For Your Advocacy – A Research Agenda for Pregnant and Lactating People

For prevention options to meet the real life circumstances of the people who need them, we need an inclusive research agenda. Advocacy for the inclusion of pregnant and lactating populations (PLP) in research has been gaining traction in recent years, building on growing evidence, several global and national initiatives and an increased focus from prevention advocates. AIDS 2022 in Montreal featured exciting discussions advancing this work. If you’ve been taking part or just getting up to speed on the issue, AVAC has resources for you—including An Advocate’s Guide to Research in Pregnant and Lactating Populations; a dedicated page on AVAC.org with background and further resources; and a four-point action plan, Advancing HIV Prevention Research in Pregnant and Lactating Populations: Priority Advocacy objectives and Next Steps.

Pregnancy and the post-partum period after giving birth are times of heightened HIV risk. Cisgender women are two to three times more likely to acquire HIV during pregnancy and four times more likely post-partum than otherwise. Women who acquire HIV during pregnancy have an 18 percent chance of transmitting HIV to their newborn, which goes up to a 27 percent chance if they acquire HIV while breastfeeding. But HIV prevention options for (PLP) are limited, and their inclusion in research has been inadequate, resulting in evidence gaps across the research landscape for new prevention products.

(Image from AVAC’s Advocates Guide)

An approach based on principles of reproductive justice is reframing the research agenda for PLP. But action is needed from a variety of stakeholders to promote ethical inclusion rather than exclusion of pregnant people from clinical trials. A multi-stakeholder think tank led by AVAC and the PHASES project brought together advocates, researchers, ethicists, regulators and donors and resulted in a four point action plan, with additional contributions from Pangaea Zimbabwe AIDS Trust. The plan identifies next steps and four priority goals:

1) Embrace a reproductive justice framework:

(Reproductive Rights Framework, Image from PHASES, 2020)

2) Engage stakeholders in an early and sustained process in the design and conduct of clinical trials

3) Develop the necessary regulations to generate needed data for PLP to safely use new therapeutics

4) Ensure sound ethics reviews that include adolescent girls and young women in HIV prevention research.

An inclusive research agenda for PLP is essential for the HIV response, elemental to equity in global health, and key to having an impact on the epidemic. If you are interested in getting involved in AVAC’s work in this area, contact avac@avac.org

For other resources toward an inclusive research agenda, check out

  • The Choice Agenda list serve: a global forum for advocacy on the latest in HIV prevention research, with monthly webinars on the hottest topics.
  • No Data No More: A Manifesto to Align HIV Prevention Research with Trans and Gender-Diverse Realities
  • Good Participatory Practice Guidelines: systematic guidance on effective stakeholder engagement in HIV prevention research.

A Look Back at Montreal

In Montreal the pressure was on.

AIDS 2022 showed the global response to HIV at a crossroads. The field has achieved groundbreaking advances in biomedical solutions. But intensifying disparities in HIV prevention and global health at large threaten to eclipse these achievements. Scrutiny of the inequities was center stage in Montreal. While the UNAIDS report In Danger, released at the conference, documents what HIV advocates have known—that during the earliest phases of the COVID-19 pandemic, progress against HIV did not just stall, it actively lost ground—the HIV Prevention 2025 Road Map by the Global HIV Prevention Coalition released just days later navigates a path to get back on track.

Click here to download the issue

Advocates see how much is at stake at this moment and were making the connections to crises across the field of global health. Their call to action was constant. Protests, formal and informal, were diverse and targeted. They demanded political support and full funding to rollout the dapivirine vaginal ring (PrEP Ring), confronted the developer of injectable cabotegravir for PrEP to go further in affordable and transparent pricing, took on an anemic response to monkeypox (POZ coverage here, TheBodyPro coverage here), challenged ongoing criminalization of sex workers and other key populations, and criticized Canada for blocking the visas of hundreds of delegates to the conference.

