guyana includes th is group. There is strong evidence too that the Ministry of Health is wi lling to work with MSM as they deliver health services to all Guyanese. Nevertheless, the challenge remains for a response to target MSM because of the clandestine nature in which the group operates due to stigma and discrimination based on sexual orienta tion which is then compounded if HIV positive. Locally the Government and opposition supported a legislative response. There was unanimous Parliamentary support in 2000 for outlawing discrimination based on sexual orientation in the Constitutional Amendment No. 5 Bill #18. This marked a key national re sponse at the political level. However, prior to the elections of 2001 the President did not assent to the amendment and this lingers to date. On the policy front Gable et al (2007) indicated that he Guyana National Policy on HIV and AIDS emphasizes the rights orientation and socio economic status . to the best quality of health care available without being subjected to any form of discrimin More specific to the response to the HIV epidemic there has been international support for example, P residents E mergency Plan for AIDS Relief (PEP FAR ) N ational A IDS P rogramme S ecretariat (NAPS) G uyana H IV/ A IDS R eduction and P revention Programme (GHARP) The Government of Guyana through the Ministry of Health has also directed focus towards: Strengthening national capacity for policy formation and Partnership/Multisectoral Response Clinical and Diagnostic management and access to care, treatment, and support which includes Access to ART VCT Home and Palliative Care (HPC) OIs and STIs Tuberculosis Lab Support Reducing risk and vulnerability to HIV infection o Condoms and lubrican t? IEC/BCC MTCT OVC Strategic information

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13 Surveillance and Research Despite these efforts the evidence from secondary data shows that there is evidence of stigma and discrimination in the health care system based on HIV status and more specifically, in some cases based on sexual orientation. Nevertheless, at the more micro level (community and group) there is high demand for health services among MSM as was reveal ed by Terborg (2006). O nly 24% of the respondents in the Terborg study never visited a health work er in 2005. The study further showed that there was a preference for health visits to the Georgetown P ublic H ospital C orporation (GPHC) followed by t he GUM 4 and private clinics respectively However, the study found that most MS M preferred to use private health facilit ies explain why most of the respondents visited GPHC. The study revealed that private facilit ies are deemed mor e efficient because of relative positive attitudes of health workers and confidentiality In the next sub section work executed and supported by donors, and development agencies, the NGO and CSO community are developed. International Best Practice for S exual and Gender M inorities P rogrammes and A daptation At the level of policy initiatives in Latin America PAHO (2008) show s that: Argentina, Brazil, Colombia, Costa Rica, Mexico, Nicaragua, and Peru have developed programmes and policies to reduce prejudice, stigma, and discrimination against homosexuals, transsexuals, transvestites, and transgender individuals, as part of an effort to prevent the spread of HIV. Adapted verbati m from PAHO (2008) health clinics to refer to transsexuals, transvestites, and transgende r people according to their self assigned gender and name. Nicaragua's National Assembly in 2007 repealed Article 204 of the Penal Code, which outlawed sexual relations between people of the same sex. Peru's Ministry of Health launched a communication ca mpaign in 2007 aimed at reducing discrimination against sexual minorities (see poster above). Colombia has launched a new communication strategy aimed at reducing barriers to access to HIV prevention and treatment services for members of sexual minorities Brazil has launched a new National Plan of Action against the HIV Epidemic among Homosexuals and Transsexuals, to improve sexual minorities' access to health and education. It will be implemented by special teams in each of Brazil's 27 states. Costa Ri can President "scar Arias in March issued an executive decree designating May 17 as National Day against Homophobia. The decree calls on public institutions to promote actions aimed at eradicating stigma and discrimination against sexual minorities. Mexic o's Ministry of Health is developing a guide to raise awareness among health providers and government officials of the importance of nondiscrimination on the basis of sex, race, religion, and sexual orientation. It will be distributed before the 17th Inter 4 This is now called the National Care and Treatment Centre

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14 Identifying champions in various sectors has been suggested by UNAIDS (2008) as useful at the policy level. There are local best practice for which MSM appreciate, these are: AIDS model has b een to work with other well establish organizations with gay friendly s ervices e.g., GRPA. Additional they blend a downstream and upstream approach. Downstream, they are on the ground reaching out to the MSM communit ies. FACTS uses a model of establishing and building decentralized support groups, building key partnerships and relationships with community members, business es and the uniform services. This sensitizes the communities, reduces stigma and discrimination and encour ages MSM to use available health services. Additionally, like GRPA, FACTS builds its team of staff around work in the fields. In fact, outreach has been the basis of success for FACTS and GRPA in targeting the MSM communit ies FACTS strength lies in the life it builds for the MSM socially and economically. GRPA model for working with sexual and gender minorities to provide access to health care has been an approach of seek and find. The organization usually sends workers in the field to mobilize the most at risk groups (MSM included). In some cases they pay the MSM to be tested GRPA workers also escort MSM to their testing facilities with their permission. This is followed by confidence building and establishing a network so that oth er MSM are encouraged. MSM in the focus groups sessions, especially sex workers pointed to GRPA as a safe space in which health services can be accessed for sexual and gender minorities. GUYBOW has a unique model of building capacity to empower MSM throu gh counseling, information sharing, and referrals to GRPA. SASOD works more at the policy level by advocating, lobbying and providing technical inputs for legislative changes so that discrimination based on sexual orientation and gender identity can be out lawed. Most of the aforementioned NGOs/CSOs have established networks among themselves to deliver better services to MSM. Some of their activities overlap but individually they offer unique inputs into working with sexual and gender minorities to prevent t he spread of HIV It should be noted that local NGOs/CSOs have the experience, training and know how to work generally with MSM but their work needs to be support ed by efforts at the policy and legislative levels for it to be sustainable. In the section th at assesses the capacities of existing NGOs/CSOs their idiosyncratic needs and deficiencies will be highlighted. At the operational level Springer (2008) has produced a manual locally on some of the perquisite training for health care service providers wor king with LGBT people.

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15 4.0 Contextualizing the Reality in Guyana 4.1 Status Quo and Entry Point The MSM community proved difficult to reach and work with as they are battling with the challenge of stigma and discrimination from the general populace. The MSM reached for the purpose of the baseline were the ones who said that they were comfortable wit h themselves and were in no way interested in how others perceived them. Because of this it was not uncommon for them to express the view that they had experienced minimal to no discrimination. Self preservation was noted as crucial for perseverance. T he operation of the MSM community is clandestine because of the stigma and discrimination attached to it and there is some difficulty getting an accurate account of the had to be done through gate keepers. If MSM are going to be supported one needs to work at the grass root s level. It was found that much of the MSM community (particularly sex workers) are out of touch with information on how to get help and make inform ed decisions. To reach this sub Davis (2006) memo found that historically (in the USA) sexual and gender minorities have not been catered for, and when they were it was done in a very limited way, focusing on their mental health predominantly. Mental health has been, the entry point because sociologically, and in some cases religiously the view was that LBGT had many emotional issues or was just simpl y mentally ill. While there may ve ry well be valid justifications for supporting LBGT mental health because of risks of suicide, and emotional anxieties based on abuse, molestation etc, there are other arguments which suggests that some of their behaviour is genetic. In Guyana t he practic e has been for CSO s and NGOs wo rking with MSM and transgender persons to focus on HIV, with the exception of SASOD whose goal s include advocating for the repeal of laws that criminalize same sex intimacy and non conforming gender expression and Artiste in Direct Support (AIDS) who historically, fought for the rights of gays. This has been the strategy because MSM are outlaw ed by dated legislation which has not been revised. Consequently, the entry point for support to MSM and transgender people has been wo rk that is HIV related. 5.0 Capacities (main findings) The capacity assessment was designed to ascertain the strength s and weakness es of NGOs/CSOs that work with sexual and gender minorities, especially their ability to off er VCT services. The methodology used for conduct ing capacity assessme nt framework and CSO assessment through face to face interview s with organizational heads or designate. A sc ale (ranging 1 through 5) was developed to assess the capacity of each NGO/CSO. [ 1=Little or no evidence of relevant capacity (merely congregate based on similar interests and issues); 2= Some evidence (coordinate S G M activities internal or externally); 3= Average (coordinate and advocate having the human capacity); 4=Above average (human and some physical capacity advocacy); 5= Capacities present to sustainably execute tasks ]

