CAPTURING EVIDENCE ON MODELS OF RESILIENCE BY HIV AFFECTED COMMUNITIES, MSM AND IDUs OF TANZANIA AND UGANDA: USING 6 ABSTRACTS TO PRESENT ON SUCH EXPERIENCES

Thomas Muyunga, Gerald Sebulime, Dr. Emmanuel Kandusi, Julius Kyaruzi,

Emmanuel Kandusi is a human rights scholar, activist and a prostate cancer survivor based in Tanzania. He is the founder of Center for Human Rights Promotion.

Gerald Sebulime is the Associate Executive officer with MARPS IN UGANDA; he is a quality assurance/HIV/TB/Malaria focal person. He is a skilled HIV Quality assurance practitioner.

Julius Kyaruzi is a human rights defender and social worker with the Center for Human Rights Promotion. He has been very pivotal in integrating MSM and IDU issues in the intervention agenda of the center.

Thomas Muyunga is the CEO of MARPS IN UGANDA; he is also the community mobilisation, health education and promotion focal person of the organisation. He has vast experience in working with at risk populations and marginalised communities.

The interplay of rights, visibility and inclusion as the vehicles towards HIV cure; show casing Center for Human Rights Promotion-CHRP- activities targeting MSM, TG and IDU in Dar-es-Salaam, Tanzania from 2010-2011.

Emmanuel Kandusi, Julius Kyaruzi and Thomas Muyunga

BACKGROUND:  Animus towards MSM, TG and IDU impacts negatively in the drive to an HIV cure. Inclusiveness is part of comprehensive HIV prevention. The bifocal nature of the epidemic at national and in key affected populations calls for appropriate strategies. This paper highlights the relevance of involvement of expert MSM, TG and IDU in eradicating HIV.

METHODS: CHRP has a resource centre in major divisions of Dar-es-Salaam targeting over 500 MSM, 300 IDU and 250 TG. The major sites are in Kinondoni, Mwananyamala, Hannanasif, Kijitonyama, Ndugumbi, Mwenge and Magomeni. The resource centre is run by coordinators. The centre has 13 community field officers who empower IDUs to benefit from the needle/syringe cleaning activities, in anticipation of government facilitated needle/syringe programme; those under methadone management are reminded by phone. MSM and TG are encouraged to form support groups as improved peer mobilisation towards HIV prevention. Major health facilities were used as referral units for further management of cases.

RESULTS: 2326 beneficiaries accessed appropriate services addressing their needs. Brochures on needle/syringe exchange, risks of flush-blood, malaria, AIDS and TB were provided in local languages. 3 major life planning skills seminars were used to design and test a five year strategic plan targeting MSM, TG and IDU. Through planned outreach services it was possible to conduct awareness drives, VCT services, provide required commodities, respond to needs, engage health workers at facilities to receive referred clients and respond to psycho-social needs.

CONCLUSION: Inclusion brings on board marginalized persons, and most at risk populations, it makes them demand services and engage in health preserving practices.

RECOMMENDATION: MSM, TG, IDU inclusion is a right and an empowerment that improves visibility. More report earlier for treatment and this improves on quality of life. This is key to comprehensive prevention that will lead to HIV cure.

 

Using already established spaces to promote awareness on risk reduction; linking microbicides uptake with anti-HIV practices among MSM, TG and IDU in Dar-es-Salaam, Tanzania from 2010-2011.

Emmanuel Kandusi, Julius Kyaruzi and Thomas Muyunga

BACKGROUND:  New prevention technologies are part of comprehensive HIV prevention commodities that improve sensitivity to key affected populations’ issues. The bifocal nature of the epidemic at national and in key affected populations calls for appropriate strategies. This paper highlights the relevance of involvement of expert MSM, TG and IDU in eradicating HIV.

METHODS: Center for Human Resource Promotion-CHRP- found in Dar-es-Salaam has programmes targeting over 500 MSM, 300 IDU and 250 TG. The major sites are in Kinondoni, Mwananyamala, Hannanasif, Kijitonyama, Ndugumbi, Mwenge and Magomeni. The centre is run by coordinators and 13 community field officers who empower IDUs to benefit from the needle/syringe cleaning activities and pick lubricants as well as condoms. Before picking commodities there are mandatory health education sessions and these are used as opportunity to introduce literature and information on breakthroughs and new prevention technologies such as microbicides.

