Structural As Well As Socio-cultural Contexts Play Major Supportive Or Subversive Roles On Stigma

In their study, “'Management of a spoiled identity': systematic review of interventions to address self-stigma among people living with and affected by HIV,” Pantelic et al (2019) highlighted what exactly entailed the structural disablers and enablers of stigma. 

Humans are self preserving at all costs, they develop habituation, work toward stability and sustainability. The processes require due diligence or due process. HIV Prevention is built around two forms of scaffolding: the structural and socio-cultural scaffoldings. These scaffoldings can be applied to stigma, discrimination and violence.

Socio-cultural disablers of stigma: dignity affirming statements, equality policy, non-discrimination policy, emancipation in diversity and inclusive advocacy skills. These are person-to-person related practices reducing as well as raising awareness about people who may not necessary look or behave like you.

BACKGROUND: Self-stigma, also known as internalised stigma, is a global public health threat because it keeps people from accessing HIV and other health services. By hampering HIV testing, treatment and prevention, self-stigma can compromise the sustainability of health interventions and have serious epidemiological consequences. This review synthesised existing evidence of interventions aiming to reduce self-stigma experienced by people living with HIV and key populations affected by HIV in low-income and middle-income countries.

METHODS: Studies were identified through bibliographic databases, grey literature sites, study registries, back referencing and contacts with researchers, and synthesised following Cochrane guidelines.

RESULTS: Of 5880 potentially relevant titles, 20 studies were included in the review. Represented in these studies were 9536 people (65% women) from Ethiopia, India, Kenya, Lesotho, Malawi, Nepal, South Africa, Swaziland, Tanzania, Thailand, Uganda and Vietnam. Seventeen of the studies recruited people living with HIV (of which five focused specifically on pregnant women). The remaining three studies focused on young men who have sex with men, female sex workers and men who inject drugs. Studies were clustered into four categories based on the socioecological level of risk or resilience that they targeted: (1) individual level only, (2) individual and relational levels, (3) individual and structural levels and (4) structural level only. Thirteen studies targeting structural risks (with or without individual components) consistently produced significant reductions in self-stigma. The remaining seven studies that did not include a component to address structural risks produced mixed effects.

CONCLUSION: Structural interventions such as scale-up of antiretroviral treatment, prevention of medication stock-outs, social empowerment and economic strengthening may help substantially reduce self-stigma among individuals. More research is urgently needed to understand how to reduce self-stigma among young people and key populations, as well as how to tackle intersectional self-stigma. For more please see this link.

Avoiding Forward Transmission And Ensuring Viral Load Suppression: Lessons From Zimbabwe

A study in Zimbabwe highlighted why there was high risk of death among adolescents while awaiting ART.

Reporting earlier for testing, taking up ART and ensuring ART-adherence are a sure way for suppressing viral load and ensuring longevity among those living with HIV. Mortality among HIV-positive adults awaiting antiretroviral therapy (ART) has previously been found to be high as reported by Shroufi et Al ( 2015). They compared adolescent pre-ART mortality to that of adults in a public sector HIV care programme in Bulawayo, Zimbabwe.

Methods: In this retrospective cohort study, we compared adolescent pre-ART outcomes with those of adults enrolled for HIV care in the same clinic. Adolescents were defined as those aged 10-19 at the time of registration. Comparisons of means and proportions were carried out using two-tailed sample t-tests and chi-square tests respectively, for normally distributed data, and the Mann-Whitney U-tests for non-normally distributed data. Loss to follow-up (LTFU) was defined as missing a scheduled appointment by three or more months.

Results: Between 2004 and 2010, 1382 of 1628 adolescents and 7557 of 11 106 adults who registered for HIV care met the eligibility criteria for ART. Adolescents registered at a more advanced disease stage than did adults (83% vs. 73% WHO stage III/IV, respectively, p and the median time to ART initiation was longer for adolescents than for adults [21 (10-55) days vs. 15 (7-42) days, pMortality among treatment-eligible adolescents awaiting ART was significantly higher than among adults (3% vs. 1.8%, respectively, p=0.004).