Veteran voices such as Fatima Hassan of the Health Justice Initiative were calling out the implications of “vaccine apartheid” in the COVID response and the “pandemic profiteering” that drives it. Global health activist and epidemiologist Gregg Gonsalves called on health advocates to go beyond “the technocratic solutions… and fight our way back to equity.” Advocates challenged the legacy of colonial imperialism in global health, and some voices demanded total reform of the intellectual property and trade system, to name a few of the issues and actions raising the heat.

Are They Listening?

Important steps in decolonizing global health are beginning to take shape. Advocates from the Global South hosted and co-hosted meetings with key decision-makers to make the urgent case for faster and more equitable access to new PrEP options—including meetings with Winnie Byanyima of UNAIDS, Amb. John Nkengasong of PEPFAR and Atul Gawande and Han Kang of USAID. These discussions, as they go beyond community engagement and towards community leadership, represent a model for how the global response must change—voices from communities where HIV is hitting the hardest must be in leadership at every stage, for every crucial decision. The UNAIDS, PEPFAR and USAID leaders say they are listening. Advocates are watching this space closely. Accountability, at every level, is essential—for HIV prevention, treatment, human rights, health systems and health equity.

Getting Rollout Right

Fulfilling the current promise of new HIV prevention options requires advancing a people-centered, integrated approach for introducing proven products. This priority was also center stage in Montreal. The Coalition to Accelerate Access to Long-Acting PrEP (with AVAC serving as the secretariat), The HIV Prevention Road Map announced by the Global HIV Prevention Coalition, and the just-launched WHO guidelines for injectable PrEP that simplify PrEP delivery, are helping to lay the groundwork. The agreement between the Medicines Patent Pool (MPP) and ViiV is also a welcome step toward a sustainable market of generic manufacturers for injectable CAB and future products.

But more must be done. Delivering the fruits of science must become as urgent as their development. Putting in place the right programs, policies and investment to deliver choices at scale and bend the curve of the epidemic utterly depends on a commitment to integrated, equitable, people-centered, and community-led approaches. Be sure to read AVAC’s Plan for Accelerating Access and Introduction of Injectable CAB for PrEP, (or a summary of it), which outlines why funding commitments, creating demand, WHO guidelines, implementation studies, technology transfer, generic manufacturing and more must be coordinated and expedited now.

Several sessions and events at AIDS 2022 took a deep dive into why and how this people-centered, integrated approach must frame product introduction. Here are quick highlights on key sessions:

Scientific Advances

The meeting saw incremental progress in research on several of the pandemics destroying life around the world today. Sessions on TB, HIV, COVID-19, monkeypox, and STIs drew lessons from the COVID-19 response. But with all that the world is learning, research and discussion have yet to tackle how to create the integrated systems needed for a truly effective global health response. This kind of pandemic preparedness means advancing health equity.

Our friends at aidsmap provided in-depth reporting on a number of sessions; you can check out their highlights here. In the meantime, here is a brief summary of some of the scientific advances we found interesting at AIDS 2022:

Populations and Products in Focus

The following sessions put an important spotlight on particular populations or products:

AVAC at AIDS 2022

For a look at AVAC’s work at AIDS 2022 go to our dedicated page. And in case you missed it, the latest webinar from The Choice Agenda provided a status update on the rollout of injectable PrEP, with presentations from providers, researchers, the WHO and others.

The picture of HIV prevention today is full of promise and peril. Navigating the challenges is both possible and imperative. Here’s how AVAC Executive Director Mitchell Warren put it at the launch of the new Global HIV Prevention Roadmap:

“In 41 years we’ve never had such opportunity in prevention. We have a package of proven methods for the first time, and global health leaders are offering renewed commitments to spearhead and sustain programs that are designed to reach those who need prevention most. These programs should be focused on integrating HIV services with sexual reproductive health and rights. But we won’t get this done without going beyond simple community engagement and the old siloed models of delivery. Now is the time to integrate, coordinate, and invest. Now is the time for a global response that is community led.”

Injectable PrEP: Upcoming Webinar from The Choice Agenda

AIDS 2022 in Montreal just wrapped up, and stay tuned for our full summary soon. For now, though, a quick update on injectable cabotegravir for PrEP (CAB), which was a hot topic at the conference and the subject of next week’s Choice Agenda webinar.

