Sue Holden | Sue Holden, development consultant

Know Much More About HIV: Staying positive and healthy in the workplace

Sue Holden Publications - English 2nd March 201217th July 2018HIV, SAfAIDS, Sexual Health

Know Much More About HIV: Staying positive and healthy in the workplace

SAfAIDS asked me to write a booklet for employees, as part of a toolkit to support workplace responses to HIV. I wanted to give readers more options and more detail than the usual HIV prevention messages, and so set out 26 ways in which individuals can reduce their risk of acquiring HIV.

The booklet also outlines the steps which individuals can take to create a supportive and healthier workplace, and is available in Portuguese.

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What has HIV got to do with your workplace?

There are many different things which affect how well you and your colleagues work, and how productive your organisation is. Among those many factors, the impact of the HIV epidemic is likely to be significant. The effects of HIV in the workplace include:

If employees become infected with HIV and do not access treatment, then HIV will, in time, badly affect their health and productivity, leading to severe illness and their eventual death;
Increased staff absenteeism and higher staff turnover cause problems. These include stalled projects, missed targets, colleagues becoming overworked, managers spending too much time sorting out problems related to health issues, and lower morale in the workforce;
Staff costs tend to rise. This is due to higher medical costs, more funeral expenses and death benefits, and increased recruitment and training costs;
Efficiency is also undermined when staff are indirectly affected by HIV. For example, caring for sick relatives, or taking on responsibility for relatives’ children, takes time and causes stress.

However, we are not powerless against HIV. We can manage HIV in the workplace in three ways:

Support staff and their family members to protect themselves from HIV infection
Support staff (and sometimes their family members) who are HIV infected to maintain their health and their ability to work.
By advocating for and creating a supportive working environment that implements its HIV policy and operates a wellness programme, with peer educators, educational awareness campaigns and programmes for staff.

What’s in this booklet?

Section 2 covers basic information on HIV transmission, progression to AIDS, and treatments for HIV and the opportunistic infections that arise from it. It may be a useful reminder for you, even though you already know a lot. You can use the information there to work out for yourself if a certain situation has potential for HIV transmission.

Section 3 deals with ways of preventing HIV transmission. This means both protecting yourself from getting infected, and stopping transmission of HIV to others.

Section 3.1 goes beyond the usual ABC of HIV prevention, and gives you 14 different options for reducing the chance of HIV transmission through sex! You may find new options there that you can use.

Section 3.2 concentrates on reducing HIV transmission from mother to child. It includes options for couples who want to get pregnant where one or both of them are infected with HIV.

Section 3.3 looks at ways of maintaining health and preventing opportunistic infections

Section 3.4 looks at ways of reducing HIV transmission through medical, cutting and injecting procedures. This section should also give you food for thought.

In Section 4 we move on to the more general topic of valuing our health. HIV is not the only threat we face, and there is a lot we can do to increase our chances of enjoying good health and productive lives.

Lastly, in Section 5 we set out the key ways in which we can create a supportive workplace for the benefit of all staff.

Saiba Muito Mais sobre o HIV: Mantendo-se seropositivo e saudável no local de trabalho

Sue Holden Publications - Portguese 1st March 201217th July 2018HIV, Português, SAfAIDS

Saiba Muito Mais sobre o HIV: Mantendo-se seropositivo e saudável no local de trabalho

A SAfAIDS me pediu para escrever um livreto para os funcionários, como parte de um kit de ferramentas para apoiar as respostas do local de trabalho ao HIV. Eu queria dar aos leitores mais opções e mais detalhes do que as mensagens habituais de prevenção ao HIV, e assim estabelecer 26 maneiras pelas quais os indivíduos podem reduzir o risco de contrair o HIV.

O livreto também descreve as etapas que os indivíduos podem seguir para criar um ambiente de trabalho mais saudável e de apoio, e foi originalmente escrito em inglês.

(The Portuguese translation of Know Much More About HIV)

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O que é que o HIV e SIDA têm a ver com o teu local de trabalho?

