Monday, July 22, 2019

With Increasing Privatization And A Young Population Explosion In Africa, Micro-Credit Extension Can Play Quality Life Improving Roles


As governments increasingly privatize, microcredit extension can be used to foster development and increase SRH And RMNCAH uptake among Ugandan Youths 13-35 years.


Background: African Governments need to increasingly use Microcredit or Micro finance services as precursors and catalysts for many other social services and development goals. This has outcome implications in many areas including:HIV, SRH, RMNCAH 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 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 with median age 26(IQR (13-35) reported self employment for past two years, flexibility to innovate, engage in self care and saved for food. One hundred seven (107/230) 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 males. All respondents were below 35 years. 53 with median age 22 (IQR13-35) were living with HIV among whom 7 are Transgender; 5 are Gay males. Microcredit supports participation in quality life practices, ability to form, maintain collateral viable groups and links businesses in the service sector that follow market demands. These businesses were linked into food consumption (72) operated a food kiosk- and a side grocery) with median age 27 (IQR 23-35); telephone kiosks operation (25) with median age 19 (IQR 13-35); attire and shoes (22) with median age 20(IQR 13-35); movie kiosk (8) artisanry (12); brick-making (32); carpentry (9); Boda-riders (7) with median age 23 (IQR 13-35); event planning and hosting (23) with median age 30(IQR 23-35); stationery (27) with median age 25 (IQR22-35); grocery shops (20) with median age 27 (24-35); and commitment to nurture goodwill and credibility e.g. return the money. 


Conclusions and Recommendations: Young people can be empowered to engage in SRH uptake. Microcredit extension catalyzes market linkage, increases citizen self preservation provisions, is linked to opportunities for social integration, through entrepreneurship and wealth creation. It increases Household income base, a precursor for self care. Age is linked to service sector start-ups and ventures. More younger people are living with HIV. The role party politics plays in addressing young persons’ concerns needs further study.

KP-led HIV Prevention Programming That Achieves UNAIDS 95:95:95 Outcome Strategies: Ugandan KP Demography


Key Population-led and mentored formulation of HIV Prevention interventions in Uganda is both targeted and evidence-based driven as Well. But, what exactly are these interventions?

There are basic outcome strategies KP-led organizations in Uganda can adopt if they were to be effective change agents cascading into UNAIDS 95:95;95. 

Working hand on hand and allowing KP-led organizations in Uganda participate in verbalizing, designing, visibilizing and mainstreaming what works is commendable. It is the only sure way to also ensure PEPFAR HIV Preventions funds are well spent. Allowing them to access funding has leveled the HIV Prevention ground. This is commendable indeed.

For most of the organizations, it will be an opportunity for autonomy and self-directed agency. For the money to be spent on efforts to eradicate HIV, there is need to include self assessment. Researchers in Uganda who have sent over 20 years working with KP designed a 6W1H model (What, Who, Where, Why, When, Which & How).

This allows organizations to conduct readiness examination into how effectively they could operationalize or implement HIV Prevention services. 

The aim of this report is to link research into KP Programmatic interventions to quality health and evidence-based goals. With this model, KP-led organizations will devise and own ways to make HIV Prevention roll out to meet UNAIDS 2030 Goals.

An effective plan must maximize opportunities to meet UNAIDS 2030 Goals. This is possible when organizations go through participatory reflexive/deflective roles with the aim of creating optimizing activities for PEPFAR/KPIF funds to be spent on the outcome strategies:

Treatment 

  • As far as TB/Malaria/Hepatitis/HIV what latest information, Education, Communication (IEC) does my organization have? What does my Social Activities Map (SAM) show as a strategy to serve my catchment area so well? Who exactly are we linking to care and other social services? Who do we meet as far as social services go? Who among us is the liaison with the social services Providers? Where do we refer our beneficiaries? Where do our beneficiaries reside? Why do we spend time, money and resources eradicating TB/Malaria/Hepatitis/HIV? Which areas do we need to invest more time, money and resources? How can we connect with other organizations as part of referral and networking?

Prevention

  • There is Primary, Secondary and tertiary Prevention. CBOs are more concerned with Primary Prevention. As far as TB/Malaria/Hepatitis/HIV is concerned, what latest prevention information, Education, Communication (IEC) does my organization have? What does my Social Activities Map (SAM) show as a Prevention strategy to serve my catchment area so well? Who exactly are we linking to Prevention Services as well as other social services? Who do we meet as far as Prevention social services go? Who among us is the liaison with the social services Providers? Where do we refer our beneficiaries? Where do our beneficiaries reside? Why do we spend time, money and resources eradicating TB/Malaria/Hepatitis/HIV? Which areas do we need to invest more time, money and resources? How can we connect with other organizations as part of referral and networking?