  • New data from the HPTN 083 and 084 trials re-confirmed the safety and efficacy of CAB for PrEP;
  • WHO guidelines added injectable PrEP as an additional prevention option;
  • ViiV, the drug-maker of CAB for PrEP, and the Medicines Patent Pool announced an agreement to provide a voluntary license and begin the process of identifying generic manufacturers;
  • A new coalition convened by Unitaid, WHO, UNAIDS and the Global Fund, with AVAC serving as the secretariat, will collaborate with civil society, normative agencies, governments, and funders, in accelerating access to longer-acting PrEP; and
  • Advocacy and activism around global access to CAB included on-stage protests, meetings with key decision makers and many, many other discussions led by advocates and partners.
  • Join us Monday, 8 August at 9:00 ET / 15:00 SAST for our next The Choice Agenda webinar, Faster, Smarter and More Equitable – Accelerating Roll Out and Uptake of CAB for PrEP.

    title card for webinar

    As injectable cabotegravir (CAB) as PrEP begins to be introduced, what lessons have we learned from the first 10 years of oral PrEP implementation? How can the field do better with a new PrEP intervention that offers new opportunities and distinct challenges? These are the questions our panel will be discussing and more.

    • Rachel Baggaley, World Health Organization
    • Caroline Carnevale, New York Presbyterian Hospital
    • Monica Gandhi, University of California San Francisco
    • Mitchell Warren, AVAC
    • US cabotegravir (Apretude) user – RJ Mitchell

    Resources

New Issue of PxWire!

PxWire is AVAC’s quarterly update covering the latest in the field of biomedical HIV prevention research and development, implementation and advocacy. Each issue includes news, emerging issues and features upcoming events.

The HIV field gathers for its first hybrid International AIDS Conference (IAC) since the start of COVID-19 pandemic at a pivotal moment in HIV prevention. Across research to rollout – accelerated product access, new products reaching the market, new trials starting (and pausing) and recent research results – the ability to deliver two new proven PrEP methods will be determined by conversations and decisions happening now.

After initial approval ten years ago, oral PrEP initiations have surpassed 2M globally, reaching 2,797,304 – with significant progress over the past year, but still well below UN targets.

Check out the full issue of PxWire here and scroll down for important updates.

phases in trial development

bar chart of PrEP uptake worldwide

preparing for new products dashboard

updates on products upstream in clinical trials

Message from Montreal: Which way will we go?

A string of announcements today coming from AIDS 2022 mark a potential turning point for HIV prevention and for the global health field at large, but a grave question hangs in the balance: which way will we go?

The big news yesterday was a dire warning: the launch of the UNAIDS report, In Danger, documenting what HIV advocates have known: that during the earliest phases of the COVID-19 pandemic, progress against HIV did not just stall, it actively lost ground.

The news today included: promising developments with new data from the HPTN 083 and 084 trials testing injectable cabotegravir for PrEP, which re-confirmed its safety and efficacy; WHO announced new guidelines adding injectable PrEP as an additional prevention option; the drug-maker for the first approved product of injectable PrEP (cabotegravir as PrEP), ViiV, announced an agreement with the Medicines Patent Pool to provide a voluntary license and begin the process of identifying generic manufacturers; and a new coalition was announced, convened by Unitaid, WHO, UNAIDS and the Global Fund, with AVAC serving as the secretariat, to collaborate with civil society, normative agencies, governments, and funders, in accelerating access to affordable longer-acting PrEP.

In the whiplash of announcements and headlines, it’s vital to understand how much is at stake at this moment.

Will proven biomedical options become feasible choices for people who need and want them? Will policies, programs and investments come together for equitable access? It’s up to all of us.

PrEP has an important role to play in reaching targets and accelerating an end to the epidemic. But new AVAC data show only around 2.7 million people have initiated use of oral PrEP since it was introduced ten years ago, falling short of the 2020 target of three million users – and representing only a fraction of the estimated number of people who need it and could benefit from it. Now, the dapivirine vaginal ring and injectable cabotegravir (CAB for PrEP) offer additional options – and an opportunity to re-imagine HIV prevention.