Conclusions: Adolescents present to ART services at a later clinical stage than adults and are at an increased risk of death prior to commencing ART. Improved and innovative HIV case-finding approaches and emphasis on prompt ART initiation in adolescents are urgently needed. Following registration, defaulter tracing should be used, whether or not ART has been commenced.

For more please follow this link. 

Effective HIV Prevention Services Targeting Sex-Workers Include Their Voices in All Planning Stages

Magnitude, behavioural patterns, contributing factors, current interventions have an impact on participation by Sex workers in HIV prevention in Malawi.

This Report "captures the voices, perceptions, views and experiences of close to 950 sex workers, along with their clients and other stakeholders from 10 Districts in a situation analysis on the Magnitude, Behavioral Patterns, Contributing Factors, Current Interventions and Impact of Sex Work in HIV Prevention in Malawi.

The study was commissioned by the Family Planning Association of Malawi (FPAM) with funding from the United Nations Population Fund (UNFPA). Using participatory, quantitative and qualitative approaches, the study involved a counting of the sex workers; engagement of what the sex workers know about HIV and AIDS; the legal and policy issues surrounding sex work; and their problems, priorities, and experiences with service providers. The study also interrogated the sex workers on what could be done to ensure the effective implementation of interventions relating to sex work in the context of HIV prevention.

UNAIDS estimates that by the end of 2009, they were 33.3 million people living with HIV globally. In 2009 alone, there were 2.6 million new HIV infections (WHO, 2010). Sub Saharan Africa continues to experience high new infections. It is estimated that 1.8 million people in Sub Saharan Africa became infected in 2009 (WHO, 2010). UNAIDS further indicates that heterosexual intercourse is the main mode of HIV transmission in the region. For example, in Swaziland, transmission through heterosexual contact accounted for 94% of new infections. In Lesotho, between 35% and 62% of new infections in 2008 were noted among people who had at least a single heterosexual contact, and in 2006 heterosexual intercourse within a stable sexual relationship accounted for 44% of all new infections in Kenya (UNAIDS 2009). 

Sex workers are defined as: “Female, male or transgender adults and young people who receive money or goods in exchange for sexual services either regularly or occasionally, and who may or may not consciously define those activities as income generating,” (UNAIDS 2010). 

For purposes of this study, the operational definition adopted for a sex worker in the context of the study was: a female aged between 16-49 years, who has received money in exchange for sex either regularly or occasionally up to 12 months prior to the survey, and who may or may not consciously define those activities as income generating. 

There are two main legal approaches to sex work and these are: Criminalisation and decriminalization. The former approach is informed by the goals of: protection of health and safety; ancillary crime. prevention; protection from exploitation; preservation of society morals; achievement of eradication of the practice through deterrence; and realisation of human rights. This approach is largely grounded in feminist theory premised on the viewpoint that prostitution victimises women and objectifies women’s bodies and sexuality. This theory argues for the criminalisation of sex work on the grounds that it inherently perpetuates the patriarchal devaluation of women, while the other alternative of decriminalising and legalising it does not hold promise for affording women with safety. This viewpoint asserts that the criminalisation should only be with respect to the actions of the one providing the services, and that the criminal laws should not punish the one who procures. The theory is supported by other schools of thought such as the conservative moral school of thought, the paternalistic or protectionist approach and the abolitionist approach.

The public health approach converges with the human rights-based approach and argues that policy responses on sex work should reflect current knowledge of the social determinants of health, and move away from intensified repression to a comprehensive agenda of medical and social support to improve sex workers access to health care, reduce their social isolation and expand their economic options. This entails a multi-pronged approach that reinforces access to medical services for marginalized people, but also tackles the structural factors that expose vulnerable groups to disproportionate health risks in the first place. Prime areas for structural intervention include gender equity, education, and economic empowerment. This means pursuing two simultaneous, mutually reinforcing priorities, i.e. bringing health services and prevention interventions to sex workers in a participatory manner, advancing universal access to HIV prevention, care, and treatment, and protecting sex workers and the general population against HIV and STIs; while at the same time accelerating policies in appropriate sectors to address the structural issues of poverty and gender discrimination that currently leave female sex workers with few credible paths to alternative livelihoods.

