Western Region/Mbarara Media science Café on HIV 2023

HEALTH JOURNALISTS NETWORK IN UGANDA

Mbarara Media science Café on HIV/AIDS REPORT – Oxford Hotel- Mbarara                                                                                                                              February, 17^th 2023 8:00AM-4:00PM

The Media Science Café 

On 17th February, HEJNU in partnership with AVAC hold a Media Science Café from 8am -4pm at Oxford Inn  Mbarara city. The cafe was be attended by 20 journalists aiming at highlight the issues of HIV and youths in the western region.

Speakers/panelists: 

1. Christopher Nahabwe: HIV Focal Person Mbarara district
2. Nuwagaba Allan Hadaadi: Youth  Community monitor ICWEA  
3. Medard Arinaitwe HIV specialist at MRRH-ISS 

The meeting started at exactly 8:30 am on 17 February 2023 and attended by 20 journalists including Annita Matsika; the HEJNU Coordinator Mbarara/Western region and Edson Kinene, the moderator as well as Christopher Nahabwe: HIV Focal Person Mbarara district, Nuwagaba Allan Hadaadi: Youth Community monitor ICWEA , Medard Arinaitwe, the HIV specialist at MUST the facilitators.

 It started with a prayer led by Beinomugisha Jonan a news reporter at Edigyito Radio. He asked God to guide through the discussion surrounding the HIOV/AIDS topic and blessed the Facilitators for such a thought.

20 journalists attended and introduced themselves one by one led by Annita Rita Matsika the HEJNU Coordinator,Mbarara region and these include:

NAME	MEDIA	CONTACT
Beinomugisha Jonan	Endigital radio	0754329453
Ainembabazi Dorothy	Crooze Fm	0750405971
Akampa Gilbert	Parrots news agency	0701492124
Amumpaire Jeninnah	Grace radio	0776921911
Peace Asiimwe	Vision Radio	0771410274
Nyesiga Elly	Endigito Radio	0701025882
Fred Turyakira	New vision	0772888665
Amos Tayebwa	Red Paper	0757145926
Birungi Harriet	Radio west	0781837063
Adolf Ayoleka	New Vision	0700799091
Nagudi Fatumah	Bukede TV	0703039238
Rumanzi Perezi	Daily monitor	0702298748
Alex Mugasha	NBS	0755997373
Aggrey Twesigye	Croose Fm-	0705494366
Innocent Arinaitwe	GNTV	0779125073
Aaron Ainemogisha	Rise news uganda	0784043745
Jemimmah Ayebale	Radio west	0703306930
Edson Kinene	URN	0701196845
Joshua Nahamya	The cooperator news	0783111993
Anita Matsika	Coordinator-   Mbarara	0702248676
Onesmus Niwagaba	UBC West	0757912311
Eli Akiza	TV west	0773963666

The media café was facilitated by;

NAME	ORGANISATION	CONTACT
Nahabwe Christopher	MDLG	0772866204
DR Medard Alinaitwe	MRRH/ISS	0702923293
Nuwagaba Hadaad Allan	ICWEA	0777206402
Alinda Bagenda Grace	Rapporteur	0789461175
Kinene Edson	Moderator	0783210324
Annita Matsika	HEJNU Coordinator	0775865759

There was a communication from Anita Matsika who insisted that the main purpose of the Café is to equip journalists with enough knowledge and information based on statistics to report about the HIV status in the western districts with emphasis to Mbarara greater, available policies, challenges and way forwards towards HIV prevention. Anita told journalist to make sure they publish stories from the Café for publicity and sensitization purposes. 

Presentations

TOPIC: HIV status in the western districts with emphasis to Mbarara greater, Available policies, challenges and way forwards towards HIV prevention- Christopher Nahabwe: HIV Focal Person Mbarara district

Facts about HIV in Mbarara district– the 95 95 95 Global goals aims to see people acquiring HIV reducing and increasing the number on care and then suppression. In control of diseases that are infectious where HIV is one of them and a disease of a public health concern because it affects everyone, government input in terms of human resource, drugs and in terms of the equipment needed to diagnose goes high so it’s a public health important disease worth to be discussed because it puts a constraint in terms of money and human resource. He put emphasis on Mbarara district where he is the focal person because there is a boundary geographically.

