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Terms of Reference for an Individual Consultant to Develop an Advocacy Framework to Strengthen HIV Programming Among Clients of Female Sex Workers

Level: Consultant

Contract Type: Consultancy

Closing date: 30 Sep 2021

Duty station: Remote, Johannesburg, South Africa

Purpose of consultancy:

The purpose of this consultancy is to develop an evidence based regional advocacy framework to strengthen HIV programming among clients of female sex workers in East and Southern Africa.

The UN Member States assembled from 8 to 10 June 2021 to discuss ways to get the world on track to end AIDS as a public health threat by 2030. The meeting noted that the international community had failed to meet the 2020 targets that were set out in the 2016 political declaration. One area that registered insufficient progress was HIV prevention. The global community had committed to reduce new infections to less than 500 000 by 2020, however, by end of 2020, new infections were three fold higher than the target (1 500 000).

Notwithstanding the limited progress in a number of areas in the HIV response, the UN Member States recommitted to end AIDS by 2030. Through their political declaration on HIV and AIDS, the UN Member States agreed to accelerate the HIV response and to address inequalities. To this end, specific targets were set for 2025, the mid-point before 2030. In respect to prevention, the global community committed to reduce new infections to under 370 000 by 2025. It was also agreed that HIV service delivery be increased to 95% to all populations at risk of acquiring HIV. These ambitious targets will require that all regions and countries reflect on ways to accelerate the response and identify all populations at risk of HIV infection.

The East and Southern Africa region, which continues to be the global epicentre of HIV and AIDS will need to adjust its strategies to ensure that the revised global targets are met. This includes revisiting and reprioritizing targets to include all populations that are at risk of infection to ensure that no one is left behind.

While globally, a framework for addressing HIV infections has been developed, anchored on five pillars, it may not adequately address the challenges faced by the region. The Prevention Framework prioritizes two populations, namely adolescent girls and young women as well as key populations. These two populations are indeed some of the most vulnerable and have been prioritized by most of the countries in the region. However, other populations that are highly vulnerable and also critical in ending new infections have been left behind. One of these population groups is clients of Female Sex Workers.

Increasing evidence suggest that prioritizing clients of sex workers in the HIV response is critical to ending AIDS for several reasons. First, clients of sex workers are twice more likely to be infected than men in the general population. Paying particular attention to clients of sex workers is therefore likely to contribute to reducing new infections.

Second, Clients of Sex Workers might contribute to high levels of HIV in the general population. Some modelling work done by Stone J and others estimated that about 20 percent of men in South Africa buy sex. It further estimated that about 40 percent of new infections are linked to clients of sex workers and their non-commercial partners. This could mean that clients of sex workers are the main bridge to infections among heterosexual couples, and could partly explain the high levels of HIV infection among women.  Indeed, studies have shown that clients of sex workers are more likely than other men to have multiple sexual partners and are also more likely to have other sexually transmitted infections.

Third, targeting clients of sex workers could be a useful entry point to reach men who are lagging behind in both access to prevention and treatment services. It could also be a useful entry point to promote consistent condom use and address gender based violence. It is estimated that scaling up treatment among clients of sex workers could avert almost 20 percent of new infections in South Africa over a decade.

UNAIDS data suggest that clients of sex workers and partners of key populations actually contribute more new infections than key populations themselves in the ESA region. Along with other partners of key population groups, clients of sex workers contributed to around 15% of reported HIV cases in 2020 among people aged 15–49 years in the ESA region. This is higher than the 13% contribution of key Population yet, there are limited investments on this group.

The prioritization of AGYW and KP as part of the HIV prevention response remains relevant for the ESA region and needs to be strengthened by bringing clients of sex workers to the centre of response in order to end sexual transmission of HIV.

Against the foregoing, the UNFPA regional office seeks to engage a consultant to review evidence and opportunities for prioritizing clients of sex workers in the HIV prevention framework.                                              

Scope of work:

The individual consultant will be expected to develop an evidence based advocacy framework to strengthen HIV response among clients of female sex workers. The work will draw mainly from systematic review of published reports and data to analyse the vulnerability of clients of sex workers to HIV, their contribution to new HIV infections, the impact of the epidemic on the group compared to other groups, and programs in place to address them. Based on this analysis, the consultant should provide recommendations on ways to strengthen HIV programming among clients of sex workers and also to develop an advocacy framework to address the gaps identified. The framework will be directed to critical players in HIV prevention. These include national governments, development partners, major funders, civil society organizations and men’s organizations.

The consultant will be expected to prepare three related reports/products. These are the inception report, the situational and response analysis (systematic review) report and finally the Advocacy framework. For each product, the consultant will develop a Powerpoint presentation to facilitate discussions with members of the reference group and regional stakeholders.