Palliative care

  • Palliative care interventions are the kind where an organization set aside time, resources and money to engage in activities that relieve symptoms and stress among beneficiaries living with long-term debilitating illnesses. What latest information, Education, Communication (IEC) on Palliative Care does my organization have? What does my Social Activities Map (SAM) show as a strategy to serve my catchment area so well? Who exactly are we linking to care and other social services? Who do we meet as far as social services go? Who among us is the liaison with the social services Providers? Where do we refer our beneficiaries? Where do our beneficiaries reside? Why do we spend time, money and resources on Palliative Care necessary for TB/Malaria/Hepatitis/HIV eradication? Which areas do we need to invest more time, money and resources? How can we connect with other organizations as part of referral and networking?

Abstinence-until-marriage programmes

  • As far as abstinence goes, what latest information, Education, Communication (IEC) does my organization have? What does my Social Activities Map (SAM) show as a strategy to serve my catchment area so well? Who exactly are we linking to care and other social services? Who do we meet as far as social services go? Who among us is the liaison with the social services Providers? Where do we refer our beneficiaries? Where do our beneficiaries reside? Why do we spend time, money and resources eradicating in linking abstinence to TB/Malaria/Hepatitis/HIV? Which areas do we need to invest more time, money and resources? How can we connect with other organizations as part of referral and networking?

OVC/Youth-Headed Households below 18 years

  • This area requires working with Ministry of Gender, Development & Social Development, Religious Organizations and other support CSOs. What latest information, Education, Communication (IEC) does my organization have on social development issues and concerns? What does my Social Activities Map (SAM) show as a strategy to serve my catchment area so well? Who exactly are we linking to care and other social services? Who do we meet as far as social services go? Who among us is the liaison with the social services Providers? Where do we refer our beneficiaries? Where do our beneficiaries reside? Why do we spend time, money and resources linking social issues to eradicating TB/Malaria/Hepatitis/HIV? Which areas do we need to invest more time, money and resources? How can we connect with other organizations as part of referral and networking?

Delay of sexual debut

  • This is a behavioural aspect very much connected to vulnerability and susceptibility chain (VASC) risks to HIV/Hepatitis/TB/Malaria. What latest information, Education, Communication (IEC) does my organization have? What does my Social Activities Map (SAM) show as a strategy to serve my catchment area so well? Who exactly are we linking to care and other social services? Who do we meet as far as social services go? Who among us is the liaison with the social services Providers? Where do we refer our beneficiaries? Where do our beneficiaries reside? Why do we spend time, money and resources linking delaying sexual debut to eradicating TB/Malaria/Hepatitis/HIV? Which areas do we need to invest more time, money and resources? How can we connect with other organizations as part of referral and networking?

Monogamy

  • This is a behavioural aspect also known as Zero-grazing. It is encouraged because it is thought having one sexual partner  lowers risk to acquiring or transmitting infections. What latest information, Education, Communication (IEC) does my organization have on monogamy? What does my Social Activities Map (SAM) show as far as a monogamy strategy goes to serve my catchment area so well? Who exactly are we linking to care and other social services? Who do we meet as far as social services go? Who among us is the liaison with the social services Providers? Where do we refer our beneficiaries? Where do our beneficiaries reside? Why do we spend time, money and resources linking monogamy to eradicating TB/Malaria/Hepatitis/HIV? Which areas do we need to invest more time, money and resources? How can we connect with other organizations as part of referral and networking?

Fidelity

  • This is a behavioural aspect in which commitments and agreements are made. It is known to highlight partner support practices (PSP) such as attending life preserving sessions with a partner. When partners attend education sessions together it builds bonding and  focus to achieve goals. What latest information, Education, Communication (IEC) does my organization have on fidelity? What does my Social Activities Map (SAM) show as far as a fidelity strategy goes to serve my catchment area so well? Who exactly are we linking to care and other social services? Who do we meet as far as social services go? Who among us is the liaison with the social services Providers? Where do we refer our beneficiaries? Where do our beneficiaries reside? Why do we spend time, money and resources linking fidelity to eradicating TB/Malaria/Hepatitis/HIV? Which areas do we need to invest more time, money and resources? How can we connect with other organizations as part of referral and networking?