Mbarara district currently has a population of over 1,745,000 people and when talking about statistics, it’s important to know how many people who are living with a disease and how many are acquiring the disease. People living with the disease at a particular time are called the prevalence.

This information is mainly got from three areas, namely: the district information center because there is a register at every service provision point to capture the information that is later put in the national data base. Preference has been a little condensed and circulated but the issue is basically on the new cases, Uganda AIDS Commissioner and Uganda population based HIV impact assessment. This is aimed at having the same information on AIDS/HIV.

We know that the highest number of HIV transmission is among the youthful age is between 15-49 years and currently, nationally the population that are living with HIV in western Uganda at 6.3%. Number one region living with HIV that is highest in central or Masaka at 8.1%, in the second position there is mid north with 7.6% and 2.1% for Karamoja region. Is there a correlation between ladies with beauty and men with money in HIV transmission? Because, it is less in Karamoja, Busoga it increases, Kampala, Masaka , Mbarara same story.

In western region, at least 6.3 percent of the people that are tested, are living with HIV. Nationally, it is at 9.5% currently and when we are at 6.3% in south western region and the national preference is at 5.5% it means we have a contribution towards increasing HIV prevalence. Mbarara district is at 9.6% male at 7.5% and female at 11.6%, Bushenyi is 9.1% tatal population male at 7% and female 11.2%, Kiruhura 8.7% total population male 6.7% and female 11.2%,  Rukungiri at 8.3 male at 6.1% and female at 9.3%, Sheema is at 8.1 total male 5.1%at and female at 11.1%. 

When we recall the presidential first track initiative where we are supposed to close the gap to engage men and reduce more infections, are we reaching there?. When 95% of the population is under control, there is some kind of reduction in infections. When we talk about incident, we are looking at the exposed population and how many new cases come in. So when we look at Mbarara’s population of over 1,745,000 people are we able to control new cases that come on board with HIV?

A financial year report for only Mbarara district shows that, the year 2019/2020 the population was at 1,745,000 and the new cases were 368,000 and that gives an incident of 2 people per 1000. We usually report in terms of proportions and percentages that caters for the risk behaviors referred because a district like Isingiro, which has many people the cases of HIV must be high because of the high population. And when you find a small district with fewer people like Kiruhura there are fewer numbers of HIV preference but that does not mean that there is less preference.

Looking at control and elimination, we are hitting the target for 20 mothers who give birth, less than one baby acquire HIV in Mbarara district.  Incidence among the age group between 20-49 years, male, is 6.1% and female, 11.8%. And the age above 50 years, male is at 3.7% and female at 1.8%. This shows that the hormones have gone low in females and their sexual activity is down and men above 50 years, they have lived most of their dreams and done most of the basics, built houses, done with school fees and they are starting to eat their money. Over all incidences in male is at 2.5 per 1000 and 4.4 per 1000 in the females. So when you are to mark where transmission is high, it is in the age group 20-49 years.

For people who have been in Mbarara, Ntungamo, Ibanda and Bushenyi, there is transactional sex and the highest is known amongst female sexual workers but also now it is rampant in villages. There is also a problem of multiple partners, you find one person has over 10 partners due to poverty and inequality-in communities. People do not have equal access to resources and finance and even skills to use what they have is limited and they do most of the things under the influence of alcohol, there is also a problem of gender base violence like rape, defilement and work related cases because in most companies including government entities, there a new saying of no sex no job. And these are the major drivers of HIV preference.

Are there policies helping health workers to serve the population? A number of policies are available and they are used to write strategic plans. Currently the ministry is doing targeted testing as a policy, there is no need of testing everyone like how it has been. Today the target is on key populations (people who do centrally to the constitution), their practices put them at risk to transmit or acquire HIV like sex workers but as health workers, they support them because they want them to have safe sex. HIV funding is majorly donor based and we are almost hitting the 95 and so they reduce on test kits meaning we also have to reduce target groups.