The news from Montreal show promise and potential to develop and deliver new PrEP options faster, smarter and with greater equity than ever before.

AVAC’s Plan for Accelerating Access and Introduction of Injectable CAB for PrEP provides a comprehensive view of all the moving parts involved in delivering this new PrEP option and identifies priorities for ensuring time is not wasted and opportunity is not squandered. The plan focuses on learning the lessons from the first ten years of delivering oral PrEP. It shows how to move faster, more strategically, and with greater coordination— to maximize the impact of injectable CAB for PrEP today, and to overcome access challenges for new PrEP options in the future.

thumbnail of the CAB plan

There is enormous work ahead, and it will require all proven prevention methods be available in a marketplace of choice. And these efforts must integrate the involvement of all stakeholders, including civil society, to hold each other accountable. We encourage you to read the plan, or our summary of it, and follow events in real time on Twitter at #AIDS2022. And learn more about the dapivirine vaginal ring and injectable cabotegravir (CAB for PrEP).

African Activists Call for Women and Girls to have a Voice in HIV Prevention Choices

African feminists and HIV prevention advocates are united in their advocacy for ensuring African women and girls in their diversity have a range of HIV prevention options to choose from, including the dapivirine vaginal ring.

While several African countries have approved the licensure of the ring and the WHO has included the ring on the list of essential medicines, some donors are backing away from their support of the ring for rollout beyond the planned Introductory studies as well as support for future research in longer acting rings. Advocates have called for accelerated access to the ring and not to lose sight of the importance of championing choice and respecting the investment African women and communities have made in bringing the ring to this point.

Read more and see the signatories to the statement on the WACI Health website.

AIDS 2022 Montreal Coming Up!

AIDS 2022 logo

The world’s largest conference on HIV/AIDS, AIDS 2022, convenes July 27-August 2 in Montreal, Canada. Hosted by the International AIDS Society, this 24th session of the conference will be the first since the pandemic to offer in-person and virtual access. Register for the full conference here and the pre-conference here.

AIDS 2022 launches at a pivotal moment in HIV prevention. The ability to deliver two new proven PrEP methods will be determined by conversations and decisions happening now. These decisions will impact policies and funding for products in the pipeline and programs to deliver what’s available today for HIV prevention. It’s time to sharpen the agenda for HIV prevention and global health equity. AIDS 2022 will offer opportunities to engage in these conversations while getting up to date on the latest research, rollout, policy and advocacy.

Below AVAC has gathered resources to help you navigate the conference overall and find the sessions on prevention that we hope will interest you, keep you informed, and support conversations that will shape the future of the global response to HIV.

Resources

Panels, Satellites, Sessions and Workshops Featuring AVAC and Partners

Friday, July 29

  • [Satellite] Next Generation PrEP: Science, policy, and community impact
    18:15-19:45 EDT

    How do clinical trials assess efficacy of new and still-needed experimental products, with highly effective options available to the public? This session explores the need to bring key stakeholders including communities, industry and regulators to questions such as: How do regulators approach groundbreaking new trial designs in HIV prevention? How do these trial designs affect patients in the trials and those that may benefit from candidate drugs?

Saturday, July 30

  • [Symposium] Equitable roll out of health products: What will it take?
    14:15-15:15 EDT

    Discussing innovative strategies, collaborative partnerships and transparent processes that engage advocates, government agencies, policy makers, government and non-governmental funders, regulatory bodies and pharmaceutical companies and result in equitable access to new products, the key to achieving rapid and effective product rollout.

Sunday, July 31

flyer for our next shot workshop

flyer for demand, delivery and data for decision-making meeting

Monday, August 1

Find these resources, conference highlights and more at AVAC’s dedicated AIDS 2022 event page. And watch this space for new opportunities to come together and shape what happens next.

It’s All About Choice

Real choices in healthcare are fundamental. They empower individuals, advance equity across healthcare systems and transcend healthcare altogether, fostering community resilience. But choice depends on commitment, requires investment and needs champions.

