Sexual minorities fall within the bounds of homosexual, heterosexual and bi-sexual. Familiar sexual minors known within most precincts may include; gays or lesbians, commercial sex workers and whores, also maybe, victims of polygamy, sexually molested, and raped.

The severe stigmatisation and discrimination faced by sexual minors can rarely be faced out in most societies, primarily because of certain cultural and religious beliefs upheld in most countries. Efforts towards minimising stigma and discrimination may be futile.

In improving access to health service for sexual minors, effective intervention may include; capacity building/workshop for social and health service providers aimed at improving relationship, acceptability and drive towards these minors, formulating mechanism to reach them in spite of how much they have been relegated to the background in most societies. It is summarised as this; an improved acceptance built within health service providers.

Secondly, in improving access to health services for sexual minorities, social and health care providers are mobilised to reach out to these minors by first, identifying them within all precincts in countries, when identified they reach out to them in areas were identified.

The intervention of reaching out to sexual minorities in places where they are identified is designed so, because stigmatisation and discrimination keeps them away from society, they finding it hard to leave their secluded places for health services. These measures above would see to accessibility of sexual minorities to health services.

Major challenges for programmes for sexual minorities revolves around the sentiments already built in the minds of targets, that they (the minors) are the relegated in society.

It's harder because sexual minors refuse to be identified and even if identified refuses to mingle with the society at large.

Which interventions are proven to be effective in improving sexual minorities' access to health services? What are the challenges for programs for sexual minorities?

I have been working with sexual minorities – MSM/TG as also women engaged in sex work. The first problem that was encountered was the geographical spread they woud have – thinly  populated but scatterdly spread in population dense countries like India.

Fortunately, in India, these two categories have  traditional and historical acknowledgement and thus there would not be a social barrier to bring in programs for them here. However, there are legal hurdles in taking up programs for them. Already, there are advocacy to scrap article 377 in the Indian constitution to provide provisions for MSM activities and there have been amendments under ITPA for female sex workers.

Nevertheless, there have been issues that hamper access to services by sexual minorities. At the same time, there are major programs implemented for these minorities by community based organizations with wide networks in support from national AIDS control organization (NACO).

In respect of MSM or TG, the intervention that attract group activities and promote group sustainability will have a lasting impact. Individually, they have fear and stigma to identify themselves as sexual minorities and they shall hide back and refuse to access these services. In order to overcome this, any service access intervention should be inclusive of advocacy measures for their recognition. Further, in country like India where most of the sexual minorities are also of low income category, there is every need to support them to access job potentials to gain independence. Therefore, the intervention shall be an integrated approach involving access to job opportunities, health facilities and skills and advocacy to raise their self esteem.

In respect of women in sex work, our experiences show that the individual women shall shy to join in groups and be unwilling to come openly to avail services. They feel comfort in accessing through an NGO or any other serving agency that could keep them in low profile. Owing to their profession, they normally develop aggression and insecurity in them and any intervention needs to address these factors.

Again, as obvious to anybody, there is no one intervention that suits to all and it needs to be location specific.

Another important factor for consideration has been to include in the intervention adequate capacity building and development of professional skills for the sexual minorities. This alone, over a period, will enable them to take up these interventions as their own responsibilities and this will help in building confidence and sustainable efforts in demanding these service accesses. Again there need to be a note of caution here. Any capacity building or skill development shall be imparted by respective professional training team and not by these community leaders as trainer of trainers.

Another inherent difficulty that may crop in is isolation of these communities owing to targeted approach. The communities or their groups need to be a part of their neighborhood ensuring geographical and social bond. This requires interventions to involve neighborhood population but in harmony with the objectives of the intervention. The decisions and activities need neighborhood involvement and participation. Whenever, there is a convention or workshops or for that matter any congregation at regional or national level, it needs to be along with the neighborhoods and not only these sexual minorities. Of course, this involves cost considerations initially but this will compensate more in the subsequent period by way of sustainability and local resource mobilization.  

We have received a number of interesting posts for this week's question in this forum, and I would like to thank all who have participated so far. Here are some of the ideas that have emerged from discussions in the other languages:

            SPANISH FORUM

-        The specific behavior and lifestyle of МSMs create difficulties in implementing programs for HIV prevention. For the development of effective preventive interventions it is necessary to understand the factors that determine the lifestyle that MSMs lead. Programs must be based on the results of research into the psychological construction of these men, the psychological distinctive features, personal qualities and the individual nature of interpersonal relationships between МSМs (read full post by Tatiana, Ukraine).

I look forward to reading more of your contributions!

Best regards,

Alastair
E-Forum Facilitator