CHRR Baseline in Mangochi (LGBTI)

CHRR and RutgersWPF

BASELINE SURVEY OF LGBTI PEOPLE in Mangochi

Final Report

Alfred M. Dzilankhulani

Lilongwe, Malawi

JANUARY 2014

TABLE OF CONTENTS

EXECUTIVE SUMMARY

SECTION ONE: INTRODUCTION

SECTION TWO: RESULTS

2.1DEMOGRAPHIC CHARACTERISTICS

2.2SEXUAL BEHAVIOUR

2.3CONDOM AND LUBRICANT USE

2.3.1Condom Use during Anal Sex among Gays

2.3.2Condom use Practices with other Partners

2.3.3Lubricant Use during Sex

2.4STI AND HIV KNOWLEDGE

2.5RISK PERCEPTION

2.6HEALTH SEEKING BEHAVIOUR AND ACCESS TO STI AND HIV AND AIDS SERVICES

2.7SELF-EFFICACY

2.8STIGMA AND DISCRIMINATION

2.9COMMUNITY KNOWLEDGE OF SHR AND ATTITUDES TOWARDS GAYS AND LESBIANS

2.10INSIGHTS FROM DISSEMINATION MEETING WITH MANGOCHI DISTRICT STAKEHOLDERS

SECTION THREE: CONCLUSIONS AND RECOMMENDATIONS

3.1CONCLUSIONS

3.2RECOMMENDATIONS

REFERENCES

ACRONYMS

AIDS / Acquired Immuno-Deficiency Syndrome
AMREF / African Medical Research Foundation
CEDEP / Centre for Development of People
CHRR / Centre for Human Rights Rehabilitation
CSE / Comprehensive Sexuality Education
CSO / Civil Society Organisation
HCAC / Health Centre Advisory Committee
HIV / Human Immuno-Deficiency Virus
ICDP / International Conference on Population and Development
LGBTI / Lesbian, Gay, Bisexual, Transgender and Intersex
MDG / Millennium Development Goal
MSM / Men who-have Sex with Men
SGBV / Sexual and Gender-Based Violence
SPSS / Statistical Package for Social Sciences
SRHR / Sexual Reproductive Health and Rights
UFBR / Unite for Body Rights

EXECUTIVE SUMMARY

INTRODUCTION

The Centre for Human Rights Rehabilitation with support from World Population Fund (WPF) Rutgers (lead member of SRHR Alliance) conducted a baseline survey targeting Lesbian, Gay, Bisexual, Transgender and the Intersex (LGBTI) persons in Mangochi. The aim of the survey was to collect baseline data for developing project interventions targeting the LGBTI community in the district.

In Malawi, same-sex sexual acts are illegal under the law (Government of Malawi, 2010). For this reason, Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) individuals do not live openly. Through earlier collaboration with Centre for Development of People (CEDEP), CHRR identified some LGBTI individuals in Mangochi. Using a handful of LGBTI persons, snow-balling technique was used to identify and sample a total of 43 LGBTI persons against a planned target of 50[1]. Once sampled, a structured questionnaire (Annexed) was administered. Questionnaire data was entered and analysed in SPSS. Two Focus Group Discussions (FGDs) involving a total of twenty-five (25) male and female community leaders were also conducted in two Traditional Authorities (Mpondasi and Namkumba).

RESULTS

Demographics: Demographically, 46.5% were Christians and 53.5% Moslems; the majority were single (88.4%) and only minority were married. Only a minority had formal employment (9.3%); otherwise, 27.9% were in school, 20.9% depended on casual labour, 23.3% on others (remittances and gifts) while 18.6% had no defined source of livelihood. The mean age of surveyed LGBTI individuals was 21.5 (SD=5.69). The youngest respondent was 14 while the oldest was 46. No statistically significant difference in age were found between male (21.97) female (20.38) respondents (t (41) =.834, p=409).

The most common relationship among male respondents was male-female relationship (43.3%). Approximately, thirty-three percent (33.3%) were exclusively gay, 13.3% had both male and female partners concurrently while 10.0% were not in any relationship at the time of the survey.