Recommendations 

 There is an urgent need to build the capacity (knowledge and skills) of service providers working in sex work programming.

  There is an urgent need for outlining proper institutional set-ups for the steering, coordination and supervision of sex work interventions in Malawi. It is important that the mandates of relevant government institutions should be analysed in terms of their linkages with sex work in order to identify the lead institution.

  Sex work interventions should, wherever possible, be distinctly designed, planned, funded, implemented and monitored and evaluated. Currently most of them are implemented under the rubric of SRH thereby getting less attention in some institutions, particularly government.

  Collaboration among stakeholders is essential for the effective implementation of interventions given the constraints with resources, competing needs and capacity limitations. The limited collaboration that exists among stakeholders involved in sex work interventions is a major setback. There is a need for collaboration to be harnessed in order to have a platform for the identification of synergies, coherence and complementarities relating to sex work interventions in order to improve efficiency and effectiveness. 

 Livelihood services should be preceded with needs assessments. 

 The female condom provision programmes are not matching their utilization. There is an urgent need for a special study to critically analyze factors for the low utilization of female condoms notwithstanding their availability. The analysis should inform complementary initiatives to ensure increase in the utilization of female condoms by female sex workers. 

 Implementing and funding agencies need to effectively streamline sex work in their programmes by among other things adopting public health and human rights based approaches. 

 Sex workers need to be assisted so that they get organized and form an alliance which could be used as a platform to voice out their concerns for appropriate action from relevant authorities. The lack of such a network makes it impossible for sex workers to channel their concerns, thereby remaining a marginalized and neglected population, despite the availability of victim support units throughout the country.

 While it is clear that the debate on decriminalizing sex work in settings such as Malawi is far from settled, the legal complexities surrounding sex work derail the effective planning and implementing of interventions in sex work. This requires harnessing capacities on public health and human rights on the part of implementing institutions. 

 In future, population size estimation for hidden populations should be separated from social and behavioural related aspects in order to allow more time for each." For more follow this link please.

Underlying KP-related HIV Prevalence Is Susceptibility To Consequences Of Persecution And Relocation

Migration, mobility and marginalisation have consequences for Sexual and Gender Minorities according to studies.

People engage in, execute activities, associate, move or voice their needs to seek fulfilment. This fulfilment could be escape from persecution, desire to seek greener pastures, desire to be part of communities, brevity, valour, recognition, daring or curiosity and self preservation. These are private interests which constitute the subjective filters or basis for negotiating how one can enjoy public spaces. This negotiation comes as narration;  commodification; labour or skills which enable one to engage in problem posing or solving; and coping with challenges. 

"As a strategy to avoid discrimination, violence and economic marginalisation or persecution, sexual and gender non-conforming people often turn to migration as a route to achieve independence and build social capital. Recent studies by the IDS Sexuality, Poverty and Law programme demonstrate that while migration can provide liberation from some experiences of marginalisation and an ability to contribute economically towards family households, for many it leads to a precarious existence. To ensure these groups are not ‘left behind’ in development, policymakers and aid programming must recognise and address marginalisation of these groups as part of overall strategies to reduce risks of migratStudies undertaken by the IDS Sexuality, Poverty and Law (SPL) programme in 15 countries demonstrate that the effects of social, economic and political marginalisation can ‘force’ people to move either within their country or overseas. People can also choose to migrate for strategic reasons in order to counteract existing marginalisation, by moving to more accepting locations where they can economically contribute to families remotely and express their identities freely.Traditionally, there is a greater likelihood of movement from smaller towns or rural communities to urban contexts. This is primarily due to greater financial prospects being available in urban as opposed to rural contexts as labour tends to flow naturally from low-wage regions to high-wage areas. For many, migration might necessitate a move as economic migrants, refugees or asylum seekers to more tolerant countries where opportunities for a safe, authentic and economically productive life are more possible. An increasing number of countries are now considering persecution of homosexuality as a ground for seeking asylum, although there is now a body of documented cases highlighting how the process can be onerous, inappropriately intrusive for applicants and has low rates of succession.