Another policy is about test and treat, whoever tests HIV positive is linked to art clinic and initiated on treatment and followed up to see that the drugs are available and viral load is suppressed. At least in every sub county where health center HC3, it should be accredited to give HIV services and for Mbarara, all health center three both public and private are able to give ART. 

There is a policy on ending stigma and discrimination and most common now is internal stigma. People are pointing fingers to HIV patients and also those who have acquired it see themselves as bad and dying. There is also a workplace policy, the ministry empowers each district to have a work place policy which guides in human resource and the employees on their rights.

Challenges? The challenges are there because of the increased numbers of key population, it makes service provision more challenging. Most of the people in key populations are not friendly. Men who have sex with men and they have a network and always move together, if they are 5, they go together so that whoever need a colleague is ready. And also the commercial sex workers are among the key populations, men in uniform like police and UPDF and prisons, the preferences are higher. 

There are people who inject drugs and giving them a service, you need to go with peers to reach them. There is another challenge of poor funding and people are acquiring HIV because some of the services are not reaching them.

However, it should be noted that much of  the transmission is between 20-49 years as they can be looked at in terms of how they play sex and have enough statistics HIV can be controlled and the 2030 goals can be archived

HIV prevention and control among the youth

Why we need an HIV Cure and the Community perspectives of HIV Cure Research in Uganda – Medard Arinaitwe: HIV specialist at MUST

• HEJNU is a good innovation because the ministry cannot do it alone. Science journalists help in disseminating proper information to the masses. 
• HIV affects everyone because we all have families, friends and colleagues who might be victims.
• HIV/AIDS medicine and science involves all the time that’s why most people who are not in main stream HIV care and treatment are struggling because almost every day something new comes up.
• What is HIV and its symptoms- it is human immune deficiency virus whicn cause AIDS and it is mainly sexually transmitted. And if you are not able to get care or treatment, it can lead to AIDS and eventually death. Majority of the people who are infected with HIV and not on treatment, they develop signs of the disease between 8-10 years on average following the natural cycle and sometimes it is shorter than that depending on the immune system of a given body. The human immunodeficiency virus (HIV) causes acquired immunodeficiency syndrome (AIDS). HIV can be transmitted during sexual intercourse, pregnancy (i.e., from mother to fetus), childbirth, breastfeeding, and other forms of exposure to bodily fluids that carry the virus. When the virus enters the body, it injects itself into vital immune cells called CD4 cells. In the absence of treatment, HIV continues to replicate itself within the body, eventually leading to severe immunodeficiency, chronic illness, and death. 
• AIDS is characterized by severely diminished immune system function, where the body is highly vulnerable to infections and cancers that are typically fought off by a healthy immune system
• The majority of people infected with HIV, if not treated, develop signs of AIDS within eight to 10 years. Stage 1 HIV disease is asymptomatic and not categorized as AIDS.(acute HIV infection, generalized LN)  Stage II (includes minor mucocutaneous manifestations and recurrent upper respiratory tract infections),  Stage III (includes unexplained chronic diarrhea for longer than a month, severe bacterial infections and pulmonary tuberculosis)  Stage IV (includes toxoplasmosis of the brain, candidiasis of the esophagus, trachea, bronchi or lungs and Kaposi’s sarcoma) HIV disease are used as indicators of AIDS. 
• Most of these conditions are opportunistic infections that can be treated easily in healthy people.

How quickly do people infected with HIV develop AIDS?

The length of time can vary widely between individuals. The time between infection with HIV and becoming ill with AIDS can be 10–15 years, sometimes longer, but sometimes shorter. Antiretroviral therapy can prevent progression to AIDS by decreasing viral load in an infected body

HIV GLOBAL PICTURE

According to the latest UNAIDS estimates, since the start of the global HIV&AIDS pandemic, over 75 million people have become infected with HIV and over 32 million people have died from AIDS-related illnesses. As of June 2021, UNAIDS estimated that globally, there were about 38m People Living with HIV (PLHIV) with the East and Southern African countries, home to 700m people, contributing 45%. 

