"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.PRACTICE IMPACT STATEMENTThe Malawi prison system is advised to resource, deliver and scale up the United Nations HIV comprehensive package of 15 interventions in order to uphold the humane treatment of prisoners and protect them from sexual violence and sexually transmitted infections.