In some countries, activists operating in nascent lesbian, gay, bisexual, transgender and intersex (LGBTI) organisations can find themselves forced to leave their countries as a result of their campaigning. Establishing a life within a new environment allows individuals to cast aside some of the social expectations and surveillance that characterises the lives of gender and sexual nonconforming individuals, although rigid gender norms may still impact on their lives.

The choice to migrate entails balancing the risk of discrimination at home with the potential loss of established social networks. For many, the loss of existing networks at ‘home’ can be offset by the formation and growth of fresh networks amongst their peers following migration to another city or country. These can allow them fresh opportunities to access resources and build social capital amongst other sexual and gender non-conforming individuals. That said, moving away from one’s family or community inevitably involves some loss of status and informal assistance that others would take for granted in making their way in the world.

Policy recommendations 

Whilst migration has challenges for everyone who attempts it, there are particular measures that would assist in ensuring it has a positive impact on economic and social prosperity of sexual and gender minority communities:

 • International organisations should become more sensitive to the reality that all international development activity affects those with non-normative sexual and gender identities and reflect this in their approach in designing, assigning resources and measuring the effectiveness of all aid programming.

 • International donors should introduce mechanisms to support ‘underground’ forms of LGBTI activism, even when this is with young organisations that might represent a small element of financial risk or where measurements of success are harder to quantify.

 • Same-sex relations should be decriminalised as a step towards securing the social, political and economic rights of gender and sexual non-conforming individuals and shifting public and familial attitudes.

 • Development programmes should not aim to discourage migration or sex work (and other forms of livelihood strategies), but instead work to resolve the multiple barriers faced by gender and sexual minorities, alongside offering diverse skills training, language and employment options.

 • Invest in research that helps to provide a greater understanding of the particular experiences of gender and sexual minorities living in rural contexts, as current evidence around exclusion is dominated by that undertaken in urban contexts. In addition, policymakers should make recommendations for improvements that can mitigate the push-and-pull factors that encourage migration.

 • Support strategies to simplify the process of obtaining identification papers for people from gender and sexual minorities (such as sex workers) who need to migrate regularly.

 • Invest further in increasing population research studies around social mobility and migration of gender and sexual non-conforming individuals.

 • Encourage and fund time for LGBTI organisations to form strong alliances with the rest of the international SOGIE (sexual orientation and gender identity and expression) community (especially regional partnerships), so that when individuals migrate to another country there is a network available to support them in the transition and the possibility of joint campaigning around common issues."

From Frying Pan To Fire: African Key Populations (KP) In A Dilemma When Provider Bias Stands In The way To Reporting IPV abuse; A Case Of Three African Cities

Alright, let us stop for a moment and analyze Key Populations (KP) vis-a-vis Intimate Partner Violence (IPV). 

Are you aware that disempowering KP from relating within their domiciliary communities across their lifespan is counter productive?

If one were to provide opportunities for KP to lead quality lives, they should not only use Heteronormative but Homonormative lenses as well. 

Disempowering by disowning, evicting, criminalizing, imprisoning, arbitrary arrests or causing harm to LGBTIPQQ children raises the likelihood of these not reaching their actualization milestones. These children undergo “what is known as children of latency who may arrive at what is termed socially decisive steps in life later in life or not at all unlike children who are allowed to grow and develop without fear of persecution. When children are denied this guidance their ideas are distorted. They may fail to form an idealized memories of adult patients who recall “the ideal of latency,” namely, the successful warding-off of instinctual impulses during this time. It is commonly agreed that the confluence of developmental and social forces propel the school-age child outward and away from the family towards peer relationships and new adult figures,” argues Wallerstein (1976).

Disempowering KP from relating within their domiciliary communities thus affects the way they relate, who they relate with, what they look for in relations, distorts self preservation goals, interrupts autonomy, agency, and eventually how they relate intimately. Studies highlighting IPV, link it to a number of traumatic causes including interruption of: sense of self, liberty, pursuance of happiness and quality life. Victims cannot engage in a full experience of life. Perpetrators on the other hand get away with it because of the muting zeitgeist around KP-related IPV. For Key Populations (KP), this has life threatening consequences.