RESULTS: 2326 beneficiaries accessed appropriate services addressing their needs. Brochures on needle/syringe exchange, prostate cancer, microbicides, risks of flush-blood, malaria, AIDS and TB were provided in local languages. 3 major life planning skills seminars were also used to design and test a five year strategic plan targeting MSM, TG and IDU. Through planned outreach services it was possible to conduct awareness drives, VCT services, provide required SRH commodities, respond to needs, engage health workers at facilities to receive referred clients and respond to psycho-social needs.

CONCLUSION: Established safe spaces are learning and re-learning points for most at risk populations, it makes them demand services and engage in health preserving practices.

RECOMMENDATION: New prevention technologies uptake for communities in need should be led by awareness raising sessions.

VULNERABILITY MOSAIC OF MSM IN UGANDA: Meta-analysis of records from 2004-2011: Meeting the First UNAIDS Political Target; reducing sexual transmission of HIV by 50% by 2015.

Muyunga Thomas, Sebulime Gerald

BACKGROUND: MSM are stakeholders in the fight against HIV/STIs. MSM HIV prevalence is 13.7% (Crane Survey, 2010). Same sex relation is a behaviour criminalised as “homosexuality”, making it a hurdle to public health programming in this sub-population in Uganda. The objective of this paper is to highlight MSM behaviour as an attraction that is enjoyed by the respondents, amidst vulnerability and risks.

METHODS: Using sample size of 7,000 MSM, data from 13 organisations and 72 gender and dignity affirming community based safe spaces, were basis for generating this report. Comfort was related to time spent in one village without relocating for more than one year. Social interaction included whether or not the respondents belonged to a self help group and engagement in support group activities. Continued demand for prevention services against HIV/STIs was taken as a measure for engagement in enduring life preserving skills.

RESULTS: All 7,000 MSM demanded and were provided with targeted information, education and communication on sexuality, orientation, gender, identity and keeping relationships. 3800 MSM were specifically playing a receptive role. 2700 were bisexual MSM. 200 MSM engaged in sex-work. 52 MSM living with HIV have been attached to 34 ART accredited health facilities. 155 experienced evictions from their homes of which 55 cases were domestic-violence related. 129 benefitted from a temporary shelter under a transitory home programme. 22 MSM had experienced black-mail due to their same sex behaviour.

CONCLUSION: In the midst of MSM exploring enduring long term sexual relations they face violence, violations, abuse, stigma and discrimination. These are pre-cursors for risks of exposure to HIV, evictions, black-mail, expulsions, disenfranchisement, ex-communication, homelessness and displacements.

RECOMMENDATION: Decriminalisation is a basic context in Uganda that will influence the way MSM demand, enjoy and access social services.

Taking the fight where it matters; lessons gained from strengthening integration of malaria, AIDS and TB interventions at 52 grass-root based communities as enduring models in Uganda from 2010-2011.

Sebulime Gerald, Muyunga Thomas

BACKGROUND:  Zero new infection, zero discrimination and zero HIV-related deaths is one call that will help rally masses in Uganda towards comprehensive prevention and eradication of HIV. Integration of malaria, AIDS and TB services as a policy will in turn provide the platform for prioritizing what works. The objective of this paper is to highlight the relevance of involvement of various actors in eradicating HIV.

METHODS: 52 grass-root community spaces scattered in Kampala, Jinja, Wakiso, Masaka, Mukono and Mpigi formed basis of the sampled areas. Local government and community leaders were part of the key mobilisers identified to conduct identification of organisations that provide integrated malaria, AIDS and TB services. 60 nongovernmental organisations and CBOs engaging in mobilisation and provision of integrated malaria, AIDS and TB prevention services within the catchment covering these spaces were involved. 50 health facilities were used as referral units for further management of cases.

RESULTS:  300 key mobilisers were identified. 50,000 brochures on malaria, AIDS and TB were provided in local languages. Schools in these communities provided spaces for 12,500 young persons to access life planning skills seminars. 20,000 insecticide treated mosquito nets were distributed. 15,000 households were mobilised to engage in clean up campaigns, mobilisers were asked to promote anti- TB drives through highlighting causes of TB. They also encouraged VCT services access and regularly engaged health workers at facilities to receive referred clients.