Sexual Behaviour: The majority of respondents (86.0%) had stable sexual partner. However, only 7.5% were staying together with their partner. Approximately thirteen percent were aware that their stable sexual partner had been having sex with other partners in last 3 months while 17.5% only suspected so. Nevertheless, over half (57.5%) didn’t think their stable partner had been having sex with other partners in last 3 months. As shown in Table 1, the average number of male and female sexual partners among surveyed LGBTI individuals in last 6 months was the same, 2.

A Paired t-test comparison in reported mean age between respondents age (mean=21.5) and their stable sexual partners (mean=19.97) shows no statistically significant differences, thus ruling out the prevalence of intergenerational sex in the surveyed population (Mean difference=1.62, t (38) =1.586, p=.121).

Condom Use:Of the surveyed 43 LGBTI persons, 39.5% reported using condoms always, 30.2% sometimes and 4.7% used condoms rarely. In terms of recent condom use, 60.5% used condom during the last sexual intercourse while the rest didnt

In terms of condom use during anal sex among gay partnerships; 46.5% reported always using condoms; 25.6% sometimes used condoms; 4.7% (“Palibe” meaning there isn’t[2]); 7.0% didn’t have anal sex while 16.3% didn’t respond to the question.
During the last time gays had anal sex, 62.8% used a condom; 16.3% did not use, 4.7% didn’t have a partner while 16.3% didn’t respond to the question.

With respect to condom use with a female partner or wife, 30.2% reported always using a condom, 16.3% sometimes used a condom, 16.3% (palibe), 7.0% said they had no female partner or wife while 30.2% didn’t respond to the question.
More respondents reported using condoms during sex with casual partners (41.9%) compared with sex with female partners or wives. However, 21.0% sometimes used condoms. In terms of condom use during last time they had sex with casual sexual partners, 55.8% used a condom, 11.6% didn’t use, 7.0% had no partner while 25.6% didn’t respond to the question.

Lubricant Use during Sex: 72.1% have relatively poor lubricant use behaviour while the rest (27.9%) have relatively good lubricant use behaviour

Of the 34 LGBTI individuals who responded to the question; 61.8% always used lubricants when they had anal sex, 8.8% sometimes used lubricants, and 2.9% used it rarely, 26.5% said (Palibe).
Of the 14 LGBTI persons who responded to the question, 24.9% reported that they could afford lubricants, 35.7% found them expensive while 21.4% said they couldn’t afford them.
Of the 27 LGBTI individuals who responded to the question, 55.6% said they concurrently used condoms and lubricants, 25.9% didn’t use them concurrently while 18.5% used them rarely
In terms of type of lubricants used, 76.9% reported using water-based lubricants, 26.9% used petroleum jelly/Vaseline or body lotion while 11.5% didn’t use.

STI and HIV Knowledge:There ishigh knowledge of STI, HIV and AIDS among surveyed LGBTI population as shown from 97.7% of them having good knowledge and only 2.3% with low knowledge. Despite the majority having good knowledge, a minority still have misconceptions about STI, HIV and AIDS.

Risk Perception: 58.2% have low risk perception while 41.8% have high risk perception. For example, 43.6% said gay sex helps reduce HIV transmission and 22.5% said the one who is on top during sex cannot get HIV infected.

Health Seeking Behaviour and Access to STI, HIV and AIDS Services: 95.3% reported getting HIV and AIDS messages. The main source was broadcasting (TV, radio, newspaper) with 76.9% accessing messages from this source. Others are NGOs and CSOs, friends (41.0%) and health facility (33.3%).

79.1% have ever been HIV tested, the rest not. The main reason (100%) for not being HIV tested is “am not at risk”
Only 12.5% reported ever contracting STI in the past. Approximately, twenty-nine percent of those who ever reported contracting STI were infected 6 months prior to baseline field data collection.
77.5% reported frequently going for STI check-up, the rest didn’t. Reasons for going for STI check-up included: to check whether infected or not (96.8%), afraid of infecting others (16.1%) and to get treatment (3.2%). Reasons for not going for STI check (100.0%) and health facility too distant (25.0%).
48.5% reported that they faced problems accessing treatment from health facility. As depicted in Table below, main problems include ridicule, shyness and stigma and discrimination.

