Marco, I concur with you whole heartedly with all the above and have learnt this is 1998/1999 while in epidemiology/infectious diseases track.

 

The rise of evidence-based public/population health policy movement is a very positive development and should be supported around the world. In theory, "evidence-based public health" and "evidenced based informed public health" sound well and good, but in practice, just to give an example, this entire model cannot stand up in Eastern Africa ...Uganda, South Africa...Southern African countries for example because the prevalency keeps going up.

 

I'm associated with a group of researchers that is coming to terms with this. We understand why and we will be providing answers in the near future. The model you are referring to is an ideal model; however, it is of Western conceptualization and orientation and is being successfully implemented. So far, it seems to be working well in Western countries. However, the model looks at problems of the developing and under developed world through a skewed Western lens. It attempts to solve the problems through that same skewed lens and disregards the discourse of addressing different worldviews, perceptions, ideologies and idiosyncracies...which are actually pivotal and most critical to solving the HIV/AIDS crisis. This is where these models and crosscutting research will provide some insight in the complexity of the problems. This kind of expertise is needed to come up with a variety of models that look at these issues in a much broader way: One must be a trained expert at recognizing:

 

1. The diversity and challenges on the ground in terms of worldview and cultural content

 

2. What are the dynamics of this worldview and how do we dissect it to understand it better?

 

3. How do human being process new constructs?

 

4. How do they link this to their traditional thought processes and knowledge systems?

 

5. What stimulus is needed to transform the worldview?

 

6. What is duration of this process for it to become knowledge to transform their lives?

 

7. How do we measure a cognitive process as complex as this? This is a very complex cognitive process.

 

I'm sharing my expertise with you as the theorist on worldview transformation through information processing, language acquisition, and language functionality. When we deal with processes of the mind we are entering a complexity which calls for comparative cross-cutting research-based evidence that may give us some answers but not all the answers. It must be noted that there are very serious drawbacks and limitations with the applications of comparative cross-cutting research-based evidence models. We cannot equate the experiences of other cultures and adapt the same model in another culture unless they are strikingly similar, our entire approach will fail.

 

The models you are referring to lack the most critical variable of a built-in adaptable core at its base where worldview transformation features prominently. This is what all the Bacchus Models feature and measure. We hope to publish them this year. The One-Size-Fits-All approach is absolutely not used by our organization; however, the flaws in the existing models used around the world are evaluated by me to see where things are going wrong and how to fix and build new philosophical frameworks.

 

Let us look at South Africa now ...7.1 million infected...we thought it was 5 million. For example, when you deal with Africa...and the diversity I see between even neighboring cultures I am studying, I cannot believe how perceptions and conceptualization of illness differ so much from culture to culture. In many cultures around the world "prevention" is not a construct that exist in their worldview, language and way of life. This again explains why the one-size-fits-all framework that is being proposed fails miserably every time.

 

Let us look at another example... the Uganda scenario. Uganda led the world in cutting its prevalency by more than half through the ABC model. They were the success story of the 20th century. They are now the mystery puzzle of the 21 st century and have not been able to change their prevalency numbers for almost 10 years. Scientifically, every explanation has failed so far and Uganda is grappling with an image problem that is getting worse. Local researchers are not telling the world the truth. However, privately, the Ugandan government is not coming forward that in other parts of country the prevelancy is through the roof and we have evidence of that. What I want to say is that their model has not been as successfull as the world has thought but that their model has actually failed!!! If this model is that good, why does the prevalency of HIV stay stagnant for 10 years? And why is it through the roof in Northern Uganda and around Lake Victoria and this is not highly publicized?

 

Lastly, if we continue marginalizing with terms as "sexual minorities" we are not solving problem but entrench it. You noticed that I don't use the terms....I say "program participants". I don't like to relegate someone else to a lesser than human position.