Uganda has an estimated 1.4 million People living with HIV of which 1.3 million are currently on treatment (MOH Annual Estimates 2021). The country has registered a 37% decline in AIDS annual related deaths that is from 27,000 in 2016 to 17,000 in 2021. New HIV infections in 2021 stood at 54,000

What can increase the risk of getting or transmitting HIV?

The higher someone’s viral load, the more likely that person is to transmit HIV.

Other Sexually Transmitted Diseases genital ulcers

Alcohol and Drug Use

When you’re drunk or high, you’re more likely to engage in risky sexual behaviors like having sex without protection 

Being drunk or high affects your ability to make safe choices.

Drinking alcohol, particularly binge drinking, and using “club drugs” can alter your judgment, lower your inhibitions, and impair your decisions about sex or drug use.

You may be more likely to have unplanned sex, have a harder time using a condom the right way every time you have sex, have more sexual partners, or use other drugs.

Engaging in unprotected anal, vaginal, or oral sex, especially with multiple partners or anonymous partners

Having sex in exchange for drugs or money

Sharing needles and other equipment for injecting drugs

HIV prevention

Know your HIV status by taking a test

Protect yourself during sex

Prevention with drugs (HAART, PrEP, PEP)

Protect others if you have HIV (adhere to treatment, consistent condom use)

Prevent perinatal transmission

Others; VMMC, ABC, STI treatment

Achieving the 95-95-95 targets for all: A pathway to ending AIDS (December 2020, UNAIDS)

• 95% of people living with HIV knowing their HIV status; 95% of people who know their status on treatment; and 95% of people on treatment with suppressed viral loads.

PEADIATRIC HIV

• Of the estimated 38.4 million [confidence bounds: 33.9–43.8 million] people living with HIV worldwide in 2021, 2.73 million [2.06–3.47 million] were children aged 0–19. Each day in 2021, approximately 850 children became infected with HIV and approximately 301 children died from AIDS related causes, mostly because of inadequate access to HIV prevention, care and treatment services
• Children (0-14) living with HIV in Uganda was reported at 88000 Persons in 2021, according to the World Bank collection of development indicators. UNICEF DATA 2022 

PEADIATRIC HIV UGANDA

• Although mother-to-child transmission of HIV is preventable through antiretroviral treatment during pregnancy and postpartum, there were more than 150,000 new infections in children (0 – 14 years) worldwide in 2020.
• The UNAIDS 2021 Spectrum estimates indicate there were 5,500 new childhood HIV infections in Uganda due to mother-to-child transmission, with half of those infections occurring among infants born to mothers who stopped HIV treatment during pregnancy and breastfeeding.
• The overall mother-to-child transmission rate at 18 months post-partum was 2.8 percent, which is below the national goal of 5 percent.
• Infants born to younger mothers had higher rates of HIV infection, with 3.7 percent of infants of mothers aged 15–24 having HIV compared to 1.4 percent among those born to mothers 25 years and older.
• Mothers on HIV treatment throughout pregnancy and breastfeeding had significantly lower risk of HIV transmission to their infants. CDC SEPT. 2022

ADOLESCENT GIRLS AND YOUNG WOMEN (AGYW) 15-24 years

• The latest UNAIDS statistics show that adolescent girls and young women (AGYW) from sub-Saharan Africa (SSA), aged 15-24, remain at substantial risk of acquiring HIV. Every week, an estimated 4900 incident infections occur among women in this age group globally.
• In SSA, approximately six out of seven new infections occur among adolescents aged 15-19 years, and young women aged 15-24 years are twice likely to be living with HIV than their male counterparts
• AGYW accounted for 63% of all new HIV infections in 2021 Hence, despite a 54% reduction in HIV incidence since its peak in 1996, the population of AGYW in Africa in SSA remains a key population for HIV epidemic control. Reducing incident infections in AGYW and among the other key populations of sex workers, gay men and other men who have sex with men, intravenous drug users, and transgender people is key to eliminating HIV infections. UNAIDS, 2022). 