Goodman (2005) argues that “intimate partner violence and real-life contexts of victims’ lives should be not only linked to state policy, criminal justice reforms mandatory responses focused on counseling, restraining, and punishing batterers, protection order system relying heavily on batterer treatment programs but should provide the victim support to prevent future violence. 

Contextualizing a sufferer centered focus responds flexibly to victims’ needs and providing them with advocacy and broad social support is a more successful strategy for safety of persons. o Expanding victim-centered resources and reincorporating a particularized perspective provides agency and autonomy in bringing about an end to IPV.”

Qualifications, ideas of success, achievements, money, assets, community roles, power roles, power sources education and occupational prestige, hegemonic patriarchy, masculine identity are some of the sources of agency, autonomy, self preservation, status and power of individual people. This power plays important roles in supporting or subverting relations. 

Jewkesa (2002) argues that “The way partners communicate and what they communicate about plays an important part in how they experience agreements, disagreements and how they resolve differences. verbal disagreements and of high levels of conflict in relationships are strongly associated with physical violence. Shared and personal time, resources and spaces need to be  explored by partners in order for them not to conflict. Transgression of conservative gender roles or challenges to male privilege, as well as matters of finance are another trigger of IPV.  Unlike many health problems, there are few social and demographic characteristics that define risk groups for intimate partner violence. Poverty is the exception and increases risk through effects on conflict, women's power, and male identity. Violence is used as a strategy in conflict. Relationships full of conflict, and especially those in which conflicts occur about finances, jealousy, enforcement of hierarchy and partner's gender role transgressions are more violent than peaceful relationships. Heavy alcohol consumption also increases risk of violence. Women who are more empowered educationally, economically, and socially are most protected, but below this high level the relation between empowerment and risk of violence is nonlinear. Violence is frequently used to resolve a crisis of male identity, at times caused by poverty or an inability to control women. Risk of violence is greatest in societies where the use of violence in many situations is a socially-accepted norm. Primary preventive interventions should focus on improving the status of women and reducing norms of violence, poverty, and alcohol consumption.”

So, what is the big deal here?

Even while we go about saying KP need to be targeted, we need to identify the needs in order to provide timely and effective interventions. One such need is the realization that perpetrators of abuses among KP are also holding high positions themselves and therefore are protected by the LGBTIPQQ Community. This study aimed at identifying the subjective character and typology (intrinsicness and extrinsicness) of IPV and link it to interventions targeting KP such as: access to police, courts of law, schools, recreation facilities, social spaces, jobs, credit facilities and health care. This study has policy and programmatic implications for development, educational, health, job recruiting, competitive sports, psychology, parenting and many other areas. 

Structured interviews, literature review and FGD were employed via Skype and face to face meetings. This helped to capture case by case narratives.

The study involved 34 Providers and 157 LGBTIPQQ people aged 23-55 years (47 TG, 25 L, 35 G, 50 B) in three cities, Nairobi, Kampala and Mbarara between 2015-2019. 

The 157 LGBTIPQQ respondents had been or were in a relationship for 6 months and above. This constituted eligibility. 

No, wait a minute. Is there a link between how one reacts to what one is provided with?

Six aspects were further investigated to show link between quality of life and Provider status and these were: sense of esteem; attributes of happiness or the happy gaze; propensity to seek lifespan or relationship counseling to understand/enjoy meaningful life; role of environment on gay relationships; and cultural sensitivity of Providers to gauge how Provider bias or affinity influences life improving seeking services.

And so? 

Providers introduced to cultural sensitivity trainings provided opportunities for KP to access them and this maintained a rapport. Providers were asked which extrinsic factor was more important: job security; welcoming communities; or accommodating parents. 17 Providers chose accommodating parents as the most important; 6 pointed out welcoming communities were the most important; and 11 highlighted job security. These Providers were involved in providing life-span guidance and counselling. So, it is clear that they were pointing toward a dependent and an independent stage of life. They affirmed that the environment has a profound influence on emotional growth which in turn affects the way a person engages in problem-posing and solving skills.

