Supporting Social Change to Curb Violence and Eliminate HIV in Guyana, by Anne Stangl of ICRW

By Anne Stangl

*This blog originally appeared on ICRW

As I fly home from the humid, vibrant and bustling Georgetown, the capital city of Guyana, I am a bit overwhelmed by the daunting task the country faces to address the high levels of intimate partner violence, sexual assault, child abuse and suicide in the country.

Over the last week, my colleague Jocelyn Lehrer and I had the privilege of speaking with people working at community-based organizations throughout the country who are an integral part of tackling these challenges. Peer educators, social workers, nurses, counselors, people living with HIV, LGBT advocates, and survivors of violence all took time from their important work to speak with us about their efforts to create a path forward for Guyana.

My visit to the South American nation was the kick-off trip for ICRW’s grant work under Advancing Partners & Communities (APC), a USAID funded project, implemented by JSI Research & Training Institute, Inc., in partnership with FHI 360. ICRW is assisting in the implementation of the project in Guyana over the next three years, helping to strengthen the capacity of local organizations in Guyana to provide HIV prevention, care and treatment services to key populations at heightened risk of HIV infection, including women, men who have sex with men, transgender individuals and sex workers. Reaching these populations is critical for eliminating new HIV infections in Guyana, but extremely challenging, as these groups face high levels of stigma, discrimination and violence in society.

Given mounting global evidence that sexual assault and partner violence are directly linked with HIV infection, it is crucial for Guyana to tackle these key drivers of the HIV epidemic head-on.

During the trip, I learned of the great work these organizations and individuals are doing to support survivors of gender-based violence and to ultimately break the cycle of violence so that no woman or girl has to experience it in her daily life. From training police to be gender- and LGBT-sensitive, to supporting abused women, men and transgendered individuals in accessing justice, to sheltering women and children when their homes are unsafe, I could see firsthand that change is coming to communities in Guyana.

And while these conversations gave me great insight into the powerful individuals working to reduce violence in Guyana, I did see something worrying.

In interview after interview, themes began to emerge: Gender-based violence is pervasive. Services for survivors are limited or very difficult to access. Marginalized populations such as men who have sex with men, transgendered individuals and sex workers are at heightened risk of experiencing violence. Resources are limited for carrying out community- and national-level programs to change harmful gender norms and break the cycle of violence.

The stories shared by these frontline workers were reinforced daily by headlines in the local newspaper: a police officer charged with sexually assaulting a young man with a wooden police baton; a 23 year old who murdered his 14-year-old girlfriend and then hung himself. 

Despite these challenges and the ubiquitous headlines, I am cautiously optimistic about what we can accomplish.

On our final evening in Georgetown - the country’s largest urban center- we attended a production of “Before Her Parting” at the National Cultural Center. The play was written by Mosa Mathifa Telford, directed by Tivia Collins and staged by Merundoi Incorporated - a community-based organization that utilizes entertainment to educate the public, affect individuals’ attitudes and behaviors, and shift social norms. The gripping drama portrays a reality that’s all too common in Guyana in which young woman is murdered by her husband, who then kills himself. The plot could have been ripped straight from recent headlines.

The play also explores the intergenerational cycle of abuse that fosters violence generation after generation in Guyanese society: A woman is abused by her husband and is violent toward her son; her son grows up to beat and ultimately murder his wife, and the cycle continues. The play was followed by a facilitated discussion with the more than 400 audience members, ranging from students to teachers to civil servants, and a panel of speakers from various government institutions. It was heartening to hear these young Guyanese demand both action to reduce violence and expanded services to support survivors.

It is my hope that though USAID’s Advancing Partners and Communities Initiative, ICRW and John Snow International will be able to strengthen the capacity of local organizations so they are better equipped to respond to gender-based violence in Guyana and can continue to facilitate social norm changes to reduce violence and reduce the spread of HIV infection.

Above all, from my time in Guyana, I saw hope and determination. Hope that the next generation will not see the type of endemic violence that has pervaded Guyana for decades, and be determined to tackle these problems head-on. It’s important that those of us in the global community echo that hope and determination, too. We need to ensure that community workers and advocates have the tools to end these human rights violations as well as to empower women and girls to live free from fear of violence or abuse.

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Thank you to Anne for allowing us to share this post. If you would like to know more about what Anne does at ICRW, check out her twitter feed.

Happy Valentine's Day and Happy National Condom Day!