 

Regards,

 

Fenna Bacchus, M.A., CHEd, CHRM, LHRM, RN FACEBOOK (has more details on our program initiatives in Africa)

Our domain is being transferred and website will not be active (www.fireinc.org)

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Thank you GlobalFund. The important role to improve access to health services of the sexual minority i.e. the lesbian, gay, bisexual and transgender LGBT to ensure fundamental rights to each and every member of the society. In different countries of the world the LGBT people living with a threat and struggle against discrimination, criminalisation, abuse, neglect and violation of human rights. In some countries the homosexuality is legally void.

 

But sexual rights are human right and include: the right to choose one’s partner and right to decide freely on matters related to one’s sexuality without fear of violence, discrimination and coercion; the right to seek and provide information and sexuality, the right of access to confidential sexual health services, and the right of all persons to express their sexual orientation. It is a challenge to ensure all human rights for the sexual minorities (LGBT) persons. The following programmes is essential for their development:

 

1. To provide education prevention and support programme for straight, gay, lesbian, bisexual and transgender youths.

 

2. To provide National Tolerance Programme.

 

3. Creating a framework for tackling homophobia to strengthen human rights.

 

4. Administrative support to the LGBT people against radicalism and fundamentalism.

 

5. Legislative: In all countries a National Level to introduce Regulation of anti-discriminatory.

 

6. The United Nations Treaty minority Body and the Special Procedures of the United Nation Commission on Human Rights have to adopt programme to prevent all human rights of the sexual minority people.

 

7. Community development and social responsibility against all moral or physical attacks on LGBT experiencing.

 

8. Media has responsibly presented the rights of the sexual minorities. They have to be more familiar, knowledgeable with the LGBT issues.

 

9. Basic condition for education of human rights to all people and introduce modern concept of tolerance, sensitive towards the rights of sexual or other minorities’ neglect, abuse, violation of rights and discrimination.

 

10. Essential initiative to be taken by the governmental institutions and the non-governmental organization [NGO] to protect and develop the sexual minorities.

 

Thank you all.

 

Asima Chakraborty, General Secretary, The Organization for Peace Environment and Human Rights [TOPER] Kolkata, West Bengal, India.

Email: toperac@gmail.com

Possible challenges that that programmes directed at Sexual Minorities groups might face, might be: (the list is not to be exhaustive),

 

• programs lacks internal capacity to provide unique entrepreneurship programs for the affected to function to their full potential while enhancing their respective communities

• funding Challenges due to some government's reluctance to recognize sexual minorities

• civil society is not viewed as a strong lobbying force making them almost ineffective to represent the voice of sexual minorities. Some governments make it unlawful for sexual minorities to function as a human being and have enacted this into law by making this a culpable offense examples: Uganda, Nigeria and Islamic States. Challenges within the wider community

• lack of community acceptance of sexual minorities. Any programs with an overt focus on sexual minorities are not accepted. For that reason we need efficiency centers that offer a wide range of services that are inclusive of this

 

 

"First of all GF should do needs assment amongst this group they trying to help and know what their needs are and have a meeting with the MSM stakeholds from around the world to really know what the issues are and have the minorities represntive on the CCM mostly places like Africa cos you can't help people when you don't know what the problems are"...ARN - Nigeria

ARN...thank you for raising this concern. The problem may not be a lack of needs assessment. The problem lies much deeper than the question we seek to address. I also work in Nigeria from time to time. Let us give the Global Fund the benefit of the doubt that they have conducted a needs assessment...By the way, sexual minorities constitues a much broader spectrum, not just MSM.

 

Firstly, for the past 10 years I've been so abundantly blessed to have as my mentor, world renown African Scholar, elder statesman and global authority in Cross-Cultural Anthropology and Counselling who I readily have access to when I enter into such heavy duty discussion groups and debates. Distinguished Prof Emmanuel Wilson is retired and a former Presidential Advisor to President Clinton and his 2 predecessors. He took the time yesterday to continue this discussion which will benefit the GF and all those that are grappling with this very challenging issue of "sexual minorities". I'm eternally grateful and indebted to him.

 

Mistake # 1. The program facilitator needs to be keenly aware of self worldview conceptualization. This is the Central Issue. If the facilitator's worldview embraces derogotary societal concepts and constructs regarding any sexual minorities (even though he/she has been trained), they will not be effective in addressing these challenges. It will be simply an overt (rote learning) exercise and speaking of realities one doesn't live. Training and certification doesn't imply that one's worldview is transformed. This is a massive problem all over the world.

