Violence Against Women and Children And Affects Quality of RMNCAH Outcomes: Analysis of reports from 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  country-specific definitive social structures impacting the stereotypes, i.e., Enabling; Restrictive; and Hindering structures.

According to MoH Guidelines on Maternal Nutrition in Uganda (2010), this includes all processes ensuring safer, optimal birth outcomes, maternal wellbeing, nutrition and autonomy for women to have opportunities for self care. Maternal malnutrition, sets in place an intergenerational cycle of maternal nutrition. Which in turn affects pregnancy, lactation, undernourishment in utero, low birth weight babies, stunted growth and adolescent pregnancies. 

 Violence as related to maternal health and nutrition here is all those actions that tend to discriminate against women’s maternal health and nutrition needs. They subsume women and elevate male needs. AT household level these come in the form of: aggression or such actions that are used to deliberately  deny a women or children access to resources that are life promoting, agency, set preservation and autonomy. According to WHO (2002), violence is “the intentional use of force or power, threatened or actual, against oneself, another person, or against a group or community that either results in, or has a higher likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation.”

Whether men seek consent before sexual intercourse; whether men are conscious of the notion of age of consent; precarious toxic masculinity practices and notion of transgression such as: gender role transgression, perceiving safer sex initiated by women as threats, tendencies for aggression to portray/power posturing, blocking or denying women access to resources (toxic custodianship) and silencing women by shaming feminine voicing ( toxic censorship).  According to Dr Olaro Charles, the Director Clinical and Community Services, “Women who give birth before age 20 are at greatest risk of fistula. Poor nutrition during a girl’s childhood can also cause stunted growth and increase her risk for fistula.”

One of the findings in a study by Kaye (2006) titled “Domestic violence as risk factor for unwanted pregnancy and induced abortion in Mulago Hospital, Kampala, Uganda,” was that pregnancy intentions have many causes: One is to pacify and aggressive male partner who may demand a child (virility) or for the woman to prove her fertility (fecundity). In other words, pregnancy intentions have social pressure causes too, on top of others.

 - d’Oliveira et al (2002) in a study titled “Violence against women in health-care institutions: an emerging problem,” argue that Maternal morbidity and mortality in childbirth also stems from violence committed by health workers in childbearing or abortion services, which affects health-service access, compliance, quality, and effectiveness.

 - The unavailability of formal recording and reporting tools that capture assault women face from their partners in domestic settings make it harder to generate accurate cross cultural estimates of wife assault because only a few countries have attempted a nationwide accounting. But the data that do exist give cause for concern according to Heise of cisas.org. 

 -Enlisting and emancipating women to report violence against them is one way violence will be checked. Whether or not women will participate fully is another matter. There is fear that if they voice, then they will exit their homes, which therefore means they prefer to take up silence and suffering. This has implications. According to (WHO 2013) report titled ‘Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence,’ “Violence against women has consequences to women’s physical, mental and reproductive health. What is new is the growing recognition that acts of violence against women, violates the rights of women and girls, limits their participation in society, and damages their health and well-being. It is a global public health problem that affects approximately one third of women globally.”

Methods: Meta-analysis of data from 2000-2019 of relationship between violence against women and children, is reflected in reports generated during: 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; catalyze the well woman agency; 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.

 These are precarious male identity and masculinity tendencies that are aggressive, abusive, silence the voice of women and children, use sexual, gender roles to posture and portray power. They are characterized as influencing sexual, gender, agency, autonomy roles. Through sexual roles, males expect and assume they are entitled to sexual intercourse at their will even if it meant without any form of protection. A precarious gender role situates the woman as the submissive kind who should not transgress that expectation. Gender transgression is construed as a threat to male identity and power. By precarious agency is meant that it is only males who are supposed to think on behalf of the family. If women demand things beyond what the male provides, this depicts him as a failed provider. A failed complex means that the man is inadequate and therefore feels threatened. Precarious autonomy, means that it is the males who are independent, get the prestige, respect, recognition and praise for all that is good and not the woman. The woman is dependent and so are all the children. This has implications on age of first sexual debut, how the woman’s input is sought when it does to planning the size of family, money and time set aside for maternal nutrition and self care. Power is derived from authority, economic, social, cultural and leadership positions.

According to the UNICEF’s Maternal And Health Disparities Uganda (2017), these negative and toxic male stereotypes contribute to higher numbers of adolescent pregnancies, higher Maternal Mortality Ratio and Neonatal mortality Rate (NMR).

