STIGMA and discrimination against key populations, remains a huge challenge in the fight against HIV.
In order to achieve the target of reducing new HIV infections among key populations by 75 per cent by 2020, a large-scale increase of programmes and the creation of an enabling social and legal environment are needed.
South African Psychosexual educator, Delene van Dyk at a media training workshop held at Sandton Park Inn last week, said this meant policies in countries should promote health equity in order to address the health needs of those key populations.
“Reinvigorating HIV prevention among key populations requires domestic and international investments to provide key populations with tools, such as condoms and lubricants, pre-exposure prophylaxis and sterile needles and syringes, and testing and treatment,” van Dyk mentioned.
However, she said the design and delivery of such HIV combination prevention services was often limited by a reluctance to invest in the health of key populations and to reach out to them.
In many countries, key populations are pushed to the fringes of society by stigma and the criminalisation of same-sex relationships, drug use and sex work.
Marginalisation, including discrimination in the health sector, limits access to effective HIV services. There is an urgent need to ensure that key populations are fully included in AIDS responses and that services are made available to them.
Guidelines and tools have been developed for and with the participation of key populations in order to strengthen community empowerment and improve the delivery of combination prevention services by community-led civil society organisations, governments and development partners.
The available evidence shows that when services are made available within an environment free of stigma and discrimination and involving key population communities, new HIV infections have declined significantly.
HIV prevalence higher in sex workers
HIV prevalence among sex workers is 12 times greater than among the general population.
Sex work is illegal and criminalised in a majority of the countries.
Globally, gay men and other men who have sex with men are 19 times more likely to be living with HIV than the general population. The incidence of HIV among gay men and other men who have sex with men is rising in several parts of the world. One international review concluded that only one in 10 gay men and other men who have sex with men receive a basic package of HIV prevention
SAFAIDS Regional Programme Manager Adolf Mavheneke said key populations should be included in all interventions if the tap on new HIV infections is to be closed. Mavheneke was addressing journalists during a media training workshop in Johannesburg, South Africa last week.
He said among prisoners, in some settings the HIV burden may be up to 50 times higher than in the general population.
“The burden of the pandemic among KPs is thus disproportionately severe – in terms of infection rates, government commitment, and access to services,” he stressed.
This burden has been worsened among KPs by the social exclusion entrenched by religious, traditional and cultural norms and values that posit KPs as socially non-conforming and therefore unacceptable within the social space that then includes access to HIV prevention, treatment and other care services.
He said the lack of respect for human rights fuels the spread of HIV by adding to the risk environment and further marginalising of people living and affected by the pandemic, such as: sex workers, people who use drugs, men who have sex with men, transgender people and prisoners.
“When human rights are not respected and protected, people are less likely to access available prevention, testing, treatment, care and support services.”
Capacity building of People Living with HIV (PLHIV) faces tremendous stigma and discrimination, even in places where treatment is widely available.
Without effective redress against discrimination, i.e. if health providers do not respect informed consent or medical confidentiality, people vulnerable to HIV may be reluctant to come forward for testing, treatment and care.
The spread of HIV and its impact are exacerbated in situations where human rights are not respected, protected and promoted. In these situations, people living with HIV are often too scared to come forward for help because of fear of stigma and other negative outcomes of disclosure.
The protection of human rights is the way to protect the public’s health. Human rights fulfil the dignity and aspirations of especially the marginalised.
Law can protect the dignity of all people and fortify the rights of those most vulnerable to HIV, for instance ‘key populations’, such as sex workers, MSM, TD people, inmates and migrants. The law can open the doors to justice when these people’s rights are trampled.
The law can improve women’s lives and gives them the power and independence to improve and preserve their health and that of their children.
‘Limited data collected on KPs’
SOUTHERN Africa HIV/AIDS Information Dissemination Service (SAFAIDS) interview with ministry of health officials showed that there was limited data and evidence gathered around issues of Key Populations (KPs) programming on HIV and AIDS.
SAFAIDS Regional Programme Manager Adolf Mavheneke during a media training workshop on Key Populations held in Johannesburg the past week said currently, the most important document with regards to knowledge on key populations and HIV in ‘Swaziland was the Swaziland Behavioural Surveillance Survey (BBS): HIV Amongst High Risk Groups’ (2013).
He said at the time of this baseline study, another study was being conducted by HC3 to map key populations and estimate their sizes across Swaziland.
“The study by HC3 raised some disagreements in the health sector with several people disputing the interim findings. The key populations mapping and estimation project had therefore not been completed because there were contestations about the methodology used and the authenticity of the subsequent findings,” he said.
Mavhneke said the study had been completed but was undergoing a peer review process.
“It was also reported that a KP network called Rock of Hope was conducting an ethnographic study on KPs but the study had not been shared.”
The 2013 BBS which had become a leading reference document sought to achieve the following objectives: to calculate an unbiased estimate of HIV and Syphilis prevalence among FSW and MSM in Swaziland, to describe the behavioural factors associated with HIV infection, including individual sexual and drug-related practices, condom use and negotiation, and knowledge of HIV transmission risk factors.
Also to examine the role of social and structural factors on HIV-related behaviours and risk for HIV infection among FSW and MSM, including human rights violations as a result of stigma/discrimination and degree of social cohesion. The Swaziland BBS, (2013:1) is an important document in Swaziland with regards to key populations only considered Female Sex Workers and Men who have Sex with men. Other population groups that are commonly regarded as key populations such as Women who have Sex with Women (WSWs) and the Transgender people were not considered.
Therefore, while the study contributed a significant amount of important data, it also fell short with regards to a holistic view of key populations.
It is important to note that the Swaziland BSS (2013) gave the needed evidence to support the establishment of a KPs office in the Ministry of Health.
While this study had become an important reference document in Swaziland planning for KPs, it is important to note that stakeholders involved in KP programming felt that there were several outstanding gaps with regards to KP data in Swaziland.
“The ministry of health indicated that data was still needed on transgender people and injecting drug users. Little was known about them. It was indicated that evidence was key as it determined the focus of programmatic area,” stated Mavheneke.
It was indicated that most programming in Swaziland was operating on what may be called ‘expired data’ (interview with the Director, Health Plus 4 Men, Swaziland).
There was a feeling that many changes had taken place since the BSS (2013) study that was undertaken. Further evaluative research was necessary to understand the effectiveness of KP programmes that had been running for