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16 NGO/CSO Region # of Staff* 2009 Services offered 2009 Duration in existence Annual budget*, 2009 Guybow 4 3 Counseling, capacity building, referrals, awareness sessions. 20yrs+ Not available SASOD 4 NA intervention and support, Legal assistance and representation, Advocacy, etc 7yrs G$1 4m FACTS 6 26+10V HIV education, OVCs, home based care, inter alia 10yrs G$28M (5%CS) AIDS 4 8 Phone, internet and peer counseling, condom and flyer distribution, support groups for targeted populations, outreach activities for targeted populations 18yrs G$1 25M GRPA 4 United Bricklayers 6 4 Counseling, distribution of condoms, educate FSW, MSM, also deal with OVC (this component is not funded) 3yrs Not available U and Me 10 2+50V HIV counseling feeding of the elderly 9yrs Founder funds from overseas Note: *V represents volunteer staff; *CS represents cost sharing. SASOD has no full time staff, only project staff and consultants.

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17 Objectives of organization/ Measures of Independence : With the exception of SASOD, GuyBow and AIDS most of the NGOs/CSOs sprung up out of a need to work on issues of HIV/AIDS as funding was available to work with at risk groups on various issues Some organizations were engaged in building capacity and so have evolved into strong entities focusing on issues affecting MSMs and coordinating their work with many stakeholders for optimal results Most organizations are aid dependent (depending on funding of donors) and as such their independence is at best subjective In fact for those organizations being funded, it was felt that even though there was some flexibility in formulating objectives, often times there is too much that has to be tailored to suit donor agencies Capacity to engage stakeholders, and build partnerships : All organizations lauded the fact that they were highly competent and had the necessary capacity to engage stakeholders and build partnerships, as it was currently being done However, there seems to be more of a network building between some gay friendly uniform force operatives as this is usually a difficult partnership to build and maintain since the unifrom forces function to uphold the law Capacity to offer HIV related and prevention services to sexual minorities : Responses here were mixed On the one hand, SASOD was not interested in working on this component On the other hand some NGOs/CSOs possessed the capacity to offer HIV related support and prevention services to Sexual Minorities, in some limited way Limited because the complete complement of, staff, space, and equipment were not altogether present Capacity for using research and evidence in decision making (assessing situations) : In the context of research and analysis, SASOD, GUYBOW, AIDS, and GRPA have these capacities The other NGOs/CSOs investigated had monitoring and tracking plans which created data and information as evidence for forward planning and programming ; they do not conduct analysis of the data and information they collect This they saw as not empowering and have implications for ownership Capacity for budget management and project implementation : All of the organizations claimed to have the capacity for budget planning and project implementation Only organizations that are receiving donor funding are compelled to build such capacity, and can adequately do so if the need arise Currently FACTS, AIDS, GUYBOW, GRPA, and United Bricklayers receive funding for which they have this capacity for monitoring, and reporting

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18 With the exception of AIDS, GuyBow and SASOD whose work started with a clear focus on sexual and gender minorities, MSM in particular, most of the NGOs/CSOs sprung up out of a need to work on issues of HIV as funding was available to work with at risk groups Some organizations were engaged in building capacity and so have evolved into strong entities focusi ng on issues affecting MSM and coordinating their work with many stakeholders for optimal results. Most organization s are aid dependent (depending on funding f rom donors) and as such their independence is at best subjective. In fact for those organization s being funded, it was felt that even though there was some flexibility in formulating objectives, often times there is too much that has to be tailored to suit donor agencies mandate s It is important to note that many of the NGOs/CSOs indicated capacit y strengths primarily on the premise of human capital (capacity) they have, and not the other complementary capacities (equipment, financial resources, physical space in some case, and training in VCT). Capacity to engage stakeholders, and build partnershi ps : All organizations lauded the fact that they were highly competent and had the necessary capacity to engage stakeholders and build partnerships, as it was currently being done. However, there seems to be more of a network building between some gay frien dly uniform force operatives as this is usually a difficult partnership to build and maintain since the uniform forces function to uphold the law which criminalizes various facets of non normative sexualities and non conforming genders. Three organizat ions are confident that they have capacity to articulate their mandate and policy positions (SASOD, FACTS, and AIDS) see table 1 In cases of AIDS and SASOD this is consistent with how and why these organizations were established, their history of advocac y at the policy level and in debates, and their presence on the issues as they have evolved over time. FACTS has its organizational strengths (work less in the policy arena), which has proven to be a concrete mechanism for building the partnerships they ha ve and for expanding as rapidly as they did in covering HIV and related work in general. GuyBow feels that it can improve on articulating its mandate, while G RPA has had a long and positive track record in the work they do, and have indicated above average capacity to articulate their mandate U and M e' was formulated by a Guyanese in the Diaspora and so the current management is not of the view that capacity exist s for th e articulation of their mandate Table 1: Does the organization have the capacity to articulate its mandate and policy positions? Count Does the organization have the capacity to articulate its mandate and policy positions? Total Some evidence Average evidence Above average evidence Sustain capabilities to execute tasks Missing NGO or CSO Assessed Artist in Direct Support 0 0 0 1 0 1 FACTS 0 0 0 1 0 1 GRPA 0 0 1 0 0 1 GuyBow 0 1 0 0 0 1 SASOD 0 0 0 1 0 1 U and Me 1 0 0 0 0 1 United Brick Layers 0 0 0 0 1 1 Total 1 1 1 3 1 7

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19 In spite of the aforementioned all NGOs/CSOs are of the view that capacity exist s within their organization to assert leadership through knowledge on the issues that affect sexual and gender minorities ( see table 2 ) In table 3 GRPA, and GuyBow, have above average capacity to manage domestic and external relations with stakeholders, while SASOD and FACTS indicated sustained capacity to do this. The other s indicated average capacity on this is sue. Table 2: Does the organization have the capacity to assert leadership through knowledge of the issues that affect sexual and gender minorities? Count Does the organization have the capacity to assert leadership through knowledge of the issues that affect sexual and gender minorities? Total Above average evidence Sustain capabilities to execute tasks NGO or CSO Assessed Artist in Direct Support 1 0 1 FACTS 0 1 1 GRPA 1 0 1 GuyBow 1 0 1 SASOD 0 1 1 U and Me 1 0 1 United Brick Layers 1 0 1 Total 5 2 7 Table 3: Does the organization have the capacity to manage relations with domestic and external stakeholders inclusively and constructively on issues of S G M? Count Does the organization have the capacity to manage relations with domestic and external stakeholders inclusively and constructively on issues of S G M? Total Average evidence Above average evidence Sustain capabilities to execute tasks NGO or CSO Assessed Artist in Direct Support 1 0 0 1 FACTS 0 0 1 1 GRPA 0 1 0 1 GuyBow 0 1 0 1 SASOD 0 0 1 1 U and Me 1 0 0 1 United Brick Layers 0 1 0 1 Total 2 3 2 7