At AVAC, we are thinking intensely about how to be a champion for choice. Wherever our work takes us. Here’s what’s top of mind today.

Our newly launched initiative, The Choice Agenda (TCA), led by veteran advocate Jim Pickett, is hosting its next webinar in its series on HIV prevention, The Research Says Yes, YES, YES – Just Like That, Wednesday, July 13 at 9:00am ET / 1:00pm GMT / 15:00 SAST. Register now.

This webinar explores insights from HIV prevention and sexual health research that point to the many positive outcomes when we center and prioritize pleasure and sexual satisfaction in our interventions and prevention programming.

We’ll be featuring a discussion with experts:

• Christine M. Curley, University of Connecticut

• Dr. Joao Alves Neto, University of Minho (Portugal) and FACEFI (Brazil)

• Anne Philpott, The Pleasure Project

Get access to our previous webinars, register for what’s upcoming on The Choice Agenda webpage, and sign up with jimberlypickett@gmail.com to join the TCA listserve for dynamic, cross-cutting conversations with hundreds of dedicated advocates.

Fighting for Choice Together

All of our voices must be heard to protect and expand access to real choices for everyone who needs them. Especially when it comes to sexual health, which is so often stigmatized and often profoundly under threat. AVAC condemns last month’s decision by the US Supreme Court, which rolls back decades of protections for those seeking safe abortion services in the US and undermines other landmark rulings that safeguard fundamental human rights, privacy and personal liberty.

Read AVAC’s statementRead AVAC’s statement condemning the opinion and declaring our commitment to stand always for reproductive justice and to work with our partners and allies to ensure that the right to abortion is protected.

Statement in Response to the US Supreme Court Opinion in Dobbs v. Jackson Women’s Health Organization

Today, AVAC executive director Mitchell Warren issued the following statement in response to the US Supreme Court opinion in Dobbs v. Jackson Women’s Health Organization:

“As a global organization dedicated to health as a human right, to social justice, and to individual autonomy and choice, AVAC stands today and always for reproductive justice. We condemn the 6-3 decision by the US Supreme Court, which rolls back decades of protections for those seeking safe abortion services in the US and undermines other landmark rulings that safeguard fundamental human rights, privacy and personal liberty.

The court’s ruling harms public health, full stop. We know that access to sexual and reproductive health care, privacy, and bodily autonomy underpin not only abortion rights, but also our ability to combat HIV and end this epidemic. We are HIV and global health advocates and activists, and our work is fundamentally about intersectional social justice and human rights. We stand in solidarity with the reproductive justice organizations and leaders who are at the forefront of the fight for reproductive rights and with everyone whose lives will be fundamentally altered by this decision.

This is a sad and scary day, but it is not the end. We commit to working with our partners and allies to ensure that the right to abortion, and reproductive rights overall, are protected for all.”

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About AVAC: Founded in 1995, AVAC is a non-profit organization that uses education, policy analysis, advocacy and a network of global collaborations to accelerate the ethical development and global delivery of HIV prevention options as part of a comprehensive response to the pandemic. Follow AVAC on Twitter @HIVpxresearch and find more at www.avac.org and www.prepwatch.org.

Changing minds: Journalists see a universe of genders

Face-to-face contact is transformative for journalists.

Mandi is the vice-president, World Federation of Science Journalists (WFSJ) and President: Southern African Freelancers’ Association (Safrea).

Ida is a global health media adviser at Internews and Coalition to Accelerate and Support Prevention Research (CASPR).

In 2019 Anna Miti, a seasoned health journalist in Zimbabwe, founder of the Health Communicators Forum, and former AVAC Fellow, was looking at the media landscape and seeing both a problem and an opportunity. In Zimbabwe, like in many regions of the world, trans and gender-diverse (TGD) people cannot safely seek HIV prevention or treatment services because of myriad barriers; social, cultural and legal barriers. As a result, little is known about this community, even as national epidemics in across Africa become increasingly concentrated among marginalized populations.