Counselling geared at increasing events where sex with partner is with any kind of HIV prevention method (that is with a condom, PrEP or an undetectable viral load)

  • This is a milestone prevention skills development opportunity that involves committing to  life promoting or prevention activities. It is known as Prehensile Prevention Prophylactics Affirmation (PPPA). It is encouraged because use of prevention lowers risk to acquiring or transmitting infections. What latest information, Education, Communication (IEC) does my organization have on Prevention methods ? What does my Social Activities Map (SAM) show as far as Prevention methods strategy goes in order to serve my catchment area so well? Who exactly are we linking to Prevention methods counseling and other social services? Who do we meet as far as social services go? Who among us is the liaison with the social services Providers? Where do we refer our beneficiaries? Where do our beneficiaries reside? Why do we spend time, money and resources linking Prevention methods to eradicating TB/Malaria/Hepatitis/HIV? Which areas do we need to invest more time, money and resources? How can we connect with other organizations as part of referral and networking?

Partner reduction activities in any host country with a generalized (high prevalence) epidemic

  • This involves avoiding toxic and precarious practices as well as deliberately reducing sexual partners. It is also best practice to familiarize yourself with country-based guidelines on how to address high prevalence. Such guidance is available from MoH and Development Partners. What latest information, Education, Communication (IEC) does my organization have on prevalence? What does my organization do to access guideline in order to serve my catchment area so well? Who exactly are we linking with? Where do we get our resources? Why do we spend time, money and resources linking resources to eradicating TB/Malaria/Hepatitis/HIV? Which areas do we need to invest more time, money and resources? How can we connect with other organizations as part of referral and networking?


There are over 107 KP organizations scattered in all over Uganda. 44 (and counting) of these also defined as sexual minorities and are registered with the Uganda KP Consortium. 

A rapid appraisal of HIV Prevention Strategies of 23 of these between 2017-2020 shows the following:

  1. 14/23 of these have positioned themselves strategically for HIV Prevention but their capacity lies in the following areas: Humans Rights/Litigation Advocacy; Condom and Lubricant sourcing and distribution
  2. 2/23 had conducted internal 3-5 internal meetings or short trainings for staff and during the events tasked the staff to give out Condoms and Lubricant consumables. 
  3. 35/44 are Kampala-based KP-led organizations, which means they are overlapping in the catchment zone. Two (2) were Kampala-based but had outreach stations 100 miles out of Kampala City. Outreaches are a good way to put HIV Prevention facilitation to good use. There is need for deciding on zoning here.

PEPFAR And Global Fund, A History:

The U.S. is the single largest donor to the Global Fund. Congressional appropriations to the Global Fund totaled $16.6 billion from FY 2001 through FY 2018. The Global Fund provides another mechanism for U.S. support by funding programs developed by recipient countries, reaching a broader range of countries, and supporting TB, malaria, and health systems strengthening (HSS) programs in addition to (and beyond their linkage with) HIV. To date, over 150 countries have received Global Fund grants; 53% of Global Fund support has been committed to HIV and HIV/TB programs, 29% to malaria, 16% to TB, and 2% to other health issues. The original authorization of PEPFAR, and subsequent reauthorizations, included a limit on annual U.S. contributions to the Global Fund that prevented them from causing cumulative U.S. contributions to exceed 33% of the Global Fund’s total contributions; this requirement is in effect through FY 2023.



Aligning  And Stepping Up The HIV Prevention By KP:

It is clear that KP-led organizations need to be supported in realistic HIV Prevention programming and the outcome strategies below need to be mainstreamed if UNAIDS 95:95:95 goals are to be met.

  1. Treatment
  2. Prevention
  3. Palliative Care
  4. Abstinence-until-marriage programmes
  5. OVC/Youth-Headed Households below 18 years
  6. Delay of Sexual debut
  7. Monogamy
  8. Fidelity 
  9. Counselling geared at increasing events where sex with partner is with any kind of HIV prevention method (that is with a condom, PrEP or an undetectable viral load)
  10. Partner reduction activities in any host country with a generalized (high prevalence) epidemic





Sunday, July 21, 2019

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.

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.



Thursday, July 18, 2019

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.