CONCLUSION: Integration improves quality of comprehensive services. More persons will be engaged in health preserving practices once mobilised by peers. More will report earlier for treatment and this will improve on quality of life.

RECOMMENDATION: Community empowerment, peer involvement and integration are key in a comprehensive prevention model that will resonate into the zero campaign.

Effect of stigma on MARPs’ uptake of HIV Prevention practices: Meta-analysis of records from 2009-2011

Sebulime Gerald, Muyunga Thomas

BACKGROUND: Integration of HIV/TB/STIs/Malaria services without considering MARPs issues such as frequent change of addresses to evade effects of visibility, social stigma, access to services and dis-regard towards them will impact on effectiveness of these services. This has effect on programming targeting MARPs at lower level governments, FBOs, CSOs and Community groups.

METHODOLOGY: Administering a structured short questionnaire, conducting 5 focus group discussions inquiring into services and what the unique characteristics attributed to MARPs were. Respondents included: 650 MSM, 11 lesbians, 3 indigenous MSM from Benets and 7 Ndorobo tribes, 71 regular substance users, 02 intersex, 05 transgender, 195 female sex-workers, 82 fisher folk and 150 leaders.

RESULTS: 02 intersex had faced ridicule, 05 transgender had faced ridicule from their communities and frequently moved from their residences in the past 2 years.  6 of the lesbians had stayed in their resident communities consistently for two years. 5 lesbians had frequently changed addresses within a year.  195 female sex-workers had all changed residences within two years; 75 had a history of abuse by clients; 100 were recruited by others to keep male clients company; 92 were involved in other forms of work; 50 sent money home in the past month; 100 had long distance drivers/ truckers as clients; 50 had a live-in partner who knew their sex-work activities.  All 82 fisher folk easily accessed social grants to engage in other forms of business as a result of fishing regulations. The leaders had heard of anal sexual intercourse experiences and incidences of stigma towards HIV+ men, women and sexual minorities. Stigma in communities perpetrated mostly by religious and media campaigns.

CONCLUSIONS: Stigma was faced disproportionately by MARPs. Religion and media fuels intolerance for MARPs, this affects access to services and health seeking practices.

Barriers to generating a same sex profile using existing and appropriate community based outreach programmes in Kampala, Wakiso, Mbarara, Jinja and Mbale districts: Where are WSW, MSM, TG and LGBTIQQ? Lessons for SRH and HIV planning in Uganda

Muyunga Thomas, Sebulime Gerald

BACKGROUND:  Same sex behaviour is penalised in Uganda according to 3 sections of the Penal Code of Uganda:  Section 145, Section 146 and Section 148. The objective of this paper is to highlight the impact of the legal regime and financing towards self determination on same sex behaviour as an attraction, amidst vulnerability and risks.

METHODS: A sample size of 300 generated from 5 districts after follow up of 13 funded organisations from 2009-2011 formed basis for generating this report. 2 organisations targeted MSM, 2 were targeting LBT, 2 were university based targeting LG, 3 targeted trans-persons, 1 targeted MSM/TG, 1 targeted intersex, 1 was an internet based social network and 1 targeted bisexual. Follow up was possible through planned activities of 3 different coalitions formed immediately after introduction of the anti-homosexuality Bill, 2009.

RESULTS: All 300 demanded and were provided with targeted information, education and communication on sexuality, orientation, gender, identity, health, advocacy and keeping relationships on a regular basis. This improved self determination. 10 bisexual MSM, 90 gay men, 5 trans-women, 22 trans-men, 150 transgender, 10 intersex and 13 WSW were able to categorically use their spaces regularly. This was basis for affirming orientation, conduct and identity. These spaces were the best venues for addressing health needs and other social issues.

CONCLUSION:  Regular and planned activities of organisations targeting MSM, TG and LGBTIQQ, influences their self determination. Appropriate SRH and HIV prevention in form of messages, counselling, SRH commodities, provision of water-based lubricants, microbicides, VCT, ART and comprehensive health services is possible.

RECOMMENDATION: Legal and financial support to WSW, MSM, TG and LGBTIQQ is not only key to self determination but can influence affirmation, equality, autonomy,  privacy,  liberty, health seeking behaviours, access to SRH and prevention commodities and promotes visibility.