Inmate populations comprise a definite group of individuals who are at risk of HIV infection; in many countries HIV prevalence rates in prisons are often much higher than those found in communities outside. Despite this alarming picture only a few prison systems provide inmates with adequate protection against HIV/AIDS. Beginning in 1995 the Copperbelt University Health Services Department has been working with the Zambia Prisons Service to respond to the challenge of HIV/AIDS in the countrys prisons. The project is called In But Free and has as its main objective the prevention and control of HIV transmission in prisons and the care and support for those living with HIV/AIDS. The lack of a concerted response to the pandemic behind bars is compounded by the belief in many societies that prisoners go to jail to be punished for offending society. Initiatives that appear to help inmates are therefore not readily supported. This is in sharp contrast to interventions that have been developed for other at risk groups like sex workers truck drivers and uniformed personnel. We however believe that prisons are not closed off worlds. Prisoners and indeed prison staff move in and out of jail each day. Many prisoners are jailed for only a short period of time and return to society after their release. Any infection acquired inside prison can therefore be readily transmitted outside. In the long run giving protection to inmates is also giving protection to society. (excerpt)
In ancient India sex and sexuality were not the taboo subjects they are today. Evidence of this is seen in the explicit portrayal of sexual intercourse on the walls of some Hindu temples. The references to sex workers held in high esteem in the epics of Ramayana and Mahabharata show the status and dignity they had in those days. Their role as entertainers and relaxation artists was well recognized and accepted. The Victorian morality introduced by the British portrayed sex work as a sin and relegated sex and sexuality to the darkness of bed rooms. After independence the British law was adapted without much modification and subsequent laws including the Immoral Trafficking Prevention Act (ITPA) and section 377 of the Indian Code of Criminal Procedure outlawed homosexual behaviour and regulate prostitution. Nowadays sex workers are exploited harassed physically beaten and otherwise abused by the police gangsters and moralists in society simply because of their status as sex workers. Known sex workers are marginalized in the health system and frequently receive inadequate medical care. There is little attention for their specific health needs especially regarding their sexual health and physical and mental traumas due to violence. Sex workers are legally marginalized by a system which has in essence criminalized prostitution. Those who engage in sex work often find themselves entangled in a debt trap: they are fined for carrying out their work but the only way they can access money to pay off fines is through more sex work. They have no legal and political rights making it impossible to make a legal case for physical or sexual violence experienced while at work. (excerpt)
Since the early days of the HIV/AIDS epidemic stigma and discrimination have been critical obstacles to delivering effective HIV/AIDS programmes. These problems are often exacerbated in an epidemic such as in Mexico where it is concentrated among men (6:1) and transmission is predominantly sexual and between men. Although stigma and discrimination are seen as important issues the lack of clear measurements articulation of problems and clear policy guidelines has meant that the issues often go unaddressed. An important area for action to reduce stigma and discrimination lies in the health-care system. A recent study of HIV-related stigma and discrimination in health service delivery in three Mexican states revealed three main types of stigma: pre-existing stigma; HIV-related stigma; and enacted stigma (the borderline between stigma and discrimination). The study was part of an overall multi-faceted HIV-related stigma-reduction project called Mo Kexteya by the POLICY Project Mexico (The Futures Group) with support from MACRO Measure Evaluation. (excerpt)
Many FBOs play a crucial role in the provision of health care in African communities. However the ambiguities between the official positions of the religious leaders on SRHR issues and the needs they encounter within the communities hinder their ability to provide appropriate and comprehensive sexual and reproductive health services. For instance doctors in a mission hospital in sub-Saharan Africa might have difficulties in educating their HIV-infected patients to prevent infection of their partners as the church forbids them to promote condom use. This ambiguity often forces FBOs to take action in influencing the religious hierarchies in which they operate to discuss sexual and reproductive health and rights (SRHR). Being close to the religious structures in which they operate gives them a unique opportunity to bridge the gap between the international protocols on SRHR and existing religious laws. (authors)