Há muitas coisas que afectam o teu trabalho e dos teus colegas e quão produtivo é a tua organização. Dentre tantos factores o impacto da epidemia do HIV e SIDA é o mais provável de ser significativo (importante). Os efeitos do HIV e SIDA no local de trabalho incluem:

Se os trabalhadores ficarem infectados pelo HIV e não acederem ao tratamento, então o HIV por sua vez irá afectar negativamente a sua saúde e produtividade, levando a doenças graves e eventual morte;
absentismo do pessoal acrescido e a uma maior mudança de trabalhadores causam problemas, tais incluem projectos não terminados, metas não cumpridas, colegas sobrecarregados de trabalho, gestores que desperdiçam demasiado tempo na resolução de problemas relacionados com questões de saúde e uma baixa moral na força laboral;
As despesas do pessoal tendem a aumentar. Isso ocorre devido aos mais elevados custos médicos, mais despesas com funerais e subsídios de morte, e custos acrescidos de recrutamento e treinamento;
A eficiência é também posta em causa quando o pessoal está indirectamente afectado pelo HIV. Por exemplo, cuidar dos familiares doentes ou assumir responsabilidades pelos filhos dos familiares, leva tempo e causa stress.

No entanto, não estamos sem poder em relação ao HIV. Nós podemos gerir o HIV no local de trabalho de três formas:

Apoiar o pessoal (e algumas vezes os membros da sua família) que estejam infectados pelo HIV para manterem a sua saúde e a sua capacidade de trabalho.
Apoiar o pessoal e os membros da sua família para se protegerem das infecções do HIV.
Advocar e criar um ambiente de trabalho de apoio que implemente a sua política de HIV e implementar um programa de bem-estar, com educadores de pares, campanhas de programas de sensibilização educativos para o pessoal.

Qual é o conteúdo do livro?

A secção 2, aborda informação básica sobre a transmissão do HIV, a sua evolução e transformação em SIDA e os tratamentos para o HIV, e para as infecções oportunistas que surgem como resultado do virus. Pode ser útil fazer lembrar, embora mesmo tu saibas muito sobre o assunto. Podes usar a informação aí existente para resolver por ti próprio, caso uma certa situação aponte para a possibilidade de transmissão do HIV.

A secção 3, aborda as formas de prevenção da transmissão do HIV, isso significa tanto protegeres-te para não ficares infectado, como evitar a transmissão do HIV para outras pessoas.

A secção 3.1, vai para além do ABC do costume da prevenção do HIV e dá-te 14 diferentes opções para reduzir a hipótese de transmissão do HIV através do sexo! Podes encontrar novas opções aí existentes que podes empregar.

A secção 3.2, focaliza-se na redução da transmissão do HIV de mãe para filho. Ela inclui opções para casais que queiram ter um filho, onde um deles ou ambos estejam infectados pelo HIV.

A secção 3.3, olha para as formas de se manter saudável e de prevenir as infecções oportunistas.

A secção 3.4, aborda as formas de redução da transmissão do HIV através de procedimentos médicos, cortes e infecção, esta secção também dá-te ideias para reflexão.

Na secção 4, passamos o tema mais geral de valorização da nossa saúde. O HIV não constitui a única ameaça que nós enfrentamos e há muitas coisas que nós podemos fazer para aumentar as nossas hipóteses de desfrutar de uma boa saúde e de levar uma vida produtiva.

Por último, na secção 5, nós apresentaremos as formas chaves através das quais nós podemos criar um local de trabalho e de apoio favorável para todos os trabalhadores.

The Big Picture: A guide for implementing HIV prevention that empowers women and girls

Sue Holden Publications - English 29th July 201117th July 2018girls, Health Rights, HIV, Sexual Rights, STOP AIDS NOW!, women

The Big Picture - Implementing HIV prevention

The Big Picture: A guide for implementing HIV prevention that empowers women and girls

From 2006 to 2010 STOP AIDS NOW! supported an innovative project in Kenya and Indonesia which gave equal weight to HIV prevention, gender equity and human rights. At the end of the project they asked me to set out the theory and practice of their partners’ efforts in a ‘how to’ guide. This is the result, which I co-authored with the project’s manager, Jennifer Bushee.

This guide will be particularly interesting for people working at community level who want to address the structural factors behind the vulnerability of women and girls to HIV.