Miti understood that the media could influence perceptions about gender. She had seen the media’s role in breaking gender stereotypes. Internews and International Media Support (IMS) have both developed strategy documents for how media can achieve this. (Internews Gender Equality and Inclusion Strategy (2022-2024) and IMS: The crucial role of media in achieving gender equality).

But many journalists themselves held stigmatizing attitudes, or had so little awareness of the issues that harmful or inaccurate assumptions were going unchallenged, even among those who regularly write about health issues. Anna had the idea to educate the journalists and harness the power of the media.

Cultural norms, taboos, rumors and old habits can all make it challenging to adopt ideal health practices. An informed media ignites conversations that change such norms over time. Local media, trusted by communities and speaking local languages, can be an especially powerful agent in changing social norms. To do so, reporters must understand many things: the history and politics, the facts and the evidence, the surrounding anxieties and aspirations, and most importantly, the real people found among the affected communities of any given health issue they report on.

For Miti, improving journalists’ knowledge of gender issues had to start with encounters. For the media to spark conversations that would reach transgender people, and win their attention, required building trust. Cisgendered reporters and transgender advocates needed a chance to get to know each other.

The HIV Connection

Zimbabwe has a high prevalence of HIV. UNAIDS data show almost 13 percent of the 15-49-year-old age group is HIV positive. Despite these high numbers, it’s an ongoing effort to get HIV onto the news agenda. Editors tend to spike stories as “not interesting or controversial enough”, said Anna.

As convener of media science cafés, which take place at the Zimbabwean NGO Humanitarian Information Facilitation Centre (HIFC), she and the team work to find ways of keeping HIV prevention issues on the news agenda. Focused on biomedical HIV prevention, the cafés bring journalists together to discuss issues they’re tackling in their work, and to learn from relevant experts, such as scientists working in the prevention field, civil society organizations and health advocates engaged in HIV prevention. Supported by AVAC and integrated into the multi-partner Coalition to Accelerate and Support Prevention Research (CASPR) program, these events have proven their value over time. The media café program, which is also active in Zambia, Kenya and Uganda, is a part of AVAC’s 25-year history of working to foster leadership by African organizations and to make sure science makes sense at the community level.

Gender dynamics are a significant factor in the HIV epidemic, and the cafés have already done transformative work in this area. For example, an exercise called “In His Shoes/In Her Shoes”, challenged gender role stereotypes with participants imagining themselves if they were a different gender. A follow up discussion explored the harm done when gender issues are framed as a “battle” between men and women. “That exercise resulted in a really intense but productive dialogue. The journalists and everyone else seemed to take away new perspectives” said Anna.

But now the plan was to go further.

Changing minds requires making connection. Ending AIDS depends on reaching communities that are often overlooked and even criminalized. Health issues of every stripe land most heavily among those with the least access to healthcare or the corridors of power that secure it. So it’s no surprise that gay, transgender and other communities of sexual minorites are at high risk of HIV infection. One study in 2020 in Zimbabwe showed that HIV prevalence among male and transgender sex workers was as high as for female sex workers. Although figures for the non-sex-worker TG population are not easy to come by, research by local organizations and anecdotal evidence suggest they are highly vulnerable to HIV as well. A recent global scientific review concluded, “Trans feminine and trans masculine individuals are disproportionately burdened by HIV. Their unique prevention and care needs should be comprehensively addressed.”

Could the work of media science cafés change attitudes toward gender-non-conforming people? Manju Chatani-Gada, Director of Partnerships & Capacity Strengthening at AVAC, has long experience of trying to change minds and engender inclusivity in societies. “It’s critical to be engaging with the media. At AVAC we have a long commitment to supporting the work of advocates, and as we’ve deepened our efforts to advance equity, it’s been very important to also work with ministries of health, program implementers and very much the media, too.”

