In Swaziland, Facing HIV Stigma Head on, with Brave and Determined Hearts

Can dialogue between key populations and health care workers decrease the stigma and discrimination which creates a barrier to those key populations accessing HIV prevention services?

Twenty-seven year old Sibusiso Masango, who is living with HIV and the KaMhlaba Ambassadors firmly believe the answer is yes. “I am a young gay man in Swaziland – I only have sex with other men. I was born like this and it’s not a choice – I was created by god like this, just like you were,” says Sibusiso Masango, to the hushed amazement of senior nurses, pharmacists, matrons and other health care workers at the Mbabane Government Hospital.

King Sobhuza II said, “We are KaMhalba,” meaning  “We are all of one world,” a statement of inclusion and compassion. But the Swaziland Behavioral Surveillance Survey revealed that sex workers (SW), gay men and other men who have sex with men (MSM) have experienced discrimination at health facilities which has resulted in lack of critical HIV preventative services for key populations. With the HIV prevalence among SW standing at 70.3 percent, any barrier to services for them is a barrier to stopping HIV in Swaziland.

The Health Communication Capacity Collaborative and the Swaziland National AIDS Program responded with a time-tested approach to creating understanding and decreasing conflict-Dialogue. Sibusiso with two other representatives of the MSM and SW populations are KaMhlaba Ambassadors.  The Ambassadors conduct on-site dialogue and sensitization sessions for health care workers and nursing students with the aim of breaking down the discrimination barriers and resolutely pushing open the doors to HIV services for socially marginalized groups. In the three-hour dialogue sessions, Sibusiso and colleagues share their experiences in accessing health care services and suggest solutions for more accessible health care for key populations.

According to Sibusiso “These sessions have also changed my behavior. I feel I should live as a role model now, as everyone that has listened to my presentations and other key populations are looking up to me.” With inner strength, grace, humor and compassion shining through, Sibusiso explains to health care workers how being stigmatized results in unwillingness to seek treatment by key populations.  “We are here to build better understanding with you and not to blame you.  But most of us are afraid to come to clinics because of dehumanizing experiences.  We are human and we want to be treated like any other client, that is all.”

The sessions are transformative on both sides and Sibusiso is confident health care workers will change their behaviors. “Health care workers now have a picture in their minds of the issues of key populations.  This means that they now want to render a good service without discriminating.” Overwhelmingly, the health care workers say they did not understand that they were stigmatizing and hurting others and that they would like more time with the issues of KP’s.  From Sibusiso, “I really feel good about this work.  These sessions have empowered me to be brave and to stand and talk on behalf of my community. Very soon we will achieve our goal which is to eliminate stigma in facilities and have KPs going without fear.” Sibusiso further states that his attitude towards health care workers has also changed because of being a KaMhlaba Ambassador.

“Through the dialogue sessions, I have become a good listener, a person of integrity as I speak on behalf of others, patient, and my communication skills with older people has improved. I have gained a lot!”