Everyone deserves to live free from violence: Assessing a model to increase access to holistic GBV-response services in Puerto Plata, Dominican Republic

Written by Robyn Dayton, Technical Advisor, LINKAGES, and Aubrey Weber, Technical Officer, Research Utilization, FHI 360


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Informational GBV materials are placed in the District Attorney’s office in Puerto Plata.

LINKAGES is partnering with the Center for the Promotion of Human Solidarity (CEPROSH), a local community-based organization (CBO), in the Dominican Republic to increase access to holistic post-gender-based violence (GBV) care, including HIV services, for members of key populations (KPs) – men who have sex with men (MSM), sex workers (SWs), and transgender women. Programs designed to decrease HIV incidence and improve the outcomes of people living with HIV (PLHIV), particularly those for KPs, must address GBV to be effective. For example, a recent study demonstrated that transgender sex workers in Santo Domingo are less likely to use condoms if they have experienced violence, thereby increasing their HIV risk. Studies from the Dominican Republic also demonstrate that violence from a sexual partner is associated with poor HIV treatment outcomes among female SWs. Evidence of the link between HIV prevalence rates and experiences of violence can also be seen among the general population – adult women in the Dominican Republic who have experienced violence are three times as likely to be living with HIV, and women in the Dominican Republic who are living with HIV are more likely to experience violence from their partners.

Given the low uptake of post-GBV care in the Dominican Republic, especially among members of KPs, and the missed opportunities to link victims of violence to services – particularly HIV services – the USAID– and PEPFAR– supported LINKAGES project, in partnership with CEPROSH, undertook an intervention in Puerto Plata, Dominican Republic to increase (1) availability of KP-friendly post-GBV services, (2) service integration for all victims of violence, and (3) post-GBV service-seeking among members of KPs. As part of the intervention, CEPROSH led the formation of a technical working group (TWG) of institutions that offer services to victims of violence, including the police, the public hospital, all local clinics for PLHIV, the district attorney’s office, and the Ministry of Women. The members of the TWG committed their institutions to providing KP-friendly services and CEPROSH trained staff from each institution. CEPROSH also led the development of materials that help identify violence, describe KP members’ rights, and list available services. These materials and outreach events were used to indicate which institutions are KP-friendly and raise awareness about and identify victims of violence. The goal of the intervention was to increase post-GBV service uptake, improving outcomes for victims of violence, including those related to HIV.

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Community leaders share the violence prevention and response services available to KPs.

To determine the impact of efforts to date, LINKAGES interviewed service providers and clients who received post-GBV care in Puerto Plata and reviewed CEPROSH programmatic data from November 2016 to August 2017. The assessment showed that the intervention achieved its desired short-term and intermediate results, demonstrating that a civil-society-led initiative can strengthen both public and private post-GBV services, make those services more inclusive, and increase their uptake by KP individuals. Pre- and post-test results from trainings demonstrate that after the trainings, attendees across sectors felt less stigma toward KPs and were less likely to blame victims for violence against them. At the same time, the intervention strengthened the overall system for violence response in Puerto Plata, with providers and clients reporting that providers across institutions now offer improved services to all victims of violence and that more members of the general population are also seeking post-GBV support. As noted by a respondent at the Ministry of Women, “Thanks to the information given by CEPROSH, the directory, and the brochure, more women are coming to get services here. Before, we might get seven girls a month. Now, we are getting six or seven daily. They have empowered themselves to come here and find assistance.”

Looking specifically at HIV services, the intervention increased access to post-exposure prophylaxis (PEP) and HIV testing, identified new HIV-positive individuals, improved antiretroviral adherence, and provided new opportunities for continuous engagement of both HIV-positive and -negative KP members. Through violence detection efforts and spontaneous disclosure, 435 people reported experiencing violence from November 2016 to August 2017. Twelve of these reports were of sexual violence in the past 72 hours, with 66 percent (8) receiving PEP. Of the 435 individuals reporting violence, 244 were members of KPs with an unknown HIV status. Forty-five percent (109) completed an HIV test as part of post-GBV care, with four new cases of HIV detected. While viral load was not specifically monitored in the assessment, doctors from HIV clinics noted that they have seen a change. One physician from the HIV clinic at the public hospital said, “Helping the clients to solve their violence situations is a direct help to their viral load, because if they are scared or suffering violence probably they won’t take their medications and their viral load will go up. We have seen in several cases, that after receiving violence response services, their adherence to the treatment has improved and therefore their viral load has declined. Their health and attitude significantly improves.”  Support groups have proven an effective way to continually engage with victims who are members of KPs. Fifty people attend the bimonthly support group meetings held at CEPROSH’s HIV clinic.

