Advocacy

Question fourteen of the Euro HIV EDAT Self-evaluation Grids focuses specifically on the social, political and legal issues that may affect the work of CBVCTs.

AIDS Action Europe’s resource ‘CBVCT Services – Current obstacles and opportunities’ aims to support the sustainability of CBVCT services. It considers them precious low threshold contexts within community based settings that have proven to be one of the best ways to reach key affected groups and test them for HIV, hepatitis and/or STIs.

It reflects the views and ideas of different stakeholders with different roles at the national and European levels and from different countries. The document contains recommendations that can guide advocacy efforts by CBVCTs in a range of settings.

The document can be downloaded here.

CBVCTS may advocate not only for low-threshold, community-based HIV testing services themselves, but also for related issues affecting MSM as a key population. These issues can impact the potential effectiveness of CBVCT, e.g. stigma and discrimination against people living with HIV, discrimination on the basis of sexuality, marginalisation of socially disadvantaged groups, criminalisation of HIV transmission etc.

Get some insights from different Checkpoints in Europe in our video from the Workshop in Ljubljana:

Russian subtitles included /Включая российские субтитры

Item	Does your CBCVT have this in place?	Is there a documented standard, guideline, plan, policy, procedure, contract or agreement?	Is it adapted to local needs and conditions?	Is it working as intended?	Action
List of advocates	Description Description A list containing people and organisations that can promote the concerns and issues of CBVCT in general, and specific CBVCT services in particular.	Guidance Guidance Advocacy relies chiefly on personal communication between people. A list of potential advocates is essential to progress advocacy issues. CBVCT teams can create a list of potential advocates by brainstorming the names of people and organisations that have influence on policy and decision makers, funders and other important stakeholders. The list could also be one of the products of a more comprehensive stakeholder analysis. Their influence may be based on: Technical expertise (e.g. research scientists, academics, specialists) Political influence (e.g. activists, politicians) Public profile (e.g. media personalities, local celebrities) Personal testimony (e.g. clients, PLHIV who are willing to use their personal story in advocacy). In order not to limit the selection, it is useful to make the initial list without particular goals or advocacy issues in mind. It is not necessary to ask the people on the list about their willingness to act as advocates until an issue arises that the CBVCT wants to pursue in a strategic fashion.	Adaptation Adaptation A list of potential advocates can serve as a resource for specific advocacy campaigns. Names can be added as new potential supporters emerge. It is useful to review and adapt it regularly as part of strategic planning processes.	Quality Improvement Quality Improvement Structured quality improvement tools (e.g. QIP and Succeed) include questions regarding stakeholders. The PQD (Participatory Quality Development) tool includes Circles of Influence, a stakeholder analysis method that can serve to identify and review the position and role of different stakeholders, including their potential to act as advocates. Using a structured tool can make it easier to think about potential advocates and review the list. See www.quality-action.eu for more information on tools.	Action plan Action plan This Action Plan helps you to work directly on the items identified as priorities (yellow and/or red fields in the Checklist). Please list actions that are as specific as possible. You can download your finished Action Plans for each section as an xlsx.-document and print it afterwards. The Action Plans form the basis for your further planning, implementation and evaluation. The Action Plan shows a sequence of steps to be taken, or activities to be performed for a strategy to succeed. The Action Plan has four major elements: (1) what will be done (specific tasks), (2) by whom (responsibility), (3) by when (timeframe), and (4) how the implementation of the task will be monitored. → Copy to action plan
Priority issues for advocacy	Description Description Priority issues for advocacy are those topics or problems that can act as catalysts for desired change if they are addressed or resolved.	Guidance Guidance The priority of an advocacy issue is determined in the first instance by the needs and demands of key populations, especially those resulting in barriers to testing for those at risk. In the case of MSM (and other vulnerable and disadvantaged populations), they are likely based on stigma, discrimination and marginalisation. Barriers to testing may result from a lack of legal rights, discriminatory public policies or exclusionary practices as well as social, cultural and religious attitudes in the society as a whole. Advocacy can also be used to reduce the level of bureaucracy, build trust and independence from the influence of some stakeholders over time and therefore increase ownership and participation of the key population. The resulting advocacy issues may be broad (e.g. human rights, homophobia) or specific (e.g. MSM-friendly health services). Prioritising algorithms can assist in selecting the issues that will have the greatest influence on the effectiveness of the CBVCT service. Download prioritising algorithm tool	Adaptation Adaptation Adapting a priority list for advocacy according to local circumstances means selecting the right topic at the right time. Factors for the success of advocacy are: Motivation of those affected Timing advocacy for when change is possible, e.g. funding cycles, new policies, strategic or action plans being developed, restructuring in the health system Potential support from policy and decision makers: e.g. newly appointed ministers, senior bureaucrats, senior staff, politicians Public attention (e.g. GLBTIQ* events, legislative changes, elections).	Quality Improvement Quality Improvement When stakeholders use structured quality improvement tools (see www.quality-action.eu), they often identify areas for improvement that lie outside the direct influence of the organisation or project because they depend on policy, regulations, societal attitudes and other external factors. The fact that these topics emerge from collective reflective processes is some indication of their relevance and potential as priority issues for advocacy.	→ Copy to action plan
Strategies for advocacy	Description Description Strategies for advocacy are the methods and channels the CBVCT uses to influence policy and decisions.	Guidance Guidance All available media and social networks can be used to raise awareness and provide background information about an advocacy issue. You can use the well-documented successes from your own and other CBVCTs in advocacy, e.g. data showing high detection rates of HIV infections and high rates of successful linkage to care. These two variables are the key data points for convincing public health decision makers, as they are core parts of the continuum of care for HIV. Other strategies to represent the community, participate in policy making/changing decisions, and achieve better access to services are: Asking for inclusion in committees, advisory groups and consultations Building professional relationships with policy and decision makers Building partnerships and networks with other organisations advocating for related change Recruiting people who have influence on policy and decision makers as allies. The ILGA manual on LGBT rights advocacy is a useful resource in this area: www.eidhr.eu/files/dmfile/advocacy_manual_www1.pdf	Adaptation Adaptation Local health systems, bureaucratic structures and politics have an influence on which advocacy strategies will be most effective. Social and cultural norms as well as ‘unwritten rules’ about how to engage policy and decision makers also play an important role. Advice from other advocacy groups or previous successes can inform the choice of advocacy strategy for a particular topic.	Quality Improvement Quality Improvement Like CBVCT operations themselves, advocacy can be improved using processes of self-reflection, especially with the participation of all relevant stakeholders. Planning, implementing and evaluating advocacy campaigns using structured tools will provide the best possible chances for success. A range of participatory quality development methods for needs assessment, planning, implementation and evaluation, including step-by-step guides can be found as part of the Participatory Quality Development tool (PQD), available at www.quality-action.eu.	→ Copy to action plan