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20 Most of the organizations have indicated the capacity to build and manage partnerships among relevant stakeholders (uniform services, NGO's, Health services, Judiciary, Legal aid) exist ( see table 4 ) This is primarily the case because these are key agencies with which they interface on a regular basis. In many cases too they have to form informal partnerships with these organizations t o address issues that may, often affect these groups. As it relates to the capacity to articulate desired outcomes and benefits of collaboration and to motivate diverse groups of stakeholders ( in table 5 ), most organization s are of the view that this is d one. In fact United Brick layers, SASOD, and FACTS indicated sustained capacities to do this, GRPA, GuyBow, and U and Me above average, and AIDS average. Table 4: Does the organization have the capacity to build and manage partnerships among relevant stak eholders (uniform services, NGO's, Health services, Judiciary, Legal aid)? Count Does the organization have the capacity to build and manage partnerships among relevant stakeholders (uniform services, NGO's, Health services, Judiciary, Legal aid)? Total Above average evidence Sustain capabilities to execute tasks NGO or CSO Assessed Artist in Direct Support 1 0 1 FACTS 1 0 1 GRPA 1 0 1 GuyBow 1 0 1 SASOD 0 1 1 U and Me 1 0 1 United Brick Layers 0 1 1 Total 5 2 7 Table 5: Does the organization have the capacity to articulate desired outcomes and benefits of collaboration to motivate diverse groups of stakeholders? Count Does the organization have the capacity to articulate desired outcomes and benefits of colla boration; to motivate diverse groups of stakeholders? Total Average evidence Above average evidence Sustain capabilities to execute tasks NGO or CSO Assessed Artist in Direct Support 1 0 0 1 FACTS 0 0 1 1 GRPA 0 1 0 1 GuyBow 0 1 0 1 SASOD 0 0 1 1 U and Me 0 1 0 1 United Brick Layers 0 0 1 1 Total 1 3 3 7

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21 Information sharing, public awareness and education on sexual and gender minorities are strengths that all of the organizations have, at above average level ( see table 6 ) In table 7, four organizations seem to have established norms for collaboration for trust building (AIDS, FACTS, United Brick Layers and GRPA). U and Me indicated average capacity to do this while GuyBow and SASOD are above average. Table 6: Does the organization have the capacity to facilitate open communication by sharing information, create awareness, and educate the public of S G M? Count Does the organization have the capacity to facilitate open communication by sharing information, create aware ness, and educate the public of SM? Total Above average evidence Sustain capabilities to execute tasks NGO or CSO Assessed Artist in Direct Support 0 1 1 FACTS 0 1 1 GRPA 1 0 1 GuyBow 1 0 1 SASOD 0 1 1 U and Me 1 0 1 United Brick Layers 0 1 1 Total 3 4 7 Table 7: Does the organization have the capacity to build trust with its partners through establishing norms of collaboration and sustaining them? Count Does the organization have the capacity to build trust with its partners through establishing norms of collaboration and sustaining them? Total Average evidence Above average evidence Sustain capabilities to execute tasks NGO or CSO Assessed Artist in Direct Support 0 0 1 1 FACTS 0 0 1 1 GRPA 0 0 1 1 GuyBow 0 1 0 1 SASOD 0 1 0 1 U and Me 1 0 0 1 United Brick Layers 0 0 1 1 Total 1 2 4 7

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22 Despite discriminatory laws pertaining to sexual orientation, rights based advocacy is an issue all the NGOs/CSOs work on in various forms and at various levels. Some work at the community and household level offering support to sexual and gender minorities, others work on advocacy at the policy level. Generally legal constraints do not make it easy for these organizations to optimize their approaches to w ork with sexual and gender minorities. Most of the NGOs/CSOs work with sexual minorities as a subset of their work on HIV. The evidence has shown that only in the case of AIDS and SASOD were the focus firmly on sexual and gender minorities, MSM in particular. Today both organizations continue this work. SASOD continues to focus on advocacy for repealing laws that outlaw cross dressing and same sex intimacy Table 8, shows that FACTS, GRPA, United Brick Layers, and SASOD have s ustained capacities to promote rights respected approaches for the support and protection of sexual and gender minorities among key stakeholders T o a lesser extent U and Me (which is above average ), and GuyBow do not seem to have evidence of such as they felt too much is mandated by donors. Table 8: Does the organization get the space to promote rights respected approaches for the support and protection of S G M with its partners and other key stakeholders? Count Does the organization get the space t o promote rights respected approaches for the support and protection of S G M with its partners and other key stakeholders? Total Some evidence Above average evidence Sustain capabilities to execute tasks Missing NGO or CSO Assessed Artist in Direct Support 0 0 0 1 1 FACTS 0 0 1 0 1 GRPA 0 0 1 0 1 GuyBow 1 0 0 0 1 SASOD 0 0 1 0 1 U and Me 0 1 0 0 1 United Brick Layers 0 0 1 0 1 Total 1 1 4 1 7 Mobilizing resources is essential to the prosperity, sustainability, and general function of the NGOs/CSOs. In t able 9, all but two organizations indicated sustained capacities to mobilize resource (FACTS, and AIDS). Table 9: Does the organization have the capacity to mobilize resources? Count Does the organization have the capacity to mobilize resources? Total Average evidence Above average evidence Sustain capabilities to execute tasks NGO or CSO Assessed Artist in Direct Support 0 1 0 1 FACTS 1 0 0 1

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23 GRPA 0 0 1 1 GuyBow 0 0 1 1 SASOD 0 0 1 1 U and Me 0 0 1 1 United Brick Layers 0 0 1 1 Total 1 1 5 7

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24 and policies concerning sexual and gender minorities and related programmes, see table 10. In t able 11 United Brick Layers and GRPA a re the only two organizations who fully believe that there are for ums at which they can address issues affecting sexual and gender minorities. SASOD is of the view that on average this is the case while GuyBow and FACT are a little more optimistic; U and Me do not share the same level of optimism as the others. Table 10: Does your organization have comprehensive knowledge of d onors' funding priorities and policies with regards to S G M and related programmes? Count Does your organization have comprehensive knowledge of donors' funding priorities and policies with regards to SM and related programmes? Total Little or no evidence of relevant capacity Average evidence Above average evidence Sustain capabilities to execute tasks NGO or CSO Assessed Artist in Direct Support 0 0 1 0 1 FACTS 0 1 0 0 1 GRPA 0 0 0 1 1 GuyBow 0 0 0 1 1 SASOD 0 0 1 0 1 U and Me 1 0 0 0 1 United Brick Layers 0 0 0 1 1 Total 1 1 2 3 7 Table 11: Does the organization have a forum at which there is an outlet for addressing the issues and concern of S G M with its partners and key stakeholders? Count Does the organization have a forum at which there is an outlet for addressing the issues and concern of S G M with its partners and key stakeholders? Total Little or no evidence of relevant capacity Average evidence Above average evidence Sustain capabilities to execute tasks Missing NGO or CSO Assessed Artist in Direct Support 0 0 0 0 1 1 FACTS 0 0 1 0 0 1 GRPA 0 0 0 1 0 1 GuyBow 0 0 1 0 0 1 SASOD 0 1 0 0 0 1 U and Me 1 0 0 0 0 1 United Brick Layers 0 0 0 1 0 1 Total 1 1 2 2 1 7

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25 Opinions on the authorities capacity to negotiate with donors about increasing transparency, predictability, and volatility of support, in table 12, shows that only one organization feels there is limited capacity of this, all else is at or above average. One organiz ation is of the view that the president has lots of experience in doing this. However, as indicated earlier only three organizations grew out of a focus on sexual and gender minorities while others focus were HIV and AIDS under which they supported or sup ports at risk groups which includes MSM and transgender persons. Table 12: Do authorities have the capacity to negotiate with donors about increasing transparency and predictability and reducing volatility? Count Do authorities have the capacity to n egotiate with donors about increasing transparency and predictability and reducing volatility? Total Little or no evidence of relevant capacity Average evidence Above average evidence Sustain capabilities to execute tasks Missing NGO or CSO Assessed Artist in Direct Support 0 1 0 0 0 1 FACTS 0 0 0 0 1 1 GRPA 0 0 0 1 0 1 GuyBow 1 0 0 0 0 1 SASOD 0 1 0 0 0 1 U and Me 0 0 1 0 0 1 United Brick Layers 0 0 0 1 0 1 Total 1 2 1 2 1 7 Most organizations indicated (above average or sustained) capabilities to monitor and track internal processes, and outcomes related capacity development, see table 13. In fact, most of the organizations core staff benefits from training programmes, exposure to conferences on issues affecting sexual an d gender minorities, etc., support offered by donors. By extension too, organizations benefit from knowledge and skills that they also pass on to wider audiences. Table 13: Does the organization have the capacity to monitor and track internal processes, and outcomes related to obtain donors support for capacity development initiatives? Count Does the organization have the capacity to monitor and track internal processes, and outcomes related to obtain donors support for capacity development initiativ es? Total Average evidence Above average evidence Sustain capabilities to execute tasks NGO or CSO Assessed Artist in Direct Support 0 0 1 1 FACTS 0 0 1 1 GRPA 0 0 1 1 GuyBow 0 1 0 1