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This guide provides ‘how-to’ information for developing a ‘transformative approach’ to HIV prevention for women and girls. Such an approach addresses key root causes of vulnerability to HIV and seeks to reshape the beliefs, attitudes and behaviours of individuals and communities in favour of women and girls and gender equality. It also aims to empower women and girls to protect themselves from HIV infection and from the negative impact of living with HIV.

It sets out the rationale for working on HIV prevention using a transformative approach. It also shares experiences and promising practices from the Gender Development Project. It then provides 5 steps based on these for developing HIV prevention work aimed at reducing the HIV risk of women and girl through promotion of gender equality and women’s rights.

This guide will be particularly interesting for people working at community level who want to address the structural factors behind the vulnerability of women and girls to HIV.

We note that the advice in this guide is not fixed and definite; please read it as providing suggestions based on the experiences of the partners in the Gender Development Project. The advice should be adapted to fit local needs and the relevant social, political and cultural context.

We also note that this guide is not comprehensive and is not written to support the development of a whole project cycle. It gives guidance about how to think from a ‘gender transformative’ perspective, but it does not, for example, give step-by-step instructions for doing a needs assessment.

Finally, we note that this guide encourages readers to think differently about how to respond to HIV, using a holistic perspective, the so-called ‘big picture’. This approach gives you wider scope for doing HIV prevention work. It allows you to integrate HIV prevention in other work on gender and rights. It also allows you to respond more closely to the felt needs of girls and women. Crucially, the ‘big picture’ approach, over time, allows you to work in a ‘transformative’ way. This means it helps supports people to transform or change gender relations in ways that are beneficial to all, including—but by no means limited to—by reducing vulnerability to HIV transmission.

A Different Way: Young women, their sexual orientations and their sexual rights

Sue Holden Publications - English 21st December 201017th July 2018Health Rights, Sexual Health, Sexual Rights, Youth

A Different Way: Young women, their sexual orientations and their sexual rights

Rutgers WPF asked gay and straight young people from around the world about what information would help girls and young women who have questions about their sexual orientation. I used their ideas and queries to write A Different Way, which was also translated into French as Vivre Sa Difference.

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All around the world, people’s ideas of sex, love and marriage focus on men and women. But this is not the whole story! There are different ways to be, including relationships between women, and relationships between men. But there is not much information available to help young women find their way.

We have written this booklet for young women who:

may be feeling different;
want to know more;
have questions about their sexuality;
and want to do what is best for themselves.

We want to give young women information about different sexual orientations. We hope it will help them to understand the issues better, and to make good choices, particularly if they are feeling unsure. This booklet should also be useful for people who work with young women, such as teachers and health workers.

Our values

We believe in human rights. They are things which everyone should have. Among them are sexual rights. Everyone should be able to choose their sexual partner, to decide whether or not to have sex, and be free to try and have a satisfying and safe sexual life.

Too often these sexual rights are abused. For example, young women are forced or pressurised into having sex, or required to marry a certain man. The situation is usually worse for women who are attracted to other women.

Sometimes information can help. In many cultures young people get a confusing mix of messages from films, magazines, friends, family members, and religious leaders. Some of this information is incorrect. Some of it is used to try and control them. Many adults think telling young people information about sex will lead to them having sex. This is not true! Many studies have shown that getting information about sex and healthy relationships helps young people to make better decisions.

What’s in this booklet

Chapter 2 is about sex and healthy relationships. It should be useful to all young women.

Chapter 3 explains what gender identity is, and outlines the different kinds of attraction or sexual orientation that are normal for humans.

Chapter 4 has a lot of questions and answers about women who are attracted to other women. They should be interesting to young people in general, and particularly to young women who are trying to figure out their sexual orientation.

Vivre sa Différence: Les jeunes femmes, leurs orientations sexuelles et leurs droits sexuels

Sue Holden Publications - French 20th December 201017th July 2018Francaise, girls, women

Vivre sa Différence: Les jeunes femmes, leurs orientations sexuelles et leurs droits sexuels

Rutgers WPF a demandé aux jeunes homosexuels et hétérosexuels du monde entier quelles informations aideraient les filles et les jeunes femmes qui ont des questions sur leur orientation sexuelle. J’ai utilisé leurs idées et leurs requêtes pour écrire Vivre sa différence. Originellement écrit en anglais.

(French translation of the publication A Different Way.)