According to MoH Guidelines on Maternal Nutrition in Uganda (2010), these included: preconception, pregnancy stage, lactation stage and recognising partner affinity to provide safe and optimal birth outcomes. The list included provisions such as: Folic acid; ensuring proper weight gain during pregnancy; Antenatal care; iron and folic acid supplementation; malaria and worm control to prevent anaemia; diet during pregnancy and lactation; Vitamin A Supplementation; Postnatal care and iron and folic acid supplementation; Iodine supplementation; Nutrition counselling and education; Breastfeeding and family planning; Education regarding local practices that negatively affect maternal nutrition; nutrition during emergencies.

Women emancipated and empowered to engage in safer sex negotiations, access to contraceptives, gain contraceptive-use expertise, provide peer education to other women who are contraceptive-use naive and ensure maternal health autonomy.

Conclusions: Safer and optimal birth outcomes are dependent on overarching social, political and economical dispensation. These manifest as: economic autonomy, religion and traditional backing which contribute effectively to overall risk-reduction as far as maternal nutrition and health are concerned. Contexts hindering violence prevail where state-led commitment thrives and these have far reaching benefits e.g., more people demand, access and benefit from RMNCAH outcomes. Effective and quality RMNCAH programming in the countries studied will be effective if it is designed to involve males and addresses hegemonic masculinity practices too. Mortality implementation audits need to be disaggregated to reflect causes of and contributing factors to deaths such as assault to women and lack of male involvement in practices promoting optimal birth outcomes.

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.

Adolescents Who Are Health-Seeking Emancipated Have Higher Chances Of Retention in Care

Adolescents with HIV need to be rapidly linked to specialist care to have best chances of sustaining engagement with HIV services

Early engagement with Health professionals, creates rapport, enables beneficiaries to engage in self care, empowers them with knowledge of danger signs and symptoms and it affirms decisions for life promoting practices. 

In a study by Carter ( 2016), “adolescents newly diagnosed with HIV need to be rapidly incorporated into HIV care networks to have the best chances of remaining in care in the long term, research from the United States published in the June 1st edition of the Journal of Acquired Immune Deficiency Syndromes shows.

Worryingly, only 62% of newly diagnosed adolescents were linked and engaged in care within 22 weeks of referral following their diagnosis. However, adolescents with shorter intervals between diagnosis and referral to HIV services, and then referral and linkage to care were more likely to quickly engage with care and to stay in care.

“This study demonstrates that the time interval between a newly diagnosed adolescent’s HIV test and care referral and the time interval between care referral and first medical visit (linkage to care) have concrete implications for long-term HIV care engagement,” comment the investigators. “These data have quality of care implications for HIV testing programs in that the speed with which HIV-positive youth are referred for linkage has downstream implications for engagement.”

The HIV care continuum has several stages, specifically diagnosis, referral to specialist care, linkage to care, engagement with care, starting HIV therapy and viral suppression. In the US, adolescents – people aged between 12 and 24 years – have much poorer rates of engagement in HIV care compared to adults, and consequently, only 6% of all adolescents living with HIV have an undetectable viral load compared to approximately a third of adults.

Investigators wanted to see if longer time between HIV diagnosis and referral and linkage to care had subsequent implications for later engagement with care for newly diagnosed adolescents.

They therefore collected data from 15 Adolescent Medicine Trials Network Clinic sites in 13 cities across the US and Puerto Rico. Each of these sites implemented the SMILE programme in 2010, which was designed to boost adolescent engagement in the HIV care continuum. SMILE used intensive case management to identify newly diagnosed adolescents, assess individual barriers to linkage to care and achieve personalised referral to specialist care services.

For the purposes of the study, linkage to care was defined as an HIV-related medical appointment within six weeks of referral following diagnosis. Engagement in care was a second visit within 16 weeks of the initial visit.

The HIV care continuum has several stages, specifically diagnosis, referral to specialist care, linkage to care, engagement with care, starting HIV therapy and viral suppression. In the US, adolescents – people aged between 12 and 24 years – have much poorer rates of engagement in HIV care compared to adults, and consequently, only 6% of all adolescents living with HIV have an undetectable viral load compared to approximately a third of adults.

The research, suggested “that each newly diagnosed HIV-infected youth needs to be linked to care as quickly as possible to facilitate more rapid engagement in care, access to medications, and better long-term prognosis,” conclude the authors. “These data should be used to build evidence and help construct a seamless continuum of care for HIV-infected youth to help fulfill the goals outlined in the US National HIV/AIDS Strategy.” For more see this link please.

Effective HIV Programming In Any African Country Must Target Foreigners, Asylum Seekers, Refugees And Immigrants Too: Lessons From Botswana

There are lessons, African countries can draw from Botswana: immigrants or refugees to any country need to be targeted if HIV Programming were to be effective and successful.