Barriers to STI, HIV and AIDS Treatment: Results show that main reasons include stigma and discrimination, shyness and not wanting to be known (noticed), selfishness (not considerate) of health workers and stock-out of medication.

SELF-EFFICACY: 74.5% have high self-efficacy while the rest have low self-efficacy. Evidently, there was minority that did not feel courageous in some areas of SRHR. Surprisingly, main areas of low self-efficacy included: telling anyone in their family that they are gay, probably for fear of stigma and discrimination; not to have sex with a stable partner who hasn’t disclosed their HIV status and remembering to use a condom while drunk or have injected drugs.

STIGMA AND DISCRIMINATION: In this baseline survey, LGBTI respondents were asked about whether they ever suffered any violence because of their gay status. 66.7% reported having suffered violence because of their gay status. Forms of violence suffered included ridicule (92.3%), beating (46.2%), discouragement (38.5%) and forced sex (7.7%).

In terms of suggested solutions on how to prevent violence against gays, slightly over half (51.7%) of surveyed LGBTI persons said laws should be changed while 48.3% said the community should be trained on violence prevention. Other solutions include train gays to protect themselves (37.9%), stiff punishment for offenders (13.8%) and finding other income generating activities for gays (6.9%).

COMMUNITY KNOWLEDGE OF SRH AND ATTITUDES TOWARDS GAYS AND LESBIANS: The majority of FGD participants have an idea of basic human rights and were able to give examples. They agreed that all people have rights, although incidences of violations of such rights were reportedly common in their areas. The participants oppose same sex relationships and observed that if found, such people should be punished, reported to police or told to stop the practice.

SECTION ONE: INTRODUCTION

1.1UFBR pROGRAMME DESCRIPTION

1.1.1Background

Five Dutch NGOs and their Southern partner organizations formed an alliance to among others, implement UFBR Programme. Members in the Sexual Reproductive Health and Rights (SRHR) Alliance are: Rutgers WPF (lead agent) and co-applicants African Medical Research Foundation (AMREF), CHOICE, dance4life international and Simavi. UFBR programme is being implemented in 9 countries, 6 in Africa and 4 in Asia: Ethiopia, Kenya, Malawi, Tanzania, Uganda, Bangladesh, India, Indonesia and Pakistan. Selection of the countries was based on external and internal factors. Among external factors, the indicators on Maternal Mortality Rate, Contraceptive Prevalence, unmet Family Planning Needs, and Skilled Birth Attendants played an important role. Major internal factors were the presence of at least two Alliance members in the country and the strength and potential of the existing partner organizations in the respective countries. In each country the SRHR Alliance works through local partners, including civil society organisations (CSOs) and formal and informal service and education providers as well as (local) governments. In addition, SRHR international advocacy activities are implemented to reinforce efforts at country level.

In the nine countries chosen, the SRHR Alliance aims to work specifically with women, young people and marginalized groups (survivors of violence, Lesbian, Gay, Bisexual, Trans-gender and Intersex (LGBTI) individuals, Men having Sex with Men (MSM), people with disabilities, people living with HIV and AIDS and people with traditional lifestyles in remote areas). The voice of women, young people and marginalised groups is not heard in many countries where the Alliance works. They face discrimination, exclusion and stigmatization and as a result are excluded from public debate. In relation to gender identity and combating sexual and gender-based violence, the Alliance includes the concept of masculinity and encouraging male involvement as a crucial strategy: women are able to transform their lives as long as their male partners will change. So, it is equally important to involve men and boys in the discussion on sexuality education, gender roles, violence and empowerment and make clear what role they can play in positively changing (gender) perceptions and values.

