Empowering Young MSM born with HIV (YMSMPoz) to communicate SRH preferences appropriately can reveal other vulnerabilities

Empowering Young MSM born with HIV (YMSMPoz) to communicate SRH preferences appropriately can reveal other vulnerabilities

MARPS in Uganda created the #YMSMPoz as an internet ribbon cutting ceremony to celebrate working with 278 HIV positive sexually active Young MSM below 35 years. 97 of them are 25-29 years; 81 are between 22-25 years; and 100 are between 17-22 years. All 278 are taking medications. 175 do not identify as LGBTIQQ. 180 use some form of substances. All of them have missed their medications at one time in the previous six months. 189 engage in a form of talent and performing art but, have had no chance of exploring their talents under a more talented mentor or instructor.

YMSMPoz has been a culmination of events. In 1997, we worked as an orphan support organization in Uganda and by 1997 had 25 young children living with HIV we were caring for. We could not look after the children so we handed them over to another organization as we were changing our objectives to work with MSM. In 2000, some of the former children came back to us, revealed they were sexually active and regularly engaged in unprotected anal sex with other boys. This was in the suburbs of Kampala City Authority. We later found out that there are many more abandoned children on the streets who were engaging in unprotected survival sex. We have  since worked with many more but we do need to be supported. We want to provide condoms, other birth-control methods and provide appropriate referral for those who want to have expressed the desire to have children.

It is important to formalize formation of a viable YMSMPoz support club; we shall use the platform for empowerment to communicate SRH needs appropriately; and establish the YMSMPoz support center for former male street children who have sex with men. Developing unique information, education and communication materials on the intersection of homelessness, will help inform policy and programming targeting survival sex-work and HIV in Uganda. Writing using simple and easy to read English provides information which is accessible and a service to make beneficiaries informed consumers. 

MARPS In UGANDA’s LGBTIQQ sexual and reproductive health (SRH) package focuses on three priority areas (Individual needs/ expectations of services/ Influences of the larger community: 

1. Integrating gender and sexual choices, childbearing choices, maternal and newborn care skills
2. Services for preventing and managing sexually transmitted infections/ hematological(blood), oral, vaginal and anal infections
3. Engaging in support mechanisms to align pressures with the goal of healthy outcomes

BACKGROUND:

In Uganda, SRH package delivered through primary health care ((Katherine Williams, Charlotte Warren & Ian Askew. 2010) with referrals and has the following standards of care:

• Family planning/birth spacing services
• Antenatal care, skilled attendance at delivery, and postnatal care
• Management of obstetric and neonatal complications and emergencies
• Prevention of abortion and management of complications resulting from unsafe

abortion

• Prevention and treatment of reproductive tract infections and sexually transmitted

infections including HIV/AIDS

• Early diagnosis and treatment for breast and cervical cancer
• Promotion, education and support for exclusive breast feeding
• Prevention and appropriate treatment of sub-fertility and infertility
• Active discouragement of harmful practices such as female genital cutting
• Adolescent & Adult sexual and reproductive health
• Prevention and management of gender-based violence.

YMSMPoz, is a unique platform and knowledge hub for a section of population fast gaining in numbers in Uganda. The youth who were born with HIV and those who have had anal sexual intercourse are the target for this service. It is our hope this will improve decision-making for quality health outcomes. As part of building a prevention and care movement in Uganda, we shall leverage our linkages through the 6 building blocks around which health services are provided in Uganda. These blocks are:

1. Service Delivery: continue exploring how best service can be available in form of friendly, effective, safe and quality interventions for improving SRH status;

2. Human Resources: to empower youths to engage in self-care awn well seek medical care to achieve the best health;

3. Health Information: to use reliable and timely information on health system performance, as well as health determinants and status;

4. Medicines and Technologies: to ensure equitable access to products and technologies that are of assured quality, safety, efficacy and cost-effectiveness;

5. Health Financing: to provide opportunities to young consumers to use needed services and are protect them from impoverishment through having to pay for them.

6. Leadership and Governance: to ensure a strategic policy framework exists, together with effective oversight and accountability.

Tailored Services:

Education services and gender planning (biological and cultural genders)

Education and services on gender and sexual planning

Education and services on voluntary family planning information

Education and services on healthcare including HIV/HPV testing and management

Education and services on anal cancer screening. Hostility to men-who-sex-with-men seeking health services is documented (SMUG, 2015). However, MARPS IN UGANDA, has medical doctors who can be facilitated to provide anal-health care services.

Education and services on sexuality, orientation, gender and identity (conforming and non-conforming identities)

Education  and services on gender-based violence like correction-rape, genital mutilation, early and forced marriage. Anti-gay movements create hostile climate which demotivates service providers, drives beneficiaries underground and raises acts of violence toward LGBTIQQ. Uganda criminalizes homosexuality but as a signatory to the UN Declaration of Human Rights it is called upon to uphold human rights standards. All persons have a duty to seek out information or counsellors with training to guide them as they make SRH plans and choices. There are different organizations in Uganda with qualified health educators and counsellors. One such organization is Spectrum Uganda Initiatives (Spectrum Uganda Initiative).

YMSMPoz Counselling Package involves:

• Sexuality, Orientation, Gender and Identity Counselling
• Individually-tailored assessment for better health outcomes provides opportunities to meet SRH needs at individual levels and open ways for referral (Lambda Legal)
• Provision of education or services on HIV/AIDS & STIs

Conclusion:

Working with YMSM, most especially those living with HIV, reveals overarching aspects. There is potential in the talent and performing arts are;  overty, stigma and poor adherence (Michaela Kerrissey, 2008); there are those who engage in survival sex-work who may or may not be identifying as LGBTIQQ; and there are those who are living with HIV. Barriers facing YMSMPoz on the road to quality SRH outcomes, include those faced by the LGBTIQQ. However, tapping into the performing art area can help build the ethos, pathos and logos of Uganda's young persons in pursuing quality life and wellness.

Reference:

Katherine Williams, Charlotte Warren, and Ian Askew. 2010. Planning and Implementing

an Essential Package of Sexual and Reproductive Health Services; Guidance for Integrating Family Planning and STI/RTI with other Reproductive Health and Primary Health Services:.Retrieved from: http://www.unfpa.org/sites/default/files/resource-pdf/Essential_Package_Integration.pdf. Retrieved on January 24th 2017.

Lambda Legal. Know Your Rights. Retrieved from: http://www.lambdalegal.org/know-your-rights/article/trans-parents. Retrieved on January 224th 2017.

Michaela Kerrissey, 2008. Adolescents Living with HIV in Uganda:  Factors Affecting Disclosure, Adherence, and Prevention. JCRC, Uganda

SMUG. 2015. Why anti-gay sentiment remains strong in much of Africa. Retrieved from: https://sexualminoritiesuganda.com/why-anti-gay-sentiment-remains-strong-in-much-of-africa/. Retrieved on January 24th 2017.

SMUG. 2015. Testimonies of Human Rights Abuses From Uganda’s Sexual and Gender Minorities. Retrieved from: https://sexualminoritiesuganda.com/wp-content/uploads/2016/04/And-Thats-How-I-Survived_Report_Final.pdf. Retrieved on January 25th 2017.

Spectrum Uganda Initiative. Retrieved from: http://www.spectrumuganda.net/. Retrieved on January 24th 2017.