Anal Sex Debut And Subsequent Disinhibition Characteristics Among Sexually Active Kampala-based Straight Males, 2000-2019: A KAPBs Analysis Informing HIV Prevention in Uganda (Kampala’s Down Lo!)


Background:

Most studies into Vulnerability and susceptibility chain (VASC) to HIV among Ugandan males, look into personality, biological and environmental factors around Prevention. It is default to assume that Ugandan sexually active males are inhibited from engaging in forms of sexual intercourse, other than heterosexual penile-vaginal kind. Yet, there are sexually active Straight males in Kampala who are disinhibited from engaging in insertive (Top) or receptive (Bottom) anal sex with other males or females. This practice exists but is less talked about. Heterosexual hegemony in Uganda further entrenched through patriarchal constructs makes sure this is so. The structures range from publicly displayed male-female gender dominant cultures, traditions, definitions, roles  and political-legal codes that valorize as well make heterosexuality the expectation and default. This study seeks to use analytical conception of the process of anal sex debut (ex ante and ex post) among Kampala males and its implications for HIV Prevention. The aim is to identify the intrinsic subjective characters supporting or subverting disinhibition as a process of subsequent anal sexual events. This will add structural constructs to other studies looking into vulnerability to HIV and STIs.

In Uganda practices outside the parameters of Hegemonic heterosexuality are criminalized. Sexual activity is permissible only during marriage, the intrinsic mating MO is as follows: style is man on top of woman; typology is penile-vaginal sex; negotiation is that mostly males make advances; consent is expected and taken for granted in marriage among cohabiting partners. This has vicarious consequences for HIV Prevention where messaging is crafted around this normativity. This study has multiple implications for HIV Prevention in Uganda, by shining a light on other forms of sexual activity and highlighting the substantive characteristics subverting or supporting disinhibition for anal sexual events.

Methodology: 

A mixed methods study (Interviews, anecdotal and desk report reviews) of 230 males aged 19 years to 45 years followed from 2000-2019. It linked Knowledge, Attitudes, Practices And behavioural themes. These were analysed qualitatively. The 230 MSM were were identified through 15 local receptive bottoms (Snowballing). Out of 230, only 115 Kampala male respondents were identified as eligible for the study. Literature review of 50 journal articles published between 2000-2019 was done to synthesize trends that inform HIV Prevention policy.

Eligibility was based on age; maintained contacts since 2000; all had used locations in Kampala for anal sexual intercourse events; maintained loosely networked membership in a group of more than 3 males with whom they shared anal sex experiences and were assured of confidentiality; had anal sex in the previous 3 months; had sexual events for more than 2 years after their first anal sex-debut; and willingly participated in this exploratory exercise. 

Findings-General (Subjective Typology/Characteristics):

All respondents reported proximity, frequent interactions, availability of sexually active and consenting males strengthened bonding and made it possible for planned, regular anal sex events.

Conclusion:

Straight Males in Kampala who have sex with other males are not necessarily identifying as Gay. They are barely mentioned in mainstream narratives on Homosexuality /Same Sex Sexuality, yet they are key actors. This makes them largely invisible and most vulnerable, because HIV response cannot target invisible populations. Clearly defining the disinhibiting  parameters of anal sex, stressing the likelihood of it being an HIV/STI transmission route, providing prevention prophylactics and Information, Education and Communication (IEC) will safeguard against HIV. The precise numbers of Straight males disinhibited from having anal sex are unknown and further examination of this less undocumented population group disaggregated by nationality, social and economic factors is needed.

*Study still developing



Ugandan-born American HIV Activist launches Kampala Sexuality Journal

Ugandan-born American HIV Activist launches Kampala Sexuality Journal. 

In the journal both peer and non peer reviewed articles on sexuality, orientation, gender, health and development will appear. 

They will be sourced from across the world.

Anyone is welcome to contribute articles.

Contact: Editor
ttom8731@gmail.com
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Wednesday, July 17, 2019

The Link Between Violence Against Women and Children And Quality of RMNCAH Outcomes In 8 African Countries


Background: Effective and quality RMNCAH outcomes are linked to reduced risk to violence. This study explored negative stereotypes of hegemonic masculinity and the social structures linked to it. An exploration of 8 Sub-Saharan African countries found 3 country-specific definitive social structures impacting the stereotypes, i.e., Enabling; Restrictive; and Hindering structures.