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26 SASOD 0 1 0 1 U and Me 1 0 0 1 United Brick Layers 0 1 0 1 Total 1 3 3 7 The organizations identified specific challenges they face in advancing their work on dealing with issues sexual and gender minorities encounter. One such challenge is that of apprehension by some faith based organization in giving national support for the advancement of the rights of sexual and gender minorities. There are persons in the faith based community who are not open ly critical of the rights sexual and gender minorities should enjoy. Another challenge revealed is that of unpredictability of funding for programmes. Thirdly, support is shortcoming to build capacity of sexual and gender minorities to empower them. Fourth ly, some organizations mentioned insufficient tools (lubricants, MSM condoms, etc.) to promote safer sexual relations In responding about capacities to overcome the challenges faced, the organizations had varying responses. Some organizations indicated that they do not have sufficient resources to respond to the challenges. This include tools (financial and/or materials) to reach the needs of beneficiaries. Others indicated they can supply information needed to address the constraints, noting that they do not necessarily have the answers and alternative solution (s). Table 15 represents the organizations views on their capacity to respond to their challenges. Table 14: What specific challenges the organization face in interacting with relevant partner s/stakeholders that affects results? Count What specific challenges the organization face in interacting with relevant partners/stakeholders that affects results? Total Little or no evidence of relevant capacity Average evidence Sustain capabilities to execute tasks NGO or CSO Assessed FACTS 0 1 0 1 GRPA 0 0 1 1 United Brick Layers 1 0 0 1 Total 1 1 1 3 Table 15: Does the organization have the capacity to respond to the needs of the audience it initiate internal and external communication strategies in order to be responsive to stakeholders? Count Does the organization have the capacity to respond to the needs of the audience it initiate internal and external communication strategies in order to be responsive to stakeholders? Total Some evidence Average evidence Above average evidence Sustain capabilities to execute tasks Missing NGO or CSO Assessed Artist in Direct Support 0 0 0 0 1 1 FACTS 0 1 0 0 0 1 GRPA 0 0 0 1 0 1 GuyBow 0 0 1 0 0 1 SASOD 0 0 0 1 0 1 U and Me 1 0 0 0 0 1

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27 United Brick Layers 0 0 0 1 0 1 Total 1 1 1 3 1 7

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28 Capacity for using research and evidence in decision making (assessing situations): In the context of research and analysis, SASOD, GUYBOW, AIDS, and GRPA have these capacities. The other NGOs/CSOs investigated had monitoring and tracking plans which created data and information as evidence for forward planning and programming; agencies supporting some of the programmes of a few NGOs/CBOs would conduct analysis of the data and information the se agencies collected As a result t his they saw as not empowering and have implications for ownership because they need to build their own capaciti es to conduct same analysis Most of the organization s have average and above capabilities to collect information or access to and capacity for the use of disaggregated data on sexual and gender minorities, see table 16. However, this primarily relates to the sexual and gender minorities the organizations work with, and over the years, the network they have fostered, built and expanded in reaching out to a wide cross section of sexual and gender minorities in Guyana. In table 17 c apacities to use and disse minate information are all above average for the organizations interviewed. Table 16: Does the organization collect or have access to and capacity for use of disaggregated data/information on SM and their key concerns? Count Does the organization collect or have access to and capacity for use of disaggregated data/information on S G M and their key concerns? Total Little or no evidence of relevant capacity Average evidence Above average evidence Sustain capabilities to execute tasks NGO or CSO Assessed Artist in Direct Support 0 0 1 0 1 FACTS 0 1 0 0 1 GRPA 0 0 0 1 1 GuyBow 0 0 1 0 1 SASOD 0 0 0 1 1 U and Me 1 0 0 0 1 United Brick Layers 0 0 1 0 1 Total 1 1 3 2 7 Table 17: Does the organization's staff have the capacity to use and disseminate data/information? Count Does the organization's staff have the capacity to use and disseminate data/information? Total Above average evidence Sustain capabilities to execute tasks NGO or CSO Assessed Artist in Direct Support 1 0 1 FACTS 1 0 1 GRPA 0 1 1 GuyBow 1 0 1 SASOD 0 1 1 United Brick Layers 0 1 1 Total 3 3 6

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29 Staff development through training, workshops is common among the organizations assessed (with the exception of FACTS who feels there is need for strengthening in data analysis), see table 18. However, there is still the view that training is deficient in data analysis, in some cases data collection processes. Strengths in capacity of many of the organizations assessed are rooted strongly in their ability to manage projects, and budgets, see table 19. This does not suggest proficiency in project management in general. Experience gained in this area is related to how long most of the gr oups are in existence and the capacity they have built over the years in working with various donors providing opportunities for training, and technical assistance. Consequently, most organization s rate highly their ability to coordinate, manage projects a nd execute budgets. Table 18: Does the organization offer staff development to strengthen capacity for advocacy, analysis etc? How often? Count Does the organization offer staff development to strengthen capacity for advocacy, analysis etc? How often? Total Some evidence Above average evidence Sustain capabilities to execute tasks NGO or CSO Assessed Artist in Direct Support 0 1 0 1 FACTS 1 0 0 1 GRPA 0 0 1 1 GuyBow 0 1 0 1 SASOD 0 1 0 1 U and Me 0 1 0 1 United Brick Layers 0 0 1 1 Total 1 4 2 7 Table 19: Does the organization build staff capacity to coordinate projects, manage budgets etc? Count Does the organization build staff capacity to coordinate projects, manage budgets etc? Total Above average evidence Sustain capabilities to execute tasks NGO or CSO Assessed Artist in Direct Support 1 0 1 FACTS 0 1 1 GRPA 0 1 1 GuyBow 1 0 1 SASOD 0 1 1 U and Me 1 0 1 United Brick Layers 0 1 1 Total 3 4 7

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30 The organizations that work with sexual and gender minorities have taken a commitment to do so and have recognized the importance and continued need to work from a rights based perspective. Most of the organizations would like to see MSM for example, treated equally and as such do not like the i dea of making the distinction between a gay perso n and an other person. Consequently, the work they do is done with respect for all. The results in table 20 should all be interpreted as organizations working within the precepts of rights for all. Table 21 reveals that all of the organizations keep updates on issues affecting sexual and gender minorities, be it local or international. Table 20: Does the organization build staff capacity on rights respected professional approaches for S G M? Count Does t he organization build staff capacity on rights respected professional approaches for S G M? Total Little or no evidence of relevant capacity Sustain capabilities to execute tasks NGO or CSO Assessed Artist in Direct Support 1 0 1 FACTS 0 1 1 GRPA 0 1 1 SASOD 0 1 1 United Brick Layers 0 1 1 Total 1 4 5 Table 21: Does the organization keep updates of S G M issues locally and otherwise, and acquire data/information on those issues? Count Does the organization keep updates of S G M issues locally and otherwise, and acquire data/information on those issues? Total Above average evidence Sustain capabilities to execute tasks NGO or CSO Assessed Artist in Direct Support 0 1 1 FACTS 0 1 1 GRPA 0 1 1 GuyBow 1 0 1 SASOD 0 1 1 United Brick Layers 0 1 1 Total 1 5 6

