Getting Real on U=U: Human Rights and Gender as Critical Frameworks for Action

Ferguson, Laura; Jardell, William; Gruskin, Sofia

doi:10.1007/978-3-030-69819-5_15

Cited by 3 publications

(5 citation statements)

References 19 publications

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“…This paper presents a more comprehensive understanding of the contexts in which women sell sex in Kampala by including women who have not been included in prior research studies and emphasizes the need to reach them and target intervention efforts to them. This aligns with the UNAIDS strategy of leaving no one behind and reaching the populations at the greatest need of care [ 28 ].…”

Section: Introductionmentioning

confidence: 65%

“…This study was approved by the Uganda Virus Research Institute Research and Ethics Committee (GC/127/912), the Uganda National Council for Science and Technology (HS2386ES), and the ethics committee of the London School of Hygiene and Tropical Medicine (28,175). We obtained written informed consent from all the respondents before data collection.…”

Section: Ethical Considerationsmentioning

confidence: 99%

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Understanding the contexts in which female sex workers sell sex in Kampala, Uganda: a qualitative study

Katumba,

Haumba,

Mayanja

et al. 2024

BMC Women's Health

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Background Structural, interpersonal and individual level factors can present barriers for HIV prevention behaviour among people at high risk of HIV acquisition, including women who sell sex. In this paper we document the contexts in which women selling sex in Kampala meet and provide services to their clients. Methods We collected qualitative data using semi-structured interviews. Women were eligible to participate if they were 18 years or older, self-identified as sex workers or offered sex for money and spoke Luganda or English. Ten women who met clients in venues and outdoor locations were selected randomly from a clinic for women at high risk of HIV acquisition. Ten other women who met clients online were recruited using snowball sampling. Interviews included demographic data, and themes included reasons for joining and leaving sex work, work locations, nature of relationships with clients and peers, interaction with authorities, regulations on sex work, and reported stigma. We conducted interviews over three months. Data were analysed thematically using a framework analysis approach. The coding framework was based on structural factors identified from literature, but also modified inductively with themes arising from the interviews. Results Women met clients in physical and virtual spaces. Physical spaces included venues and outdoor locations, and virtual spaces were online platforms like social media applications and websites. Of the 20 women included, 12 used online platforms to meet clients. Generally, women from the clinic sample were less educated and predominantly unmarried, while those from the snowball sample had more education, had professional jobs, or were university students. Women from both samples reported experiences of stigma, violence from clients and authorities, and challenges accessing health care services due to the illegality of sex work. Even though all participants worked in settings where sex work was illegal and consequently endured harsh treatment, those from the snowball sample faced additional threats of cybersecurity attacks, extortion from clients, and high levels of violence from clients. Conclusions To reduce risk of HIV acquisition among women who sell sex, researchers and implementers should consider these differences in contexts, challenges, and risks to design innovative interventions and programs that reach and include all women.

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Section: Introductionmentioning

confidence: 65%

Section: Ethical Considerationsmentioning

confidence: 99%

Understanding the contexts in which female sex workers sell sex in Kampala, Uganda: a qualitative study

Katumba,

Haumba,

Mayanja

et al. 2024

BMC Women's Health

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“…A lack of provider knowledge, disbelief in U = U, a fear of accountability, and negative and discriminatory attitudes have been identified as underlying factors. 34 While all women LWH need information to facilitate their informed decision-making, migrant women may face complex barriers in accessing updated, comprehensive and linguistically and culturally tailored information about the U = U message. 34 , 35 These gaps in knowledge can lead to limited power and inequalities in the ability to access services and fulfil the right to achieve and maintain good sexual and reproductive health.…”

Section: Discussionmentioning

confidence: 99%

“Discrimination is harder to live with than the disease”: an interview study of the perceptions and experiences of sexual and reproductive health and rights among women living with HIV in Sweden