Finally, although participation in the intervention meant increased responsibilities for already overtaxed staff, service providers were enthusiastic about their new ability to address client needs and committed to offering new services. One CEPROSH staff person noted, “I have changed my way of speaking to clients and how I handle them. Before I just mentioned the issue of violence, now I’m able to help them address the issue. The attitude of the staff has changed significantly… When the activity began, some had a small notion of the GBV subject, but they said that there wasn’t any time to deal with that; now everyone feels committed.” Police respondents also indicated that trained officers took new pride in their work, “I’ve always been proud of being a police officer, but some of my partners who weren’t that proud, now they are.”

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Puerto Plata police officers attend a violence prevention and response training.

Most importantly, KP clients described a new willingness to attend services and corresponding improvements in their lives due to those services. As one sex worker who disclosed intimate partner violence said, “I understand a lot of things better. Before I was really closed inside myself. I believe that that man was everything for me; I was used to a man who was bad.  I was attached to that relationship but after the appointments with the psychologist I became stronger and understood that I deserved better. I left that relationship and feel better about myself. They lifted my self-esteem.”

These positive findings, as well as the identification of opportunities for improvement – such as the need for more messaging on the importance of reporting violence quickly to have access to PEP and other time-sensitive services – are helping to inform the expansion of the intervention beyond Puerto Plata.

The findings also demonstrate that integrated HIV and GBV programming benefits members of the general population as well as KPs. New strategies and laws are being contemplated and implemented to address the incredible burden of violence against women in countries like the Dominican Republic. Collaboration with implementers who focus on issues that intersect with violence against women, such as GBV against KPs and efforts to address the HIV epidemic, can be an important part of an effective response.

 

Violence Prevention and Response: An Integral Part of LINKAGES’ HIV Interventions with Key Populations

Written by Vanessa Mosenge, Gender-Based Violence Consultant, LINKAGES


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Representatives from the government, local NGOs, and CBOs pose for a group photo at a GBV stakeholder meeting in Yaoundé, Cameroon. Photograph by Christian Tanyi.

In Francophone Africa, as in many other contexts, key populations (KPs) experience violence and other human rights abuses, including harassment, exploitation, rejection, and denial of health, legal, and security/safety services. As violence increases HIV risk and poses serious barriers to KPs’ ability to access HIV services, the LINKAGES project has systematically worked to integrate violence prevention and response (VPR) into HIV programs for KPs.

Community-based organizations (CBOs) in Burundi, Cameroon, the Democratic Republic of the Congo (DRC), and Mali have shown great interest in addressing violence against KPs, including ensuring that service providers – health care workers, peer educators/outreach workers, and police officers – understand that violence is a real, priority issue for KPs and provide KP-friendly VPR services. As one KP member put it, “We want to get help like any other victim would and deserves, without things turning against us.”

Recognizing this need, a central component of LINKAGES’ VPR programming is building the skills of service providers – peer educators, outreach workers, and police officers – to ask about violence and provide first-line support to KP individuals who disclose violence, including linking them to essential health, psychosocial, and legal services. I have trained teams from Burundi, Cameroon, DRC, and Mali on VPR over the past three years, and one thing that has stood out to me is that many services providers start with the harmful belief (however untrue) that KPs make choices that expose themselves to violence and cannot blame anyone but themselves. During training activities – particularly panels where KPs share personal experiences – I’ve seen service providers introspectively assess how some of their behaviors hinder KPs’ access to services. In fact, I have seen doctors, lawyers, police officers, and government officials become more receptive and affirm that KPs also have a right to live free from violence and deserve services.