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31 Capacity for budget management and project implementation : All of the organizations indicated they possess the capacity for budget planning and project implementation. However, o nly organizations that are receiving donor funding are compelled to build and maintain such capacity, and can adequately do so if the need arise. Currently FACTS, AIDS, GUYBOW, GRPA, and United Bricklayers receive funding for which they have this capacity for monitoring and financial reporting All of the organizations indicated that they have the capacity to manage financial resources appropriately in the implementation of programme and delivery of services, see table 22. This is the case because most funding agencies offer training to these organizations in this regard. Additionally, these organizations are monitored often, and have to meet funding agencies criteria of financial management before qualifying for support. Further, service delivery are mo nitored too as it is the basis for programming. Hence, it is no su r prise, in table 23, that all the organizations indicated sustained capacities to trac k how resources are being spent and disbursed. In fact, as per project all organization s have record and general bookkeeping practices. Table 22: Does the organization have the capacity to manage financial resources appropriately in the implementation of programmes and delivery of services? Count Does the organization have the capacity to manage financial resources appropriately in the implementation of programmes and delivery of services? Total Sustain capabilities to execute tasks NGO or CSO Assessed Artist in Direct Support 1 1 FACTS 1 1 GRPA 1 1 GuyBow 1 1 SASOD 1 1 U and Me 1 1 United Brick Layers 1 1 Total 7 7 Table 23: Does the organization have the capacity to track whether resources are being spent for what they are intended for, i.e. are there proper business processes, book keeping etc in place? Count Does the organization have the capacity to track whether resources are being spent for what they are intended for, i.e. are there proper business processes, book keeping etc in place? Total Sustain capabilities to execute tasks NGO or CSO Assessed Artist in Direct Support 1 1 FACTS 1 1 GRPA 1 1 GuyBow 1 1 SASOD 1 1 U and Me 1 1 United Brick Layers 1 1 Total 7 7

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32 Due to the continuous training, monitoring and strict guidelines on financial management under which the organizations receive support, table 24 shows sustained capacities to design appropriate tools for effective financial management. In most cases donor s/supporters provide the tools for such management. With specific reference to capacity to use and analyze data to improve business processes, most organizations collect such information for lesson s learnt, determining results and the effectiveness and impact of such, and future programming. It is noteworthy that s ome organization s express ed key interest in being part of the analysis or building capacity for such. Table 24: Does the organization have the capacity to use and design appropriate analytical tools to undertake effective financial management? Count Does the organization have the capacity to use and design appropriate analytical tools to undertake effe ctive financial management? Total Sustain capabilities to execute tasks NGO or CSO Assessed Artist in Direct Support 1 1 FACTS 1 1 GRPA 1 1 GuyBow 1 1 SASOD 1 1 U and Me 1 1 United Brick Layers 1 1 Total 7 7 Table 25: Does the organization have the capacity to use and analyze data to improve business processes? Count Does the organization have the capacity o use and analyze data to improve business processes? Total Above average evidence Sustain capabilities to execute tasks NGO or CSO Assessed Artist in Direct Support 0 1 1 FACTS 0 1 1 GRPA 0 1 1 GuyBow 0 1 1 SASOD 1 0 1 U and Me 1 0 1 United Brick Layers 0 1 1 Total 2 5 7

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33 Capacity to offer HIV related and prevention services to sexual and gender minorities : Responses here were mixed. On the one hand, SASOD was not interested in working on individual behaviour change and so most of what was asked in this section did not appl y to them On the other hand some NGOs/CSOs possessed the human capacity to offer HIV related support and prevention services to s exual and gender m inorities. Deficiencies exist primarily because of a lack of equipment, in some cases l imited contingent of staff and in others physical space SASOD indicated that they are not interested in offering VCT but remain committed to the policy advocacy. GuyBow showed little or no capacity to offer VCT, while FACTS has the human skills to conduct VCT, but no equ ipment. 'U and Me' has the trained personnel and physical space to offer VCT but lack the equipment to do so. GRPA is the only entity with sustained capacity to offer VCT services as they have been doing so for many years. The aforementioned is illustrate d in the organizations responses in table 26 and 27. Table 26 : Does the organization have the capacity (trained staff with competencies, equipment, etc) to offer VCT to S G M? Count Does the organization have the capacity (trained staff with competencie s, equipment, etc) to offer VCT to S G M? Total Little or no evidence of relevant capacity Average evidence Sustain capabilities to execute tasks Missing Not Applicable NGO or CSO Assessed Artist in Direct Support 0 0 0 1 0 1 FACTS 0 1 0 0 0 1 GRPA 0 0 1 0 0 1 GuyBow 1 0 0 0 0 1 SASOD 0 0 0 0 1 1 U and Me 0 0 1 0 0 1 United Brick Layers 0 0 1 0 0 1 Total 1 1 3 1 1 7 Table 27: Does the organization have the physical capacity (office, and other space) to effectively provide VCT services? Count Does the organization have the physical capacity (office, and other space) to effectively provide VCT services? Total Little or no evidence of relevant capacity Sustain capabilities to execute tasks Missing Not Applicable NGO or CSO Assessed Artist in Direct Support 0 0 1 0 1 FACTS 0 1 0 0 1 GRPA 0 1 0 0 1 GuyBow 1 0 0 0 1 SASOD 0 0 0 1 1 U and Me 0 1 0 0 1 United Brick Layers 0 1 0 0 1 Total 1 4 1 1 7

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34 Outreach capacity is a critical component of reaching sexual and gender minorities, particularly in presence of discrimination based o n HIV status sexual orientation and gender identity A large component of FACTS and s is outreach. U and Me ha s the capacity to conduct outreach as measured by the largest component of volunteers, but there is no evidence other NGOs/CBOs in their current programm es have similar capacity GuyBow emp hasized that the capacity for outreach is very limited, see table 28. Table 29, shows that all the organization s have capacity to build the partnership or play a role in a stakeholder willing to offer VCT for sexual and gender minorities, as most of them would have had experience with various funding agencies in this regard. Table 28: Does the organization have the capacity to do outreach as it regards VCT for S G M? Count Does the organization have the capacity to do outreach as it regards VCT for SM? Total Little or no evidence of relevant capacity Average evidence Sustain capabilities to execute tasks Missing Not Applicable NGO or CSO Assessed Artist in Direct Support 0 0 0 1 0 1 FACTS 0 0 1 0 0 1 GRPA 0 0 1 0 0 1 GuyBow 1 0 0 0 0 1 SASOD 0 0 0 0 1 1 U and Me 0 0 1 0 0 1 United Brick Layers 0 1 0 0 0 1 Total 1 1 3 1 1 7 Table 29 : Does the organization have the capacity to build the partnership or play a role in a stakeholder group that is willing to offer VCT for S G M? Count Does the organization have the capacity to build the partnership or play a role in a stakeholder group that is willing to offer VCT for S G M? Total Above average evidence Sustain capabilities to execute tasks Not Applicable NGO or CSO Assessed Artist in Direct Support 0 1 0 1 FACTS 0 1 0 1 GRPA 0 1 0 1 GuyBow 0 1 0 1 SASOD 0 0 1 1 U and Me 1 0 0 1 United Brick Layers 0 1 0 1 Total 1 5 1 7

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35 All the organizations indicated a capacity to collect information on their services and clients, see table 30 However, not all the organization have the capacity to analyze information collected or are involved in the analysis of the data collected and a s such th is mi t i g ate s against data analytical capabilities in general. Table 3 0 : Does the organization have the mechanism for collecting administrative data on the services offered and clients served to make further evidence based decision, recognized emerging issues and require adjustment of services offered etc? Count Does the organization have the mechanism for collecting administrative data on the services offered and clients served to make further evidence based decision, recognized emerging issues and require adjustment of services offered etc? Total Sustain capabilities to execute tasks Not Applicable NGO or CSO Assessed Artist in Direct Support 1 0 1 FACTS 1 0 1 GRPA 1 0 1 GuyBow 1 0 1 SASOD 0 1 1 U and Me 1 0 1 United Brick Layers 1 0 1 Total 6 1 7 Consistent with the information revealed in table 29 all organizations assessed indicated that they have the capacity to establish networks among national institutions and agencies that are responsible for VCT. In fact, the modality in which most of the NG Os/CSOs operate is through partnership and networking with national and international institutions to solicit support for beneficiaries. Table 3 1 : Does the organization have the capacity to establish a network among national institutions and agencies that are responsible for VCT? Count Does the organization have the capacity to establish a network among national institutions and agencies that a re responsible for VCT? Total Sustain capabilities to execute tasks Not Applicable NGO or CSO Assessed Artist in Direct Support 1 0 1 FACTS 1 0 1 GRPA 1 0 1 GuyBow 1 0 1 SASOD 0 1 1 U and Me 1 0 1 United Brick Layers 1 0 1 Total 6 1 7