Methods: A meta-analysis of data from 2015-2019 of relationship between violence against women and children, is reflected in: Trauma Informed Care (TIC); comprehensive RMNCAH strategies such as IMNI, A/PNC, KMC, perinatal death review, and/or integrated maternal and perinatal death surveillance and response (MPDSR) processes; enforcement of legal gender equality; religious and traditional support for respect and dignity of women; uptake of gender-specific prevention services; Domestic Violence (DV) reports and HIV Prevention. 170 articles and reports were identified but 80 met inclusion criteria.

Results: Stereotypes of hegemonic masculinity exist in all 8 countries studied. Politics, religion and tradition influence risk reduction, e.g., enforcement of legal gender equality, political commitment and accountable judiciary ensure women can report abuses. Male dominance beliefs; traditions e.g. precarious toxic masculinity, indifference to expectant mother health by males, stigmatization of frequent clinic visits; and gender of breadwinner are linked to violence-related risks. Compared to all 8 countries, Rwanda, Ethiopia and Kenya have a hindering structure promoting significant risk reduction with institutions fostering increased rule of law, political commitment to RMNCAH outcomes, enforcement and risk-reduction consciousness. Uganda and Tanzania have a restrictive structure characterised with legal loopholes, irregular enforcement and ambivalent political commitment to address acts of violence against women and children. In Senegal, South Africa and Nigeria political, religious and traditional factors blatantly backing traditional negative stereotypes of hegemonic masculinity foster violence enabling structures entrenching repressive acts and hate crimes against women and children. In all countries however, Delivery room reception; level of Health Information Management skills; HIV criminalization; affinity and sensitivity to quality health by all people; stigma around attending clinics by males; negotiating for safer sex by women which is circumscribed as a threat to male dominance, subvert or support optimal RMNCAH goals.

Conclusions: Justice dispensation, economic autonomy, religion and traditional backing contribute effectively to risk-reduction. Contexts hindering violence prevail where state-led commitment thrives and these have far reaching benefits e.g., more people benefit from RMNCAH outcomes. Effective and quality RMNCAH programming in the countries studied will be effective if it is designed to address hegemonic masculinity practices too. Mortality implementation audits need to be disaggregated to reflect causes of and contributing factors to deaths.

The Link Between Violence Against Women and Quality of HIV Programming in 8 African Countries


Background: Effective and quality HIV programming is linked to reduced risk to violence. This study explored negative stereotypes of hegemonic masculinity and the social structures linked to it. An exploration of 8 Sub-Saharan African countries found 3 country-specific definitive social structures impacting the stereotypes, i.e., Enabling; Restrictive; and Hindering structures.


Methods: A meta-analysis of data from 2013-2017 of relationship between violence and comprehensive combination HIV prevention strategies, political commitment, rule of law, enforcement of legal gender equality, religious and traditional support for respect and dignity of women, uptake of gender-specific prevention services, Domestic Violence (DV) reports and HIV trends. 175 articles were identified and 80 met inclusion criteria.


Results: Stereotypes of hegemonic masculinity exist in all 8 countries studied. Politics, religion and tradition influence risk reduction, e.g., enforcement of legal gender equality, political commitment and accountable judiciary ensure women can report abuses. Male dominance beliefs; traditions e.g. precarious toxic masculinity, forced marriage, genital cutting; and gender of breadwinner are linked to violence-related risks. Compared to all 8 countries, Rwanda, Ethiopia and Kenya have a hindering structure promoting significant risk reduction with institutions fostering increased rule of law, political commitment, enforcement and risk-reduction consciousness. However, HIV criminalization and stigma subvert risk-reduction goals. Uganda and Tanzania have a restrictive structure characterised with legal loopholes, irregular enforcement and ambivalent political commitment to address acts of violence against women. In Senegal, South Africa and Nigeria political, religious and traditional factors blatantly backing traditional negative stereotypes of hegemonic masculinity foster violence enabling structures entrenching repressive acts and hate crimes against women. Clinical trials and male medical circumcision (MMC) in the 8 countries are poorly received. Negotiating for safer sex by women is circumscribed as a threat to male dominance.


Conclusions: Justice dispensation, economic autonomy, religion and traditional backing contribute effectively to risk-reduction. Contexts hindering violence prevail where state-led commitment thrives and these have far reaching benefits e.g., more people engage in clinical trials, TB prevention, Hepatitis screening and immunization. Political and legal commitment are key in violence risk reduction. Effective and quality HIV programming in the countries studied is possible if it is designed to address hegemonic masculinity practices too.