Gender and Sexual Diversity Training: A Facilitator's Guide for Public Health and HIV Programs

"...addressing norms and attitudes related to sexual orientation and gender identity are important components of gender integration..."

With a focus on how gender and sexuality affect all people, this curriculum was developed specifically for the United States (US) President's Emergency Fund for AIDS Relief (PEPFAR) staff and their country-level implementing partners to help country programmes understand and address the needs of gender and sexual minority (GSM) communities in the context of HIV programming, US workplace policy on non-discrimination, and through a human rights lens. While the focus of this training curriculum is HIV programming, and it is centred on US Government-funded programmes, much of the material could be adapted and applied to a variety of country-specific and technical programme areas.

GSMs are people whose gender, sexual orientation, or sexual characteristics differ from what is typically expected by a culture or society. ("GSMs" describes a very diverse group of people who may or may not identify as lesbian, gay, bisexual, and transgender - LGBT). GSMs "are treated unfairly in almost every society. This unfair treatment, which includes stigma and discrimination: directly impacts health; interferes with access to health services, including HIV-related prevention, care, and treatment; and undermines productive work environments."

The gender and sexual diversity (GSD) training was developed by the United States Agency for International Development (USAID)- and PEPFAR-funded Health Policy Project (now Health Policy Plus) in coordination with a US Government interagency team made up of members of the PEPFAR Key Populations Working Group and the PEPFAR Gender Technical Working Group. The considerations provided in this guide have been developed after implementing trainings in approximately 39 countries between September 2014 and September 2015. Training teams included US Government staff, Health Policy Project staff, and local gender and sexual minorities and their allies as trainers and panelists.

The one-day training "helps participants understand GSD concepts and empathise with GSMs. Participants become aware of how stigma and discrimination negatively affect GSMs' health and lives, and recognize opportunities to reduce its impacts. Understanding and applying concepts about gender and sexuality, including using appropriate language, is essential to public health programming. The training provides practical guidance on creating welcoming, inclusive, and equitable workplaces and designing effective health and development programs to reach those most at risk." Its aims are to:

• Educate participants on terminology, US government policies, and workplace expectations related to GSD;
• Sensitise participants to the needs of gender and sexual minorities, including as beneficiaries of HIV and other health programmes;
• Provide examples and recommendations for meaningfully engaging GSM beneficiaries when developing and implementing programmes; and
• Connect participants with local/regional resources on GSD issues.

This guide is designed for interactive learning; the idea is that participants will only become aware of their own attitudes and assumptions through an active process in which they are encouraged to talk and think critically for themselves. The goal is to create a safe space where participants can move beyond a purely intellectual or abstract view of gender and sexuality and begin to explore how these concepts directly impact their own lives and their day-to-day work. "The guide is also designed for group learning. Working with others helps people collectively develop common ideas about what needs to be done, set group norms for new attitudes and behaviors, support each other in working for change, and monitor the results of change." Throughout the one-day training, individuals: explore their own experiences of gender; express their fears and concerns; discuss the values and beliefs that underlie gender norms; gain a better understanding of sexual diversity; look critically at their attitudes towards GSMs; take ownership of a new set of principles, values, and feelings; and work practically to challenge GSD-related stigma and discrimination and develop new codes of practice.

The 4 modules focus on:

1. Introduction to U.S. Government Policies, Non-discrimination, and Gender Norms offers participants a logical rationale for engagement with GSMs, describes nondiscrimination and gender-related policies, and makes the case for why gender norms not only impact everyone, but also lead to pervasive and harmful HIV-related health effects.
2. Concepts and Terminology on GSD introduces participants to key theoretical dimensions about a person's gender, including a continuation of the discussion on gender norms. There are discussions about key terminologies and on the impact of language on stigma and health.
3. Local Advocates' Panel is a chance for participants to meet local GSM advocates and legal experts. The participants hear narratives about personal struggles and timely recommendations for policy and programmes.
4. Meaningful Engagement helps generate a shared understanding of the importance of actively and consistently engaging GSMs throughout health programmes and asks participants to begin thinking concretely about how to put meaningful engagement into action.

Annexes include: responding to difficult questions, gender person handout, terminology cards, terminology lists, case studies, study worksheet, and pre- and post-test evaluation questions.