In addition to changing harmful beliefs, training service providers has helped them to become more informed about violence and its link with HIV, and service providers have begun to sensitize KPs on what violence is and what support is available through peer outreach, violence screening, psychosocial counselling, and support groups. For example, a peer leader in Cameroon shared, “Violence is prevalent; people don’t respect us; our clients and police do violate us. With this training, we know what to say to our peers; we tell our peers to talk about violence because it is very important to our health.” Service providers are also better able to create a safe environment and provide support to KP survivors. A health care worker in Cameroon further noted, “Training on GBV response helps us address stigma in relation to violence in the sense that we can help survivors know that violence is not their fault, and to speak up. We can also assure survivors of confidentiality and help them feel safe to disclose violence.” In fact, soon after LINKAGES VPR trainings take place, we observe a marked increase in the number of cases of violence reported and the number of KP members receiving support.

In-country capacity building has also helped service providers, government partners, and other stakeholders come together for a coordinated, multisector response to violence among KPs. LINKAGES’ engagement of service providers and other partners is important not only to ensure that KPs get all of the services they need and deserve, but also to garner political support for VPR work. In particular, the involvement of police is critical. Police are often cited as perpetrators of violence against KPs, leaving many KPs feeling as if they have no recourse when they experience violence. In Mali and DRC, we have successfully involved police and other law enforcement personnel in VPR trainings and activities, sensitizing them to the rights and needs of KPs, helping them to see their roles as allies and protectors when KPs experience violence, and helping to build trust between KP communities and the police.

One thing is common among KPs, irrespective of country and context — the desire to live in their community without fear of being abused and mistreated and, instead, to feel safe and protected. The LINKAGES VPR work fulfils the desire and right to live free from violence and contributes to effective KP programming that is responsive to the needs of KP community members.

Using a gender lens to increase impact of HIV programming for key populations: the LINKAGES Gender Strategy

Written by Giuliana Morales, Senior Technical Officer, Research Utilization, FHI 360, and Aubrey Weber, Technical Officer, Research Utilization, FHI 360


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LINKAGES, CHAMP, and CBOs participate in a small group discussion on strategies to improve the implementation of the minimum package of gender-based violence services for key populations in Bamenda, Douala, and Yaoundé, Cameroon. Photograph by Christian Tanyi.

Key populations (KPs) – including men who have sex with men (MSM), people who inject drugs (PWID), sex workers, and transgender (trans) people – often suffer from rigid and harmful gender norms. They underlie much of the stigma, discrimination, and violence faced by KP groups worldwide, inhibiting their ability to access HIV prevention, care, and treatment services. For example, in Kenya, women who inject drugs often face more stigma, discrimination, and violence than their male counterparts but may  be left out of PWID programming altogether due to the gendered expectation that PWID are male.gender strategy

While KP programming has rarely employed gender integration on a systematic level, gender integration has been shown to improve and sustain HIV outcomes. To address this missed opportunity, the USAID– and PEPFAR-funded LINKAGES project developed a Gender Strategy that describes the benefits of gender integration and provides specific actions and tools to integrate gender in HIV programming for KPs. Based on the mandate of the LINKAGES project and in accordance with PEPFAR guidance, LINKAGES focuses its gender integration efforts in three areas:

Designing and implementing activities that reach all members of KPs and challenge harmful gender norms at the root of stigma, discrimination, and violence against KPs

A gender analysis is the first step in the process of gender integration. As gender analyses have not been traditionally conducted with KPs, LINKAGES developed a Gender Analysis Toolkit, using learning from analyses conducted in Cameroon and Kenya. As the briefs from both countries show, a gender analysis can help programs answer important questions such as: Are all members of KPs being considered in your programming? What harmful gender-related beliefs may contribute to HIV risk, a lack of service uptake, stigma, discrimination, or violence against KPs? How do harms caused by gender norms link KPs and the issues they face to those of the broader population, and are there opportunities for combined efforts? The answers help in the design and implementation of gender accommodating and transformative HIV programming (the programming types most likely to result in lasting change).

Promoting the inclusion of trans people in KP programming

Trans women are 49 times more likely to be living with HIV than the general population, yet they have historically been ignored in HIV programming. Many of the reasons for this exclusion are gender-related; therefore, LINKAGES’ gender strategy emphasizes the need for increased understanding of and improved HIV programming for trans people. To support advocacy efforts for more trans-competent programming, LINKAGES developed Rights in Action: Transgender Health and HIV, a brief that includes information on the importance of working with trans people, the way that transphobia ultimately leads to HIV acquisition, and the many opportunities for intervention that address both current health needs and the underlying causes of the epidemic.