In a study by Daniel J Escudero et al ( 2019), they found that Botswana has the highest level of HIV viral suppression globally, yet HIV incidence remains > 1% per year in adults aged 15 to 49. 

"Although causes of this continued elevated incidence have been postulated, a firm understanding remains elusive, especially in the presence of a highly successful HIV treatment programme in Botswana. 

Although Botswana provides free antiretroviral therapy (ART) for all citizens living with HIV through its national HIV programme, the first free national ART programme in sub‐Saharan Africa, non‐citizen immigrants (documented/undocumented) are currently ineligible for treatment within the national programme. Documented refugees living with HIV in camps do have free access to ART as long as they remain within the confines of the camp. Private HIV treatment is available, but remains prohibitively expensive for many non‐citizens. In addition to gaps in treatment coverage among men and young people, the lack of free treatment for non‐citizens may contribute to elevated HIV incidence in Botswana, as suggested by research in other settings. There is precedent for providing government‐sponsored HIV treatment to non‐citizens in Botswana. In 2014, a court ruling found that denying non‐citizens in prison access to ART violated their right to receive basic health services, as guaranteed by the Botswana Constitution. 

They concluded by asserting that “substantial research is needed to inform potential expansions in non‐citizen testing and treatment coverage. Data may be needed prior to significant policy changes since Botswana already self‐funds at least two‐thirds of its HIV response, and further strain on the country's programme capacity may be detrimental without increased donor input. This research should be nationally‐representative and address the extent of disease burden in the migrant population, and the population‐level benefits of viral suppression in vulnerable migrants. Policy decisions should also consider how to ensure undocumented non‐citizens may share in the benefit of treatment expansion. Preliminary review of these three important questions confirms that the HIV epidemic in this vulnerable population remains largely hidden, and its impact on the overall HIV epidemic in Botswana cannot be known without further study. Furthermore, the impact that expanded coverage may have on overall HIV incidence will require even further investigation into long‐term HIV treatment outcomes and antiretroviral resistance among immigrants, as well as patterns of sexual mixing between migrant and citizen communities.”

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."

Key Populations (KP) Provided With Information On Ebola Prepares Them To Be More Vigilant

The Ministry of Health (MoH) has put in place measures to manage Ebola into the country. This done with the help and support from Development Partners. The Government of Uganda, determines whether an event constitutes a public health emergency of international concern (PHEIC).

It set up the National Ebola Preparedness and Response Contingency Plan, which combats the spread should there be a case. It has also put the health workers in various facilities on high alert to be watchful of various patients taken ill. These are called Ebola Treatment Units (ETU). That part of a team that scours the country in case of emergency is called the Ebola Rapid Response Team (RRTs). For more, please follow this link.

On top of physical structures, the MoH sends out regular notices and has a hotline operated by an Emergency Operations Centre.

The public is argued to remain vigilant and report any suspected cases of persons presenting symptoms and with a history of recent travel to affected countries, to the nearest health facility or Health’s Emergency Operations Centre .

The numbers to call/ hotlines:

 +256732353535/

+256729471414

Ebola is highly infectious and kills very quickly

When the disease breaks out , it is called Ebola Virus Disease (EVD)

Shaking hands with a person who is infected with Ebola transmits the disease

During an Ebola outbreak, avoid bush-meat, as it can affect you with Ebola

The signs and symptoms for Ebola are: fever, headache, muscle pain, vomiting, body weakness, bloody diarrhoea, bloody urine, sore throat, bleeding from body openings

Prevent Ebola by regular hand wash with soap and water; keep latrines, shutters and environ clean; regularly wash all utensils and clothes

A person gets Ebola by coming in direct contact with: body fluids of a person who has Ebola, a person who has died of Ebola, infected blood, vomit, urine, feaces, sweat, saliva

A person gets Ebola by coming in direct contact with: objects or materials contaminated with virus such as needle and medical equipment

A person gets Ebola by coming in direct contact with: with infected primates and bats

A person gets Ebola by coming in direct contact with: semen, saliva, mucous during sexual intercourse ( anal, vaginal and oral) from a person who has had Ebola or recovering from Ebola and has not yet been followed up to prove the person is Ebola-free

Ebola spreads through: touching a person who has died of Ebola; touching the clothes of a person with Ebola; lifting a person who has Ebola without proper protection; having sexual intercourse with a person infected with Ebola; touching the person infected with Ebola.

As key Populations are empowered to take lead in the HIV eradication, it is imperative that they are aware of the contexts within which they are working. Ebola is one such infection anyone who comes in contact with bed-ridden persons should watch out for by knowing symptoms and having their ear to the ground.