We had several great achievements during Year 1. First, we created a meaningful collaboration with knowledgeable partners. Developing a mission statement, purpose, guiding principles and values as part of our Governance document supported the partnership in cultivating a spirit of friendship and community. We demonstrated that being open, appreciating and understanding that each person at the table has different experiences to offer enriches the collective work of the partnership. Our name, the Tulumbe! Project, which means “to engage” in Luganda (a language in Uganda, East Africa) was defined. The name Tulumbe has helped us to form an identity and it became a mantra with the community. TULUMBE! TULUMBE!
We also focused on engaging stakeholders – African immigrants, community organizations, health care providers, and researchers. We held 2 community forums to hear from African immigrants about barriers and facilitators to utilizing HIV services. More than 70 African community members, including patients, were engaged through community forums in Lowell, MA and Boston, MA. In addition, we collected survey responses from health care providers on the critical issues and successes experienced when providing HIV screening, linkage to care, and treatment services to African immigrants. Most respondents resided in Massachusetts (68%), worked at local community health centers (42%), and had more than 10 years providing services to African immigrants (40%).
We analyzed the information collected and developed 5 health topics.
Increase safer sex and testing among African immigrant youth: There is a lack of cultural, youth friendly HIV prevention services tailored to African immigrant youth. Youth are not getting information on HIV prevention and are not engaging in safer sex practices.
Reduce HIV stigma in the community: High levels of stigma within the African immigrant community affect HIV/STI testing, disclosure, access to care and the overall health of African immigrants. HIV stigma associated with the fear of being HIV-positive and negative social consequences deter African immigrants from getting tested. In addition, because of stigma, HIV positive African immigrants often live in isolation, not telling anyone in their family or community of their diagnosis. This can often lead to poor health outcomes, internalized stigma, and depression.
Improve family communication (parent-child, parent-parent, child-child) about sexual health: Discussions about HIV and HIV prevention are not common among African immigrant families. There is often no dialogue between parents and children about sex, safe sex practices and the need for HIV/STD screenings.
Increase self-efficacy among African immigrant women: African culture regards men as head of the house. Women are expected to be inferior and submissive to men. The power imbalance limits women’s ability to make safer sex decisions. Women need to be empowered to know their bodies, options for sexual health and challenge gender dynamics in order to protect themselves from HIV and other sexually transmitted diseases.
Deconstruct masculinity to increase testing, risk reduction and partner communication: The gender power imbalance is a hindering issue that prevents HIV and sex related discussions among couples. Men are seen as heads of the households giving them the power to make family decisions without regarding their female partner’s inputs. Thus, communication with their partners on HIV is limited. There is a need for men to understand HIV risk reduction and value dialogue between their partners to prevent HIV.