WE NEED TO TALK ABOUT “REGGIE”: THE IMPORTANCE OF INTEGRATING LGBTQ MESSAGING WITH HIV INFORMATION

Written by Georgia Arnold, executive director and founder of the MTV Staying Alive Foundation, and executive producer of the award-winning “edutainment’ campaign, MTV Shuga.

MTV Shuga is a 360 mass media campaign that uses the power of entertainment to generate positive sexual and reproductive health outcomes amongst young people. At the core of MTV Shuga is a TV drama, which follows the lives of a group of young friends as they encounter sexual, social, and educational challenges throughout their adolescent years. Following on from two seasons in Nairobi and another two set in Lagos, the fifth season has been produced in South Africa for the very first time.

The issue of HIV and AIDS among young people is as important today as it has ever been. Every day, 1,300 adolescents around the world are infected with HIV.

In the run-up to National Youth HIV & AIDS Awareness Day on April 10, we are reminded of the need to challenge the stigma surrounding HIV and AIDS and empower young people to take charge of their sexual and reproductive health.  One of the ways we can achieve this is by breaking down the taboos surrounding adolescent sexuality.

Across many countries in the world, the idea of sexual activity among young people carries strong negative connotations. Accurate and judgement-free conversations with young people about sexual behaviors or safe sex practices are few and far between, meaning that many teenagers are uninformed and misguided when it comes to sexual health.

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Photo Credit: MTV Shuga

This is particularly true in the case of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community who, in the rare cases where information on sex and sexuality are provided, are often entirely ignored or are described as wrong.

Holding open, in-depth, and inclusive discussions about sexuality is imperative in our efforts to reduce HIV transmission and ensure that those living with HIV have access to care. Such conversations allow us to break down rigid norms attached to young people’s sexual behavior and sexual orientation.

This represents the first, and most important step, in ensuring that all young people feel able to access the necessary information and sexual health services available. After all, you can’t get information that protects you from HIV if you are afraid that your questions about your sexual behavior will be met with discrimination and disdain from your health care provider.

As part of our work on MTV Shuga, we aim to challenge harmful norms by fusing hard-hitting entertainment with important social, sexual health, and educational principles.  In our latest series set in South Africa, a new character Reggie – who is trying to understand his own sexual orientation – represents the medium through which LGBTQ messaging and HIV information can be successfully merged.

In Africa, where MTV Shuga is primarily broadcast, most countries have anti-homosexuality legislation and members of the LGBTQ community are often marginalized. Even in South Africa, where LGBTQ rights are legally enshrined, 55% of LGBTQ people live in fear of discrimination because of their sexual orientation. These data emphasize the need to talk about and create empathy for the “Reggies” of this world, but in a way that is carefully produced to maximize our potential impact.

This is a particularly complex endeavour as we broadcast in countries where LGBTQ storylines are not permissible. Although we cannot change existing laws, we can traverse state borders through our mass-media approach. Making use of digital platforms, such as YouTube, has allowed us to reach those living in places where LGBTQ stories are rarely told, and circumnavigate broadcasting regulations.

Young people face so many challenges throughout their formative years; the added burden of hidden sexual orientation has adverse implications for their health and well-being. We need to create safe spaces where all young people are free to explore who they are, including their sexual orientation, and get the information they need to live healthy and productive lives. While our approach may vary depending on the environment, the end-goal must always remain the same: to challenge harmful norms and affect a positive change in all young people’s sexual lives. Incorporating LGBTQ messaging in a sexual health context is an important way to realize this goal.


For more information on the important work being carried out in the LGBTQ community in South Africa, ANOVA and OUT represent two leading organisations in this field. These groups promote the need to incorporate HIV information with LGBTQ messaging as a means of generating positive sexual health outcomes among South Africans.

 

Commission on the Status of Women & Transgender Women

Written by Beyonce Karungi, Executive Director, Transgender Equality Uganda

The Commission on the Status of Women (CSW) is the largest international gathering of governments and civil society dedicated to developing an agenda that promotes progress for women and girls. Each year, the UN brings together women and girls from all over the world to discuss issues that affect women from all spheres of life. Despite the sense of total inclusion, transgender women and girls are often underrepresented in this crucial space. Consequently, the transgender community faces a challenge in raising and addressing the issues specific to them.

