Let Us Talk About PrEP And Being Transgender in Uganda: Implications For HIV Prevention

MARPS in Uganda and Masaka KP HIV Awareness & Prevention Support Organisation ( MAHIPSO) have collaborated to provide Information, Education, Communication (IEC) on Transgender Persons’ quality health best practices. 

We have heard of Transgender who are living with HIV. But, beyond that what else do we hear? Have you ever wondered where such a conversation would lead?

An analysis by the Centers for Diseases Control and Prevention (CDC) of PrEP prescriptions between suggests PrEP is being disproportionately prescribed to Transgender persons being the most affected by HIV across all key populations (KP). This scenario can be transferred to Uganda as well.

When analysed for across KP types, Transgender are the most under represented as far as reporting on ARV uptake in Uganda, despite their being the most vulnerable to HIV. 

Most Transgender who are out are between 17-35 years. Generally, there are less PrEP users aged between 18 and 44, suggesting younger people from key populations are not accessing PrEP. Yet young people (aged 13-24) account for a bigger percentage of new HIV infections in Uganda.

It is not known among the Transgender using antiretrovirals for treatment rather than prevention purposes, in addition to those defined as post-exposure prophylaxis users. 

LGBTIQ+ related data need to be made available to analyze PrEP users, address low proportion of Transgender persons being offered PrEP. 

The overall gap between those in need of PrEP and those to whom it is being prescribed, suggests significant barriers to PrEP access exist. 

These barriers need to be better understood and addressed for PrEP to become truly effective as a tool for preventing HIV.

Source: Avert

Stigma-Free Health Services In Greater Masaka Area

As far as HIV Prevention, stigma has its repercussions:

1. Beginning with deterring full participation in health seeking by those who fear being stigmatized

2. Demotivates health providers in providing quality, full unconditional and confidential services to clients

3. Increases vulnerability to stigma itself and other forms of abuse

4. Fuels further denial of services 

5. May lead to below optimum ARV adherence and no suppression of virus

MAHIPSO In Position To Make HIV Testing Popular in Greater Masaka

We want to benefit from the UNAIDS 95:95:95 Goal. We want to contribute to the number of people living with HIV who are aware of their status; diagnosed people on sustained treatment; and those on treatment to attain viral suppression. 

We target Key Populations as a demography with higher HIV burden that general population. According to recent studies categories of KPs accounted for 18% of new HIV infections in Uganda in a 2015/16 Survey.  In another study, another KP demography had 36% reporting regularly having unprotected anal sex, 38% selling sex, 54% having multiple steady partners, 64% having multiple casual partners, and 32% using some of intoxication and drugs. 

These are the social and economical factors around which HIV interventions must revolve for our beneficiaries to shift from being a sink from which HIV draws into the general population. With support from funders and other Districts, we shall be able to create enduring infrastructure which will translate as stigma and discrimination busters. We identified bias, stigma and discrimination against the Key Populations we serve as a major barrier to HIV Services access. 

We propose a unique approach with entails intimate immersion on one hand and driving demand for HIV Testing Services on the other in areas we serve. GMA is known for hotspots and we identified roadside towns with low cost housing, destination stops such as islands and urban centres and education institutions. We have what we call the first 12 in 12 weeks, where we go out to 12 venues conduct HIV Testing Services for 12 weeks and then use that as a model to roll out for the next 40 weeks. The first 12 venues: Masaka, Nnyendo, Bukomansimbi, Kalungu, Lyantonde, Kyazanga, Kalangala, Lukaya, Mukoko, Ssembabule, Kalisizo and  Kyabakuza. 

At the leadership level, we shall be involved with cultural, technical and political leaders. We shall ensure: leadership buy-in; safe space to conduct services for our beneficiaries; identify and train local focal persons in peer education and resilience on how to sustain rapport with leaders so that there is no interruption of HIV services including: Testing; PrEP, PEP, ARV-Adherence and care continuum, U=U best practices; IEC informing decisions for staying negative or for PrEP, PEP and ARV uptake; prophylactics for protection to break transmission cycle; nutrition support; housing and livelihood support. In this project, it is planned that much effort will be focused on increasing HIV testing and case identification among key population, promoting linkage to treatment for those with positive diagnosis and other package of interventions.