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Partout dans le monde, les idées que l’on se fait de la sexualité, de l’amour et du mariage se limitent aux relations entre hommes et femmes. Et pourtant, ce n’est pas tout ! Il existe différents types de relations, y compris des relations entre femmes ou entre hommes. Cependant, il n’y a que très peu d’informations disponibles pour aider les jeunes femmes à trouver leur voie. Nous avons rédigé ce livret pour les jeunes femmes qui :

se sentent peut-être différentes ;
veulent en savoir plus ;
se posent des questions sur leur sexualité ;
et veulent faire ce qui est le mieux pour elle.

Nous voulons donner aux jeunes femmes des informations sur les différentes orientations sexuelles. Nous espérons que cela les aidera à mieux comprendre ces questions et à faire les bons choix, en particulier si elles ne se sentent pas sûr d’elles. Ce livret pourra également être utile aux personnes qui travaillent avec des jeunes femmes, comme par exemples les enseignants ou le personnel soignant.

Nos valeurs

Nous croyons aux droits humains. Chacun devrait pouvoir en profiter. Les droits sexuels en font partie. Chacun devrait pouvoir choisir son partenaire sexuel, décider si oui ou non il souhaite avoir une relation sexuelle et être libre d’essayer et d’avoir une vie sexuelle à la fois satisfaisante et sûre.

Ces droits sexuels sont trop souvent bafoués. Par exemple, des jeunes femmes sont forcées ou poussées à avoir des relations sexuelles, ou sont obligées de se marier avec un certain homme. Pour les femmes qui se sentent attirées par d’autres femmes, la situation est souvent encore pire.

Parfois, les informations peuvent aider. Dans de nombreuses cultures, les jeunes reçoivent de nombreux messages prêtant à confusion de la part des films, des magazines, de leurs amis, des membres de leur famille et des responsables religieux. Certaines de ces informations sont correctes. D’autres sont utilisées pour essayer d’exercer un contrôle sur les jeunes. De nombreux adultes pensent que fournir des informations aux jeunes sur la sexualité va les encourager à multiplier les relations sexuelles. C’est faux ! De nombreuses études ont montré que le fait d’obtenir des informations sur la sexualité et sur des relations saines aide les jeunes à faire de meilleurs choix.

Qu’allez-vous trouver dans ce livret ?

Le chapitre 2 est consacré à la sexualité et aux relations saines. Il peut être utile à toutes les jeunes femmes.

Le chapitre 3 explique ce qu’est l’identité de genre et souligne les différents types d’attirances ou d’orientations sexuelles qui existent chez l’être humain.

Le chapitre 4 contient de nombreuses questions et réponses sur les femmes qui se sentent attirées par d’autres femmes. Ce chapitre intéressera les jeunes en général et les jeunes femmes qui essaient de mieux comprendre leur propre orientation sexuelle en particulier.

Managing HIV in the Workplace: A Guide for CSOs

Sue Holden Publications - English 5th July 201022nd May 2018HIV, HIV in workplace

Managing HIV in the Workplace: A Guide for CSOs

STOP AIDS NOW! commissioned me to research and write this handbook (which they translated into French) to help organisations reduce the effects of HIV on their staff and their work. Other terms for this include ‘internal mainstreaming’ or ‘mainstreaming HIV at the organisational level’ or ‘addressing HIV in the workplace’.

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The costs and benefits of managing HIV

Of course, managing HIV in the workplace is not free of cost.

One cost is the staff time your CSO will use to come up with plans, and to put them into action. You may also need extra money, for example, if your CSO hires trainers to help you run workshops, or helps with the insurance or medical costs for staff.

The actual costs in time and money vary a lot between CSOs in different countries. But whatever they are, you might think that ignoring HIV has to be cheaper, because that doesn’t cost anything. Yet in the case study on page 7, when the CSO ignored HIV the consequences included: staff away from work; a failing project; the death of a valued member of staff; misuse of resources; management stress; a sacked member of staff; loss of a donor; underperforming staff; and bad feelings among staff. The costs of the consequences of doing nothing can be substantial.

We don’t have much information on the costs and benefits of managing HIV in the CSO sector. Many CSOs don’t record sick leave, and CSOs’ outputs are often hard to measure. But recent research among companies in Zambia showed that, on average, the benefits of managing HIV were three times the costs. So for every kwacha (or dollar) spent, they saved three.

