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PEPFAR COP/ROP: GBGMC’s Guide on Structural Interventions to CSOs


The Global Black Gay Men Connect (GBGMC) has today published a guide for CSOs involved in this year’s (2022) Country Operations Plans (COP) and Regional Operational Plan (ROP) under PEPFAR. The guide is for CSOs to better address structural interventions and demand for funding and accountability that ensure such interventions are prioritized. 

What are Structural Interventions?

All interventions/strategies/activities that aim to address and correct social, cultural, political, and legal barriers that challenge access and uptake of healthcare services, especially among vulnerable groups.  Structural interventions promote an enabling environment or act as critical enablers which “aim to improve the accessibility, acceptability, uptake, equitable coverage, quality, effectiveness and efficiency of HIV interventions and services.

“Critical enablers aim to overcome major barriers to service uptake, including social exclusion and​ marginalization, criminalization, stigma and inequity”​ and “are crucial to implementing comprehensive HIV programs for key populations in all epidemic contexts.

What is the COP/ROP 22 Guidance on Structural Interventions?

The guidance is clear that structural interventions should be prioritized by PEPFAR country teams.  There is a renewed focus on equity and equality. There is also specific language around “addressing the broader, legal and policy environment including reducing stigma and discrimination present in public and private HIV and other service settings, strengthening the KP-competency of service delivery providers, and ensuring zero-tolerance policies regarding discrimination among PEPFAR-funded staff and partners”.

For more on structural interventions, including a supporting directive from President Biden, see section 2.2.2 pgs. 59-67; section 2.6 pg. 128 and section 6.5 pgs. 424 and 425.

What can I do as an activist to ensure Structural Interventions are addressed in COP/ROP 22?

As part of this guide, GBGMC is providing some concrete action plans to better support activists in their efforts to ensure structural interventions are addressed in COP/ROP 2022.

We are adding to a large number of resources available to advocates on the same, especially from HealthGAP’s PEPFAR WATCH.


Review the COP/ROP 22 guidance on structural interventions Structural interventions are covered in various sections of the guidance, some of which are highlighted in the section above, on COP/ROP 22 guidance


Identify the key structural barriers in your country or region Are there laws policies that criminalize HIV or KPs?  Is stigma and discrimination evident in communities and healthcare facilities?  Are KPs and other vulnerable groups marginalized and have reduced employment and educational opportunities?  Is there adequate participation of communities (including KPs/MSM) in the COP process?  Are KP/MSM-led CSO being funded by PEPFAR?


Formulate suggestions recommendations to address these barriers and submit to them to the PEPFAR team Depending on your context you may consider the following:  Funding CSOs to advocate for legal reform and decriminalization of HIV, KPs/MSM, and other vulnerable groups; introduction of laws/legislation to protect the human rights of KPs/MSM; sensitization trainings for policymakers, PEPFAR implementing partners, healthcare workers on the needs on KPs/MSM and other vulnerable groups; advocacy for increased funding for KP/MSM led CSOs; increased funding to build the capacity of KP/MSM led CSOs to serve their communities; educational opportunities and other socio-economic support, such as housing, nutritional support programs and violence prevention to HIV positive and other vulnerable  KPs/MSM to assist with treatment adherence/retention and personal development.


Follow up with your PEPFAR team to ensure that these demands are included in the final COP/ROP or SDS After you submit the list of demands, be sure to regularly check in with the PEPFAR team for feedback.  Request that draft documents/presentations are shared way ahead of the main COP/ROP meetings to ensure that your demands were included – if they weren’t, request a meeting with your PEPFAR team to discuss the reasons.  If funding availability is brought up, ask your country chair to take the request to S-GAC.  Continue to follow up until the final COP/ROP or SDS is produced and of course, engage the PEPFAR team should your demands not be included. Contact GBGMC if you need support


DOWNLOAD the guide (PDF): One Pager on Structural Interventions – Final

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