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36 6.0 Focus Groups (main findings) Group characteristics The consultant conducted 10 focus group sessions distributed across regions 4, 6 and 10 ; in regions 2 and 7 members of the MSM community are mostly closeted gays and preferred to remain anonymous. The group sizes ranged from 7 to 13. Combined, the age range of respondents were 20 through 58 years old of varied ethnicity mainly east Indians and blacks. Most of the respondents in the rural communities visited only completed primary schooling Similarly, those primary schooling Commonalities Most of the MSM community socialized among themsel ves, particularly those who are open about their sexual orientation. Others, for survival, suppressed their identities and function within all circles of the society. Nevertheless, there is the occasional gay pageantry, and gay friendly spaces (in some rur al and urban communities). Online is becoming one of the most regular meeting and safe spaces for MSM. Most groups revealed that there is so much emphasis on HIV that there is an implicit neglect of information on other STIs. Most persons who faced ope n discrimination based on their sexual orientation gender identity and expression indicated that abuse (physical and verbal) came mainly from teenage boys and young men. HIV and related health services (privately and publicly) are available, but access v aried based on knowledge, and receptiveness of health worker s, level and scope o outreach programmes Differences The level of stigma and discrimination, based on the focus group discussions and research material reviewed, varied widely across and within regions investigated, perceivably by ethnicity, education level openness of sexuality, and religious beliefs. Age did not seem to be a factor influencing stigma and discrimination. The leve l of accuracy and concomitant weight that can be leveraged by such evidence to make generalized pronouncements may be questionable. On the one hand, focus group discussions in region 10 revealed that MSM were discriminated against by members of the commun ity. In fact some revealed that their homes were stoned, another re counted to being shot by a pellet gun from a group in front of a bank where two security guards were present and did nothing. T hese stories were never officially reported to the police, bu t the same group also indicated that they had no problem with the police. This revealed that lack of confidence that their matters would be treated equally, or simply lack confidence in the services offered. On the other hand, in region 6 it was revealed that a more receptive community in some parts. With this type of evidence there is inclination of cultural differences in how receptive a community is towards MSM.

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37 Even though there is opposition by religious groups towards promoting rights of sexual and gender minorities, in some communities, as revealed in the focus groups conducted MSM attend and are active members in church. Cross cutting In all the sessions FGD participants shared that there exists some form of support for the MSMs. This support some MSM are not familiar with the existing services of CSO s /NGOs which have implications for access. Often NGOs/CSOs who recognize this implement outreach programmes. The limitation within these established relationships and networks are the result of resources which affect the scope of work an NGO/CSO can do. In some cases fragme ntation can affect the coordination and collaborative efforts of these groups working for the same cause. This may result since among MSM their own group dynamics affect these outcomes. MSM who are open about their sexual orientation revealed that they a re not discriminated against in terms of seeking and finding employment, but they do not seek out jobs. This reflects implicit discomfort that is the likely result of discrimination perceived or real. With reference to police, some groups revealed relatio ns while others did not. However, what was clear is that gay friendly police existed and would often tolerate LBGT I and heed their concerns cases of those who are Needs MSM revealed the need for gay friendly medical personnel. There is a need for attention and information on STIs other than HIV. There is a need for the scaling up of outreach programmes for MSM, as it seems to be one of the most effective ways of reaching out to the community There is a need to change attitudes and behaviour towards LBGT people This is a very long term goal but can be initiated through legislation that decriminalizes cross dressing, and abuse fuelled by discrimination based on non normative sexuality. 7.0 Uniform Forces Based on focus groups with sexual and gender minorities reports pointed to the leniency of the uniformed forces in dealing with the MSM community whil e in some of the secondary literature and on the account of some NGOs/CSOs the situation has been mixed In most cases, MSM claimed to have a good relationship with the police. In fact, some of the mobilization of MSM groups for this study was done by pol ice who seem to have easy access to this group. There is clear evidence that MSM are often threatened within the

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38 community by the general populace. They further indicated that if threatened; they were quite comfortable with making reports to the police th ough this did not seem to be a common practice. For open ly gay and bisexual men the research enquired if they had to assume the role of a heterosexual to get attention the Dem done know we meaning that the police was aw are of their sexual identity. Upon discussions with a few police it was stated that in training, members of the force are taught basic human rights. More specifically, they are taught that all persons should be respected regardless of their race, class gender and sexual orientation. However, the police must uphold the local law; this coupled with, pressure from the LBGT I community for a repeal of those laws and opposition to the repulsion of those laws by strong religious groups puts the police in a precarious position. Technically, only in the presence of strong evidence and until conviction can one be subjected to punishment of the law. Consequently, if a criminal offence is alleged ones human rights must be upheld. The space exists for punishment of abuse in the laws of Guyana, and Guyana is a signatory to the main UN treaties which guarantee and protect h uman r ights. Therefore, until such time as a conviction there must be respect for ones human rights, access to health care, protection etc for all Guyanese. In some of the consultations held under this study, it was revealed that there is a police management procedure plan which encompasses training and procedures for dealing with sexual and gender minorities. While the researcher has not seen this plan, if it exists, there is room for UNDP to support this initiative. In the case of the prisons services known MSM are separated f rom the general heterosexual environment as they are termed a security risk as well as deemed at risk. If found in same sex act s, prisoners are taken before the court for buggery. Condoms are not allowed in prisons, however there is a VCT site but its lev el of functionality is unknown. In the army, VCT and other medical services exist, however on the issue of sexual and gender minorities the modus oper andi although there is no indication of an official policy. Additionally, th e army does not have a mandate (other than in high crime wave situations) to deal with the civilian population. 8.0 Health Services Providers Access to health care as revealed earlier is subjected to a few factors which can be addressed. Perception of he alth care workers is mixed, but there was a clear need for medical workers sensitive to the needs of sexual and gender minorities. The quality of health care and issues related to service delivery such as waiting time, variety and availability of drugs etc, often affects sexual and gender minorities. These constraints also affect general users of health care in Guyana and are not unique to sexual a nd gender minorities.

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39 9.0 Validation Workshop (required Interventions identified by NGOs/CSOs) A workshop was hel d with NGOs/CSOs which primarily working with sexual and gender minorities. Specific ally break out session s covering 3 general areas Health Service Providers, Uniform Forces and Capacity Building delineated on key findings of the report and formulated collective actions that are deemed useful as next steps. Through the use of a dvocacy tools the groups ident ified the following: On Health Service Providers Training of health service providers : T raining had specific connotations and required focus on key areas, these are: Promotion of a better understand ing of the diversities of sexual practices/behavior of MSM ; A need for more attention t o risk reduction and not the behaviour of clients or their sexual lifestyle ; Promotion of a g ay f riendly environment, which they felt should mean: No preaching or imposition of religious beliefs; No judging of behavior or li festyle just be neutral/professional; Be courteous and respectful at all times; Maintain privacy/confidentiality at all times Finally, there is a need for a special unit created for people who experience discrimination by health service providers based on sexual identification. At this unit, people should be able to report incidents and seek and obtain recourse On Uniform Forces Sensitization (sexual and gender minorities, magistr ac y, Police, and prison officers) ; Equal employment policies (similar to HIV in the work place policy possible collaboration with ILO) ; Rights and responsibilit ies of LBGT I people ; and Prison reform Unfairness in terms of the treatment meted out to many MSM, especially by the some policemen and prison staff nee ds to be rectified through some form of code of conduct T he fear expressed is that when put before the court, the magistracy is hardly ever sympathetic towards s exual and gender m inorities MSM are not the only ones who suffer this faith, but they were no netheless especially vulnerable. It wa s stated that the law itself and all its inequities created an environment for criminality On Capacity Building There are specific needs for strengthening capacity of the NGOs/CSOs, these were highlighted as: Proposal Preparation