On the inception response, the consultant will be expected to demonstrate a clear understanding of the TOR and the subject matter. The latter will be exhibited through sharing of preliminary literature review in the area. Furthermore, the consultant should reflect on a plan of action and timelines. This will be a report not exceeding 15 pages. It will, among other things, cover the following elements:

  1. Introduction
  2. Background –  Preliminary literature review
  3. Purpose of the consultancy – Interpretation of the TOR
  4. Methodology – describing the framework on how information will be collected, including data sources. The study will do a deep dive in at least 6 countries. Selection criteria for the countries will be discussed. Key informants for the study should be considered. These should include major stakeholders such as financial institutions, National AIDS Authorities and leading development partners in HIV Prevention. It will be useful to develop a conceptual framework for effective prevention of HIV among men who buy sex and use it to assess progress or lack of it.
  5. Expected outputs and timeframe
  6. An annotated outline of the situational and response analysis as well as the advocacy framework

With regards to the situational and response analysis (systematic review) of clients of sex workers and HIV in the ESA region, the consultant will be expected to contextualize the vulnerability to HIV of men who buy sex. The consultant will first, gather evidence to demonstrate the risk of men who buy sex to HIV compared with other men. Second, S/he will demonstrate evidence of the contribution of men who buy sex to the overall epidemic. Third, the consultant will be expected to highlight programmatic responses/interventions to men who buy sex in the region. The response analysis will include an analysis of programme funding to the clients of sex workers  compared to other vulnerable  groups such as AGYW and KP. An analysis of funding from at least one of the three major players (Government, Global Fund and PEPFAR) will be sufficient. The consultant should indicate the major gaps in programming and similarly, promising practices. Finally, on the basis of the analysis, specific recommendations should be proposed. This will be a 30-page report, excluding annexes. The proposed content of the report is as follows, but the consultant is expected to propose any necessary improvements:

  1. An Introduction
  2. Method and approaches
  3. Situational Analysis of HIV in ESA with a particular focus on men who buy sex
  • Epidemiological analysis of the epidemic
  • Analysis of what is covered on clients of sex workers under the national strategic plans
  • An analysis of the implication of the epidemic to non-commercial partners in ESA
  • An analysis of obstacles to strengthening HIV programming for men who buy sex in ESA
  • What opportunities can help strengthen programming for Men who buy sex?

4. Response analysis to HIV prevention among men who buy sex in ESA (below are some critical questions to answer):

  • What prevention interventions are in place to address men, especially those who buy sex?
  • Has the funding for HIV programming been adequate for this group?
  • Are the current responses relevant?
  • Is there evidence that the responses have made an impact on men who buy sex

5. Lessons learned (questions to address)

  • What is working and needs to be continued?
  • What is working and can be expanded?
  • What has not worked and why

6. Recommendations

Finally, the consultant will be expected to prepare an advocacy framework that is based on the recommendations of the Situational and Response Analysis of Men and HIV in the ESA region. The Framework will not exceed 20 pages.

Duration and working schedule:

The Consultancy will be expected to take 42 days spread over a period of over 2 months from October to 31 December 2021.

Place where services are to be delivered:

The drafts will be submitted electronically to ESARO office through the Technical Advisor, SRH/HIV.

Delivery dates and how work will be delivered:

All deliverables will be presented in an electronic copy.

Deliverable

Person days

Deadline

Inception Report including literature review and methodology  for carrying out the assessment and presentation to the Reference Group

5 days

October 30, 2021

Draft situational and response analysis and final draft inception report and presentation to the reference group.

20 days

November 29, 2021

Final draft situational analysis and response analysis, draft Advocacy Framework and presentation to the validation workshop

12 days

December 20, 2021

Final Advocacy Framework

5 days

December 31, 2021

Monitoring and progress control, including reporting requirements, periodicity format and deadline:

The consultant will be required to provide regular update through emails, participate in teleconferences as required to monitor adherence to the tight schedule.

Required expertise, qualifications and competencies, including language requirements:

The consultant must meet the following minimum criteria:

  • A postgraduate degree in public health, epidemiology, demography, sociology or related fields. Additional qualification will be an added advantage.
  • Strong epidemiological analysis skills, including conducting systematic reviews.
  • At least 10 years’ experience in undertaking development work;
  • Track record in HIV and SRH work, especially in Africa;
  • Experience in conducting research, with demonstrated ability to write clear and comprehensive reports for UN or other development partners,
  • Traceable work experience on Sex work related programming/research 
  • Experience in developing advocacy Frameworks or Strategies; and
  • Experience in program finance analysis will be an added advantage.

UNFPA will provide documents that will provide the necessary background including UNAIDS latest epidemic report, and sites for national strategic plans for HIV.

For an analysis of funding on HIV Programmes, the consultant will need to review funding from the government and at least one of the following sources: Global Fund or PEPFAR. These are the main funders for HIV in the ESA region. This will focus mainly on resources allocated clients of sex workers compared to other groups such as AGYW and KP in the past 5 years. With regards to HIV programming, the consultant will be expected to review national strategic plans for HIV and any latest population based surveys.

To apply:

Application letter and CV to be sent to jobs.esaro@unfpa.org with email subject clearly stated ''International Consultancy - Development of Advocacy Framework".