PV’s organisational strategy works toward strengthening systems for health and influencing programmes and advocacy initiatives through its particular approach to its work, its strategic partnerships and by using the LILO curricula. Meaningful research processes contribute to building a stronger evidence base for programming and advocacy for better health systems. To that end, in 2017, the Namibian team undertook a mixed methods study, ‘Together Tomorrow’, funded by the Human Sciences Research Council exploring the HIV prevention needs of male-male couples in South Africa and Namibia.
Nearly 600 participants (589 partnered gay, bisexual and other men who have sex with men (MSM)) contributed to help better understand the stressors faced by these couples, relational dynamics, HIV prevention and treatment needs, and potential areas of systems and programmatic strengthening.
Results:
Health service engagement: Respondents largely viewed public health services as catering primarily to heterosexuals, with limited access to tailored services for MSM. They felt this caused increased levels of homophobia and ridicule in these spaces, and elected to not disclose their sexual orientation. Many preferred to use health services offered by private institutions and civil society. The main factors leading to low service uptake were fear of knowing one’s status or losing one’s relationship (if tested positive) and the reactions of insensitive/prejudiced healthcare workers. In general, HIV prevention and transmission knowledge levels were quite high, with the exception of pre-exposure prophylaxis (PreP) where only 33% of respondents had heard of it and only 2% were using it;
Sexual agreements: While monogamous agreements were high, 20% of respondents indicated they’d had sex with someone other than their primary partner in the past three months; * Stress and risk: 17% of respondents expressed variables indicating depressive symptoms, and named similar stressors, despite the legal protection in South Africa. Mechanisms used to reduce stress included denial that sexual orientation-related stigma and discrimination caused distress; hiding by acting straight or maintaining a concurrent heterosexual relationship; and/or substance abuse, i.e. using alcohol or substances to lower inhibitions or reduce pain during anal sex.
Recommendations
- Rights-based health services: Tailored interventions to ensure the integration of and inclusion of issues of sexuality, sexual orientation, gender identity and gender expression and human rights;
- Institutionalising sexual and reproductive health and rights (SRHR): Strengthening the integration of comprehensive SRHR in health interventions, starting from training to ensuring institutionalisation, standardisation and sustainability of standard operating practices;
- Strengthening harm reduction, psychosocial and relationship support: To redress harmful defense mechanisms employed when facing stressors. Self-stigma also needs to be addressed within the relationship and broader community to ensure overall wellbeing, this includes better communication between partners on sexual agreements;
- Strengthening the multi-sectoral response: SRHR integration needs to extend to health facilities to ensure comprehensive health care for diverse populations. This should include other public services, i.e. law enforcement, social workers, educators, etc. National monitoring systems should be aligned across sectors and synergies sought to promote the co-implementation of interventions to ensure cost and implementation efficacies. This also calls for all sectors to collaborate in legal and policy reform to allow for legislation that enables equal access to SRHR services.