Strengthening Malaria, HIV&AIDS, TB (SMAT) Community-Based Responses in selected parts of urban and rural Uganda 2017-2027

Strengthening Malaria, HIV&AIDS, TB (SMAT) Community-Based Responses in selected parts of urban and rural Uganda

SCOPE:

Conducting a “KAP-related” strengthening around HIV transmission and use of safe space as empowerment opportunities in Uganda

Purpose: To conduct “KAP” Dialogue sessions, plan follow- up processes, identify/ train key mobilisers to own, scale up and sustain self-efficacy activities  and prevention skills against HIV/STIs.in 102 safe spaces

A brief overview of the MARPS IN UGANDA “SMAT” Programme

The Strengthening Malaria, HIV-AIDS and TB (SMAT) Community-Based Responses in identified spaces was piloted in 2004.  In 2006-2011, it became the standard roll out flagship. We encouraged formation of “Gender-Dignity Responsive spaces”, we worked at grass-root consistently targeting MSM in Uganda. We have worked as: Good Samaritan Uganda, SOGIAH-Uganda and MOST AT RISK POPULATIONS' SOCIETY IN UGANDA (MARPS IN UGANDA).  Unfortunately, circumstances beyond our control forced all of us to go underground. Advocacy work is not effective if one lacks resources. It is not easy advocating for safer sex practices; access to ARV's; documenting human rights abuses; and maintaining an organization. 

Between 2004- 2011, the combined beneficiaries reached were  7,000 MSM.  This number was all we could reach economically with targeted services. Good Samaritan Uganda was established in 1995 as a platform and safe space for marginalised sub-population to share experiences in Uganda. Topical issues such as roles and responsibilities toward elderly, Persons with disabilities, displaced persons, parents and children were raised. An internet-based/social media network was established when issues of sexuality and identity were introduced as action points. Explorations and social diagnosis of sexuality in different spaces around  Kampala were documented. There were health issues identified and all effort was done to address them. The quadruple tragedy of being being outed as gay; being HIV positive; stigma; and discrimination reared its large head. While, we confidentiality is important, the need for disclosure complicated care delivery. One solution was initiating informal partnerships with concerned people in spaces covering many parts of Uganda. As part of  the agenda development called for coming up with different groups such as Good Samaritan Uganda which continued to  pursue popularizing public health programming, consequential counselling themes among LGBTIQQ as well as maintaining membership to various professional list-serves.

SOGIAH-Uganda was established as early as 2008 as a CBO to specifically address needs around sexuality, orientation, gender, identity and health hence the name SOGIAH. 7,000 MSM formed our data-base (2004-2011) and were provided with targeted information, education and communication. 

A characteristic typology developed as follows: 4000 confessed to using non-ordinary forms of lubrication other than water- based lubricant; 3500 who were not circumcised but were willing to have that service done; 57 MSM living with HIV were attached to accredited ART facilities; 2700 MSM were between 17-26 years. Over 1700 were bisexual, above 22 years and engaged in some form of work. Over 1500 MSM were engaged in sex-work for favours including lodging, money and food. We witnessed or heard of 155 cases who were evicted from their homes and of these 129  benefitted from being given temporary shelter under our transitory home programme. 62 MSM experienced black-mail and extortion. 

A  Young MSM Club Uganda (YMCU) was formed to cater for the increasing number of young Ugandan males who sought services at MARPS IN UGANDA. MARPS IN UGANDA formally registered with the Uganda Registrar Office and had the following 3 permanent staffs: Chief Executive Officer, HIV/TB/Malaria Focal Person and Finance/Administrator. When it came to getting more staffs for activities, we contracted volunteers or had people come from other organizations who were willing to conduct community health education drives with us. The most sustainable approach was for us to train grass-root organisations to “own, scale up and sustain” their tailored programmes and then we do monitoring and evaluation. Thus began the seed and the origin of satellite support groups.

We continued providing IEC, Trainings in form of capacity building and referrals to other better established partners who had got support in form of funding to support a range of programme areas within Malaria, HIV prevention, care and treatment and TB management. 

Our SMAT Programme was the vehicle through which we did implement planned interventions by supporting community based organizations (CBOs). The support ensured alignment with international and national policy ranging from: Zero discrimination, zero deaths, zero infections, own, scale up, sustain, reduce sexual transmission (this is done through our own initiated “prevention of anal sexual transmission”-PAST-strategy with its 7 steps), Combination HIV Prevention and many other relevant policies. Our experience with the minority subpopulations was hinged on four themes: Policy, normativity, social services and community based readiness/response.

MSM in Uganda have some unique characteristics that included:

• Significant contributors to HIV in Uganda (MOT Study, 2008) and an HIV  prevalence  of 13%  (Crane Survey Report, 2010)
• High level of multiple concurrent sexual relationships.
• High level of transactional sexual activity
• Significant numbers disclose a history of early same sexual intercourse
• Significant number are not circumcised
• Significant number not aware unprotected anal sex is a transmission route for HIV/STIs.
• Significant number are bisexual and have families or intend to have
• Significant number are in closet
• Significant number in sex-work (1500 by 2011; 800 being through telephone/internet based sex-work).
• Significant lack of aggressive health seeking behaviour and few know their HIV status-378 last tested and knew their status (World AIDS Day, 2011).