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40 Financial Management Resource Mobilization Project Management Monitoring and Evaluation

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41 10.0 Conclusion 1. A review was conducted to collect available information and materials developed in Guyana on sexual and gender minor ities and concomitant human rights. It was found that there is an acute deficiency in information available on sexual and gender minorities. Most of what existed focus ed on MSM as an at risk group of the contraction and spread of HIV. It was found that ke y sensitivities, such as stigma and discrimination, religious/cultural beliefs, and the existing legislative framework, can somewhat explain the challenges that LGBTI people face. This reinforces the strong dual approach need to confront the challenges p olicy and legislative advocacy, and function/operational work at the grass root s levels to bring immediate support for health and other services required. A communication strategy with a heavy element of outreach, and se nsitized medical practitioners are c ritical too. 2. Best practices for programmes that support sexual and gender minorities were highlighted within the region (Latin America) and locally by a few NGOs/CSOs. Most of the programmes recognized the need for policy, legislative and attitudinal c hanges which are easily adaptable to Guyana, but this has not been the case. In fact, there are examples of parliamentary support for legislative changes in Guyana but this has been met with protest and lack of assent. Other support is fragmented and needs to be more coordinated for the purpose of educating on the needs, from a human rights perspective, of sexual and gender minorities. There are some local models of work that can be enhanced to serve the sexual and gender minorities, once additional capacit ies are built and resources are made available. 3. There were both negative and positive responses from health services providers and uniform ed forces in the response and interactions with sexual and gender minorities. Sexual and gender minorities face the same challenges in accessing available health services as others, except in cases where individuals are discriminated against because of their HIV status sexual orientation and/or gender identity Notwithstanding, more work is needed to liberate the rights, further, of sexual and gender minorities, as this is deemed a catalyst for the comfort needed for individuals to come forward in the fight against HIV. 4. Finally a needs assessment on capacities to offer VCT revealed that NGOs/CSO s covered under this investigation has had the experience, knowledge, passion and commitment in working with at risk groups, for example, sex workers, MSM, among others. A platform exists therefore for the work to continue once the necessary and sufficien t support is available.

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42 10.0 Recommendations 1. Train and build capacity of uniformed services Support police management procedure plan on areas where it purports to deal with sexual and gender minorities; Support prison officers training, and strengthen VCT site in prisons where they exist ; 2. Train and build capacity of community based organizations Build capacity of some NG O /CSO Functional Support and Other Strengthening for VCT Support, despite some MSM having a preference for public health facilities ; Strengthen capacity for Policy and Advocacy among NGOs/CSOs who focus on these areas ; There is a need for the scaling up of outreach programmes for MSM, as it seems to be one of the most effective ways of reaching out to the community; 3. Train and build capacity of health service providers Support initiatives of public and private health agency to sensitize medical personnel on how to work with MSMs ; There is a need for attention and information on STIs other than HIV such as viral hepatitis, rectal gonorrhea and syphilis. 4. Champion principles of universal human rights There is a need to change attitudes and behaviour towards LBGT I people This is very long term but can be initiated through legislation that decriminalizes cross dressing, and abuse fuelled by discrimination based on non normative sexualities.

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43 Reference: Gable L et al. (2007). Legal aspects of HIV/AIDS: a guide for law and policy reform. Washington DC, World Bank. Homosexuality in the Caribbean Crawling out of the Closet, Maryzoon Press ISBN 13 978 976 630 495 9 sex workers and men who have sex with providers to deliver optimal care to Lesbian Gay, Bisexual, and Transgendered peopl Health Unit, Ministry of Health Guyana, 2008. Ministry of Health Behaviour Surveillance Survey 2005, conducted by Family Health International in collaboration with Guyana Responsible Parenthood Association and the Ministry of Health. Ministry of Health Guyana 2005. Guyana Aids Indicators Survey 2005, GRPA and ORC Marco, Ministry of Health 2006. Guyana MDG Report 2007, UNDP Guyana: http://www.undp.org.gy/documents/bk/MDG_Guyana_Report2007.pdf sex www.yogyakartaprincples.org The Laws of Guyana 1973, Vol. 2, Criminal Offences Act Chapter 8:01 part 5, title 25, section 351 through 353; __________ Chapter 8:02 part 5 title 12 section 153 x1vii. Guyana Chronicle January 21, 2001, _________Guyana Chronicle July 25, 2003 GINA, July 18, 2003. joint University of Guyana, Vanderbilt University study, http://sitemason.vanderbilt.edu/lapop/GUYANABACK Posted By Iana Seales On November 24, 2009.

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44 http://www.undp.org.gy/documents/bk/Human_Rig hts_booklet.pdf Guyana Constitutional Amendment No. 2, Bill No. 9, 2003. __________________ Constitutional Amendment No. 5 Bill #18, 2000. Health Organization, 2008.

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45 Appendix: Appendix A Field Reconnaissance Visits were carried out in several regions : 2, 4, 6, 7 and 10. Institutions involved in Capacity Assessment 1. SASOD, GUYBO and Artiste in Direct Support, FACTS, United Brisk layers, U and Me 2. Impromptu IDIs, Army, Prisons, Police Force Agencies, Library and Documentation centers consulted 3. Ministry of Human Services 4. Parliament 5. CARICOM library 6. Ministry of Health policies in relation to sexual minors 7. Legal Affairs and Bar Association 8. University of Guyana 9. National library 10. UNICEF 11. UNAIDS 12. UNFPA Meetings held: Meeting with NGOs Guybow, SASOD, AIDS, UNDP

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46 Appendix B UNITED NATIONS DEVELOPMENT PROGRAMME Guyana Country Office Terms of Reference I. Project Details Name of Project: HIV Sexual Minorities Project Job Title: Consultant HIV Sexual Minorities Pre Classified Grade: SSA Purpose: Provide Consultancy Duration of Consultancy: 2 Months II. Background Sexual minorities face a significant burden of and vulnerability to HIV as a result of stigma and discrimination. This often results in many of them not accessing or receiving services to help in HIV prevention, treatment, care and support. Among the most vulnerable are men who have sex with men (MSM) and transgendered people. Alt hough MSM have access to STI, HIV and ADIS related services such as knowledge, condoms, early treatment of STI, and HIV testing, there are many complaints about the qua lity of the services, in particular public health services. One of the main human rights issues affecting sexual minorities in Guyana is pervasive abuse and harassment at the hands of police. There is an urgent need for sensitivity training for police on HIV human rights and AIDS vulnerability issues to enha nce th eir knowledge and understanding of the rights and issues affecting sexual minorities, especially MSM and gay and/or transvestite sex workers on the streets. Given the sub standard quality of services for sexual minorities, there is also an urgent need fo r comprehensive peer and professional counselling services. Existing services, provided mostly by NGOs, are not fully prepared to address the needs of sexual minorities. These service providers can benefit from sensitivity training. Further to that, local CBOs SASOD and GuyBow, are increasingly being called on to provide peer counselling services, as homophobia, stigma and discrimination drives sexual