Power roles, status and gender expression are three pivotal in triggering or deterring IPV among LGBTIPQQ persons. When the victims cannot report the perpetrators because they fear losing a bread-winner or face, then it becomes complicated. But one way to address this anomaly is to empower the abused or vulnerable person with employable or money generating skills. E Pelled (2000), argues that “holding such abusive partners accountable motivates them to commit to their own and the partner’s well-being. Which under certain conditions, contributes to the healthier emotional fulfillment of both.” He continues to argue that “children who grow up in abusive situations, grow up terrorized, witnessing violence, become rigid and sometimes self destructing practices. Because they are exposed to negative or limited opportunities for role models, they end up with traumatic secrets. Examples of these traumas are constant fear, feeling loneliness, experience instability, discontinuity, are always moving and cannot get a foothold into economic independence.” Perceptions of non violence companionship improve wellbeing, sense of being and direction. This means that access to life saving information, education and communication ( IEC) is crucial.

Lamerial (2015) chronicles how “differences between feminine and masculine lesbian, gay, bisexual, transgender, queer (LGBTQ), self-reported victimization, perpetration, and acceptance of IPV. Results identified that masculine LGBTQ-identifying students reported higher levels of victimization, perpetration, and acceptance of violence, providing implications when assessing for risk and protective factors of same-sex IPV. 83% of LGBTQ adults reported suffering emotional abuse and coercion within their same-sex relationship; 32% of LGBTQ adults reported some form of physical abuse, and 52% experienced being threatened by their same-sex partner. Although high prevalence rates of same-sex IPV exists, little is known regarding the risk and protective factors of IPV.” 

He re-emphasizes the role of community in ensuring quality life. 

“Individual and relational development remains important, and healthy relationship patterns serve as a protective factor to violence in adult relationships due to the lack of role models displaying healthy relationship behaviors for LGBTQ-identifying individuals,” he asserts. When it comes to IPV, Transgender and Lesbians report more incidences than say Gay persons. This is what Lamerial (2015) in another study of who among Transgender, Lesbian and Gay are more likely to report IPV. “IPV victimization, perpetration, and related attitudinal differences exists between male and female LGBTQ. Study results found that females reported higher levels of psychological victimization than gay males. Additionally, the male participants reported greater attitudinal acceptance of IPV and a propensity for sadism. Counseling implications regarding IPV victimization, perpetration, and attitudinal acceptance for IPV among LGBTQ populations need to be one-shoe fits-all.” The need for interventions that are KP-led or ally-led and focused on improving health of KP increased a culture of dignity at individual, household and community levels. This is what Strickler (2015) argues when he asserts that “Lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) persons experience partner and other violence at high levels requiring culturally competent interventions.Focusing on LGBTQ experiences of violence, with intentions to collaborative or build networks with other organizations builds opportunities for experiencing fuller life by KP. It also provides opportunities for referral because different organizations would be involved in addressing sexual and partner violence, promoting LGBTQ community health and safety, and concerned with social inclusion and legal protection of LGBTQ individuals, families, and communities. These programs increase provider and community competency and capacity toward improving LGBTQ safety, health, and well-being.”

Can you tell us more? This gets interesting!

90 LGBTIPQQ respondents with median age 25 (IQR 23-45) claimed being well off was connected to access to services, admission to social spaces that improve life, freedom to associate, speech, movement, emotional growth, integrity, dignity affirmation, confidence and self care practices. Restricting the movement of others means that they cannot associate, exercise their autonomy, agency or engage in life preserving activities. 

Three FGDs of 15 members each in three cities were used to understand how emotional growth or maturity was connected to IPV. FGD A of 15 with median age 24 (IQR 22-45) cited regular or steady salary, going out, and relationship counseling were key in deterring aggressive practices, coping and dignity affirmation. 

FGD B of 15 members with median age 23 (IQR 23-45) reported that dependency and power status or the roles one played were a major role in deterring or fueling IPV events.

