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)