1.1.2Programme Priority Areas and Objectives

The following four priority areas were identified that require urgent and increased attention in order to meet Millennium Development Goals (MDGs) 3,5 and 6; the International Conference on Population and Development (ICPD) Programme of Action and other international agreements for promoting sustainable development: (a) improved sexual and reproductive health services; (b) Comprehensive sexuality education; (c) Combating sexual and gender-based violence and (d) Freedom of expression of sexual diversity and gender identity. The following are programme objectives:

Increased utilization and quality of comprehensive Sexual and Reproductive Health (SRH) services;
Increased quality and delivery of Comprehensive Sexuality Education (CSE);
Reduction of Sexual and Gender Based Violence (SGBV); and
Increased acceptance of Sexual Diversity and Gender Identity.
CHRR Baseline Survey
Purpose

1.3Data collection methods and SAMPLING

In Malawi, same-sex sexual acts are illegal under the law. For this reason, Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) individuals do not live openly. Through earlier collaboration with Centre for Development of People (CEDEP), CHRR identified some LGBTI individuals in Mangochi. Using a handful of LGBTI persons, snow-balling technique was used to identify and sample a total of 43 LGBTI persons against a planned target of 50[3]. Once sampled, a structured questionnaire (Annexed) was administered to sampled LGBTIs.

1.4process Overview

The baseline data was conducted alongside 2013 Outcome Measurement from 19-22 August 2013. Data collection was done by CHRR staff and UFBR Malawi National Programme. Once collected, the data were passed on to a consultant. The roles of the consultant were to:

Design data entry database in SPSS and identify and recruit data entry clerk to capture the data
Clean the data once data entry completed
Analyse the data
Prepare draft report based on the data analysis and submit it to CHRR and WPF Rutgers for feedback
Review draft report based on feedback received from CHRR and WPF Rutgers and submit final report.
Present final report at a validation workshop at a venue to be agreed
Data Management and Quality Control

The following data management and quality control procedures were also enforced:

Field supervision of data collection, entry and processing procedures and physical examination of data to verify correctness and consistency.
Daily debriefing sessions to share best practices, discuss and agree solutions to emerging challenges
Random checks of completed questionnaires and taking corrective action for questionnaires that are found to have errors.
Orientation of data collectors to standardize interview techniques and approaches.
Ethical Considerations

Given the sensitivity of LGBTI issues in Malawi, efforts were made to conduct the baseline survey following standard ethical processes required when conducting assessments of this nature. Among others, standard ethical considerations require that no one be coerced to participate in study interviews. In this assessment, data collectors explained the purpose and scope of the outcome measurement. This was important to assist respondents make informed choice, either to accept or not to participate. The consenting process involved explaining to respondents that:

They were free to choose to or not participate without attracting any penalty. This was despite their awareness that permission had been granted by the community leaders, but this permission did not mean that they had to.
They were free to discontinue participation at any time of the interview and that they were free not to answer a particular question if they did not want to.
Data Entry, Cleaning and Analysis

Questionnaire data were captured in SPSS by data entry clerks under the supervision of the consultant. Data cleaning was conducted by the consultant. Cleaning included checking that all data were entered as captured. The consultant sampled 10% of completed questionnaires and physically matched responses on hard copy and entries in the SPSS database. Where anomalies were found, concerned data entry clerks were instructed to check all data entries and make corrections. Furthermore, frequencies were run to identify any values that were out of range in the data entry. When a problem was spotted, relevant questionnaire was fished out and anomaly rectified.

The quantitative data from questionnaire interviews were analysed in Statistical Package for Social Sciences (SPSS). SPSS data analysis included descriptive and limited inferential statistics.

SECTION TWO: RESULTS

2.1DEMOGRAPHIC CHARACTERISTICS

A total of 43 LGBTI individuals were interviewed against a planned sample size of 50. The following are summary demographics of the respondents:

46.5% Christians, 53.5% Moslems. Historically, Mangochi has high proportion of Moslems and the high proportion of Moslems in the survey is expected.
Only a minority had formal employment (9.3%); otherwise, 27.9% were in school, 20.9% depended on casual labour (ganyu), 23.3% on others (remittances and gifts) while 18.6% had no defined source of livelihood.
The majority were single (88.4%) and only minority were married.
The mean age of surveyed LGBTI individuals was 21.5 (SD=5.69). The youngest respondent was 14 while the oldest was 46. No statistically significant difference in age were found between male (21.97) female (20.38) respondents (t (41) =.834, p=409).
As depicted in Figure 1 below, the most common relationship among male respondents was male-female relationship (43.3%). Approximately, thirty-three percent (33.3%) were exclusively gay, 13.3% had both male and female partners concurrently while 10.0% were not in any relationship at the time of the survey.