Leave no Stone Unturned: Multiple Structural Response for KP Programming in the Kingdom of Eswatini

Transcription

1 Leave no Stone Unturned: Multiple Structural Response for KP Programming in the Kingdom of Eswatini Bheki Sithole Programme Technical Lead, FHI 360 LINKAGES Kingdom of Eswatini INTEREST Conference, Kigali, 29 May 2018

2 Presentation Outline Background and context of HIV in the Kingdom of Eswatini Global LINKAGES response Kingdom of Eswatini s multistrategy response Key success Gaps and opportunities Lesson learned

3 HIV Pravalence (%) An Overview of the Epidemiology of HIV in Eswatini The Kingdom of Eswatini has a total of 1.1 million people. 2016/17 Swaziland HIV Incidence Measurement Survey estimated HIV prevalence at 27% in adults between the age of 15 and above. Women are proportionately affected at 32% higher 54.2% aged and men 20.4% higher 48.8% aged Swaziland IBSS estimated high HIV prevalence among key population for FSWs at 70.3% and MSM at 17.7% Age Group (Years) Prevalance MSM (IBBSS, 2011) Prevalance Males (SHIMS, 2011)

4 HIV Epidemic Drivers among Key Population in Eswatini Structural landscape: Elements of same sex and sex work are illegal in the Kingdom of Eswatini. Police arbitrary arrest of key population (KP), especially FSW. Police and clients violence, rape and harassment during arrests for FSW (IBSS 2011). Lack of access to treatment during arrests. Arrests during service provision. FSWs and MSM reported experienced and perceived stigma in HCF seeking health care in MSM 51 and FSWs 45% (BSS 2011). Experienced dual stigma Lack of disclosure Lack of social support Challenges in ART adherence Increased burden of HIV

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6 Multiple-sectoral strategy in Eswatini Stigma reduction in health care facilitates Reduction of human rights violations and violence Community engagement to address S&D and HR violations

7 Engagement with key KP stakeholders Creating forums for KP stakeholders to plan and implement activities In collaboration with MoH, facilitated the formation of KP technical working group. Stigma reduction in health facilities Conducted pre-service trainings for 3 nursing tertiary institutions. In collaboration with MoH and KP ambassadors conducted sensitizations in 57 health care facilities. Police training and sensitization Conducted trainings from Police executive, senior management and front-line, including to police-topolice learning exchanges. Training translated into training of 84 focal KP officers in unit responding to violence. Conducted sensitizations with Police addressing KP rights to care, human rights violations in all 7 police regions and 2 police stations. Community engagement: Super Groups Created forums where MSM and FSW organizations meet to discuss program design, implementation, monitoring and advocacy; KP CBOs capacity building Human rights and safety education to KP from police and other stakeholders Engaging human-rights lawyers and the judiciary on KP

8 Key Successes Reducing Stigma in Health Facilities To the KP, we are sorry, we did not know we were hurting you, we did not understand. I will no more allow this discrimination. Hospital Matron These sensitizations are eye-openers. We never learned about these things from our tertiary training. Clinic Nurse I went to Raleigh Fitkin Memorial Hospital as a transgender person. I received a friendly reception and the nurse understood my needs even before explaining as well as my gender issues. I was impressed. Transwoman Reducing Police stigma and HR violations: When we were first approached about working with KP, I never thought it would be something I will do and my religion would have never allowed me, but learning from other police in the LEPH conference opened my eyes, sex workers have rights. Senior Deputy Commissioner all LGBTI Some and other Successes vulnerable people will be treated like everyone else Police PRO Since sex workers had a legal representation from HR lawyers the last time they were arrested police are treating them with respect when they are on the streets. VooV leader, member of the FSW Super Group

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10 Key Population Programming Opportunities and Gaps Challenge Limited or inadequate training manuals for KP stakeholders including Police and Judiciary. Cultural perception of sex for sale; issues of morality in the context of the Kingdom of Eswatini: police and HCWs. Police take orders from higher authorities within the kingdom to act. Elements of same sex practices and sex work remain criminalized. Possible Solution FHI 360 supporting RSPS develop a police training manual on KP human rights and rightsto care pre/post service. On-going constant engagement of police from senior level to the front line officers. Promoting interactions between police and KP and other stakeholders. Engaging judiciary and legal fraternity. Supporting SNAP develop approach for stigma reduction in health facilities.

11 Lesson Learned Top-bottom approach for police works: it s a command institution. Constant engagement, at all levels, is key, memory can be lost. Partnerships, especially with MoH and other partners in structural response is key. Pre-service training for both police and HCWs is important. Community empowerment important: vulnerable populations should know their rights. Engagement of legal fraternity and judiciary can be a game changer for both the police response and the KP individual perception.

12 Sithole, B 1 ; Muzart, L 1 ; Dlamini, P 1 ; Mthethwa, T 1 ; Msibi, Z 1 ; Akolo, C 2 ; Wilcher, R 2 ; Mark, N 2 ; Mahler, H 2 ; Matse, S 3.; Gambu, N. 3 ; Lukhele, K. 3 ; Dlamini, M. 3 ; Chilongozi, D 1 AFFILIATIONS Authors 1 FHI 360, LINKAGES Swaziland, Mbabane, Swaziland 2 FHI 360, Washington, DC, USA 3 Ministry of Health, Swaziland National AIDS Programme, Mbabane, Swaziland

13 Acknowledgments

14 Siyabonga! Enkosi! Thank you!