It is estimated that around 130 million women and girls worldwide have undergone female genital mutilation (FGM) with a further two million girls thought to suffer the same fate every year. FGM is thought to occur mainly in 28 African countries although the practice has also been recognized in some countries in Asia and the Middle East. In Guinea FGM is widely practised with only slight differences in prevalence between different ethnic groups or regions. In 2000 GTZ partner organizations working on FGM found that the attitudes expressed by communities and anti-FGM activists did not correspond to actual practice in relation to FGM. They found themselves confronted with an urge to seek dialogue rather than confrontation: this became the guiding principle in the development and design of an ‘intergenerational dialogue on gender and sexual and reproductive health including FGM. FGM comprises all procedures that involve partial or total removal of the female external genitalia and/or injury to the female genital organs for cultural or any other non-therapeutic reason. In Guinea the most widespread form of FGM is Type II (excision of the clitoris) followed by Type I (excision of most of the prepuce – the fold of skin surrounding the clitoris – and total removal of the clitoris) and Type IV (unclassified includes incising of the clitoris and/or labia cauterization (burning) scraping or cutting of vaginal tissue). The age at which girls undergo FGM ranges from several months to 18 years with an average age of 9-10 years. Results from the November 1999 Demographic and Health Survey (DHS) indicate a prevalence of more than 98% among women aged 15-49 years although data suggest that FGM may be on the decline: a 1997 survey in Upper and Central Guinea showed that from 1984-1997 the rate of girls and women having undergone FGM dropped from 100 to 86%. (excerpt)
Contemporary scholars in Africa highlight the special vulnerability of young mostly urban (school) girls to the social menace of socalled ‘sugar daddies. These are often portrayed as much older adult men who indulge in sexual relationships with young unsuspecting powerless and needy females. Sugar-daddy relationships enhance risky sexual behaviour – such as non-use of condoms concurrent multiple partnerships across diverse risk groups and/or social strata denied or unwanted pregnancies and resultant unsafe back-door abortions violence and rape – and exposure to STIs including HIV. Social research on sexual behaviour in Uganda and other African countries however highlights the need to debunk popular myths surrounding sugardaddy relationships if this social problem is to be curbed. Sugar daddies are not a homogenous group of actors. The stereotypical images of ‘the dirty old man with a sardonic twinkle in his eye ‘the big fat pot-bellied guy or the ‘smooth talker with a sleek motor car are just subsets of the diverse range of adult men who indulge in sugar-daddy relationships. Research among relatively younger migrant adult men (average age 23 age range 17-40) employed as motorbike-taxi riders in Uganda revealed ambiguity of meanings of the tag ‘sugar daddy.1 It also socially labels young adults who are earning such as traders teachers or employees and who are sexually involved with young females. Numerical age gaps are not as crucial as social and economic status gaps between the partners. While interventions target urban populations the phenomenon also stretches to rural settings particularly in cases of cyclical rural-urban migration whereby adult men regularly travel to village girls and indulge in repetitive irregular casual sex with them. Furthermore not only schoolgirls are vulnerable but also out-of-school young females housemaids college/university students and early employees. Young females seeking employment are particularly vulnerable because they need money and a job from adult employers who are mostly men. (excerpt)
Sex death prolonged illness blood drug use poverty race and ethnicity promiscuity and homosexuality are all linked to HIV and AIDS. Not surprisingly such a heady cocktail of judgement-laden associations can trigger strong and complex reactions including frustration aggression denial and silence. HIV/AIDS – and the complex issues it represents – challenges our ability to reason and amplifies existing inequalities prejudices and human rights abuses. Individuals and communities already stereotyped stigmatised and disadvantaged are further marginalized by the fear ignorance and intolerance generated by HIV/AIDS. stigma is a real or perceived negative response to a person or persons by individuals communities or societies. It is characterized by rejection denial discrediting disregarding underrating and social distance. It frequently leads to discrimination and violation of human rights. HIV/AIDS-related stigma and discrimination pose a serious threat to the basic human rights for all people infected affected or associated with the disease. The right to health care the right to freedom of speech and movement the right to services like housing and education the right to confidentiality dignity liberty and security and ultimately the right to life are all threatened by stigma and discrimination. (excerpt)
Sexual coercion among young people encompasses a range of experiences ranging from non-contact forms such as verbal sexual abuse and forced viewing of pornography as well as unwanted contact in the form of touch or fondling to attempted rape forced penetrative sex (vaginal oral or anal) trafficking and forced prostitution. It also includes sex obtained as a result of physical force intimidation pressure blackmail deception forced alcohol and drug use and threats of abandonment or of withholding economic support. Transactional sex through money gifts or other economic incentives (especially in the context of extreme poverty) often has a coercive aspect as well. In this context youth programmes need to consider patterns of coerced sex when addressing reproductive health HIV prevention and other needs. What can we learn from research? Reproductive health and HIV prevention programmes for youth rarely address the reality of coercive sex that many youth face. Such coercion is a violation of a