Investigating contexts, perceptions and practices around Sexual and drug use risks in 35 identified spaces and communities surrounding them: Lessons for HIV/STIs Programming targeting MARPs.

Muyunga Thomas, Golooba Martin, Kabayaga Grace, Nabaggala Deborah

BACKGROUND: HIV/STIs risk transmission routes messages should include anal sex. Smoking, alcohol and khat are perceived to enhance sexual performance in both females and men. These and other issues were discussed in talk spaces and trends around these practices were followed by MARPS IN UGANDA with a median follow-up of 10 months.

OBJECTIVE: To determine sexual and drug use ‘risks’ that inform decisions of different stakeholders and show to what extent these definitions correspond or compete with HIV/STIs prevention programmes.

DESIGN: This exercise used desk reviews, Internet social spaces, newspaper clips and followed guided conversations in 35 spaces between June 2010 and March 2011 (10 months).

SETTING: This exercise was community and office-based.

PARTICIPANTS: The participants evaluated were 550 persons in; 12 urban townships (127 bike stages (boda), 73 repair garages, 4 development work CSOs, 25 truck-stages, 12 car-parks, 13 furniture marts, 147 film kiosks, 08 markets, 25 food kiosks, 122 washing-bays, 200 in-door game spaces, 5 media houses and 70 leaders), 5 rural townships (20 bike stages, 30 bars/lodges, 12 sports grounds and 25 community leaders), 15 MSM-groups, 45 sex-workers, 12 substance users and 23 fisher folks.

INTERVENTION: Uganda has continued to provide an environment in which HIV/STIs are discussed and treatment programmes reach out to a majority of population groups. This formed basis for referral of cases that needed treatment and management.

MAIN OUTCOME MEASUREMENT:  IEC materials addressing HIV/STIs/TB programmes, anal sex, HSV, HPV, HBV and Drug use targeting MARPs are only developed on a smaller scale during seminars to address participants’ raised needs.

RESULTS:  Major newspapers in Uganda had cases depicting sex-work, anal sex and drug use as objectionable. 10 major religious denominations had through radio, community campaigns and demonstrations continued with campaigns denouncing “sodomy” acts, sex-work and drug-use. Discussions and comments picked from internet social spaces and with participants revealed experiences involving multiple concurrent partners, un-planned pregnancies, intoxication before sex-act, self-medication for STIs, low targeting of MARPs, unprotected anal sex and performance enhancement drug use.

LIMITATIONS: Following competition from corrective and rehabilitative agenda towards the sex-work industry programmes, we were perceived as diversionary and this made it difficult to get more time to probe further.

CONCLUSIONS: Religious, cultural and media campaigns influence health promotion and prevention when certain contexts of risk are obscured or not talked about. Organisations targeting MARPs need to address less talked about issues as core activities.