Effect of stigma on MARPs uptake of HIV Prevention practices

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.

OBJECTIVE: We wanted to check effects of stigma on programming targeting MARPs at lower level governments, FBOs, CSOs and Community groups.

DESIGN: Administering a structured short questionnaire to respondents and 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. 

SETTING: This appraisal covered various social spaces (towns, suburbs of Kampala, CBOs/CSOs/FBOs/ LLGs, Village Health Teams, men and young males’ board game spots, repair garages, furniture marts, kiosks and security organs).

RESPONDENTS: The respondents included political leaders in communities, organisation heads and focal persons, religious/cultural leaders, established community traditional leaders, sex-workers, same sex practicing persons, substance users and clients of both male/female sex-workers as key informants.

INTERVENTION: Programmes targeting MARPs exist in Uganda. However, there is little or no conscious seeking of these services by would be beneficiaries due to social stigma.

MAIN OUTCOME MEASUREMENT: The primary outcomes of this exercise were: MARPs are disproportionately affected by stigma.

RESULTS: 02 intersex had faced ridicule in the past and also had children from a past marriage, 05 transgender had faced ridicule from their communities and frequently moved from their residences in the past 2 years, 02 are seeking sex/gender re-assignment.  6 of the lesbians had stayed in their resident communities for past two years. 5 lesbians had frequently changed addresses in the past year.  195 female sex-worker had all changed residences for past two years, 75 had a history of being abused by clients when they had just got into sex-work (17 years-20 years); 100 were recruited by others to keep male clients company; 92 were involved in other kinds of work. 50 sent money home in the past month; 100 had long distance drivers/ truckers as clients in the past 4 weeks; 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 and women, sexual minorities and persons by communities perpetrated mostly by religious and media campaigns. Stigma was faced disproportionately by MARPs.

LIMITATIONS: This was a rapid and observational exercise in which we were moving from one place to another over short periods reviewing programmes and contexts targeting MARPs.

CONCLUSIONS: Religion and media fuels intolerance for MARPs, this affects access to services and health seeking practices.