Nkulu-Kalengayi,

Hurtig,

Linander

2023

Sexual and Reproductive Health Matters

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Around 40% of people living with human immunodeficiency virus (HIV) in Sweden are women. However, little is known about their experiences, particularly those related to sexual and reproductive health and rights (SRHR). This study aims to explore perceptions and experiences of SRHR among women living with HIV (LWH). Twelve interviews were conducted with women LWH from September to October 2019 and analysed using thematic analysis. The central theme describing participants’ experiences of social relationships, intimate encounters and reproductive life, “Discrimination is harder to live with than the disease itself”, is based on three themes that contain subthemes. Theme 1 describes how participants reconsider and reorient their sexual and reproductive life after diagnosis. Theme 2 highlights how (mis)perceptions of HIV affect sexual and reproductive life and lead to abusive treatment and internalisation. Theme 3 describes a paradoxical shift of responsibilities where participants experience being compelled to take greater responsibility in some situations and stripped of the right to decide in others. This study suggests that despite notable progress in HIV treatment, stigma and discrimination stemming from outdated beliefs and (mis)conceptions, ambiguous policies and guidelines, and unequal access to information affect SRHR experiences of women LWH more than the virus itself. The results emphasise the need to: update knowledge within healthcare settings and among the public; clarify ambiguous legislations and guidelines; ensure equal access to information to enable all women LWH to take informed decisions, make fully informed choices and realise their SRHR; and consider the diversity of women LWH and enable shared decision-making.

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“…PLHIV who achieve and maintain an undetectable viral load by regularly taking ART as prescribed will not sexually transmit HIV to others [ 107 ]. This concept of U=U is underpinned by “treatment as prevention”, where achieving viral load suppression through ART is used as a prevention strategy at the population level [ 108 ]. Communicating U=U was associated with improved overall sexual and mental health, medication adherence, and viral load suppression [ 109 ].…”

Section: Hiv Treatment and Care Deliverymentioning

confidence: 99%

“…Communicating U=U was associated with improved overall sexual and mental health, medication adherence, and viral load suppression [ 109 ]. Moreover, it is a huge step in de-stigmatization, particularly among people who face multiple intersecting stigma [ 108 , 110 ].…”

Section: Hiv Treatment and Care Deliverymentioning

confidence: 99%

The State of the HIV Epidemic in the Philippines: Progress and Challenges in 2023

Gangcuangco

Eustaquio²

2023

TropicalMed

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In the past decade, the Philippines has gained notoriety as the country with the fastest-growing human immunodeficiency virus (HIV) epidemic in the Western Pacific region. While the overall trends of HIV incidence and acquired immunodeficiency syndrome (AIDS)-related deaths are declining globally, an increase in new cases was reported to the HIV/AIDS and ART Registry of the Philippines. From 2012 to 2023, there was a 411% increase in daily incidence. Late presentation in care remains a concern, with 29% of new confirmed HIV cases in January 2023 having clinical manifestations of advanced HIV disease at the time of diagnosis. Men having sex with men (MSM) are disproportionately affected. Various steps have been taken to address the HIV epidemic in the country. The Philippine HIV and AIDS Policy Act of 2018 (Republic Act 11166) expanded access to HIV testing and treatment. HIV testing now allows for the screening of minors 15–17 years old without parental consent. Community-based organizations have been instrumental in expanding HIV screening to include self-testing and community-based screening. The Philippines moved from centralized HIV diagnosis confirmation by Western blot to a decentralized rapid HIV diagnostic algorithm (rHIVda). Dolutegravir-based antiretroviral therapy is now the first line. Pre-exposure prophylaxis in the form of emtricitabine–tenofovir disoproxil fumarate has been rolled out. The number of treatment hubs and primary HIV care facilities continues to increase. Despite these efforts, barriers to ending the HIV epidemic remain, including continued stigma, limited harm reduction services for people who inject drugs, sociocultural factors, and political deterrents. HIV RNA quantification and drug resistance testing are not routinely performed due to associated costs. The high burden of tuberculosis and hepatitis B virus co-infection complicate HIV management. CRF_01AE is now the predominant subtype, which has been associated with poorer clinical outcomes and faster CD4 T-cell decline. The HIV epidemic in the Philippines requires a multisectoral approach and calls for sustained political commitment, community involvement, and continued collaboration among various stakeholders. In this article, we outline the current progress and challenges in curbing the HIV epidemic in the Philippines.

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Getting Real on U=U: Human Rights and Gender as Critical Frameworks for Action

Cited by 3 publications

References 19 publications

Understanding the contexts in which female sex workers sell sex in Kampala, Uganda: a qualitative study

Understanding the contexts in which female sex workers sell sex in Kampala, Uganda: a qualitative study

“Discrimination is harder to live with than the disease”: an interview study of the perceptions and experiences of sexual and reproductive health and rights among women living with HIV in Sweden

The State of the HIV Epidemic in the Philippines: Progress and Challenges in 2023

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