SMAT has FIVE major objectives that include:

• Increasing access to, coverage of, and utilization of quality comprehensive Malaria, HIV&AIDS and TB prevention, care and treatment services within district  health  facilities and their respective communities
• Strengthening decentralized Malaria, HIV&AIDS and TB service delivery systems with emphasis on community outreach.
• Improving quality and efficiency of Malaria, HIV&AIDS and TB services delivery at grass- root
• Strengthening networks and referral systems to improve access to, coverage of, and utilization of Malaria, HIV&AIDS and TB services
• Intensifying demand generation activities for Protection, leadership, empowerment, attitude- enhancement, education for skills development, Malaria, HIV&AIDS and TB prevention,  care and treatment services.

Background and Problem

Although Uganda has had stable overall national adult HIV prevalence ranging from 6% to 7%, we hope to use this opportunity to popularise appropriate downstream anti- HIV Community actions. We shall train groups to become support spaces to break the cycle of infections partly due to extensive risky sexual behavior. While Uganda has implemented HIV prevention interventions for over 3 decades, the country has not yet attained universal access to HIV prevention services; and some of the prevention interventions have not adequately focused on the sources of new infections. When appreciating the scale up of care and treatment services, the long-term sustainability of the national HIV/AIDS response lies in intensifying and enhancing the effectiveness of HIV prevention that are evidence-based and context specific. There are still sections of the population that are at a relatively higher risk of HIV infection compared to the general population. Unprotected anal sexual transmission (most especially among MSM) is scientifically known to contribute to prevalence of HIV&AIDS. National data on the prevalence rate is still not available, reported prevalence from  MSM participants of project studies shows the rate is higher than the national average. MSM are characterized with risky sexual behaviours that make them more vulnerable to HIV infection than the general population. Lack of sufficient prevention and population based information on this specific sub-population  to  guide  development  of  effective  interventions  contributes  to  this.    

SMAT is MARPS IN UGANDA approach to fill in a gap to conduct a Knowledge, Attitudes and Practices (KAP)-related sessions to empower minorities adopt prevention skills.

Purpose

The purpose was to design Malaria, HIV-AIDS and TB prevention interventions that are evidence-informed and population-centred.

Intervention areas:

SMAT will always seek to provide:

1. A mosaic of minorities by geographical location, sex, age and population type and nature and level of their vulnerability.
2. Understanding of unique needs.
3. Drivers and predictors pointing towards commercial and other risky sexual activity in target communities and factors associated with the vulnerability.
4. Knowledge into behavior and what influences their behavior, what they know, believe, and think about involvement in work, contribution to community activities, Malaria/TB/ HIV, their causes, impact and prevention.
5. Information on what makes it easier to access the needed HIV prevention services and what their unique HIV prevention needs are.

Specific objectives/Deliverables/Outputs:

Specifically, SMAT will help to;

1. Characterize and categorize selected minorities by geographical locations, type and facilitate development of focused and contextual interventions.
2. Provide understanding into the Knowledge, Attitude and Practices (KAP) in relation to  HIV&AIDS and perceived vulnerability to facilitate development of an effective behaviour change and communication strategy. In this case ours have been the PLEASE and PAST Strategy (Strategies that enable policy/programme look into issues of protection, legal, empowerment, attitude, education for skills, risk reduction messages, address appropriate needs and a documenting culture)
3. Obtain and provide sexual reproductive health commodities
4. Contribute to the National HIV Prevention Strategy and Action Plan.
5. Design appropriate capacity building strategies that increase knowledge, skills and ability of community structures, local government structures, households as far as access and sustaining local response to HIV prevention is concerned.
6. Make recommendations pertaining to sustainable care and wellness.

Methodology

Geographical scope /coverage

Work will be among 102 identified spaces covering many parts of Uganda and among selected key informants that include district local government and civil society personnel as well as the general population.

Populations, Approach and locations

SMAT interventions to target:

• At-risk adults who engage in unprotected anal sexual behaviour.
• At-risk adults who are in bisexual relations
• At-risk adults who engage in transactional sex
• At-risk adults who normally work away from their designated home areas or education  settings.
• At-risk youths ( having more than one sexual partner or those engaged in cross-generational sex or those engaged in both behaviours)

We target minorities who will come to our resource center as well as at our outreach spaces located at various spots (including the internet social spaces) in Uganda though with more emphasis through their networks, entertainment sites, highway truck stops along the Transport Corridors (Major highways), residential estates, boarding facilities (including education institutions, in-mate correctional houses..), an established hotline and through our partnership outcomes with the 5 East-African countries.

Roles of Our partners

1. Provide support in form of financial resources and other logistics needed to execute the exercise from 2017-2027.
2. Empower MARPS IN UGANDA, share experience and technical expertise.
3. Reviewing reports and providing feedback.

Supervision and Management

The CEO (also the Community mobilisation and health Promotion Focal person) is the focal point person to handle all partnership functions. The HIV/TB/Malaria Focal Person will provide the overall implementation functions. They form part of the management committee in addition to a person/s from Partnership organisations. All queries/ clarifications needed on this will be channeled through the CEO on:

marpsinuganda@gmail.com

MOST AT RISK POPULATIONS’ SOCIETY IN UGANDA-MARPS IN UGANDA

MOST AT RISK POPULATIONS’ SOCIETY IN UGANDA RESOURCE CENTER

Plot 22 Kampala Road Zone, Lubaga Division, Kampala City Council Authority Box 25730 Kampala

Uganda

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