Claiming the right to health for women who have sex with women: analysing South Africa’s National Strategic Plans on HIV and STIs

Daly, MF; (2015) Claiming the right to health for women who have sex with women: analysing South Africa’s National Strategic Plans on HIV and STIs. DrPH thesis, London School of Hygiene & Tropical Medicine. DOI:

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Introduction: Evidence has emerged that women who have sex with women (WSW) in South Africa face multiple vulnerabilities to sexually transmitted infections (STIs) including HIV. This health policy analysis seeks to understand why and how interventions to improve sexual health of WSW were initially proposed in the HIV & AIDS and STI Strategic Plan for South Africa 2007-2011, what was implemented and how issues were reframed in the National Strategic Plan (NSP) on HIV, STIs and TB 2012-2016. Methodology: Qualitative methods were used to analyse changes over time in policy discourse around WSW sexual health. A conceptual framework considered four factors determining political priority setting for WSW issues in NSP development processes: actor power, ideas, political context and issue characteristics. 25 semi-structured key informant interviews were conducted in South Africa in 2013 and findings were triangulated through document analysis. Results: Breakthrough in participation in policy making on HIV/AIDS in 2007 enabled the women’s sector of the South African National AIDS Council (SANAC) to present testimony from WSW affected by HIV. Policy content of the 2007-2011 NSP included WSW issues but no activities were implemented in the public health system. Policy actors were mandated to redevelop an evidence based NSP for 2012-2016 and discourse on key populations vulnerable to HIV, including men who have sex with men (MSM), shaped policy content. Data on HIV and STIs among WSW existed but resources to disseminate or undertake further research were limited. The SANAC LGBTI sector, created to represent community interests, became preoccupied with MSM programming. Focus on WSW was not maintained in the 2012-2016 NSP due to limited health metrics, limits on participation and growing social conservatism. Conclusion: In the future advocates must reiterate rights based arguments on the vulnerabilities of WSW and call for a revised research agenda on the epidemiology of WSW sexual health.

Item Type: Thesis
Thesis Type: Doctoral
Thesis Name: DrPH
Contributors: Spicer, N (Thesis advisor);
Faculty and Department: Faculty of Public Health and Policy > Dept of Global Health and Development
Copyright Holders: M. Felicity Daly


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