‘Shamba’: Understanding and responding to the drivers and dynamics of same-sex sexual activity, sexual violence and HIV risk in the Malawi prison system.
Consensual same-sex relations and transgender expression are prohibited in Malawi. In-depth interviews (eight professionals, 30 former prisoners) were conducted to garner unique insights into the dynamics and complexities of prison conditions, human immunodeficiency virus (HIV) transmission, same-sex sexual activity and sexual violence. Reflexive thematic analysis yielded six themes: Covert same sex sexual activity behind the walls of the Malawi Prison System; Survival-based sexual transactions; Consensual and forced same-sex sexual activity; Sexual urges and crossing the homosexual Rubicon; Health consequences; and Inadequate and insufficient vocational development and rehabilitation.. The government is recommended to repeal its laws and improve standards of detention (safety, space, food), healthcare and provide trauma-informed rehabilitation/reintegration for all. Advocacy efforts are warranted to scale up the HIV comprehensive package