persons rights and can have severe physical mental and reproductive health consequences. Sexual abuse can occur in premarital extramarital and marital situations. Perpetrators are usually people with whom the victim is familiar including intimate partners peers family members teachers and other youth and adult acquaintances. Coercion often occurs in the course of routine activities in the home neighbourhood community and school. Perpetrators are generally but not always males. Data on sexual coercion among youth in developing countries are limited; most studies are small with findings that may not be representative. A review of thirteen studies found that between 2 and 20% of girls and fewer than 15% of boys reported ever experiencing sexual coercion. The youth surveyed were generally aged 15 to 19; of these thirteen studies six included males. In a review of fourteen studies that asked about forced first sexual experience about 15 to 30% of sexually active girls reported coercion; and fewer than 10% of boys. Of these fourteen studies five included males. (excerpt)
Now at the start of the 21st century one of every 35 persons worldwide is an international migrant. If all international migrants lived in the same place it would be the planets fifth biggest country. The world saw 80 million people migrate in relation to labour in 2001; there were also 10- 15 million undocumented migrants who crossed borders. In 2002 22 million people were refugees and internally-displaced persons while another 4 million persons were trafficked for labour and sexual exploitation purposes. In addition each year almost 700 million travellers also cross international boundaries. People move from one place to another for many reasons. Some migrate to join family members. Others such as airline personnel truckers people serving in uniformed services petty traders and sex workers travel for professional reasons. Many people move in search of economic opportunities. Yet others are pushed by war human rights abuses ethnic tensions violence famine and persecution. Movement may be voluntary or forced. It may be temporary seasonal (e.g. during harvests) permanent or circular (returning home repeatedly). Categories shift: people intending to migrate permanently may change their minds and return home; people intending to stay only a short time may settle permanently; students or tourists entering countries legally may become undocumented migrants when their visas expire; undocumented migrants may have their status regularised; and refugees and internally-displaced persons may be able to return to the communities from which they fled as they are currently doing in Angola and Afghanistan for example. (excerpt)
It has been known for a long time that people whose jobs require them to travel a lot such as truckers traders seafarers army personnel etc. are extremely vulnerable to HIV and STIs. In the case of truck drivers overnight stays away from home less social control long waiting periods in ports and border stations the availability of commercial sex and other factors work together in creating this vulnerability. In various countries of the world mainly in South Asia South Africa and Western Africa projects have been set up to increase HIV/AIDS awareness among truckers and their occasional sexual partners and teach them about the importance of consistent condom use. In South Africa several roadside container clinics for HIV/AIDS education and treatment of STIs were set up by the road freight industry. In South Africa national HIV prevalence rates grew from 0.8% in 1990 to 22.4% in 1999. By the end of 2001 an estimated five million South Africans were living with HIV/AIDS and 1600 people were contracting HIV daily. Long-distance truck drivers and their sexual partners were found to be especially vulnerable population groups. To counteract the spread of HIV/STIs among its mobile personnel the South African road freight industry set up several mobile health clinics along the main roads of the country. The project is carried out by the Learning Clinic a local NGO. (authors)
Over the past decade or so schools have been viewed as a primary place for educating young people about HIV prevention and safer sex. However many schools are in fact sites of high levels of sexual violence most of it directed at girls who we know are particularly vulnerable to HIV infection. Young people engage in sexual activity at an increasingly early age and if schools tolerate an environment that condones male aggression and intimidation then they are encouraging rather than discouraging high-risk sexual behaviour and contributing to the spread of the disease rather than to its reduction. Regular media reports and recent research provide evidence that sexual violence is commonplace in schools at least in sub-Saharan Africa; it may well be pervasive elsewhere. There is therefore an urgent need to break the silence around this issue. (authors)
Most reproductive health and family planning programs focus on serving the needs of women. However practitioners have realized that focusing primarily on women--and neglecting men and their reproductive health needs--is not an effective strategy and may have negative consequences especially in the context of HIV/AIDS. EngenderHealths Men As Partners (MAP) program aims to place the needs of men--as womens partners and as individuals--on the agenda of health care providers worldwide. (authors)
