“You cannot eat rights”: a qualitative study of views by Zambian HIV-vulnerable women, youth and MSM on human rights as public health tools

Abstract

BackgroundHuman rights approaches now dominate the HIV prevention landscape across sub-Saharan Africa, yet little is known about how they are viewed by the populations they are designed to serve. Health interventions are most effective when they resonate with the worldviews and interests of target groups. This study examined local Zambian understandings of human rights approaches to HIV-prevention among three highly HIV-vulnerable groups: women, youth, and men-who-have-sex-with-men (MSM).MethodsFocus groups included 23 women, youth, and MSM who had participated in activities organized by local non-governmental organizations (NGOs) using rights-based approaches, and interviews included 10 Zambian employees of these NGOs. Topics included participants’ experiences and views of the utility of these activities. Thematic analysis mapped out diverse ways participants viewed the concept of human rights in relation to HIV-prevention.ResultsWhilst NGO workers noted the need for human rights programs to address the complex drivers of the HIV epidemic, they struggled to tailor them to the Zambian context due to donor stipulations. Women program beneficiaries noted that the concept of human rights helped challenge harmful sexual practices and domestic abuse, and youth described rights-based approaches as more participatory than previous HIV-prevention efforts. However, they criticized the approach for conflicting with traditional values such as respect for elders and ‘harmonious’ marital relationships. They also critiqued it for threatening the social structures and relationships that they relied on for material survival, and for failing to address issues like poverty and unemployment. In contrast, MSM embraced the rights approach, despite being critical of its overly confrontational implementation. ConclusionsA rights-based approach seeks to tackle the symbolic drivers of HIV—its undeniable roots in cultural and religious systems of discrimination. Yet, it fails to resonate with youth and women’s own understandings of their needs and priorities due to its neglect of material drivers of HIV such as poverty and unemployment. MSM, who suffer extreme stigma and discrimination, have less to lose and much to gain from an approach that challenges inequitable social systems. Developing effective HIV-prevention strategies requires careful dialogue with vulnerable groups and greater flexibility for context-specific implementation rather than a one-size-fits-all conceptualization of human rights.

Determinants of HIV-risk sexual behaviors among Zambian adolescents: The role of gendered power

“…Further investigation is needed to explore gendered variations in effects of sexual abuse and mechanisms through which sexual abuse history impacts sexual behavior. The link between economic disadvantage and sexual risk was supported in our study, per our second hypothesis, and has been well established (Butts et al, 2017;Butts et al, 2018;Cluver et al, 2016;Gyimah et al, 2014;Jukes et al, 2008;Madise et al, 2007;Muzyamba et al, 2015;Ranganathan et al, 2016;Wamoyi et al, 2014). Social dominance theory posits negative health outcomes for groups with limited access to resources.…”

“…schools, health care, job allocation, marital or relational practices) in ways that generally advantage men while facilitating undesirable outcomes for women (Pratto & Walker, 2004;Rosenthal & Levy, 2010;Sidanius et al, 2004). Research among sub-Saharan African adolescents indicates that poverty, education, economic dependence on men and transactional sex are associated with women's increased HIV risk (Gyimah et al, 2014;Jukes, Simmons, & Bundy, 2008;Madise, Zulu, & Ciera, 2007;Muzyamba, Broaddus, & Campbell, 2015;Ranganathan et al, 2016;Wamoyi et al, 2014). For example, Zambia has more females than males with no formal education, and men are twice as likely to complete secondary school (Central Statistical Office (CSO) [Zambia], Ministry of Health (MOH) [Zambia], and ICF International, 2014).…”

Disclosure of Same-Sex Behaviors to Health-care Providers and Uptake of HIV Testing for Men Who Have Sex With Men: A Systematic Review

“…MSM (sexual minorities) who are African Americans (racial minorities) or rural residents (geographical minorities) face triple difficulties in disclosure practice and should be given priorities in future intervention efforts and resources distribution. In the regions where medical mistrust and concerns regarding disclosure are often compounded by health inequality and intersectional stigma, promotion of disclosure could be integrated into human rights advocacy for MSM as well as in stigma and health disparity reduction campaigns in medical institutions ( Muzyamba, Broaddus, & Campbell, 2015 ).…”

Young Key Populations Left Behind: The Necessity for a Targeted Response in Mozambique    

“…Thus, both behavioral and structural interventions are of paramount importance and the participatory engagement of youth in the design and implementation of programming for a targeted response cannot be ignored (2,24,38,(40)(41)(42). UNAIDS outlines the importance of capacity building initiatives of youth-led organizations and associations to ensure their ability to mobilize and advocate for their peers (3).…”