Time to invest in a ‘counterpublic health’ approach: promoting sexual health amongst sexually active young people in rural Uganda

Abstract

This paper contributes to thinking about counterpublic health, a term used to think about those areas of public health in which investment in particular moral ideologies compromises the ability to respond effectively to public health needs (Race 2010). Drawing on findings from a qualitative study conducted with young people and NGOs in rural Uganda, findings reveal how young people become involved in secretive sexual relationships because of inhibitive mainstream influences discouraging more open expressions of sexuality. The analysis of NGO HIV prevention and sexual health programming illustrates few opportunities to normalise perceptions of young people's sexual behaviour as it is actually lived and challenges an accepted public morality which systematically enhances young people's vulnerability to HIV and other sexual health threats. This paper identifies three ways in which NGOs might adopt a counterpublic health approach to HIV prevention and sexual health programming with young people.

Keywords:

• young people
• sexual health
• HIV prevention
• counterpublic health
• Uganda

Notes

Under the Penal Code in Uganda, ‘defilement’ applies to all cases of sexual contact outside marriage involving girls younger than 18 years, regardless of consent or the age of the ‘perpetrator’. Defilement carries a death sentence or imprisonment for 18 years with or without corporal punishment. In the research areas, defilement was often dealt with more informally. Boys were held in a local prison under impoverished conditions, completing heavy manual labour until a settlement fine (e.g. USH500,000–800,000, £160–270) is paid to the girl's parents.

This has been documented widely, including problems communicating with parents (Seeley et al. 1991, Amuyunzu-Myamongo et al. 2005), extended family members (Muyinda et al. 2004), health professionals and teachers (Kinsman et al. 1999).

The provision of ‘safe spaces’ through clubs parallels other literature documenting marginalised groups' development of spaces where they can develop positive self-dignity and solidarity, acting on their own, as well as with others, identified variously as ‘homeplaces of resistance’ (Hooks 1991), ‘Third spaces’ (Ruddick 1998, p. 343), ‘offstage social sites’ (Scott 1990, p. 119) or ‘urban niches’ (Beazley 2000, p. 484).