By Erica Kuhlik
Allan Rosenfield HIV/AIDS Policy Fellow
While major efforts have succeeded in reducing HIV/AIDS in much of the world, the epidemic among gay men, other men who have sex with men, and transgender individuals (GMT) in sub-Saharan Africa remains remarkably high. A report published by amfAR and Johns Hopkins University last year found that both national governments and international donors have largely neglected the toll of HIV/AIDS on the GMT communities in Southern Africa. In all countries examined- Botswana, Malawi, Namibia, Swaziland, Zambia, and Zimbabwe- the criminalization of same-sex sexual practices justified discrimination against GMT at all levels of the national HIV response. Unless human rights violations and health disparities affecting GMT are resolved, an AIDS-free generation in Southern Africa cannot be achieved.
A Matter of Human Rights
A primary obstacle to reducing HIV/AIDS among GMT in Southern Africa is the criminalization of the GMT communities. Criminalizing individuals based on sexual identity has devastating effects: the communities suffer widespread and blatant discrimination, hatred, and stigmatization. This translates into inadequate access to HIV services that are not implemented extensively for GMT. Health care providers may refuse to treat criminalized groups and some even alert law enforcement of GMT patients. Decriminalizing GMT is essential to protecting their human rights and winning the fight against HIV/AIDS in Southern Africa.
Limited Funding, Limited Programming
Few governments in Southern Africa have mounted a meaningful response to the HIV/AIDS epidemic in GMT. As a result, HIV programming for GMT is often funded solely by outside donors and implemented largely by local civil society organizations. Therefore, HIV services targeting GMT are severely limited to prevention services while neglecting treatment, care, and capacity building of local partners. In addition, the report noted that HIV epidemic does not affect all GMT in Southern Africa the same way (ex. many countries saw higher HIV prevalence among older than younger GMT), yet programming remains generalized among the GMT community. Not only must programming be increased, but it must also be targeted, and based on local evidence and systematic research.
Signs of Progress
Despite the challenges, the report highlighted signs of progress across Southern Africa, such as a surge in research studies on HIV in GMT communities. The results of these studies can be used to advocate on the national level for policy changes with regard to GMT, as well as encouraging international donors to increase funding and programming for these communities.
The report also noted new opportunities for GMT in HIV/AIDS policies in Southern Africa. For instance, some countries now mention GMT in their national HIV/AIDS strategies, which offers potential for a more effective response to HIV in GMT. Additionally, the GMT community now finds representation on The Global Fund country coordinating mechanism (CCM) for many countries in Southern Africa. As the CCM is responsible for drafting the country’s grant proposals, GMT representation on the CCM increases the likelihood that their needs are recognized and met by The Global Fund. Civil society engagement around GMT and HIV is also on the rise in Southern Africa with CSOs in both Botswana and Swaziland actively advocating for GMT rights.
A Call for Action
While these trends demonstrate a step in the right direction for Southern Africa, they are not yet enough to meet the needs of GMT. Funding and programming for GMT and HIV remain deficient despite increased research and evidence. The policy environment in many countries is still predominantly negative and discriminatory toward GMT, and the promises made in the National Strategic Frameworks are often left unfulfilled. While civil society has begun mobilizing around GMT and HIV issues, the legal environment still prevents them from making meaningful change at the national level.
For there to be any real hope of achieving an AIDS-free generation, national governments in Southern Africa need to show leadership in ending discrimination against GMT and work with donor agencies to increase HIV/AIDS funding, engage civil society, and fulfill their promises with actionable, on-the-ground programming and results.