Violence, at-risk populations and HIV/AIDS in Uganda

*Muyunga T., Sebulime G., Wangalwa S., Amina A., Margaret N., Susan N., Hirome N.

BACKGROUND: There are links between violence, abuse, discrimination and stigma to risky sexual behaviours.

OBJECTIVE: To show disproportionate link between violence, abuse, discrimination and stigma to risky behaviours as faced by MARPs.

DESIGN:  Literature review, Qualitative information using a structured short questionnaire and focus group discussions inquiring into violence, abuse, discrimination, stigma, sexual life of MARPs, needs of MARPs, where MARPs got services and what the unique characteristics attributed to MARPS were.

SETTING: This covered all parts of Uganda which was divided into 10 regions. Various social spaces were chosen (towns, suburbs of Kampala, CBOs/CSOs/FBOs/ Lower Level Governments, Village Health Teams, Farmer Groups, Youth, Village markets, 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: Opportunity to talk about assault, evictions and abandonment due to HIV, orientation and sex-work in controlled spaces was initiated and established for discussion groups.

MAIN OUTCOME MEASUREMENT:  The extent and scale of violence, abuse, discrimination and stigma that may be life threatening faced by HIV+ve people, sex-workers, sexual minorities, Fisher-folk, long distance truckers and uniformed services persons is disproportionate.

RESULTS:  Of 650 MSM (16 years to 64 years), 140 MSM (22%) faced violence in residence communities, 370 (57%) of these faced violence in towns, 600 (92%) experienced psychological violence, 3 who were from indigenous tribes of the Benets and 7 Ndorobo MSM faced stigma due to being from ethnic minorities. 71  respondents (16 years to 52 years; 65 males and 06 females (18 years-25 years with a history of being street children; three of the females were having children) were regular substance users and all were victims of violence during their life time and reported this had a great impact on their lives. 02 (100%) were intersex ( all had been forced into corrective sex by their relatives),  05 (100%) were trans-gender ( 20 years and 45 years, all had faced child sexual abuse and later serious physical harm) and  11 ( 100%) were lesbians (18 years to 24 years and had a history of corrective sex). Of 195 (100%) female sex-worker, 75 (38%) expressed a history of being abused by clients and had bodily injuries to that effect); 25 (13%) had live-in partners who threatened them with black mail, confiscating property and abandonment if they failed to give them money from sex-work.  All 82 (100%) fisher folk from Lakes Albert and Kioga were able to switch to other forms of work and access money in form of credit. In the 30,000 spaces, the leaders had heard of anal sexual intercourse experiences and had also heard of incidences of violence which resulted in abuse, discrimination and stigma towards HIV+ men and women, sexual minorities. The leaders intimated that violence towards sexual minorities was as a result of religious and media campaigns.

In depth interviews revealed: “ I was beaten because as a girl I used to dress up as a boy, later 3 male cousins of mine with the full knowledge of my other relatives bound me up and raped me in turns, I later was diagnosed with HIV ” – Teddy, Mbale

 “My parents were both alcoholics and we used to witness insults and fights, I ran away at 12 years and joined a street gang, I was initiated into smoking, sexual intercourse and anal sexual intercourse by our gang leader with whom we also shared marijuana and khat leaves ”-Godfrey, Kampala

“In Prison, I used to give in to male sexual advances and used to engage in unprotected anal sex, I was discharged after serving my 3 year term.  I could not stay in Kampala for fear of being stigmatised so I went back to my ancestral village and got a wife but after 1 year was diagnosed with HIV when she was asked to bring her partner during her pregnancy, we both are HIV” –Patrick-Mpondwe

CONCLUSIONS: MARPs are subject to disproportionate violence, abuse, discrimination and stigma. The extent of violence, abuse, discrimination and stigma prior to HIV diagnosis and its impact on MARPs is a risk factor for HIV/AIDS. This association must be recognized and must be part of the training for service providers targeting MARPs in advising them in protection, HIV prevention, care, treatment as an integrated approach.

*All authors are from MOST AT RISK POPULATIONS’SOCIETY IN UGANDA.