FGD C of 15 with median age 28 (IQR 23-49) with pensionable jobs, had health insurance and were openly gay reported that Providers who treated them with dignity encouraged them to engage in self care, errand-running, school retention up to when they gained qualifications and keep their jobs. They further pointed out that this set actualizing background compelled them to adhere to higher civic standards.

32 respondents with median age 30 (IQR 23-55) said they were happy and claimed it was due to five things: Spiritual growth, they attributed their happiness on being able to let their spirituality grow and thrive; chemistry/connecting with one another. This gave them confidence and trust; financial contentment, meant that even they earned little they could afford their lifestyle, spent or saved well; recreation, meant they engaged in a variety of community activities; compassionate and mutuality, meant they were invested in the relationship, were genuinely there for each other emotionally, financially and physically; and lastly, fidelity, was the ‘Holy Grail’ of relationships and it empowered them to agree on life preserving or safer practices and boundary setting.

35 respondents with median age 24 (IQR 23-29) had experienced IPV more than one time, reported they were deluded by grandeur, a partner had a sweet tongue and somehow they stayed. They were disappointed but preferred to be locked in abusive relationships than open up to Providers who may end up ridiculing them. 7 cited alcohol, drug and cigarette abuse. All regretted committing to the relationship but hoped things would change. Commitment remorse and avoidant coping is a common KP phenomena.

A Word To The Wise!

Relationships thrive on a continued effort to sustain investment in care, quality living, agreements of good conduct and creativity. Not delusions of grandeur, lies, appearances and pretending. This continued effort toward a goal is known as fidelity which by itself is the ‘Holy grail’ of relationships. Don’t take anything for granted but rather work harder toward thriving and happy lives.

It is like filling up one's car with fuel only to forget about coolant, water and oil. Or, forget to fill up air pressure in the wheels, and expect to run the car smoothly. Relationships start emotionally but they must be watered by the other requirements of the body. Relying on emotions may be a barrier to nurturing the structural side of relationships. This leads to a frustration domino. Poorly managed frustration breeds anger and depression. Poorly managed anger and depression breed general anxiety disorder (GAD). GAD in turn breeds aggression, which breeds self-abuse, depression and violent acts.

Conclusion:

The environment has a profound influence on emotional growth which in turn affects the way a person engages in problem-posing and solving skills. Providers empowered with cultural sensitivity trainings are more likely to motivate KP to take demand, take up and be retained in service delivery continuum. KP empowered to engage in fully experiencing their communities, thrive well and achieve quality life goals. They are able to explore meaning out of life. This opens many ways to understand people before  and if they identify a partner they have pointers to committing to long term relationships. Reading about or seeking relationship counseling is an important best practice. Age and status are crucial in understanding IPV. Identifying and measuring IPV makes it easier to provide interventions against its perpetration. Definitions or claims of being well off, should factor in attributes other than monetary or material. Emotional, biological and social services are as equally important a consideration. Finance and fidelity counseling services are an important intervention self esteem of KP is to be sustained. Further studies into life-span mentorship and guidance cultures led by KP will throw more light on positive coping skills. KP Providers who are culturally sensitive to KP-related provide quality services. When KP are willing to demand and access social support when in need and have the desire to improve on their lot, it sets in place a role model culture. It is an opportunity for self care, healing and thriving. 

For more, read Kampala Sexuality Journal. Find us at tweeter  @JournalKsj

Reference:

E Peled, Parenting by men who abuse women: issues and dilemmas, The British Journal of Social Work, Volume 30, Issue 1, February 2000, Pages 25–36, https://doi.org/10.1093/bjsw/30.1.25

Goodman, Lisa, and Deborah Epstein. “Refocusing on Women: A New Direction for Policy and Research on Intimate Partner Violence.” Journal of Interpersonal Violence, vol. 20, no. 4, Apr. 2005, pp. 479–487, doi:10.1177/0886260504267838.