The CSW recently emphasized inclusion of transgender people in its sustainable development goals. The discussion surrounding trans inclusion was unprecedented and a major credit to the UN organizers. Hopefully, this discussion continues to provide an ongoing dialogue that will work toward the improvement of the status of all women – including trans women – around the world.

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Beyonce Karungi presenting at a sex worker panel during CSW

I was one of the few transgender women present at the latest CSW. While there, I participated in many forums including development of the UN Women’s Strategic Plan development (2018-2021) at the UN headquarters. We lobbied UN women to include the transgender community in the strategic plan by connecting us with country offices and registering us to participate not only in trans-specific events but also in the main CSW discussions that typically include all women and girls.

At CSW, I also participated in a sex worker session focused on the conditions faced by this key population. Internationally, policy discourse has shifted in many ways to defend sex work as real work. Still, efforts to criminalize clients are unaligned with what sex workers need in order to be able to thrive as workers.

I was also involved in the Lesbian Bisexual Transgender Intersex (LBTI) women’s session. LBTI women are not explicitly mentioned as a vulnerable group in many spaces. This cultural stance and attitude is in large part internalized by LBTI people, which creates a strong obstacle to self-identification. The stigma surrounding LBTI women makes them a socially invisible community within general society. The result is that, with a few exceptions, the most vocal leadership of LBTI women’s rights has traditionally been men.

CSW participants discussed many issues, including peace and security for women and human rights defenders, sexual and reproductive health and rights, maternal health, gender-based violence, and family planning. Transgender women and girls continue to be excluded from the economic, political, and social sectors, which limits their access to education, health services, and employment.

While one of the main goals of the CSW is to empower all women and girls, transgender women remain unfairly marginalized.

The CSW needs to ensure that transgender people are represented and that data collection is supported so we can begin to advance the livelihood and well-being of transgender women everywhere. It is within the power of the CSW to include all women in discussions on women’s status in the world, and doing so will increase the awareness and importance of transgender inclusion, health, and rights.

International Day to End Violence Against Sex Workers

The Global Network of Sex Work Projects (NSWP) exists to uphold the voice of sex workers globally and connect regional networks advocating for the rights of female, male, and transgender sex workers. NSWP represents 264 sex-worker-led organizations in 79 countries.

Globally, sex workers of all genders face physical, psychological, and sexual violence. Gender-based violence against sex workers has particularly acute repercussions, given that in many countries, sex workers do not have equal protection under the law and therefore are unable to seek due justice. Perpetrators of violence against sex workers are often:

  • Members of the general population (including state actors) who pose as clients in order to target sex workers
  • People who facilitate sex work and abuse their power—for example, managers, brothel keepers, receptionists, maids, drivers, landlords, and hotels keepers
  • State actors, including police and health care providers.
  • Anti-sex-work organizations that seek to “rehabilitate” sex workers and work with the police to “raid and rescue” sex workers and their children

Issues faced by sex workers vary from region to region depending on laws and social and cultural contexts. One common issue faced by all sex workers is their vulnerability to and experience of violence.

Violence against sex workers in Kenya drew international attention when Philip Onyancha confessed to murdering 17 sex workers in the town of Thika in 2010. Bar Hostess Empowerment and Support Program (BHESP) led demonstrations to highlight the violence and to demand justice. More recently, the Kenya Sex Workers Alliance drew attention to the murders of sex workers in Nakuru County, while NSWP drew attention to the mass arrest and mandatory testing of Kenyan sex worker in Kisii County in 2015.

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Key populations fight erasure during High Level Meetings on Ending AIDS in New York. Photo Credit: MSMGF

Transgender Europe (TGEU) tracks violence against transgender people in Europe. According to TGEU a majority of the transgender people murdered in Europe in 2016 were sex workers. This year, NSWP highlighted the high levels of violence faced by transgender sex workers in Turkey. NSWP called for urgent action to uphold the human rights of male, female, and transgender sex workers in their country. However, transgender sex workers in Turkey still face on-going violence with little or no protection from the law. On 12 August 2016, Hande Kader was murdered, which drew international attention to the extreme violence faced by transgender people in Turkey.

