STRUCTURAL FRAMEWORKS NECESSARY FOR MEN-WHO-HAVE-SEX-WITH-MEN (MSM) AND OTHER MOST-AT-RISK-POPULATIONS (MARPs) TO ACCESS SERVICES IN UGANDA: LESSONS FOR MEETING THE MILLENIUM DEVELOPMENT GOALS BY 2015
THOMAS M. / STEFAN B.
KEY-POINTS: Recognising MARPs as key drivers of HIV/STIs.
Criminalisation fuels vulnerability, indignity and exposure to risks.
Uganda criminalises commercial sex-work, substance use and same sex sexual behaviour. The effects of discrimination, vulnerability and exposure to risk that arise from criminalisation reverse the big strides Uganda has made in the fight against HIV. The Constitution of Uganda promotes human dignity for all Ugandans. The Ministry of Health (MoH) is mandated to provide services to all. The National STD Unit of the MoH provides an environment where Most-at-risk-populations (MARPs) access services and from January 2008- March 2010 under the plus-up fund to Makerere-Mbarara-University-Joint- Teaching Hospitals’ AIDS projects (MJAP) provided support for the first service component that strengthened services at the National STD unit for all Ugandans and specifically targeted; commercial sex-workers, MSM/Sexual minorities, substance users, young people in tertiary institutes, couples and communities around entertainment centers. This service component was formalized under the name of most-at-risk-populations’ Initiative-MARPI, as a project under the National STD Unit. This is in line with the National HIV/AIDS Strategic Plan 2008-2012 which recognises the risk factor among MARPs, outlines MARPs as the key drivers, embraces innovations and supports technologies that are evidence-based and applicable in the fight against HIV/STIs.
Over 50.000 were targeted to access Comprehensive friendly SRH/HIV/STI services. Peer leaders of different MARPs categories were trained and with their input helped MARPI reach; 300 MSM, 100WSW, 400 CSW, 391 Couples and 4219 students.
Comprehensive friendly services and interventions targeting MARPs are provided without discrimination at the Unit and during planned outreaches at identified safe-spaces. 23 staff members were trained in Unconditional Positive Regard (UPR) techniques, 30 MSM/Sexual Minorities’ peer leaders were identified and trained in peer-to-peer counselling techniques, 20 Condom outlets were identified as safe spaces where 100.000 sachets of water-based lubricants were distributed, 100 MSM accessed STI treatment, 20 Health Action Groups generated activity plans that were MSM/Sexual Minorities specific, 20 MSM living with HIV were given follow-up HIV –Care.
Participation by MARPs in programmes concerning them, promotion of attitude and context for improved health seeking behaviour, trainings to keep abreast of trends, sustained advocacy and documentation provide evidence-base.
High risk sexual behaviour among MARPs can be reduced and made safer. Participation of MARPs is critical for the successful prevention and control of HIV/STIs. Documentation of these outcomes has generated unequivocal evidence necessary for informing policy, programming and planning.
1. Mulago-Mbarara-Joint Teaching Hospitals’ AIDS project-MJAP
2. Johns Hopkins University-JHU
3. Most-at –risk-populations’ Initiative-MARPI staff.
4. Sexuality, Orientation, Gender Identity and Health-Sogiah-Uganda
5. Sexual Minorities Uganda-SMUG
6. Womens Organisation Network for Human Rights Advocacy-WONETHA
7. Makerere II health action group-MAK II
6. Purity Affirmative Organisation for Transgender Health-PAOTH
7. Purity Makerere Uganda-PMU
8. UNAIDS Uganda Country Coordination Office
9. 2nd East Africa School on Law, Human Rights and HIV/AIDS.
10. MSM/GF-Be Heard
11. Friends who have provided morale support
AIDS 2010-XVIII-IAC TRACK C: EPIDEMIOLOGY AND PREVENTION SCIENCES