AGYW at a high risk of HIV acquisition in SSA

• Biological factors
• Biologically, women are more vulnerable to HIV infection than men because of the greater mucosal area that is exposed to HIV during penile penetration. Because of an underdeveloped cervix and low vaginal mucus production, AGYW are at an even greater risk of acquiring HIV

Socio‐economic factors

• Economic marginalization among AGYW in SSA forces some young women to be involved in transactional, age-disparate, and multiple concurrent sexual relationships for survival. Transactional sex has been shown to have a positive correlation with HIV infection in women 
• Transactional sex has been correlated with the use of alcohol and drugs, multiple and concurrent partnerships, history of experiencing intimate partner violence, non-use of condoms, and having less power in the relationships, and all of these factors lead to increased chances of HIV infection
• AGYW from poor households are at an increased likelihood of being involved in age-disparate relationships 

Socio‐economic factors cont…

• AGYW orphaned by HIV deaths are usually left vulnerable to predatory sexual behavior of older men who may be respected figures in some communities. Some of the orphaned AGYW may be forced into sexual relationships or even polygamous marriages, which put them at a higher risk of acquiring HIV
• The limited access to secondary and tertiary education among AGYW in SSA results in them being financially reliant on men, mostly older men, who expose them to a higher risk of HIV
• Reports indicate that the COVID-19 pandemic might have added to the risk through prolonged school closures, increased school dropouts, and loss of families’ sources of income, forcing AGYW to engage in risky trades including vending and cross-border trading, and being married off to older men 

Marrying off young girls remains rife in some African communities where bride price is the norm, as it is a source of income for some families. Patriarchal culture in some African communities exacerbates women’s inferiority in sexual matters. Such practices put the AGYW at a greater risk of HIV and STIs because the identified man may have multiple sexual partners

Strategies to reduce HIV transmission among AGYW

• Strict legislation on sexual offender’s strict legislation against sexual offenders is critical for preventing sexual abuse of AGYW, but this requires strong political will and commitment.
• Providing SRHR education to AGYW There is limited access to confidential SRHR education for AGYW in SSA. Increasing early SRHR education is therefore critical for empowering AGYW, as it will enable them to resist sexual predators, negotiate condom use, and resist being given away for bride price at a young age.
• Economic empowerment of AGYW Social protection measures that we recommend include educational scholarships, cash transfers, feeding programs at schools, career skills training, livelihood training, early childhood development interventions, micro-credit, and self-help projects.
• Community engagement and education on sexual matters Community engagement and education may help increase HIV knowledge among them, which will reduce harmful practices that put the AGYW at an increased risk of HIV, and improve attitudes of communities towards people living with HIV, resulting in reduced stigma and discrimination

Reducing HIV transmission among AGYW cont…..

• Increasing AGYW’s access to pre‐exposure and post‐exposure prophylaxis AGYW often experience challenges in accessing pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). These challenges emanate from the stigma and discrimination they experience from healthcare workers while trying to access these services, and the lack of financial resources to travel to health centers that offer the services. Access can be increased by establishing youth-friendly corners at health facilities, eliminating costs associated with the services, and introducing long-acting formulations, such as the recently approved long-acting injectable cabotegravir for PrEP
• Treatment as prevention adopting  the test and treat policy because when people are started on treatment early, their viral loads in blood, semen, and vaginal fluids will decrease and the chances of infecting others will be reduced 
• Increasing women’s access to SRHR services increasing accessibility and utilization of SRHR services, including family planning, screening and treatment for HIV, and other STIs, are critical for the control of HIV.

1. Accessibility can be increased by offering the services for free to AGYW at facilities that are closer to where they live in youth-friendly corners. Utilization can be increased by availing SRHR education through the different digital and social media platforms that AGYW use

User Experience

Nuwagaba Allan Hadaadi: Youth Community monitor ICWEA  

ART- The treatment for HIV is called antiretroviral therapy and combination of HIV medicines (called an HIV treatment regimen) . ART is recommended for everyone who has HIV. People with HIV should start taking HIV medicines as soon as possible. ART cannot cure HIV, but HIV medicines help people with HIV live longer, healthier lives. ART also reduces the risk of HIV transmission. A main goal of HIV treatment is to reduce a person’s viral load to an undetectable level. An undetectable viral load means that the level of HIV in the blood is too low to be detected by a viral load test. People with HIV who maintain an undetectable viral load have effectively no risk of transmitting HIV to their HIV-negative partners through sex.