Lamerial Jacobson, Andrew P. Daire & Eileen M. Abel (2015) Intimate Partner Violence: Implications for Counseling Self-Identified LGBTQ College Students Engaged in Same-Sex Relationships, Journal of LGBT Issues in Counseling, 9:2, 118-135, DOI: 10.1080/15538605.2015.1029203

Lamerial E. Jacobson, Andrew P. Daire, Eileen M. Abel & Glenn Lambie (2015) Gender Expression Differences in Same-Sex Intimate Partner Violence Victimization, Perpetration, and Attitudes among LGBTQ College Students, Journal of LGBT Issues in Counseling, 9:3, 199-216,DOI: 10.1080/15538605.2015.1068144

Rachel Jewkesa. “Intimate partner violence: causes and prevention.” The Lancet Vol. 359, Issue 9315, 20, April 2002, pp. 1423-1429, https://doi.org/10.1016/S0140-6736(02)08357-5

Wallerstein, J. S., & Kelly, J. B. (1976). The effects of parental divorce: Experiences of the child in later latency. American Journal of Orthopsychiatry, 46(2), 256-269.

http://dx.doi.org/10.1111/j.1939-0025.1976.tb00926.x

Strickler, Edward, Jr, MA, MA,M.P.H., C.H.E.S., and Quillin Drew. "Starting and Sustaining LGBTQ Antiviolence Programs in a Southern State." Partner Abuse, vol. 6, no. 1, 2015, pp. 78-106. ProQuest, https://stmarys-ca.idm.oclc.org/login?url=https://search.proquest.com/docview/1648967251?accountid=25334, doi:http://dx.doi.org/10.1891/1946-6560.6.1.78.

Microcredit, Its Promise And Mirage For Fostering Development And Rolling Back HIV Among Ugandan Youths 13-35 years; A Casuistic Qualitative Analysis Of Reports 2015-2019

Background: Microcredit or Micro finance services are precursors and catalysts for many other social services and development goals. This has policy, programming and planning implications in many areas including services for Young Persons, eradicating HIV and Key Population-led Programmatic Interventions and increasing household level living standards. The aim of the report is twofold: explore the categories that made Microcredit a catalyst for quality life practices; how Key Populations (KP) can use Microcredit to engage in quality life improving practices.

Methods: Community immersion, literature review and key informant interviews were used to generate the report between December 2015-February 2019 in 15 Ugandan Town Councils. 230 respondent aged 17-34 years were eligible out of 330. Eligibility was based on age; 5-7 months grace period after first loan withdrawal; small interest on loans ranging 0.002-0.009%; membership to more than one group or social collateral; did not have to deposit money in bank as collateral; plans set aside to ensure food sustenance; number of months in business between 6 months and 3 years; had plans for long term investments; and requested first/kick-starter loan equal to or below Ugx. 2,000,000.00. 

  

Results:  All 230 reported self employment for past two years, flexibility to innovate, engage in self care and saved for food. Out of two thirty (230), one hundred seven (107) with median age 29    (IQR17-34) tested for HIV at least five times in 2018. 

A disaggregation of respondents: 101 Straight females; 90 Straight males; 22 Transgender; 7 Lesbians; 20 Gay male. All respondents were below 35 years. 53 with median age 25( IQR 17-34) were living with HIV among whom 7 are Transgender; 5 were Gay males. 

Microcredit supports participation in quality life practices, it is a motivator to demand SRHR/RMNCAH/HIV Services, it galvanizes communities into forming, maintaining collateral viable groups and links businesses that follow market demands because their businesses were linked into food consumption (72) operated a food kiosk- and a side grocery); telephone kiosks operation (25); attire and shoes (22); movie kiosk (8) artisanry (12); brick-making (32); carpentry (9); Boda-riders (7); event planning and hosting (23); stationery (27); grocery shops (20); and commitment to nurture goodwill and credibility e.g. return the money.  

Conclusions and Recommendations: Microcredit supports engagement in quality life improving practices most especially for young women and people. People explore their potential to develop financially, it increases interpersonal and intrapersonal skills. Businesses that are market-linked provide possibilities for increased Household income base. Further study into how young people can use the funds to save for pensions and insurance is called for.