Happy Valentine’s Day to our beloved #StigmaWarriors!

Did you know that February 14th is not only Valentine’s Day, but also National Condom Day as well??? It is a pretty perfect combo because what could be a better way to show someone you love them than by keeping safe and protected? [AND—as if that wasn’t cool enough—it gives you an opportunity to get creative and deviate from the cliché heart-shaped boxes of calories and overpriced flowers that will barely last the weekend! But I’m getting ahead of myself!]

To celebrate both National Condom Day and Valentine’s Day we’re going to discuss the many merits of condom use, but first let’s have a little fun with some possible ideas for your very own DIY cute and creative Valentine’s Day condom crafts!

1. For an easy one, why not make some DIY valentines with condoms? Simply write a loving message to someone on a condom with a sharpie! It’s that easy!

2. If you’re just in it for the candy, buy a chocolate box and fill it with condoms! After all, studies show that it takes an hour of sex to burn off one box of chocolate…

3. If you want something a bit more creative, why not a bouquet – with the flowers made out of condoms?! All you need is some rose-colored condoms (personally I like pink!), some wire, and tape, and there you have it! A lovely condom bouquet to give to your sweetie. 

4. If you don’t like flowers, and you really want to put yourself out there, you can make yourself a lovely condom dress out of expired condoms to wow your date! The condoms may be past their prime, but this style will last! (Though obviously don't use the expired condoms for intercourse!)

Look at all the potential for condoms on Valentine’s Day/National Condom Day! Though let’s put the, crafts and fun aside for a moment now, and discuss the important role condoms play in protecting you against a whole host of STDs, including HIV. Latex condoms are the best option, though if you or your partner has a latex allergy, you can use plastic condoms. It is important to remember to only use latex or plastic condoms, as natural condoms, such as sheepskin, are porous.

It is extremely important for you to have a discussion with your partner about condoms and protection, especially prior to sex, and in some cases to take initiative to purchase condoms on your own. If you’re nervous about having this discussion with your partner, have the discussion with yourself first– visit this site with some tips about conducting this conversation! 

Basic Facts about Condoms and Protection:

A Female Condom

• When used properly, male condoms can protect you up to 98% of the time (and between 75-85% when used normally) [1]. In fact, condoms are so effective that they make sex 10,000x safer than if you don’t use one (Planned Parenthood) [2]! Only water-based lubes can be used with these condoms, as oil-based lubes or Vaseline can break down the condom (WebMD) [3].
• Though not as much research has been done on female condoms, it has been proven that HIV cannot pass through these contraceptives (CDC) [4], and that any type of lube can be used without the condom breaking. Female condoms can also be inserted long before sex, so even if you and your partner decide to have sex at the spur of the moment, you can still be safe!

What does all this talk about condoms mean for those living with HIV and looking for love (or for those lucky ducks who have already found it!)? Well, it means you can do anything that those who are not living with HIV can do! Many people living with HIV believe their diagnosis will force them to be alone –we here at the SAN love busting myths, so want to shout from the rooftops that this is absolutely not true! HIV cannot travel through plastic or latex condoms which means that those living with HIV and their partners are able to to enjoy safe and worry-free sex! Whether you are a sero-discordant couple or a couple where both partners are living with HIV and are looking to protect each other from a different strain of the virus, you can still experience love as you have always wanted to. Not convinced yet? Check out these testimonials and dating sites for those living with HIV. And remember: your diagnosis shouldn't hold you back from finding and enjoying love! NO MATTER WHAT, you are still you and you ARE worth loving!

Happy Valentine's Day and Happy National Condom Day #StigmaWarriors! Please share this blog to show others that there is no shame about being HIV positive and that life doesn’t end with a diagnosis. On Valentine’s Day and every day, let’s all remember to bust myths, end stigma, love smart, love safe, and love love!

"Shuga" is Saving Lives in Nigeria - Mario Christodolou

Read the original post in its entirety here, at The Impatient Optimist: http://www.impatientoptimists.org/Posts/2014/01/Media-Can-Change-Lives-and-it-Can-Save-Lives

MARIO CHRISTODOULOU

January 06, 2014

Sophie has just had unprotected sex with her “Sugar Daddy” (a person who exchanges large amounts of money or gifts for sexual favours). While he goes to freshen up in the bathroom, she innocently snoops around the bedside drawer to reveal a box of pills—little does she know that they are antiretrovirals. She has unknowingly put herself at risk of HIV infection.

