The KP REACH programme is funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) to impact on HIV prevention and reduce HIV-related deaths among two main Key Population (KP) categories – Lesbian, Gay, Bisexual and Transgender persons (LGBT) and sex workers (SW) in eight southern African countries – Botswana, Lesotho, Malawi, Namibia, South Africa, Swaziland, Zambia and Zimbabwe. The programme is directed through the Humanist Institute for Cooperation with Developing Countries (HIVOS).
The KP REACH programme was developed by a consortium of KP networks and organisations including the African Men for Sexual Health and Rights (AMSHeR), African Sex Worker Alliance (ASWA), Coalition of African Lesbians (CAL), the emerging Southern Africa Trans* Forum, Positive Vibes, SAfAIDS and M&C Saatchi World Services (M&CS WS). Guidance to the programme is provided by a Communications Working Group (CWG) comprised of representatives from the KP networks, their member organisations across the eight programme countries, M&CS and HIVOS.
During 2016 and 2017, a series of studies were commissioned by M&CS WS to understand how to reduce stigma and discrimination as a key barrier to service access through the development and dissemination of messages co-created with KP Networks to shift attitudes and beliefs across key segments of public.
The overall study comprised five components: 1) A literature review; 2) A cultural analysis; 3) Hypothesis Testing; 4) Co-creation; 5) Stimulus review. Components 3-5 involved qualitative research in all eight countries. This took the form of a series of participatory workshops with youth, men, women and stakeholders, and was complemented by interviews with stakeholders, LGBT and SW.
The literature review clarified that KPs face stigma and discrimination that is exacerbated by overlaps with HIV stigma, gaps in protective laws and policies, stigmatising beliefs and values related to religion and culture, xenophobia and self-stigma. The literature on KP stigma and discrimination is uneven and there is less emphasis given to understanding stigma-related experiences of sex workers, transgender persons and older persons. There is also limited information on stigma reduction programmes.
Stigma experiences of each category within the LGBTI construct and SW vary in form and intensity, and intersectional concerns include nationalism, racism, sexism, ageism, and other prejudices. With regard to response, the adversarial relationship between LGBTI rights and concerns about cultural preservation need to be addressed, and strategies should be inclusive of contemporary and traditional cultural values.
The hypothesis testing phase established that there are large overlaps in recognising that concepts of sexual orientation, gender identity and sex work are communicated through dominant ideas and belief systems related to religious, cultural and political belief systems. While the media plays a role in conveying stigmatising information, this is largely through representing these dominant voices. Alternative points of view are seldom presented. Such views are seen as a form of wielding power, but also as representing ignorance and selfishness.
It was found that:
- Existing language towards LGBTI and SW is unhelpful and problematic
- There is limited understanding of concepts of sexual orientation and gender identity
- Empathy towards sex workers and LGBTI subcategories varies
- It is widely recognised that judging others is wrong
- Stigma and discrimination conflicts with personal values, especially the desire to not cause hurt or harm to others, but it is difficult to speak out
- It is preferable to promote shared benefits such as responsibility and mutuality, and to see peaceful communities where people live in harmony as a common goal.
The co-creation phase was conducted in South Africa, Swaziland and Zambia. Love and common humanity were identified as the foundation for stigma counter-narratives. It was found that a key lever for change was the understanding that judging others is inappropriate and wrong, and that churches were failing to diversify their messaging towards preaching love and acceptance. The positive and influential role of families was highlighted, with acceptance of KPs in families contributing to community inclination to do the same.
Losses from stigma and discrimination include being ignorant and ‘closed minded’ about the world, contributing to the break-up of families, isolating KPs, and increasing conflict and disharmony in communities. Losses include not allowing for contributions to be made by KPs, with a consequent loss of skills, talents and role-models.
Benefits of stigma reduction include being able to express respect and trust between people (individual level); valuing one’s family, providing love, and accepting one’s children for who they are (family level); and allowing for empathy, friendship, support, and sociability with others (peer and community level).
The value of telling stories that expressed processes of stigma reduction was highlighted. Telling stories builds confidence of KPs and non-KPs alike, and provides an opportunity to normalise loving and harmonious relationships between people, no matter their differences.
Stories must be authentic and be told through the voices of both KPs and non-KPs. Stories can also be educational, and it is important to address gaps in understanding and knowledge as many people feel that they have an insufficient understanding of many aspects of LGBT and SW identities.
KPs noted that love, common humanity and empathy are not politically threatening. Negative views from a religious perspective can be broken down by highlighting that hatred is inconsistent with Christian principles, and judgement is for God alone. Negative views from a cultural perspective can be broken down by normalising KPs. Negative views at community level can be broken down by showing unity within families, irrespective of a person’s sexual orientation, gender identity or form of work.
The stimulus review phase was conducted in Lesotho, Malawi, Namibia, South Africa and Zimbabwe (again, selection of these five countries for the stimulus review phase is explained in section XX). Following results from the co-creation phase and feedback from the CWG, creative stimulus based on three broad strategies was reviewed: 1) Highlighting our common humanity; 2) Charting journeys of change; 3) Moving beyond labels. Strategies 1 and 2 were found to resonate most with participants, with strategy 2 being most favoured overall. Respondents readily agreed that we share a common humanity – ‘We are all human’ – and that discriminating and being judgmental are negatives: ‘Let he who is without sin cast the first stone.’
Strategy 2 shows that sharing personal stories of change is an emotionally compelling way to humanise KPs and to transform people’s thinking with an alternative narrative. The approach supports findings from previous study phases and insights were gathered regarding how best to communicate values and principles that reduce stigma.
The findings of the overall study are consistent between phases, and the direction given is robust.
Factors contributing to the internalisation of change goals from the various study phases include: 1) Recognise the value of common humanity as central to change processes; 2) Increase knowledge and reinforce humanising values to draw in audiences; 3) Deepen understanding of sexual orientation, gender identity and sex work to provide insight and support empathy; 4) Mobilise widely held religious values including the understanding that judgment of people is for God alone and that faith is about love and acceptance and not hatred and isolation; 5) Increasing proximity by supporting engagement between KPs and non-KPs, acknowledging that many people may not personally know KPs, but that they are open to engaging with KPs to support stigma reduction; 6) Link to the value placed on peace and harmony by acknowledging that people are averse to interpersonal and social conflict; 7) Acknowledging the value and benefits of other similar struggles – for example, changes brought about in attitudes towards people living with HIV and people with disabilities; 8) Having a vision for the future that envisages a society free from stigma and discrimination towards KPs as an attainable goal will provide impetus to change.
The study identified a phased narrative approach to support a vision for the future where KPs are not exceptionalised, where community resources are enjoyed equally by all, and where space exists for full contributions to be made to community and social life and development.