Through street and community outreach HIV prevention clubs and training workshops an innovative project called the Baabas takes HIV prevention messages to street children the local community and local leaders. This GOAL Uganda project seeks to reduce street childrens vulnerability to HIV/AIDS and sexual exploitation by providing training resources and ongoing support to 12 nongovernmental organizations (NGOs) working with this target group. At the center of the project are 140 so-called Baabas--street youth elected by their peers from participating street children NGOs (in the local language Luganda a Baaba is a respected older brother or sister who advises and guides his/her younger siblings). The Baabas are trained in HIV/AIDS and sexual health issues as well as participatory teaching methods. (excerpt)
Female infanticide is as old as many cultures and has likely accounted for millions of gender-selective deaths throughout history. It remains a critical concern in a number of countries today notably the two most populous countries China and India. Female infanticide reflects the low status accorded to women in many parts of the world and is arguably the most brutal and destructive manifestation of existing anti-female bias. It closely linked to the phenomena of sex-selective abortion which targets female foetuses almost exclusively and neglect of girl children. While men tend to be the main victims of war and political-military genocide the example of female infanticide reminds us that there are institutionalised forms of discrimination and violence that are at least as destructive as the more traditional forms of mass killing. (authors)
Female genital cutting (FGC) is the standard international terminology for the cutting away of part or all of the female external genitalia. The World Health Organization estimates that 100-132 million women and girls living worldwide have been subjected to FGC. In Sudan it affects almost 90% of women and girls. Since 1985 the Sudan National Committee on Traditional Practices (SNCTP) a grassroots-oriented NGO working on womens and childrens human rights issues has been working to eradicate FGC and other harmful traditional practices such as early marriage and non-spaced pregnancies. (authors)
Infertility is a global phenomenon. An estimated one in ten couples around the world has difficulty conceiving at some point in their reproductive lives. Although a growing body of social science and biomedical evidence suggests that nearly 40-50% of infertility is attributable to problems suffered by men women bear the brunt of the blame for infertility problems. As a result women may face guilt anxiety exposure to dangerous medical and ethnomedical interventions social ostracism stigma and the threat to divorce or abandonment. Anthropological research in India and ongoing observations in Morocco highlight some of the complexities underpinning infertility and its impact on the lives of women and men in these two countries. (authors)
In 1994 governments attending the International Conference on Population and Development (ICPD) recognized the need to improve reproductive health. Since then most Latin American countries have initiated programs to develop reproductive health services and make them available to the majority of men and women. This was not easy given resistance by the Vatican and other conservative sectors that viewed this as promoting abortion and liberal sexuality. Promotion of emergency contraception (EC) reopened the debate partly because of the term morning-after pill. The term creates confusion because some claim it has an abortive effect on implantation of a fertilized egg cell. EC actually has a contraceptive effect because its fundamental mechanism prevents fusion of the egg cell and sperm. (authors)
Over the last 40 years numerous intrauterine devices (IUDs) to prevent pregnancy have been developed and marketed. Currently copper-containing IUDs are the most widely used of these contraceptive devices which offer high efficacy in reducing the risk of unwanted pregnancy. The most significant drawbacks have been pain and expulsion problems causing women to discontinue their use. Against this background an improved frameless intrauterine system has been developed and marketed under the name of Gynefix. Marie Stopes Bolivia is promoting introduction of Gynfix in Bolivia as part of its reproductive health services. (authors)
The role of the family in sexual health in Tanzania and in particular in gender socialisation has changed tremendously due to a number of factors. The rise of the level of education among 34.5 million people the change from a state-run socialist economy to a liberal economic system and the shift from a one-party to a multiparty system which came with more freedom of speech have all affected gender roles and socialisation from household to country level. More recently large scale rural-urban migration the HIV/AIDS pandemic privatisation and globalisation forces have fuelled a national debate on the role of the family in sexual health and gender socialisation. While the anti-AIDS campaign calls for parents to talk openly to their children about safer sex the free market economy requires parents to work around the clock to ensure basic family income. (authors)
The first case of AIDS in the Philippines was discovered in the mid-1980s but the disease remained a novelty there for the next decade possibly because HIV/AIDS did not have a human face. It seemed more like hype by the international media rather than a real-life problem. Therefore when Population Services Pilipinas Incorporated embarked on HIV prevention in 1991 it decided to use a popular medium--street theater--for bringing critical information to vulnerable audiences. Kaalamang 343 an indigenous street play on HIV prevention based on an original script was born and performed to audiences across the capital Manila for 5 consecutive years. (excerpt)