It is no coincidence that businesses were the first organisations to manage HIV. They are very sensitive to higher costs and reductions in productivity because they mean lower profits. Many businesses have recognised that it is cheaper to manage HIV than to ignore it. This is also the experience of many of the CSOs supported by STOP AIDS NOW!’s projects in Uganda, Ethiopia and India. They have found that investing some time and money now allows them to get benefits now, and to avoid higher costs in the future.

So, managing HIV within organisations is cost-effective. It is also necessary, particularly in places with high HIV prevalence, if your organisation is to protect its ability to deliver its outputs.

CSOs that have chosen to manage HIV report various benefits. These include:

Staff are better informed, and more able to talk about HIV and sexuality issues;
There is less stigma and discrimination in the workplace;
Staff feel more confident that they can keep their job if they are HIV-positive, and are more willing to disclose their status;
More staff and their family members get tested for HIV (in STOP AIDS NOW!’s Uganda project, 65% of CSO staff had tested, compared to 13% of the population);
Staff report safer sexual behaviour, so are less likely to get infected with HIV;
More HIV-positive staff link to positive living networks, prevent opportunistic infections and use ART, so have better health and longer lives;
Staff become more gender sensitive leading to less discrimination against women and transgendered members of staff;
Staff feel more valued and, through participatory approaches, have a greater sense of togetherness;
Staff capacity is enhanced, and the organisation is stimulated to improve its work by adapting its programmes to take account of HIV, or by doing AIDS work;
The positive effects spill over to family members and the wider community.

La gestion du VIH sur le lieu de travail: Un guide pour les OSC

Sue Holden Publications - French 4th July 201017th July 2018Francaise, HIV, HIV in workplace

The costs and benefits of managing HIV Of course, managing HIV in the workplace is not free of cost. One cost is the staff time your CSO will use to come up with plans, and to put them into action. You may also need extra money, for example, if your CSO hires trainers to help you run workshops, or helps with the insurance or medical costs for staff. The actual costs in time and money vary a lot between CSOs in different countries. But whatever they are, you might think that ignoring HIV has to be cheaper, because that doesn’t cost anything. Yet in the case study on page 7, when the CSO ignored HIV the consequences included: staff away from work; a failing project; the death of a valued member of staff; misuse of resources; management stress; a sacked member of staff; loss of a donor; underperforming staff; and bad feelings among staff. The costs of the consequences of doing nothing can be substantial. We don’t have much information on the costs and benefits of managing HIV in the CSO sector. Many CSOs don’t record sick leave, and CSOs’ outputs are often hard to measure. But recent research among companies in Zambia showed that, on average, the benefits of managing HIV were three times the costs. So for every kwacha (or dollar) spent, they saved three. It is no coincidence that businesses were the first organisations to manage HIV. They are very sensitive to higher costs and reductions in productivity because they mean lower profits. Many businesses have recognised that it is cheaper to manage HIV than to ignore it. This is also the experience of many of the CSOs supported by STOP AIDS NOW!’s projects in Uganda, Ethiopia and India. They have found that investing some time and money now allows them to get benefits now, and to avoid higher costs in the future. So, managing HIV within organisations is cost-effective. It is also necessary, particularly in places with high HIV prevalence, if your organisation is to protect its ability to deliver its outputs. CSOs that have chosen to manage HIV report various benefits. These include:  Staff are better informed, and more able to talk about HIV and sexuality issues;  There is less stigma and discrimination in the workplace;  Staff feel more confident that they can keep their job if they are HIV-positive, and are more willing to disclose their status;  More staff and their family members get tested for HIV (in STOP AIDS NOW!’s Uganda project, 65% of CSO staff had tested, compared to 13% of the population);  Staff report safer sexual behaviour, so are less likely to get infected with HIV;  More HIV-positive staff link to positive living networks, prevent opportunistic infections and use ART, so have better health and longer lives;  Staff become more gender sensitive leading to less discrimination against women and transgendered members of staff;  Staff feel more valued and, through participatory approaches, have a greater sense of togetherness;  Staff capacity is enhanced, and the organisation is stimulated to improve its work by adapting its programmes to take account of HIV, or by doing AIDS work;  The positive effects spill over to family members and the wider community.