The scenario described above is from the new series of the MTV show Shuga, which has now landed in Nigeria. Condensed into this 60-second scene are issues related to transactional sex, negotiation of safer sex, HIV treatment, and HIV disclosure. But this depiction is just the tip of a gargantuan, mass-media behavior-change iceberg.

A scene from Shuga showing Sophie and Solomon in bed. Photo © MTV Staying Alive Foundation

Produced by the MTV Staying Alive Foundation in partnership with the Bill & Melinda Gates Foundation, US President’s Emergency Plan for AIDS Relief (PEPFAR), and the Nigerian National Agency for the Control of AIDS (NACA), the award-winning Shuga TV show has already had two hit seasons in Kenya. But Georgia Arnold, the Executive Director of the MTV Staying Alive Foundation and Executive Producer of Shuga, has a vision for the Shuga campaign in Nigeria that far exceeds anything attempted previously in Kenya.

“Shuga is a ground-breaking TV show that portrays the lives and loves of a group of young people. Seamlessly interwoven into the storylines are vital messages related to HIV and a wide range of other sexual health messages,” explains Arnold. “Alongside the TV series is a substantial mass-media campaign, which reaches our audience at all the points where they interact, improving their access to vital sexual and reproductive health messaging and directing them to the health services they need.”

As well as the TV show, the points of interaction that Arnold alludes to include a radio series, a mobile service (SMS), a comic book (focused on the domestic violence story line in the TV drama, aimed specifically at girls with low literacy levels), digital and social media, and a Skype service through which users can “call a character” from the show and share their thoughts.

Nii and Malaika in Shuga. Photo © MTV Staying Alive Foundation.

“The particular nature of stories and dramas not only deliver informational content but create emotional connections to characters and role models, which promote a better context for learning and behavior change than do factual presentations,” observes Victor Orozco, an economist at the World Bank and coordinator of their Africa HIV/AIDS Impact Evaluation Program. “TV could play an important role in introducing ideas to large segments of a society, especially segments where literacy is low and social norms discourage discussion of stigmatized issues such as HIV/AIDS and teen pregnancy.”

 Shuga series 3 aired for the first time on World AIDS Day, 2013, on more than 70 channels, with a potential audience of a half billion people.By keeping messages from the TV show at the forefront of people’s minds, the introduction of multimedia elements may have the potential to reinforce and promote positive behavior change. For example, sending weekly text messages can significantly increase adherence to antiretroviral treatment for people living with HIV. The Shuga campaign in Nigeria will aim to reinforce the messages of the Shuga TV show with a 360-degree campaign, including several social media and mobile components, such as text messaging and interactive voice recordings. Orozco is working with MTV to evaluate the behavior-change effects of the show and the additional impact of mobile messages through a randomized study.  

A character on the show is tested for HIV. Photo © MTV Staying Alive Foundation.

Shuga has made the journey from Kenya to Nigeria for several reasons. While some might argue that on the basis of prevalence, the need for a campaign like Shuga is greater in Kenya than in Nigeria—HIV prevalence in Kenya (6 percent) is double that of Nigeria (3 percent). However, Nigeria has the second highest number of people living with the disease, and while maternal mortality has significantly fallen since 1990 in the country, one in 13 women still die during childbirth. Additionally, of Nigeria’s burgeoning population of over 150 million, nearly a third are young people aged 10 to 24 years—a population that falls neatly into the MTV demographic and who will relate more closely with stories portrayed in Shuga.

These public health concerns are compounded by a severe lack of knowledge about HIV among young men and young women. “Comprehensive knowledge about HIV is defined as knowing that condom use and having just one HIV negative and faithful partner can reduce the chances of contracting HIV; knowing that a healthy-looking person can have HIV; rejecting the two most common misconceptions about HIV transmission—that HIV can be transmitted by mosquito bites and that HIV can be transmitted by supernatural means," explains Dr Emmanuel Alhassan, Director, Resource Mobilization at NACA. “However, only 22 percent of young women and 33 percent of young men [in Nigeria] have comprehensive knowledge about HIV.”

Shuga has the potential to displace the silence that has engulfed serious issues like HIV in Nigeria and beyond, and to fill the knowledge vacuum that such silence has created. Shuga series 3 aired for the first time on World AIDS Day, 2013, on more than 70 channels, with a potential audience of half billion people. With this kind of reach, the ability for this so-called entertainment education to inform, change attitudes, and even change behavior is undeniable.