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47 minorities away from services which are not community run. As a corollary to counselling, local CBOs als o need to develop the capacity to provide Voluntary Counselling and Testing (VCT) services. Anti gay attitudes also deter sexual minorities from HIV testing. If services are provided by their peer run CBOs, many, who may not otherwise access vital HIV serv ices, would seek VCT services. The project has 3 components to be lead by local partners with support from Joint UN Team on AIDS: 4. Right based advocacy for policy makers, armed service providers, health service providers and sexual minority groups. 5. Compr ehensive counselling services programme for sexual minorities 6. Capacity building for sexual minority supporting NGOs and sexual minority groups themselves III. Objective To reduce stigma and discrimination directed to sexual minorities in Guyana and to improve the use of high quality, HIV related services by sexual minorities through the provision of evidence informed competencies of civil society organisations that work with sexual minorities to take the lead in advocating for and supporting good qua lity and easily accessible HIV related services IV. Specific Duties and Responsibilities The Consultant will be engaged in the following: 1. Conduct desk review and collect information available and materials which may have been developed in Guyana on sexual minorities and on promoting human rights. 2. Document HIV sexual Minorities best or effective practices from successful programmes for the health and uniform services, on the issue of sexual minorities, which may be adapted in Guyana. 3. Conduct rap id assessment among health service providers on their attitudes to and behaviour towards sexual minorities, the availability, quality and access of services available to them. 4. Conduct rapid assessment among the uniform services on their attitudes to and behaviour towards sexual minorities. 5. Conduct rapid assessment among sexual minorities, on their experiences with health service providers and the uniform services. (Police, Military and Prison staff) 6. Conduct HIV and rights based competencies needs assessment among sexual minorities and organisations working in

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48 this area. V. Key Outputs Inception report detailing methodology for conducting reviews and Surveys and general approach that will be taken towards achieving the products of the consultancy; Rapid assessments conducted among target health service providers, uniform services and Sexual Minorities on their attitudes to and behaviour towards sexual minorities and experiences with health se rvice providers and the uniform services, respectively; Host validation workshop with key stakeholders; Full report on findings of reviews and rapid assessments, submitted. VI. Required skills and experience 5 7 years experience in HIV related research and analysis; Excellent proven ability to asses and analyse qualitative and quantitative data ; Post graduate qualifications in the social sciences; Ability to develop and present electronically generated analytical data; Capacity to work closely with mino rity groups VII. Schedule Subject Date Venue Time Methodology generated and submitted for review Commence desk and web reviews Commence Rapid assessment Conduct validation workshop Submit final report Appendix C Instruments:

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49 Rapid/Capacity Assessment Instrument 5 (illustrated below) is adapted. More specifically, the focus is on engaging the key stakeholders, and conducting an assessment after which a response will be formulated and validated by the workshop. The assessment component which is the focus of t his instrument delves into the functional and technical capacity. Tools: 5 See UNDP capacity assessment practice note, 2008. Step 1: Engage stakeholders Step 2: Assess capacity assets and needs (individual and organizational) Step 3: Formulate a capacity development response Step 4: Implement a capacity development response Step 5: Evaluate capacity development

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50 1. Background on organization Mandate: Services offered: Partnerships: Duration in existence: Staff evolution: Task evolution: Annual budget evolution (income versus expenditure): 2. Objectives (measures independence etc) Yes No Comments Have the objectives of your organization been defined and are they clearly formulated to treat the needs of SM? Have the objectives been developed together with all relevant stakeholders (including those delivering services to SM)? 3. Capacity to engage stakeholders, and build partnerships Questions scale 1=Little or no evidence of relevant capacity (merely congregate based on similar interests and issues) 2= Some evidence (coordinate SM activities internal or externally) 3= Average (coordinate and advocate having the human capacity) 4=Above average (human and some physical capaci ty advocacy) 5= Capacities present to sustainably execute tasks Comments (the why of the responses on the scale is documented in this column) Does the organization have the capacity to articulate its mandate and policy positions

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51 1 2 3 4 5 Does the organization have the capacity to assert leadership through knowledge of the issues that affect sexual minorities? 1 2 3 4 5 Does the organization have the capacity to manage relations with domestic and external stakeholders inclusively and constructively on issues of SM? 1 2 3 4 5 Does the organization have the capacity to build and manage partnerships among relevant stakeholders (uniform services, NGOs, Health services, Judiciary, Legal aid). 1 2 3 4 5 Does the organization have the capacity to articulate desired outcomes and benefits of collaboration; to motivate diverse groups of stakeholders? 1 2 3 4 5 Does the organization have the capacity to facilitate open communication by sharing information, create awareness, and educate the public of SM? 1 2 3 4 5 Does the organization have the capacity to build trust with its partners through establishing norms of collaboration and sustaining them? 1 2 3 4 5 Does the organization get the space to promote rights respected approaches for the support and protection of SM with its partners and other key stakeholders? 1 2 3 4 5 Does the organization have the capacity to mobilize resources? 1 2 3 4 5

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52 Does your organization have comprehensive knowledge of policies with regards to SM and related programmes? 1 2 3 4 5 Does the organization have a forum at which there is an outlet for addressing the issues and concern of SM with its partners and key stakeholders? 1 2 3 4 5 Do authorities have the capacity to negotiate with donors about increasing transparency and predictability and reducing volatility? 1 2 3 4 5 Does the organization have the capacity to monitor and track internal processes, and outcomes related to obtain donors support for capacity development initiatives? 1 2 3 4 5 What specific challenges the organization face in interacting with relevant partners/stakeholders that affects results? 1 2 3 4 5 Does the organization have the capacity to respond to the needs of the audience it initiate internal and external communication strategies in order to be responsive to stakeholders? 1 2 3 4 5 4. Capacity for using research and evidence in decision making (assessing situations) scale Comments Does the organization collect or have access to and capacity for use of disaggregated data/information on SM and their key concerns? 1 2 3 4 5 capacity to use and disseminate

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53 data/information? 1 2 3 4 5 Does the organization offer staff development to strengthen capacity for advocacy, analysis, etc? How often? 1 2 3 4 5 Does the organization build staff capacity to coordinate projects, manage budgets etc? 1 2 3 4 5 Does the organization build staff capacity on rights respected professional approaches for SM? 1 2 3 4 5 Does the organization keep updates of SM issues locally and otherwise, and acquire data/information on those issues? 1 2 3 4 5 5. Capacity for budget management and project implementation scale Comments Does the organization have the capacity to manage financial resources appropriately in the implementation of programmes and delivery of services? 1 2 3 4 5 Does the organization have the capacity to track whether resources are being spent for what they are intended for, i.e. are there proper business processes, book keeping etc in place? 1 2 3 4 5 Does the organization have the capacity to use and design appropriate analytical tools to undertake effective financial management? 1 2 3 4 5 Does the organization have the capacity to use and analyze data to improve business processes? 1 2 3 4 5

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54 6. Capacity to offer HIV related support and prevention Services to SM scale Comments Does the organization have capacity (trained staff with competencies, equipment, etc) to offer VCT to SM? 1 2 3 4 5 Does the organization have the physical capacity (office, and other space) to effectively provide VCT services? 1 2 3 4 5 Does the organization have the capacity to do outreach as it regards VCT for SM? 1 2 3 4 5 Doe the organization have the capacity to build the partnership or play a role in a stakeholder group that is willing to offer VCT for SM? 1 2 3 4 5 Does the organization have any mechanism for collecting administrative data on the services offered and clients served to make further evidence based decision, recognized emerging issues and require adjustment of services offered etc? 1 2 3 4 5 Does the organization have the capacity to establish a network among national institutions and agencies that are responsible for VCT? 1 2 3 4 5

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55 Appendix D Snowball, and FGDs. Basic information (testing acceptance/integration etc) Age: Race: Education: Rural/Urban: Forms of recreation/socialization: Support Groups/Organization: Shortcomings: How can group/organization further support you? What type of s exual and gender m inorities exists? How would you define discrimination? Forms of violent discrimination Forms of non violent discrimination Health Care: Access to health care Perception of health care workers Quality health care Scope adequacy of services offered Protection (Rights based): Social protection Interaction with religious organizations Interaction with other groups (sports, educational, etc.)

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56 Economics protection Interaction with employers, employees Interaction within job market Security (legal rights, phys ical protection, Abuse) Physical protection Interaction with discipline forces (police, army, and prison) Abuse