Preventing and responding to gender-based violence and other forms of violence against KPsresourcelist

Violence against KPs is widespread and can often be traced back to rigid beliefs about acceptable gender expression and sexual behavior for men and women. Global evidence shows that violence is both a cause and consequence of HIV: violence can increase HIV risk, decrease testing uptake and disclosure, and decrease adherence to antiretroviral treatment among KPs while living with HIV can increase KPs’ vulnerability to violence. To achieve lasting results in the fight against HIV, LINKAGES developed and is rolling out practical guidelines for integrating violence prevention and response into HIV programs. The LINKAGES Gender Strategy also provides information on international resources that can be accessed when violence occurs or safety threats intensify.

Addressing the HIV epidemic against KPs is necessary to achieving 90-90-90 goals, and incorporating a gender lens into KP programs will increase the impact of investments made in this vital programming area.

Making the case for asking key populations about violence: A success story from South Sudan

Written by Kim Dixon, Gender-Based Violence Consultant, LINKAGES


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LINKAGES’ South Sudan team shares their commitment to addressing GBV during the 16 Days of Activism Against Gender-Based Violence campaign.

Before joining the LINKAGES project, I spent most of my career developing, managing, and evaluating gender-based violence (GBV) prevention and response programs for women and girls in emergency, post-conflict, and development settings, as well as in the U.S. In my role as a GBV consultant for LINKAGES, I support country programs to develop and implement violence prevention and response (VPR) programs for key populations (KPs). I have learned directly from KPs themselves about the multiple layers of stigma, discrimination, and violence that prevent them from seeking and accessing services after they experience violence.

Because KPs’ behaviors are frequently viewed as not conforming to traditional gender norms and are often criminalized (e.g., sex work, homosexuality, drug use), they are afraid to seek help after experiencing violence due to fear of being arrested, shamed, or denied services. For these reasons, unless we become proactive in identifying KP individuals who experience violence, we are missing opportunities to link victims to important post-violence services, such as HIV post-exposure prophylaxis (PEP) and emergency contraception. The chance to address any barriers that interfere with adherence to ARVs among people living with HIV – such as not taking ARVs for fear of an abusive partner finding out their HIV status – is also missed. The failure to address violence among KPs ultimately limits our ability to achieve the 90-90-90 goals.

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Health care workers in South Sudan practice screening for violence during role plays.

This is why much of the VPR work in the context of LINKAGES focuses on building the capacity of project staff — including health care workers and outreach workers — to be proactive in identifying violence among KP individuals via violence screening. If we wait for KPs to disclose violence, we may not hear about it due to the barriers just mentioned. Instead, training providers to ask KP members about violence and building their skills to provide first-line support increases the likelihood that KP victims will get linked to important, time-sensitive post-violence clinical services and may increase uptake of and adherence to HIV care and treatment.

Success in South Sudan

Some LINKAGES countries that are implementing violence screening and response interventions are already showing good results. In South Sudan, health care workers were trained on core concepts related to sex and gender, harmful gender norms, and the connection between violence and HIV. They then developed skills for screening KP individuals for violence and providing first-line support to KP victims, including linking them to health, psychosocial, and legal services. Since the training, Jennifer Iden, GBV coordinator for LINKAGES South Sudan, and the rest of the team have successfully integrated VPR screening and response services into existing HIV prevention, care and treatment services. During the last quarter (July-September 2017), 608 female sex workers were screened for violence by health care workers during mobile clinics. Of those screened, 293 (48 percent) reported experiencing sexual violence in the past three months. In turn, 87 (30 percent) of those reporting sexual violence were eligible for PEP, which means that health care workers identified the sexual violence within 72 hours of the assault. Of the 87 women who were eligible for PEP, 87 (100%) received it and were able to reduce their risk of HIV infection.

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Health care workers are trained to screen KPs for violence.

The LINKAGES project in South Sudan is a success story that illustrates the direct link between violence screening and increasing KP victims’ access to critical HIV prevention services. I hope South Sudan’s success inspires others to integrate VPR activities into their HIV programming for key populations.