Item

Does your CBCVT have this in place?

Is there a documented standard, guideline, plan, policy, procedure, contract or agreement?

Is it adapted to local needs and conditions?

Is it working as intended?

Action

List of advocates

Description

A list containing people and organisations that can promote the concerns and issues of CBVCT in general, and specific CBVCT services in particular.

Guidance

Advocacy relies chiefly on personal communication between people. A list of potential advocates is essential to progress advocacy issues.

CBVCT teams can create a list of potential advocates by brainstorming the names of people and organisations that have influence on policy and decision makers, funders and other important stakeholders. The list could also be one of the products of a more comprehensive stakeholder analysis.

Their influence may be based on:

Technical expertise (e.g. research scientists, academics, specialists)
Political influence (e.g. activists, politicians)
Public profile (e.g. media personalities, local celebrities)
Personal testimony (e.g. clients, PLHIV who are willing to use their personal story in advocacy).

In order not to limit the selection, it is useful to make the initial list without particular goals or advocacy issues in mind.

It is not necessary to ask the people on the list about their willingness to act as advocates until an issue arises that the CBVCT wants to pursue in a strategic fashion.

Adaptation

A list of potential advocates can serve as a resource for specific advocacy campaigns. Names can be added as new potential supporters emerge. It is useful to review and adapt it regularly as part of strategic planning processes.

