BONELA’s Prevention Research Initiative for Sexual Minorities (PRISM) programme recently produced a Needs Assessment Report on the Lesbian, Gay, Bisexual and Transgendered community in Botswana.
PRISM is a Sexually Transmitted Infections (STI) /HIV prevention and human rights programme designed to advocate for and implement an HIV prevention initiative targeting men who have sex with other men (MSM), women who have sex with other women (WSW) and service providers in Botswana.
The Needs Assessment is a result of the collaboration between the Botswana Network on Ethics, Law and HIV and AIDS (BONELA), Lesbians, Gays and Bisexuals of Botswana (LeGaBiBo) and Schorer. The overall goal of the Needs Assessment was to establish a basis for an HIV/STI prevention intervention programme for sexual minorities who were vulnerable and at risk because public and private facilities did not respond to their needs. The Needs Assessment aimed at identifying areas where interventions could be made that ensured lesbians and gays would continue to be involved in prevention programmes. Information generated during the Needs Assessment would be channeled into advocacy activities and, with the help of the media, amplify human rights issues as they relate to sexual diversity.
The prevention model used in this research was the Predisposing, Reinforcing and Enabling Constructs in Ecosystem Diagnosis and Evaluation (PRECEDE) model. This model analyses personal determinants to behaviour such as issues of disclosure; behavioural factors that lead to risky sexual behaviour; health problems such as lack of access to health services and prevention methods; environmental factors encompassing policies and laws and quality of life indicators influencing access to services, responsibility for one’s life and engaging in responsible sexual behaviour.
The Needs Assessment adopted a descriptive and exploratory research design. The descriptive component aimed at capturing details of the gaps in the services provided to the Lesbian, Gay, Bisexual, Transgendered and Intersexed (LGBTI) community in relation to sexually transmitted infections. The exploratory component focused on the issues of HIV, human rights and service provision as experienced by WSW and MSM. Qualitative research was seen as the most appropriate way of gaining a holistic understanding of the problems associated with developing prevention interventions for LGBTI.
A brainstorming group of 11 members was set up and included representatives from BONELA, LeGaBiBo, the Ministry of Health, the University of Botswana and the Botswana Network of AIDS Service Organisations. UN agencies concerned with HIV/AIDS and NGOs were also involved to ensure that there is a multidisciplinary wealth of experience. A comprehensive literature review was undertaken despite limitations of sources and availability. This information was used to further develop the questionnaire.
The Needs Assessment targeted three groups. Firstly, the WSW and MSM community with emphasis on accessing preventive services in health facilities; secondly health care providers with direct experience in service delivery who could provide insight into the challenges and successes in their sector and make recommendations about future STI/HIV prevention measures, and thirdly, experienced partner organizations, faith-based organizations and traditional healers who were aware of the problems associated with effective policy making, service delivery and curriculum development and training.
The Needs Assessment was carried out in phases. Respondents were identified for face to face interviews to assist in defining needs and identify gaps in HIV/STI policies. Interviews were held
at five sites where LeGaBiBo had contacts. The selected respondents proved willing to talk and cooperated closely with the objectives of the Needs Assessment. A database agency was employed to develop databases for each of the three target groups and to enter data.
Two research assistants were recruited and trained in interview techniques. They supported the BONELA team during field work. Respondents were fully informed of the needs assessment objectives, how the information generated would be used and care was taken to safeguard respondents’ rights during the interviews.
Potential participants were first approached with an informative letter of invitation to participate. This resulted in three target groups, that is, 41 LGBTIs (25 males and 15 females); 16 representatives from faith based organizations and traditional healers; and 53 members of partner organizations, health care providers and training institutes. In addition to interviews, focus group discussions were also held with stakeholder organizations generating more information. Specific attention was given to linking the Needs Assessment to the target group and networking it externally. The findings of the Needs Assessment were first disseminated to the brainstorming group for comment and subsequently made available to stakeholders for their input. The final Needs Assessment Report has and is still being shared with national and international stakeholders.
Limitations of the Study
The sample size was small and perhaps not representative of the entire population. During fieldwork it sometimes proved difficult to arrange meetings with respondents. Poor transport and communication, other delays like institutional protocols, time as well as funding constraints were amongst the problems encountered. Measuring attitude was also a complex process and the translation of some of the terms used in the Needs Assessment into local (Setswana) language proved a problem.
Perhaps the most significant effect of the Needs Assessment given the current homophobic climate and secrecy surrounding LGBT issues in Botswana was the confirmation that there are WSW and MSM communities in the country. Respondents recognized that there was a need to accommodate LGBT and change laws and policies to ensure their rights are recognized. The Needs Assessment showed that more research was needed on the issues covered and that advocacy should focus on prevention methods for STIs to curb HIV infection, discriminatory laws and policies.
It highlighted the fact that amongst the barriers preventing LGBT accessing services and exercising their rights was a lack of knowledge about what those services and rights are and the discriminatory and exclusive practices of the organizations concerned. The Needs Assessment made it clear that there is an urgent need to educate society at large on prevention, human rights and the general well-being of WSW and MSM both at individual and organizational levels.