GENDER-BASED VIOLENCE AFFECTS TRANSGENDER PEOPLE AND OTHER KEY POPULATIONS

Written by Hally Mahler, Project Director, LINKAGES, and Rose Wilcher, Director, Research Utilization, FHI 360

This blog post was first featured on the LINKAGES blog in November 2016.


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In 2015, a friend and colleague, Beyonce Karungi, wrote about what it is like to be a transgender woman in Uganda. She talked about being rejected by family members and about being beaten up and burned with cigarettes for being transgender. She described being harassed by police who wanted to make her a “proper man.” She recounted being raped at gunpoint by a client when she was a sex worker, because she insisted that he use a condom. Beyonce wrote that “… from the standpoint of a transgender woman like myself — our human rights and unique challenges are not addressed and not given the attention they deserve.”

Beyonce’s story is not uncommon. Experiences of violence are widespread among key populations: sex workers, men who have sex with men, transgender people and people who inject drugs. Here are just a few examples:

This violence can often be traced back to homophobia, transphobia and other rigid beliefs about acceptable behavior for men and women. For example, perpetrators of violence against men who have sex with men often claim that they are attempting to “cure” men who are perceived to have rejected their masculinity. Likewise, transgender people experience violence from those who believe they have not fulfilled expectations associated with the sex they were assigned at birth.

Trans women are particularly vulnerable to violence from those who believe that experiencing violence is part of what it means to be a woman. Much of the violence that is directed at female sex workers and women who inject drugs is a manifestation of gender inequality and discrimination against women more broadly. But levels of violence against both are exacerbated by the belief that women who sell sexual services or inject drugs are immoral and have strayed from socially acceptable behaviors for women.

A broader understanding of gender-based violence

From November 25 through December 10, individuals and organizations around the world are participating in the 16 Days of Activism against Gender-based Violence campaign. Every year, this campaign brings attention to the urgent need to eliminate violence against women and girls. But, the campaign is also an opportunity to examine the root causes of gender-based violence and shed light on those who experience such violence but who are not traditionally recognized during the 16 days.

FHI 360’s LINKAGES project promotes an inclusive view of gender-based violence — one that acknowledges that it affects not only women and girls in the “general population,” but also men who have sex with men; transgender individuals; and highly marginalized groups of women, such as sex workers and women who inject drugs. These groups are often omitted from calls to end gender-based violence.

HIV and gender-based violence

Experiences of violence increase the risk of key populations acquiring HIV and deeply affect their desire and ability to obtain health care, get tested for HIV and adhere to HIV treatments. For example, epidemiologic modeling has shown that reducing violence against female sex workers would reduce new HIV infections among sex workers and adults in the general population by 25 percent and 6 percent, respectively.

We will not make sustainable gains against the HIV epidemic if we do not also address the violence that key populations experience at the hands of family, community members, health care providers and police. Here are five ways that everyone who works with key populations can address gender-based and other forms of violence:

  1. Uncover the root causes and gender dimensions of violence against key populations. By conducting gender analyses, as LINKAGES has done in Kenya and Cameroon, we can reveal how gender norms and beliefs underlie much of the violence faced by key populations and identify ways to challenge harmful beliefs and better address such violence.
  2. Support community-led solutions. Community-based organizations headed by members of key populations are taking the lead in delivering the HIV services that their community members want and need, including addressing violence. In addition, outreach workers and peer educators from key population communities can be trained to screen for violence and provide first-line response in line with global best practices.
  3. Work with police and other community power holders so that they become allies in responding to violence and building stronger crisis response systems. Programs must garner commitments from local attorneys, hospital staff, psychologists, peer educators, and police that they will offer client-centered, nonjudgmental services to all survivors of violence, and that they will facilitate key populations’ ability to report violence when it occurs.
  4. Advocate for legal and policy reforms that explicitly protect the human rights of key populations. Even in hostile legal environments, steps can be taken to prevent and respond to violence. For example, we can advocate for the explicit inclusion of sex workers, men who have sex with men and transgender people in any legislation that is created to protect women and girls from gender-based violence.
  5. Draw attention to the science and the stories on the causes, consequences and experiences of gender-based violence among key populations, as well as the evidence-based strategies for addressing such violence. Through the LINKAGES blog series, Key Population Heroes, and our project newsletter, The LINK, we amplify the voices of key population members who have bravely shared their experiences of stigma, discrimination and violence and called on us to join them in fighting for change.