Anna had heard journalists remark that there are none, or hardly any, transgender people in Zimbabwe and thus no need to focus on this community in HIV storytelling. But she knew it wasn’t true. She and the HIFC team began to work with Trans and Intersex Rising Zimbabwe (TIRZ) on a media café with journalists where they could introduce themselves to each other, explore the issues and begin an exchange. TIRZ Programs Director, Queen Bee Meki Chihera, played a crucial role. Queen Bee is deeply concerned about HIV infection rates, especially high rates her organisation’s research had revealed among young transgender men. Despite a previously adversarial relationship with media, driven by what she characterises as “distortions” in reporting, she well understands the leverage of journalism: “We need journalists to bring transparency, and to follow up on promises made by government,” she said.

“Something Clicked”

A date was set in October 2019 for an initial media science café, with a talk by Chamunorwa Mashoko of ACT (Advocacy Core Team, a collective of 20 civil society organisations working for access to decent health services for all in Zimbabwe and part of the Coalition to build Momentum, Power, Activism, Strategy & Solidarity (COMPASS) Africa), followed by Queen Bee, who spoke about the difficulties faced by trans people in negotiating life, from accessing health care to facing discrimination and violence. “Some of the journalists were shocked,” Anna recalls. “Others were really, really surprised and really not comfortable.” One journalist who is normally talkative went very quiet, she said.

Participants now say it was transformative. Face-to-face exposure to a person who is “different” is one of the most powerful tools available to change minds. The differences fade as people find the similarities.

“Something changed; something clicked for a lot of those present,” said Manju. “I was actually surprised at how big an impact it made. Queen Bee was the right person with the right message at the right time.”

Queen Bee has been a welcome and willing guest at several media science cafés since that seminal event in October 2019, answering questions and opening minds to the way gender dynamics and prejudices affect everything, from family relationships to risk of infection, to, crucially, access to health care. Transgender people are subjected to invasive questioning and casual cruelties when they seek medical care and it has been enlightening for journalists to hear from Queen Bee how such stigmatising treatment drive sexual minorities away from the health services they desperately need.

More Media Connections, More Shifts

And the information has hit home. Articles which have been published following these events have focused on “the difficulties in getting access to services, and how homophobia affects people seeking services,” said Anna. (Many of these stories appeared in local languages or on the radio, but these two examples can be read in english: Dreading To Go Home: The Plight Of Transgender People in Zimbabwe and Trans woman opens up on journey.)

“Before the face to face meeting with the transgender community at Transmart, I used to view the community or paint the community with one brush”, said Michael Gwarisa of the Health Times.

Gwarisa said he did not know the difference between a trans person or a gay person or lesbian. However, following the workshop where presenters from the transgender community shared their experiences, he came to a new realisation. “I started appreciating some of the challenges they face in terms of accessing basic services such as health, travel and even in terms of exercising their electoral right to vote”, said Gwarisa. He said awareness raising via the media should continue. And health care workers should also be engaged to ensure they do not deny the trans community any services based on their sexual orientation.

Catherine Murombedzi, a freelance journalist in Zimbabwe agrees: “I feel the workshops really helped me understand issues of transgender people; it’s difficult writing about them because we are very homophophic as a people due to culture and religious beliefs”, she said. “From a health journalist’s perspective it’s always important to look at different sides so that we leave no one behind.”

In another ground-breaking move, in a country where LGBTQ people face legal challenges, Queen Bee has appeared on Anna’s radio programme. As expected, it elicited some bigotry, but also opened a door to information that had before been taboo in the media.

TIRZ went on to hold a series of media trainings in partnership with Zimbabwe’s National Aids Council and others. In particular, TIRZ conducted training on sexual orientation, gender identity and expression, SOGIE, including for journalists in Chinhoyi and in Marondera, two towns out of Harare. Other trans advocacy groups are also raising their profile and expanding the perspective of journalists through the café. Transmart Trust held its first-ever media engagement, presenting at a media science café that was hosted by the Health Communicators Forum, a health journalism organization affiliated with the HIFC. Transmart works towards recognition and rights for transgender and intersex people.

The most recent media training with Queen Bee was in December 2021 where she highlighted how COVID-19 was also affecting sexual minorities. She said she is really pleased with the results of slowly but steadily building media connections and awareness. The narrative has changed.