I have always loved to share my story. I tested HIV positive for the first time when I was 11 years. I actually did not know the source but after feeling ill with a lot of combined diseases for like a month ranging from malaria, typhoid, diarrhoea etc my caretaker got suspicious.  I went to TASO Mbarara center for an HIV test and it turned out positive. And to the most of everyone’s surprise, both my parents were negative, the caretaker and all the people we stay with. If you ask me where I got it from, I was 11 years in 2011, I cannot really tell  but the fact remained that I was HIV positive and the only thing was to accept the fact and start on medication and move on with life.

Everyone loves a good comeback story and that’s why we watch inspirational movies. At TASO where I am a service recipient for 13 years, we have had an honor of seeing firsthand information.  I have not had a chance to go to campus due to economic hardships but hopeful that anytime, I will join because universities have no age limit. I am a resilient person with the ability to bend but not to break, to stumble but not stay down because a person of resilience cannot be shaken. I grew up in an area surrounded by cultural evils and it was not easy growing up. I went through un imaginable conditions whereby I was discriminated by most of my relatives and both my parents abandoned me because of my HIV status. Thriving in a community and focusing on school was not easy because of discrimination from fellow students due my HIV status but a part from being strong, there was nothing I could do about my discrimination.

Lucky enough, I am now a stigma free person but after battling it for over 10 years and I can now speak openly about my HIV status. If someone asked about my HIV status I can gladly say I am positive. And if I don’t disclose my status, I’m good enough for anyone to think that I am HIV free but I am not. It is just a mindset with a wrong attitude on it commonly in people who lack awareness in the communities and it is a big challenge.

Am now able to help to confront HIV in my society, fight against stigma and discrimination with the aid of my passed experience. My facility TASO Mbarara had over 18 adolescents and children who were non suppressing in the year 2021 due to the effect of lockdown and now over 10 of them have already suppressed the virus in their body due to my impact in their lives and now I am a good role model to young people as far as HIV adherence is concerned by having several advocacy platforms especially through my twitter handle @officialHadaad with over 2.2k followers and I have succeeded in raising the voice of the voiceless under this social media platform.

I have represented young people as the “MR. YPLUS” or YPlus Ambassador Western Region 2021-2022 under Uganda Network Of Young People Living with HIV (UNYPA), I have also represented young people on the TASO CLIENT’S COUNCIL COMMITTEE as a Youth Representative, I’ve also been awarded to be an “ARIEL AMBASSADOR” under EGPAF where I address all the adolescents and Young People’s issues that I have been getting from the community. Currently I’m a Community Monitor under International Community of Women Living with HIV Eastern Africa (ICWEA) and I have been doing clinic monitoring in 8 PEPFAR supported health facilities by interviewing the service recipients getting to know their perspectives on the HIV and TB services they receive in their particular health facilities. 

Why is it that HIV is growing high in Mbarara in the age group of young people from 18-40 years? It is the age bracket that is most sexually active and it is natural. But putting the natural factor aside, there are other social and economic factors. This is the age category where most people are unemployed and they want to earn a living.

                      SRHR IN MEN AND BOYS

My background is in HIV, particularly in community since I have been doing community and clinic monitoring work with vulnerable, PLHIV, KPs, and PPs populations. Work has shifted to focus more on sexual and reproductive health and rights (SRHR) than HIV. More recently, I noticed that work around gender was being equated to work with women and girls, so we started a community of practice via online advocacy that would help in engaging men and boys. 

And during clinic monitoring I found that the key issues for men are the same as for women. Men have sexual lives; they need sex education and life skills. Comprehensive sex education is the place to start talking about what it means to be a man or a boy, and to address masculinity. Men can have sexually transmitted infections (STIs) and HIV, and many experience sexual dysfunction. There’s hyper sexuality as well as lack of libido and the stigma associated with that. There is sexual and gender-based violence against men and boys, and particularly against Trans and non-binary people. This is an area that is often neglected and men are generally seen only in the role of perpetrator. Then there are the cancers of the sexual organs: prostate, testicular and penile cancer.