Sex workers also experience stigma and discrimination when their voices are disregarded or when they are silenced as they speak about the realities of their lives to the media, programmers, and policymakers. People often assume to know what is in the best interests of sex workers, without meaningfully consulting sex workers themselves. When sex workers are silenced or disregarded in the development of policies and programmes that directly affect their lives, it leads to policies and practices that are harmful to sex workers and is a form of violence against marginalized populations. For example, this year at the United Nations High Level Meeting on Ending AIDS, member states adopted a political declaration that did not meaningfully include key populations, including sex workers, men who have sex with men, transgender people, LGBT people, and people in prisons. NSWP wrote a joint statement documenting the devastating effects of this exclusion.

NSWP calls on those who fight gender-based violence to support the global sex workers movement on the 17 December, the International Day to End Violence Against Sex Workers.

Reducing Gender-Based Violence Against Women Who use Drugs: The Right to be Free

Written by Judy Chang, Board Member, International Network of People who use Drugs

Globally, it is estimated that one out of three women experiences gender-based violence (GBV) in her lifetime. Data on women who use drugs and their experiences of violence are scarce; this is not surprising given our status as an invisible population. As a result of criminalization, discrimination, and stigmatization, women who use drugs are disproportionately affected by violence. Women who use drugs commonly experience violence at the hands of state actors, notably the police, and when violence comes from intimate partners and the wider community, it is often perpetrated with impunity.

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Tanzanian Network of People who use Drugs. Photo by Ruth Birgin.

GBV against women who use drugs manifests as a result of a range of interrelated structural, systemic, and sociocultural drivers. Our experiences of GBV are both driven and compounded by stigma and discrimination and inequality. In 2015, the International Network of Women Who Use Drugs (INWUD), along with Women and Harm Reduction International Network, released a statement for the International Day for the Elimination of Violence against Women. The statement included a number of testimonials from women who use drugs and have been affected by violence. One woman shared her story.

“The insidious creep of abuse of domestic violence makes it hard to speak out. But when police fail to act on a charge, it becomes a double act of injustice. The neighbours called the police to my house, after I had just gone through a window. Under questioning he [my partner] told the police officer I was a drug user. Tearful and shaken, I found the tables turned on me. Rather than pursue a clear case of domestic violence, he chose to search me for drugs. It only took those two little words of ‘drug user’ for the police officer to see me not as a victim of domestic violence, but as a woman not deserving of equal protection under the law. At a time when I felt the most broken, I had to bear the force of a broken system which treats women who use drugs as undeserving of the same rights as other women.” (INWUD Virtual Consultation, 2015)

Our current value system that embraces prohibition places an inordinate amount of focus and effort on regulating and controlling what a woman puts into her body, rather than what is being inflicted on her body, more often than not by those with more power. Driven by political ideology and moral attitudes, the damage that the war on drugs wages on women’s bodies needs a political solution. INPUD argues that community organizing, community mobilization, and solidarity building remain the most effective and protective barriers against abuses and violations. Historically, we have seen these used as political tools to make critical gains in labor rights, civil rights, liberties, and in the HIV movement.

Ruth Birgin, INPUD’s Women’s Policy Officer has been catalyzing women who use drugs in countries in Asia and across Africa. She has been working with women from national drug user networks and supporting them to come together, develop plans and strategies to meet their community-defined needs, and create mechanisms for collective support. In Indonesia, for instance, INPUD supports the activities of PKNI, the national drug user network, that contributes to broader goals of increasing understanding and awareness of violence against women who use drugs and developing elements of protection. In Tanzania, INPUD’s Women’s Policy Officer is coordinating with women from the Tanzanian Network of People who use Drugs (TANPUD), who will be running their own activities, including a public event on December 10. A women’s advocacy team comprised of TANPUD members has been formed.  They are currently developing a statement on violence against women who use drugs, which is to be presented to the Ministry of Community Development Gender and Children on the 2016 International Day for the Elimination of Violence against Women.

The upcoming years are crucial. As we prepare for increasing onslaughts on the rights of women worldwide—including sexual and reproductive health rights, the right to bodily integrity and self-determination, and the right to be free from violence and sexual assault—women who use drugs need to come together to organize and strengthen our networks and communities. This is the first, crucial step to challenging damaging political realities. Now more than ever, the status quo will no longer suffice.


Judy Chang (MIntDev) is a board member of INPUD; a consultant with Coact, which is a technical support agency specializing in HIV and drug use; and an MPhil Candidate at the National Drug Research Institute (NDRI) in Australia.