 

Mistake # 2. What we fail to address and understand is that the mere usage of the word "SEXUAL MINORITIES" has already relegated "them" to a less than human position and edified ourselves as being in the superior position of "we". One concludes then that we have successfully segregated, compartmentalized, prejudiced and categorized..."them" and systematically engaged in this practice for decades.

 

Mistake # 3. We have entered this discussion with preconceived ideas...what we are actually saying is that "they" are "sexual minorities" and "we" are the "straight majority".

 

Mistake # 4. The UN family of organizations has copied Western modalities of addressing people, so when "they" look through that lens of "sexual minorities" and quietly impose their ideologies on us, we tend to think and act as arrogant as them and relinguish our own individuality to fit into their mold. This is morally and ethically wrong.

 

Mistake # 5. How can we bring "sexual minorities" on board to do things with us if we first have "categorized" them as being different? That is the main reason why our "program participants", who I respectfully address as "sexual minorities", are not prone to accept anything from us or interact with our statistical departments, surveyors, data collectors and program facilitators on any level because they have not been treated as human beings and have preconceived ideas about our system. We have to deal with the concept of differentials.

 

In conclusion: We are the culprits that created this monster and we are the ones that have to dismantle our monstrous creation if we want to be inclusive of all program participants. The problem is with "us" not "them". Thank you for your input.

Which interventions are proven to be effective in improving sexual minorities’ access to health services?

FIRE Africa's (www.fireinc.org) (FACEBOOK: Fenna Bacchus; a listing of all our initiatives is provided) approach for sexual minorities' access to health services is setting up ACCESS EFFICIENCY POINTS (AEPs) that offer wide range of services which must include onsite "Special Services". These AEPs must be staffed with higlhy skilled/trained facilitators (strong interdisciplinary background) and able to provide/share expertise in:

1. community oriented grassroot sexual minority advocacy and councelling
2. human rights education
3. gender education and diversity
4. public health especially infectious diseases
5. teaching models in adult functional literacy and applications
6. community integration
7. productive enterprises that the wider community can benefit from
8. training of a sexual minorities to part of the AEP to provide services and counceling
9. training on how to facilitate a support group
10. Some policy makers on the government level are highly educated, but functionally illiterate on this topic and therefore also need to be made functionally literate on these matters.

What are the challenges for programs for sexual minorities?
Program challenges:
1. staff members may lack skills and competencies necessary to function effectively
2. programs lacks internal capacity: skills/expertise to create a warm environment conducive to learning, to facilitate sharing and learning that is inviting to sexual minorities to come forward to share and accept services
3. programs lacks internal capacity to provide unique entrepreneurship programs for the affected to function to their full potential while enhancing their respective communities
4. funding Challenges due to some government's reluctance to recognize sexual minorities
5. civil society is not viewed as a strong lobbying force making them almost ineffective to represent the voice of sexual minorities. Some governments make it unlawful for sexual minorities to function as a human being and have enacted this into law by making this a culpable offense examples: Uganda, Nigeria and Islamic States. Challenges within the wider community
6. lack of community acceptance of sexual minorities. Any programs with an overt focus on sexual minorities are not accepted. For that reason we need efficiency centers that offer a wide range of services that are inclusive of this
7. sensitization of the community takes a very long time since many communities may not tolerant to sexual minorities. Lack of functional literacy and functional illiteracy factors and adherence to a strong traditional worldview can prolong the process from 5 years to decades.

8. if we are not informed of the behaviours of sexual minorities and we don't know what percentage of the wider community they represent, we will not provide accurate figures on the prevalency and also loose grip of virus mutations in STD's. Sexual minorities must be identified preferably voluntarily and need to provided with services in a non-discriminating atmosphere that is confidential. When they are confronted with discrimination and stigmatization they tend to engage in unsafe sexual practices that may be far more harmful and will not access healthcare until its too late. If we want to make a dent in the infection rates and preventing new infections we must change our approach worldwide.