The other side of reproductive health for men is in fatherhood and parenting. Parenting is often seen as a female domain, but lots of men are interested and willing to play a much bigger role. This could be an engaging entry point to improving both male and female reproductive health. I personally look at these issues in different life stages. For boys, age-appropriate comprehensive sex education is important; then adolescents need us to focus on contraception, STIs, HIV etc. In adulthood, there are the fertility issues, fatherhood and parenting, and then as men grow older there are the issues of sexual dysfunction and cancers. Thinking about the different life stages can help to frame policy and service provision.

There are also sexual and reproductive rights issues, particularly for gay men and Trans people. Trans people are often ignored in SRHR and their needs won’t be met in services focused on heterosexual cis women. 

BARRIERS MET BY MEN AND YOUNG BOYS IN ACCESSING SRHR SERVICES

1. At a policy level, the very fact that gender is usually perceived as only meaning women and girls is a barrier. At the service level, for lots of understandable reasons, we often look at making services more female friendly and for some services that’s a good thing. But if you have dedicated spaces for women, it’s important to consider whether there is a need for an equivalent service for men. Most of family planning clinics are notoriously unwelcoming to men.

2.   The service providers themselves. SRHR service providers are predominantly female and if, for example, an infertility clinic has no male counsellors, a lot of men will be put off from talking about their private concerns. Another important barrier is men themselves. Male health-seeking behavior is famously bad, not just in SRHR.

3. Trans-women and men sex workers bear the greatest brunt of HIV and other sexually transmitted infections (STI). Trans-women and Men are 49 times more at risk of HIV infections compared to the general population. However, they remain underserved and continue to grapple with access to and utilization of HIV/STI prevention services. This study explored barriers to access and utilization of HIV/STI prevention services and associated coping mechanisms.

4. Individual level barriers to access and utilization of HIV/STI prevention and care services included internalized stigma and low socio-economic status. Healthcare system barriers included social exclusion and lack of recognition by other key population groups; stigmatization by some healthcare providers; breach of confidentiality by some healthcare providers; limited hours of operation of some key population-friendly healthcare facilities; discrimination by straight patients and healthcare providers; stock out of STI drugs; inadequate access to well-equipped treatment centers and high cost of drugs. At community level, Trans phobia hindered access and utilization of HIV/STI prevention and care services. The coping strategies included use of substitutes such as lotions, avocado or yoghurt to cope with a lack of lubricants. Herbs were used as substitutes for STI drugs, while psychoactive substances were used to cope with stigma and discrimination, and changing the dress code to hide their preferred gender identity.

5. Individual, community and healthcare system barriers hindered access and utilization of HIV/STI prevention and care services among the trans-women sex workers. There is a need to create an enabling environment in order to enhance access to and utilization of HIV/STI prevention and care services for trans-women sex workers through sensitization of healthcare providers, other key population groups and the community at large on the transgender identity.

MY SUGGESTIONS TOWARDS WHAT I HAVE FOUND.

1. The main thing I’d like to see is the recognition that men and boys have sexual health needs and are potential beneficiaries of SRHR. If you see SRHR as a public health issue, then you have to look at anybody who has SRHR needs and address those needs.

2. The second thing I’d like to see change in policy is that even if you define SRHR as being focused on women and girls, the most effective way of engaging men and boys in furthering outcomes for girls and women is to see them as allies – not to blame them, but to engage them with issues like fatherhood and parenting.

3. If you recognize that men also have desires and needs, that is the best way to bring them in and make them allies.

4.The LGBTQ community is the most targeted group of males that need to access SRHR services first because they are 49 times at higher risk of acquiring HIV/ STIs and therefore they need their rights reserved and respected and by doing this you will protected the rest of populations from being affected by the same trauma. 

‘’We all need to support the young people to fight HIV because they have the highest transmitters.

ALINDA BAGENDA GRACE-Rapporteur

0789461175/0759873499

alindabgrace@gmail.com