However, Orozco notes that policy makers and funders might be seriously under-investing in such mass-media approaches due to lack of rigorous evidence. But with the support of the Gates Foundation and MTV Staying Alive, he and other researchers are remedying this by evaluating Shuga and creating a knowledge base of what methods works and what is worth scaling up in Nigeria and elsewhere.

“Our vision for Shuga is to see a transformation in attitudes about the way the world talks about sex, not as a dirty topic, or something that should be hidden, but something that is openly discussed: parent to child, peer to peer,” envisions Arnold. “Only by doing this will we see a real change in people’s attitudes about HIV and their knowledge about it. Only through open and honest dialogue can we can hope to save lives.”

Find links to the episodes that have aired so far here. 

Read the original post in its entirety here, at The Impatient Optimist: http://www.impatientoptimists.org/Posts/2014/01/Media-Can-Change-Lives-and-it-Can-Save-Lives

An Interview with "James" by Brian Fuss

The following is from an interview with James (not his real name) an HIV+, gay male, sex worker, pro-Dom, and former drug user.  Thank you for sharing your story, James.

James grew up in a Midwest town Pentecostal family where religion and family were constantly reinforced by their twice a week church attendance. James remarked, “All of my friends were from that church; in fact, I did not know anyone other than church members.” At the age of 16, after struggling with his sexuality “forever,” James shared with his older sister about being gay. James stated, “My sister betrayed me and told my parents and this ensued a shit storm in my life.” His parents demanded he “repent of his homosexual, evil ways and go back to loving the Lord.” However, James knew he could not deny who he was, and told his parents as much. His parents threw him out of the house until “he properly repented and served the Lord.” Alone, hungry, scared with his last $100.00, James went to LA hoping a friend would help.

“The friend was a total asshole and basically had sex with me for a few days and then told me to beat it.” Now, completely alone, in a strange city, and frustrated, James had no idea what to do. Then, a kindly man offered him a warm bed and food. “He was a nice guy…at first he said I could just hang out until I got on my feet. Then he started to flash around a lot of money. When I asked him what he did, he said he worked in the porn and sex industry. This was more money than I saw in my whole entire life.” He became James’s mentor, telling him what porn shoots to go on and what places to stay away from. “The way to make more money was to do it (sex) raw (bareback), so of course I became that type of actor. I was making a lot of money between this and my lucrative escort business. With that came the partying, more sex, and HIV.”

“HIV completely changed my life. First, it [HIV positive status] got me into recovery.” James explained he left partying and entered (drug and alcohol) recovery and has been sober for 5 years. “Being an escort brings its own stigma, but it, honestly, is something I do not have to self-disclose, unless I want to date you…there is the rub…most guys are completely intrigued by my sex work, but hesitate to get involved with me because of it. I have heard numerous times…you are a great guy but I can’t be with (date) a hooker…I ain’t no hooker!” James further explained that HIV is the second hurdle that creates a lot of stigma in his life, both professionally and personally. “I have an obligation to tell clients, if they ask, about my HIV status (James explained he is 80% safe with clients and is undetectable) if they want to fuck raw.” James stated he has been single because no one wants a “HIV positive sex worker for a boyfriend, and that just hurts.”

I asked James two question, which I believe are important and pertinent to the discussion of stigma and I offer James’s answers in their entirety.

Many profiles on gay dating sites have the terms clean and dirty to describe someone who is HIV- verses someone HIV+. What are your thoughts? “I’m not dirty! When I see that shit, I just get pissed and usually say someone. Gay men can be so pathetic when it comes to HIV status. Think about the terms…because I am HIV+ I am somehow defective and should be ignored or worse cleaned up…it reminds me of what my parents said when they threw me out of the house…maybe I am just dirty.”

What is your advice to other young men in a similar situation? “You are more than your status, the drugs you take or the work you do! Don’t let anyone take your humanity away from you!”

In conclusion, James tells a story of stigma and shame from growing up gay in a Midwestern town to being a sex worker to being in recovery to being HIV+. It is estimated that more people delay treatment or refuse to get tested out of shame and stigma, especially if they are involved in the sex industry.

_ _ _ _ _ _ _

This interview was conducted by Brian Fuss of the Harm Reduction Coalition