Quality Improvement

Structured quality improvement tools (e.g. QIP and Succeed) include questions regarding stakeholders. The PQD (Participatory Quality Development) tool includes Circles of Influence, a stakeholder analysis method that can serve to identify and review the position and role of different stakeholders, including their potential to act as advocates. Using a structured tool can make it easier to think about potential advocates and review the list. See www.quality-action.eu for more information on tools.

Action plan

This Action Plan helps you to work directly on the items identified as priorities (yellow and/or red fields in the Checklist). Please list actions that are as specific as possible. You can download your finished Action Plans for each section as an xlsx.-document and print it afterwards. The Action Plans form the basis for your further planning, implementation and evaluation.

The Action Plan shows a sequence of steps to be taken, or activities to be performed for a strategy to succeed. The Action Plan has four major elements: (1) what will be done (specific tasks), (2) by whom (responsibility), (3) by when (timeframe), and (4) how the implementation of the task will be monitored.

→ Copy to action plan

Priority issues for advocacy

Description

Priority issues for advocacy are those topics or problems that can act as catalysts for desired change if they are addressed or resolved.

Guidance

The priority of an advocacy issue is determined in the first instance by the needs and demands of key populations, especially those resulting in barriers to testing for those at risk. In the case of MSM (and other vulnerable and disadvantaged populations), they are likely based on stigma, discrimination and marginalisation. Barriers to testing may result from a lack of legal rights, discriminatory public policies or exclusionary practices as well as social, cultural and religious attitudes in the society as a whole.

Advocacy can also be used to reduce the level of bureaucracy, build trust and independence from the influence of some stakeholders over time and therefore increase ownership and participation of the key population.

The resulting advocacy issues may be broad (e.g. human rights, homophobia) or specific (e.g. MSM-friendly health services).

Prioritising algorithms can assist in selecting the issues that will have the greatest influence on the effectiveness of the CBVCT service.

Download prioritising algorithm tool

Adaptation

Adapting a priority list for advocacy according to local circumstances means selecting the right topic at the right time. Factors for the success of advocacy are:

Motivation of those affected
Timing advocacy for when change is possible, e.g. funding cycles, new policies, strategic or action plans being developed, restructuring in the health system
Potential support from policy and decision makers: e.g. newly appointed ministers, senior bureaucrats, senior staff, politicians
Public attention (e.g. GLBTIQ* events, legislative changes, elections).

Quality Improvement

When stakeholders use structured quality improvement tools (see www.quality-action.eu), they often identify areas for improvement that lie outside the direct influence of the organisation or project because they depend on policy, regulations, societal attitudes and other external factors.

The fact that these topics emerge from collective reflective processes is some indication of their relevance and potential as priority issues for advocacy.

→ Copy to action plan

Strategies for advocacy

Description

Strategies for advocacy are the methods and channels the CBVCT uses to influence policy and decisions.

Guidance

All available media and social networks can be used to raise awareness and provide background information about an advocacy issue.

You can use the well-documented successes from your own and other CBVCTs in advocacy, e.g. data showing high detection rates of HIV infections and high rates of successful linkage to care. These two variables are the key data points for convincing public health decision makers, as they are core parts of the continuum of care for HIV.

Other strategies to represent the community, participate in policy making/changing decisions, and achieve better access to services are:

Asking for inclusion in committees, advisory groups and consultations
Building professional relationships with policy and decision makers
Building partnerships and networks with other organisations advocating for related change
Recruiting people who have influence on policy and decision makers as allies.

The ILGA manual on LGBT rights advocacy is a useful resource in this area: www.eidhr.eu/files/dmfile/advocacy_manual_www1.pdf

Adaptation

Local health systems, bureaucratic structures and politics have an influence on which advocacy strategies will be most effective. Social and cultural norms as well as ‘unwritten rules’ about how to engage policy and decision makers also play an important role.

Advice from other advocacy groups or previous successes can inform the choice of advocacy strategy for a particular topic.

Quality Improvement

Like CBVCT operations themselves, advocacy can be improved using processes of self-reflection, especially with the participation of all relevant stakeholders. Planning, implementing and evaluating advocacy campaigns using structured tools will provide the best possible chances for success.

A range of participatory quality development methods for needs assessment, planning, implementation and evaluation, including step-by-step guides can be found as part of the Participatory Quality Development tool (PQD), available at www.quality-action.eu.

→ Copy to action plan

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