Community Based Study Exploring HIV Transmission in Fiji
27 August 2011
[Busan, 27 August 2011]— Meaningful engagement, ownership and respectful partnerships with community are minimum essential requisites when conducting effective operational research with marginalized groups such as men who have sex with men, transgendered persons and sex workers which are not often achieved. However, these are the requisites to which “Secret Lives, Other Voices… A Community Based Study Exploring Male-to-Male Sex, Gender Identity and HIV Transmission” has aspired.
The project recently completed through funding from the United Nations Development Programme (UNDP) is the first research since 1998 engaging with men who have sex with men (MSM) and transgender (TG) people in Fiji that fully involves the community. MSM and Transgender community members of various ethnic backgrounds were involved in every stage of the process, including initiation of the study, planning and study design, data collection, data entry, data analysis and reporting. Instead of being treated merely as subjects, the community is this instance were actors in the research.
According to Niraj Singh, Project Manager with the AIDS Task Force of Fiji (ATFF), Suva, “There is very little acknowledgement of capacity within civil society organizations. The success of this research lies in capitalizing on respectful and symbiotic relationships between ATFF and The New South Wales AIDS Council (ACON), Sydney, Australia, who provided the technical expertise for the project.”
The relationship between ATFF, a Fiji based non-governmental organization and ACON, Australia’s largest LGBT organization stands as an example of positive networking that has resulted in fruitful partnership that has produced community based research of high standard.”
Singh further said that, “We are appreciative and grateful to UNDP for facilitating this research and their trust in us as implementers. Their on-going encouragement and support continued well beyond the initial funding for the project.”
Deemed as rising the bar in terms of community based research (quote Edmund) in Asia and the Pacific… this community based study in Fiji provides the much needed baseline data to address the gap in information regarding social and sexual behaviours of men who have sex with men and transgender persons and how the behaviours relate to STI/HIV risk and access HIV prevention services. This study will contribute to ongoing national and regional efforts to respond more effectively to MSM/TG issues and inform development of targeted programming for these groups.
The results show that despite the high levels of knowledge regarding HIV in Fiji, many people are simply not motivated to use condoms. Despite the recent removal of discriminatory laws, these communities remain highly stigmatized. Participants identified significant barriers to HIV testing, such as: lack of trust in clinics, confidentiality issues, privacy issues, and the feeling to be judged by unfriendly clinic staff. The majority of respondents (approximately 67-70%) had never been approached by HIV outreach workers. Up to 30% of the respondents have experienced physical violence in the past 6 months. The results also showed that the boundaries between “ordinary sex” and “transactional sex” are often blurred in Fiji.
These findings suggest that specific and targeted approaches to prevention and sexual health services for MSM and transgender persons are urgently needed as many of these sub-groups have fatalistic attitudes towards their health and well-being because of the significant levels of stigma and discrimination that they face in their everyday life.
For these efforts to ‘work’ homophobia, transphobia and gender based-violence need to be addressed at the societal level and greater community empowerment is needed to ensure the dignity and rights of everyone are promoted, fulfilled and protected.
ATFF has a very clear vision of the priorities leading from research to action. As part of STI/HIV prevention and health promotion, a range of peer prevention programmes, taking a segmented approach will be designed and implemented to effectively reach a diverse range of MSM/TG in locations throughout Fiji. ATFF is the recipient of The Foundation of the AIDS Research (amfAR) MSM Initiative Awards to pilot the participatory production of resources for STI/HIV Prevention among MSM and TG.
In terms of clinical and sexual health services, ATFF will scale up access to competent and user friendly VCCT and STI services for MSM/TG in the greater Suva area. A very important component will involve the sensitization of health care workers to the specific health and social support needs through programmes delivered in collaboration with MSM/TG CBOs.
A screening tool for Gender Based violence and Stigma and Discrimination against MSM/TG will be developed and piloted for application by health service providers to increase their recognition and response to these issues when providing HIV/STI counseling.
The psychosocial needs of MSM/TG, particularly with issues of GBV and S/D, will be addressed through peer support as well as mitigating the impact of GBV and SD among feminine gays and TG by building resilience and self empowerment.
MSM and TG in Fiji will be supported to develop skills in community organizing and to implement community activities. This will be achieved through building the capacity of identified key MSM.TG leaders to organize and implement activities which engage and involve the community.