La gestion du VIH sur le lieu de travail: Un guide pour les OSC

STOP AIDS NOW! m’a chargé de rédiger ce manuel pour aider les organisations à réduire les effets du VIH sur leur personnel et leur travail. Originellement écrit en anglais.

(This is the French translation of Managing HIV in the Workplace.)

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Les coûts et les avantages de la gestion du VIH

Bien entendu, la gestion du VIH sur le lieu de travail n’est pas dépourvue de coûts.

L’un des coûts est le temps de travail dont le personnel de votre OSC aura besoin pour établir des plans et pour traduire ceux-ci dans des actions. Peut-être aurez-vous également besoin d’argent supplémentaire, par exemple si votre OSC engage des formateurs pour la tenue d’ateliers, ou bien si elle contribue à l’assurance maladie ou aux frais médicaux du personnel.

Les coûts réels, exprimés en temps et en argent, sont très différentes d’une OSC et d’un pays à l’autre. Mais quels qu’ils soient, on pourrait croire que le déni de l’existence du VIH est la solution la plus avantageuse, parce qu’elle ne coûte rien. Cependant, l’étude de cas à la page 7 montre que lorsqu’une OSC ne tient pas compte du VIH, les conséquences s’enchaînent: absentéisme du personnel; échec du projet; décès d’un membre du personnel apprécié; utilisation abusive des ressources; stress pour la direction; renvoi d’un membre du personnel; perte d’un donateur; sous-performance du personnel; et des tensions entre les membres du personnel. Les coûts de l’inaction peuvent être élevés.

Nous n’avons guère d’information sur les coûts et les avantages de la gestion du VIH dans le secteur des OSC. De nombreuses OSC n’enregistrent pas les congés de maladie, et les résultats des OSC sont souvent difficiles à mesurer. Mais une enquête récente auprès d’entreprises en Zambie a montré qu’en moyenne, les avantages de la gestion du VIH étaient trois fois supérieurs au coût5 . Donc, pour chaque kwacha (ou dollar) dépensé, ces entreprises en ont économisé trois.

Ce n’est donc pas par hasard que les entreprises ont été les premières à gérer le VIH. En effet, elles sont très sensibles à des coûts en hausse et à une productivité en baisse, car ces phénomènes s’accompagnent d’une perte de bénéfices. De nombreuses entreprises ont admis qu’il est moins cher de gérer le VIH que d’ignorer son existence. C’est également l’expérience de nombreux projets d’OSC soutenus par STOP AIDS NOW! en Ouganda, en Éthiopie et en Inde. Ces OSC ont compris qu’en investissant du temps et de d’argent maintenant, elles en tirent des avantages aujourd’hui et réduisent les coûts à l’avenir.

Par conséquent, la gestion du VIH au sein des organisations est une activité rentable. Elle est également nécessaire, particulièrement aux endroits à forte prévalence du VIH, si votre organisation doit protéger sa capacité à fournir des résultats.

Les OSC qui ont décidé de gérer le VIH signalent divers avantages:

Les membres du personnel sont mieux informés, plus disposés à parler du VIH et de questions de sexualité;
La stigmatisation et la discrimination sur le lieu de travail diminuent;
Les membres du personnel sont plus sûrs de garder leur emploi s’ils sont séropositifs à VIH et plus prêts à révéler leur statut;
Plus de membres du personnel, et plus de membres de leur famille, passent des tests VIH (dans le projet STOP AIDS NOW! en Ouganda, 65 % du personnel de l’OSC avaient passé un test contre 13 % dans la population);
Le personnel a un comportement sexuel plus sûr et a donc moins de chances d’être infecté par le VIH;
Plus de membres du personnel séropositifs au VIH se relient à des réseaux de vie positive, préviennent les infections opportunistes et suivent un TAR; ils sont donc en meilleure santé et vivent plus longtemps;
Le personnel est plus sensibles aux questions de genre, ce qui réduit la discrimination à l’encontre des femmes et des membres du personnel transsexuels;
Les membres du personnel se sentent plus appréciés et, par des approches participatives, ont plus le sens de l’étroitesse des liens;
La capacité du personnel augmente. L’organisation est incitée à améliorer son travail en ajustant sesprogrammes de telle sorte qu’ils tiennent compte du VIH, ou bien en travaillant dans le sida;
Les effets positifs se répandent aux membres de la famille et à la communauté générale.