INPUD is a global peer-based organization that seeks to promote the health and defend the rights of people who use drugs. INPUD challenges stigma, discrimination, and criminalization of people who use drugs and the impact they have on the drug-using community’s health and rights. The International Network of Women Who Use Drugs is a subnetwork comprised of those who self-identify as women and who use drugs.

Comprehensive violence-response services in the Dominican Republic: A spotlight on CEPROSH

LINKAGES would like to thank the clinical staff members of CEPROSH, the police chief, and the key population members in Puerto Plata who contributed to this interview.

LINKAGES has the privilege of working with many incredible community-based organizations throughout the world that offer violence-response services to key populations. Below is an interview with The Centro de Promoción y Solidaridad Humana (CEPROSH), an HIV/AIDS awareness and prevention organization based in the northern region of the Dominican Republic. CEPROSH works to improve regional capacity to deliver quality services related to HIV and gender-based violence to key populations

1. How are key populations affected by gender-based violence in Puerto Plata? What types of violence do they most experience?

Intimate partner violence, hate crimes, and stigma and discrimination are significant issues faced by transgender people and sex workers in the Dominican Republic (DR). Transgender people also face difficulty in securing employment and are often rejected because of their gender identity or sexual orientation. Transgender people who engage in sex work also experience violence at the hands of the police. Police will often handcuff them, spit on them, and pull their hair.

Stigma and discrimination against key populations are prevalent in the DR. A patient at CEPROSH relayed her experience with transphobia, which she said humiliated her and left her in a great deal of pain:

“I got in a taxi and when the driver realized that I was trans, he stopped the car, got out, opened my door, and said, ‘Get out my car you *expletive*! I don’t allow *expletive* in my car!’ In that moment, I wanted nothing more than the ground to open up and swallow me. Everyone was looking at me, and only one onlooker showed any kind of indignation at the taxi driver. I will never forget that kind of humiliation for as long as I live.”

2. What are some of the links between violence and HIV for key populations in the Dominican Republic?

The links between violence and HIV that we see through our work at CEPROSH stem mainly from:

  • Social and family exclusion
  • Lack of knowledge among key populations about their health and human rights
  • Lack of will to seek health services
  • Poor mental health
  • Stigma and discrimination

3. What kind of services does CEPROSH offer to support key populations who have experienced violence?

We work with peer outreach workers and counselors at the clinic, and counsel key populations on their rights in an effort to empower them. We also have agreements with their supervisors at their jobs (for those who are able to work), which permit key populations to leave work in order to make their appointments at the clinic. For those who are not able to visit the clinic, we offer community-based HIV testing. Additionally, we take a comprehensive approach toward offering health services to key populations by offering the following:

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CEPROSH Peer Educators

  • Crises response services
  • Clinical services
  • Psychosocial support
  • Rapid HIV testing
  • Post-exposure prophylaxis
  • STI testing and treatment
  • Emergency contraceptive
  • Mental health services
  • Legal services
  • Support groups

 

 

 

 

 

 

4. What is something you learned during your time working with key populations who have experienced violence?

We learned that it is very difficult for someone to leave the circle of violence that entraps them. We have seen how violence can rob you of your identity, your profession, your family and friends, and your willpower. We also learned that through counselling and violence-response services, you can return a sense of confidence, strength, and self-worth to victims so that they can move forward.

5. What is a lesson that you’d like to share with other organizations that offer services to key populations who have experienced violence?

In order to help key populations who have experienced violence, you need to train organizational staff and health workers on key population service delivery. This includes helping staff to confront and address any negative biases they may have toward key populations, to dismantle any myths or negative stereotypes about key populations, and to deliver correct health information in a stigma-free environment.

6. How does CEPROSH work with other members of the community (police, doctors, religious leaders) to address gender-based violence toward key populations?

We sensitize community stakeholders through informal meetings and workshops with key populations to help them to understand the ways in which systemic violence is a violation of human rights for all people. We explain that often this violence comes from a fear of the unknown, or from people operating with misinformation about key populations. We work to reverse those preconceived notions and prejudices about key populations. We also form alliances among various community services that could work to protect the health and human rights of those most vulnerable.