Greater Masaka Regional Parent and Community Leaders’ Development Public Dialogues (PACOD) 2019-2021

Greater Masaka Regional Parent and Community Leaders’ Development Public Dialogues

 (PACOD) 2019-2021

MASAKA KP HIV Prevention & Support Organization (MAHIPSO) 

Background and History

We started our work as a mobilization entity. We have worked together with Kampala City-based organizations as the mobilizers for different interventions ranging from circumcision;  voter education; immunization; and other services. In 2015, we mobilized young persons to access HIV testing and engage in World AIDS Day; we mobilized 50 young males to attend Safe Male Medical  Circumcision sessions; 100 girls to attend to hepatitis immunization. In 2016, we were part of the South Uganda region wide mobilization of communities to engage in immunization drives; with time we have identified vulnerable transgender persons with whom we have been involved more than any other category. We have experienced a lack of prevention commodities in Greater Masaka Region; a lack of Information, education and communication materials on Life Planning Skills, young persons specific HIV Care and Prevention information or services. We are now writing this proposal to enable us establish a young persons friendly Resource Center and engage community leaders in dialogue sessions to accept their Transgender children. This followed a spate of home evictions, disowning, abandonment, assault, imprisonment and brutality.

Vision:

Using secular, spiritual and  religious freedom to mobilize, promote expression and quality life for young persons. 

Mission:

Establish Greater Masaka Regional young persons friendly Resource Center to address a paucity of Sex-young persons-related services in Greater Masaka Region which serves South Uganda.

Theme: Parent and Community Leaders’ Development Public Dialogues (PACOD)

Increased social inclusion: Uganda has increased tightening the Public Order Management Act (POMA). So, all forms of social meetings must be registered, notified and given permission. We use music, dance, drama and gardening to meet our members.  We hope to increase reach out social events to provide meeting or get together opportunities for young persons in Greater Masaka Area three times a month.

Cascading into Core focus: Provide support for groups to meet frequently under the different music, dance, drama and gardening themes. We shall document and influence rates of acceptance; build collective voices to advocate for inclusion; and build and coordinate long-term strategies to strengthen inclusion for transgender and sex workers. The following are our strategies:

Advocacy: Increase coverage using social media platforms by writing, talking or showcasing information,  education and communication around life preserving practices, announce health events in the region, mobilize communities for development, build resilient viable groups and network with leaders to address discrimination and violence

Documentation: Engage in generating, disaggregating, and analyzing data on public opinion and themes directly affecting life of young persons in rural conservative Uganda districts (rates, what messaging generates change, understanding of lived realities of young persons—particularly the most marginalized); and tracking and analyzing media representation.

Training: Organize, plan and conduct outcome-based training, including for media coverage of all parents/leaders, with whom we can advocate for specific changes as well as catalyze social inclusion plans

Objective 1 Activity: Pay Rent

Activity: Rent

Activity: Manage a resource center

Activity: Provide drop-in services/space

Objective 2 Activity: Recruit and maintain support staff 

Activity: Front Office Manager and Drop-in staff

Activity: Provide Services at a friendly space

Objective 3 Activity: Office Administration 

Activity: Deal with documentation, filing and record keeping

Activity: Movement building

Activity: Engage in other administrative activities

Objective 4 Activity: Music, Dance, Drama and Gardening Practices

Activity: Rent space

Activity: Conduct practices

Activity: Gardening

Objective 5 Activity: Social Outreaches

Activity: Conduct outreaches

Activity: Transportation and logistics

Objective 6 Activity: Social Media

Activity: Documentation & Update

Activity: Internet connectivity

Activity: Conferences

Source: Google