Break Another Silence: Understanding Sexual Minorities and Taking Action for Sexual Rights in Africa

Sue Holden Publications - English 2nd March 200917th July 2018Oxfam, Sexual Health, Sexual Rights

understanding sexual minorities in Africa

Break Another Silence: Understanding Sexual Minorities and Taking Action for Sexual Rights in Africa

This booklet is about marginalised sexualities and human rights and is also available in French.

In a context of widespread homophobia and misinformation, it aims to give Oxfam’s and other NGOs’ staff both facts and food for thought about alternative sexualities. It’s written for people working in civil society and government organisations, with a focus on Africa, particularly the Horn, East, and Central Africa.

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The idea for this booklet came from an HIV and AIDS forum, held in the Horn, East & Central Africa region, for Civil Society Organisation (CSO) staff working on HIV. The forum focussed on learning about linkages between gender, HIV & AIDS, and sexual rights. Two East African activists from a sexual minorities network spoke about how badly sexual minorities are treated, the violence and discrimination they experience, and the difficulties they face in accessing HIV and AIDS prevention, treatment & care services. Their testimonials stirred the participants’ interest. Some felt that they needed to know more. Many were surprised; they were working on HIV, and yet had not given much thought to sexual minorities. Some, perhaps, felt negative towards the two activists, a common reaction in African cultural settings. Others wondered how they and their organisations might support sexual minorities to claim their rights.

This booklet is to encourage staff in civil society and government organisations to: understand sexual rights as human rights; to become aware of the ongoing abuses of sexual minorities’ human rights including lack of access to essential services; and to take action to protect rights for all, including minority groups.

Chapter 1 focuses on basic information and key debates. Chapter 2 looks at reactions to sexual minorities and their sexual rights. The linkage between sexual minorities, human rights and HIV programming is explored in Chapter 3, while Chapter 4 deals with why most NGOs have been silent on the issue. The concluding chapter suggests ways to break that silence.

Briser un Autre Silence: Comprendre les minorités sexuelles et mener des actions en défense de leurs droits sexuels en Afrique

Sue Holden Publications - French 1st March 200917th July 2018Francaise, Oxfam, Sexual Health, Sexual Rights

Briser un Autre Silence: Comprendre les minorités sexuelles et mener des actions en défense de leurs droits sexuels en Afrique

Cette brochure traite des sexualités marginalisées et des droits de l’homme et a été écrite en anglais.

Dans le contexte de l’homophobie généralisée et de la désinformation, il vise à donner au personnel d’Oxfam et d’autres ONG à la fois des faits et des éléments de réflexion sur les sexualités alternatives. Il est écrit pour les personnes travaillant dans la société civile et les organisations gouvernementales, en mettant l’accent sur l’Afrique, en particulier la Corne, l’Afrique de l’Est et l’Afrique centrale.

(The French translation of Break Another Silence)

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L’idée à l’origine de ce livret est venue d’un forum sur le VIH et le SIDA tenu dans la région de la Corne, l’Est et le Centre de l’Afrique à l’intention du personnel des Organisations de la Société Civile (OSC) travaillant sur le VIH. Le forum portait sur l’apprentissage au sujet des liens existant entre : Genre, VIH, SIDA et droits sexuels. Deux activistes est-africains provenant d’un réseau de minorités sexuelles se sont exprimés au sujet de la manière dont les minorités sexuelles sont maltraitées. Ils ont parlé de la violence et de la discrimination que ces minorités subissent et des difficultés auxquelles elles font face pour accéder aux services de prévention du VIH et du SIDA, de traitement et de prise en charge. Leurs témoignages ont suscité l’intérêt des participants. Certains ont eu le sentiment qu’ils avaient besoin d’apprendre davantage. Certains d’entre eux étaient étonnés ; ils travaillaient sur le SIDA mais, hélas, ils n’avaient pas beaucoup pensé aux minorités sexuelles. Certains, peut-être, ont eu le sentiment de désapprouver les deux activistes; une réaction considérée comme ordinaire dans un contexte culturel africain. D’autres se demandaient comment eux-mêmes et leurs organisations pourraient aider les minorités sexuelles à revendiquer leurs droits.