Toward a more inclusive campaign against gender-based violence

Many people think of gender-based violence only in relation to women and girls. But, by developing a more inclusive view, we can help ensure that policies, preventive efforts and response systems benefit all those who experience such violence. Understanding and addressing the broader gender-based aspect of this problem will also allow us to strengthen the networks and combine the resources of the groups that are working to dismantle gender-based discrimination and advance the human rights of all women, girls, and sexual and gender minorities.

During the 16 Days campaign, we will hear from colleagues representing key population communities about how they are affected by gender-based violence and what they are doing about it. We invite you to subscribe to the LINKAGES blog, contribute to the conversation on social media, and join us in advocating for the right of all people to live free from gender-based violence.

Transgender day of remembrance: thoughts from a trans peer educator in Dominican Republic

Interviewee: Macarena Pérez, Transgender Peer Educator, Centro de Promoción y Solidaridad Humana (CEPROSH), Dominican Republic
Interviewer: Betty Alvarez, Consultant, FHI 360


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Transgender Day of Remembrance (TDOR) is an annual observance on November 20th that honors the memory of lives lost in acts of transphobic violence. On TDOR, LINKAGES is honored to feature the work and perspectives of one of our trans peer educators – Macarena Pérez. Macarena works with CEPROSH in the Dominican Republic to help trans women understand their right to live free of violence and access services if they experience violence. The interviewer, Betty Alvarez, is a LINKAGES consultant based in the Dominican Republic.


What does Transgender Day of Remembrance mean to you?

For me, this is a very important and significant day. Just as there is a day that commemorates the fight against violence suffered by cisgender women, we – the transgender community – deserve a day, too. It makes me proud that there is a day on which members of the global transgender community that have become victims of gender-based violence can be remembered, because we are also an important part of society.

How does your work as a peer educator help prevent violence against transgender people? How does it help ensure transgender people have access to services if they are victims of violence?

Being a peer educator has empowered me and helped me understand the importance of education and training. Being able to share my knowledge and life experiences with my peers has strengthened my own identity as a transgender individual and, in turn, helps my peers empower themselves and know their right to live free of violence.

I teach my peers about important gender-based violence information – including its links with HIV – provided to us by the LINKAGES project and CEPROSH. I explain “La Ruta” (route of available services) and give information about our rights and how to identify violence. The members of my community feel more confident in seeking health and gender-based violence services and demanding that their rights be upheld.

What kind of support is available to transgender people in your community if they become victims of violence? How is this different than the support that was available in the past?

Transgender people in my community have several services available to them if they become victims of gender-based violence. There are a number of clinical and psychological services provided by CEPROSH, the gender-based violence unit of the District Attorney’s Office, the local police, and peer educators like myself. These services have been strengthened and made more friendly to trans women with support from the LINKAGES project. We have more entry doors to free KP-friendly services than ever before.

What do you believe still needs to be done to end gender-based violence?

To end gender-based violence against trans women, we need to do a very big job. We need to create a new generation with a new way of thinking. We need to educate people from a young age to understand that being different is not a bad thing and that being different does not mean that we do not have the right to live free of stigma and discrimination. We have the right to live a dignified live.

How does gender-based violence against transgender people increase their risk of HIV and make it more difficult for them to access health services?

Many trans people are ignorant of their rights. We have been mistreated for so long that many of us are afraid to seek help because we are afraid of being rejected and discriminated against while seeking services. So, after being victims of violence, many transgender people do not go to services on time or do not go at all, increasing their risk of HIV and other physical and mental health complications.

Why is it important for HIV programs to offer violence services?

It is very important for HIV programs to talk about violence because when people go to a workshop or an educational session about violence in the community, they empower themselves and discover their value as a human being. Then they are more willing to seek services, including HIV services, when needed. As a trans woman, I have fought and will keep fighting so these kinds of programs continue to increase empowerment in the trans community and reduce the incidence of violence.

The participation of LINKAGES and partners and HIV clinics in offering gender-based violence services is fundamental for all key populations. Transgender people in Puerto Plata are now able to get stigma-free and cost-free clinical services, like post-exposure prophylaxis, and psychological counseling if they are victims of violence.

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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.