New UNDP Publication: "Me, My Intimate Partner, And HIV."
A New UNDP Publication On Fijian Self-Assessments Of HIV Transmission Risks
01 December 2011
[Suva, Fiji – December 1] What do people from all walks of life including sex workers, gays and lesbians, Christian pastors, university students, taxi-cab drivers, and healthcare workers in Fiji know about HIV transmission? What perceptions do couples in Fiji have of their risks of HIV transmission and of Sexually Transmitted Infections (STIs)? How prevalent is condom use in Fiji?
These are some of the findings contained in a new report by the United Nations Development Porgramme (UNDP) launched in Suva today on World AIDS Day.
The report, “Me, My Intimate Partner, and HIV: Fijian Self Assessments of Transmission Risks” is the fruit of a part-training, part- research project undertaken in 2010 The project’s aim was to strengthen Fiji’s response to HIV and AIDS by collecting and analyzing qualitative data about Fijian perceptions of their risks of HIV transmission and of STIs.
The project interviewed 74 couples, with respondents being interviewed separately and by different researchers so as to protect their confidentiality and anonymity. They belonged to one of six “target groups”: people in sex work; gays and lesbians; Christian pastors; university students; taxi-cab drivers; and healthcare workers. The research team interviewed 20 ”Key Informants,” including expatriates; conducted 14 audiotaped, focus group-interviews; led 74 face-to-face interviews; collected 148 drawings by research participants that depicted ”Me, My Intimate Partner, and HIV” and ”How I Try to Prevent HIV Transmission”; and collected another 222 drawings depicting “Risky Behaviour,” “Risky Person,” and “Risky Setting.”
In launching the report, the UN Resident Co-ordinator and UNDP Resident Representative Knut Ostby said that the study enrolled couples from a range of ‘walks of life’ that are not all typically identified as ‘at risk groups’ because they are married or in a de facto married relationship.
“A lot of emphasis has been made on the individual HIV risk of certain sub-populations such as sex workers or gay men. This can lead us to fail to identify and respond to important contextual information, especially when the epidemiological data we have do not yet give us some clear pointers. As evidence from Papua New Guinea shows, HIV transmission in the Pacific islands could be more frequent where most people do not expect it, for example in marriage This carries an important message that also resonates with the theme of this World AIDS Day “Zero Discrimination”. As learned from Asian epidemics, the prevailing focus on identified ‘at risk groups’–not only gives a false sense of security to those who do not identify with these groups, but often reinforces stigma and discrimination towards these ‘identified’ groups who are then unjustifiably blamed for HIV transmission,” said Mr Ostby.
“This project, like others focusing on Intimate Partner transmission, signals a considerable change afoot in public health and epidemiology. Women in sex work and ‘MSM’ (Men who have Sex with Men) have been over-studied (and blamed for HIV transmission). Christian pastors, taxi-cab drivers and university students, by contrast, have been under-studied (and their HIV transmission risks ignored). By focusing on members of these and other target groups and their intimate partners—simultaneously but separately—we hope to find prevention methods that would work and uncover cognitive models of risk that don’t,” said Dr. Lawrence Hammar, the principal researcher and UNDP consultant.
The researchers participated in a five-weeks-long research methods training workshop, learning the crafts of research and practicing their skills on one another.
The researchers found little understanding of STI signs and symptoms and inconsistent condom use. Fijian self-assessments of HIV and STI transmission risks are externalized, away from intimate partners Participants held back from pressing for safer sex and greater communication about these issues in favor of relying on “trust” and “love” and “faith” in a partner’s fidelity and uninfectedness. Extramarital sex was common among participants, both male and female, and STI signs and symptoms were commonly reported among them, too. Because condom use is so low and inconsistent, intimate partner transmission of HIV is in Fiji as elsewhere a real and perhaps growing risk. Additionally, a large number of respondents believe that faith and various “Fiji medicines” will prevent or cure HIV transmission.
The report recommends the need to challenge Fijians not to externalize their HIV and STI transmission risks and to engage in less unprotected sex. The report also recommends that public health messaging for HIV prevention should include relational terms of “wife” and “husband,” “boyfriend” and “girlfriend.” Condom use should be constructed as an effective means of preventing unwanted pregnancies, HIV and STI, not as something pertaining only to strangers or to commercial sexual encounters. There is also a need to address the common beliefs in Fiji in miracle cures, herbal or faith-related, which are delaying or blunting the effectiveness of HIV medication and their roll-out.
The national capacity to respond to HIV and AIDS will be strengthened further by supporting and carrying out qualitative HIV social research.
The report can be accessed from: http://www.undppc.org.fj/pages.cfm/publications/mdg-achievement-poverty-reduction-reports/