Ce livret est destiné à encourager le personnel des organisations gouvernementales et de la société civile à : Comprendre les droits sexuels comme des droits humains ; Prendre conscience de l’abus des droits humains dont sont victimes au quotidien les minorités sexuelles, dont le manque d’accès aux services essentiels ; et entreprendre une action pour protéger les droits de tous, y compris pour les groupes minoritaires.

Le premier chapitre porte sur une information de base et sur les grands sujets de débats. Le chapitre 2 analyse les réactions courantes face aux minorités sexuelles et à leurs droits sexuels. Le lien entre minorités sexuelles, droits humains et programmation sur le VIH est explorée dans le chapitre 3, pendant que le chapitre 4 traite de la manière dont la plupart des ONG sont restées silencieuses sur la question. Le chapitre de conclusion suggère des voies de sortie pour briser ce silence.

Failing Women, Withholding Protection

Sue Holden Publications - English 6th August 200817th July 2018Oxfam, Sexual Health, Sexual Rights, women

15 lost years in making the female condom accessible.

Oxfam Novib has been one of few organisations in the world investing in allowing the female condom to serve its purpose. I was fortunate to have the job of researching and writing this briefing paper for them.

They and the World Population Fund used it in their advocacy push at the 2008 International AIDS Conference. Find out more about their Universal Access to Female Condoms campaign here.

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Extract

2008 marks 15 years since the female condom was invented, and, disgracefully, 15 years of failing to make them accessible to the women who need them. Despite the absence of any other female-initated form of protection, and unprecedented rises in funding for the response to HIV, female condoms remain inaccessible, and their contribution remains untapped.

The urgent need for access to female condoms is evident in the feminisation of the HIV pandemic, the large unmet need for contraception, and the pitiful progress towards meeting Millennium Development Goals 5 and 6 on maternal health and halting and reversing the spread of HIV.

Why provide female condoms, when male condoms are readily available, much cheaper, and provide a comparable level of protection?

Female condoms are a tool to assist women’s empowerment. Women who use female condoms report an increased sense of power for negotiation of safer sex, and a greater sense of control and safety during sex. It will be many years until women have any alternative femaleinitiated means of protecting themselves.
Providing both female and male condoms leads to more instances of protected sex and reductions in the incidence of sexually transmitted infections (STIs). Their additive effect, providing protection in instances which would not be protected by male condoms, makes them a costeffective form of HIV prevention.

Studies have repeatedly shown high levels of acceptability for female condoms. Some users prefer them over male condoms, as they offer more flexibility regarding the timing of putting them on and taking them off, and have a more natural feel. However, many donors and policy-makers remain sceptical that sufficient demand for them exists. Yet examination of femalecondom projects reveals significant demand, even though it is often deliberately suppressed and unintentionally undermined by stigmatisation and running out of stock. What is perceived as an issue of demand is actually one of supply. Expanding access to female condoms is held up not at the users’ end, but at the start of the chain: how much money donors and governments are willing to invest in buying female condoms, supporting female-condom programmes, and developing low-cost female condoms.

What is behind the failure to act comprehensively to create access to female condoms? Responses from donors and policy-makers to the female condom mirror the common reasons for not using a male condom: responses formed by ignorance, culture, denial, ‘poverty’, and conservatism. Added to this are overarching errors of a lack of leadership, a huge funding bias against existing forms of primary HIV prevention, failure to scale up programming, and failure to invest in strategies to lower the cost of female condoms.

Of course, some efforts have been been made in the past 15 years, which have accelerated since the launch of the United Nations Population Fund’s (UNFPA) global Female Condom Initiative in 2005. The rapid expansion of sales and free distribution in the few countries at the forefront of female condom programming demonstrates the massive unmet demand for female condoms. But there is so much more to be done. Worldwide, in 2007, roughly 423 male condoms were produced for just one female condom. Female condoms currently have a unit cost about 18 times higher than male condoms.

The levels of investment and programming needed to increase the choice of available female condoms, to lower prices and to expand production are highly feasible. Through collaborative action, donors, governments, civil society organisations and the private sector can begin the progress of achieving universal access to female condoms. Female condoms exist now, and concerted efforts to make them accessible must begin now.