7. How have the attitudes of CEPROSH staff and the community members mentioned above changed as a result of the LINKAGES project?

There have been many positive changes, but there is still work to do. Many of us recognize that before receiving gender sensitivity training from the LINKAGES project, we treated key populations with disrespect. Some of us growing up were even taught to hate them because they were different. Since the trainings, we have recognized the need to not treat key populations differently, but rather, treat them with the kindness, respect, and dignity they deserve.

The urgent need for violence response systems within HIV programming

Written by Tisha Wheeler, Senior Technical Advisor for Key Populations, U.S. Agency for International Development (USAID)

Never before have HIV prevention, care, and treatment programs for key populations been available in so many countries. Key population access to HIV services globally is expanding at a rate we can see changing monthly. However, structural barriers that key populations face persist, and violence, stigma, and discrimination continue to pose significant roadblocks to achieving meaningful progress toward an AIDS-free generation.

The wide-ranging manifestations of violence that key populations (transgender people, men who have sex with men, sex workers, and people who inject drugs) routinely face are often socially sanctioned and institutionally perpetuated. As criminalized and discriminated groups, key populations experience violence that is exacerbated by the lack of recourse available for addressing these abuses, compared to those offered to the general population. This lack of support and violence manifests in the family, among police, partners, landlords, in schools serving the children of key populations, and in many other facets of life. The violence and resultant trauma faced by key populations lead to a lack of stable housing and schooling for their children, a lack of agency in sexual negotiation, riskier sexual behavior, lower service uptake, and eventual increase in HIV incidence among key populations. It is obvious to conclude that HIV programming for key populations will continue to be incomplete and ineffective without basic violence response mechanisms at the community level.

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Bithia, a sex worker and a peer navigator of CHAMP Cameroon

For many of the key population individuals in HIV programs, addressing violence is of greater importance than HIV. If prompted, a member of the key population community will speak with deep emotion and fluency about the far-ranging violence that they and their friends face. If you ask that same person to speak about HIV testing services, it is unlikely that you will hear the same level of urgency in their voice despite their knowledge about HIV diagnosis and treatment. I recently had the opportunity to sit down with Bithia,* a sex worker, and a peer navigator of CHAMP Cameroon, about her lived realities dealing with violence and the steps she has taken to advocate for change in her community:

“There are three main types of violence, number one is police. Two, the clients and people around in the bar, and yes three, health facilities that don’t receive us well. They all see who we are and they don’t like us. They see we are dressed half naked, they know what we do. I have started to work with my friends, the other sex workers who are around where I work. We started a group called Glamour Girls. We talk about issues of violence and we find ways to help each other. We have been able to meet in the drop-in clinic, but we don’t have money for anything. Still, change is possible. We just need to plan and work together.”

In order for HIV programs to be effective, they need to be designed to address these realities. In the past five years, the international donor community has made significant strides to work toward this. Recognizing the importance of key population programs both to control the HIV epidemic, and to address the human rights of key populations who face violence and discrimination, PEPFAR has funded the largest scale-up of key population programming by any single donor through the LINKAGES project. The Global Fund, Robert Carr Civil Society Networks Fund, Elton John Foundation, and USAID have been recognized for their dedication to funding comprehensive HIV programming. Moving forward, the vision is that governments will build upon this momentum to further scale up key population programming beyond the levels we might have imagined just five years ago and that they will do this hand in hand with local key population civil society groups, who should drive the programming on the ground to best meet their needs.

We know that inadequate funding for global HIV programming will always be a persistent challenge. However, even in the face of resource constraints, we must reframe the conversation to focus on how to prioritize funding to address stigma, discrimination, and violence in key population programs and institutionalize those approaches in national program planning. For example, the Kenya national program under the leadership of Dr. Martin Sirengo has included violence as an indicator in its national key population HIV dashboard, and PEPFAR has included a budget line item for violence programming in their HIV expenditures. More countries need to follow this example.

To support national programs, PEPFAR also needs to go further to invest in policy change, to bring new funding opportunities, and to work on creating country budgets for key population programs that include violence. By taking these important steps, we can gain a better understanding of how to scale up violence response work through key-population-led approaches and create the changes needed to fast-track the end of the epidemic.


*The author and the LINKAGES project would like to thank Bithia and the staff at CHAMP Cameroon for their contributions to this post.