Punitive laws drive sexual minorities away from HIV services

AHF doctor Abraham Mapfumo with matrons manning the OI clinic at Glen View 8 polyclinic

Fashion crazy Charlie Square (not real name) puts on a stylish floral sweatshirt and fitted jeans completed by a pair of white sneakers as he leaves his rented apartment in Glen View 8, Harare.

He has to pass through the local clinic to collect his three-month supply of antiretroviral medicines something which he has been doing religiously for the past three years.

Square has to be at the clinic at 8am; collects the medicine, return home and rest before he boards a commuter omnibus into town for work later in the day.

A bar attendant at a club in Harare’s central business district, Square has lived the better part of his life in isolation due to his sexual orientation.

Being gay in Zimbabwe particularly when living in the ghetto hasn’t been a bed of roses for Square and other sexual and gender minority citizens.

“I have to be at the clinic very early to get my ARV drugs and come back home,” he said.

“It was difficult getting these drugs during my first year, but I have realised that at a local clinic they now have specific services for people like us.

“However, it’s so difficult when you reside in the ghetto.”

Square has to endure everyday experiences of stigma, discrimination, violence and hate crimes on top of threats of jail.

Such a scenario has kept lesbian, gay, bisexual, trans and gender diverse, intersex and queer (LGBTIQ) communities further in the closets.

“Only a few people like me are going out and collecting ARV drugs and accessing sexual and reproductive services at public health centres,” Square said.

“The rest can’t come out they fear being arrested while the community is yet to accept us.

“Our country criminalises same-sex sexual relationships and one can be jailed for up to 14 years.

“But the reality is that same-sex sexual relationships are there.”

Gay men and other men who have sex with men are disproportionately burdened by HIV infection.

In 2018, UNAids estimated gay, bisexual, and other men who have sex with men were at 22 times greater risk of HIV acquisition than members of the general population.

Transgender women were estimated at 12 times the risk of HIV acquisition compared with those in the general population.

Global estimates further suggest the burden of HIV infection on these populations is increasing, despite broad international commitment to end the HIV epidemic and address the stigma and discrimination that fuels it.

The World Health Organisation indicates that new HIV infections among key populations, thus LGBTIQ sex workers as well as people who inject drugs, make up an increasingly larger share of all new infections worldwide.

Square believes the criminalisation of same sex relationships contributes to a cycle of stigma and discrimination.

“These jail threats fuel the HIV epidemic as they push some of us away from treatment while healthcare workers would discriminate us,” he said.

“When I was initiated on ARV three years ago, it was difficult to go and get the drugs until I went to a drop-in centre that had been established by Gays and Lesbians of Zimbabwe (GALZ).

“I got counselling and I told myself I would get my drugs from my nearest health centre.

“Fortunately, when I went to Glen View 8 polyclinic, I was told that at the OI [opportunistic infection] clinic, they have specific services for people like me.”

A recent visit to Glen View 8 polyclinic of course showed that the health centre has established a special setting to cater for the LGBTIQ community.

“We have created an all-inclusive OI clinic catering for all people regardless of age, race, gender and sexual orientation,” Aids Healthcare Foundation (AHF) doctor Abraham Mapfumo said. 

“Yes, we have people from the LGBTIQ community coming here to get HIV medical care and treatment.”

AHF is a global non-profit organisation providing cutting-edge medicine and advocacy to over 1 700 000 people in 45 countries, including Zimbabwe. 

The organisation has been working in Zimbabwe since 2016 and currently provides HIV and Aids medical care and treatment to more than 59 000 registered patients, including the LGBTIQ community.

Zimbabwe has over the last decade made steady progress in reducing new HIV infections, but that progress is fragile in a context where stigma is widespread, key populations face violence and young women are denied their right to sexual and reproductive health.

As such, Rise Above Women’s Organisation (RAWO), a lesbian, bisexual and queer women’s organisation in the country, has gone a gear up in claiming space for working towards achieving economic, health, political and social security for its members.

“We seek to improve the legislative frameworks and encourage a non-discriminatory environment for lesbian, bisexual and queer women,” RAWO director Mary Audry Chard recently told Standard Style.

“However, in the short-term (two to three years), we hope to enhance the support for the LBQ community in various sectors and facets of society and increase in the number of voices speaking against discrimination and violence against the community and hope to use that collective voice, in the long term (five to seven years), to change legal frameworks.

“We hope to see a decrease in hate speech, reports of violence, blackmail, and cases of discrimination within the communities.”

With support from Aids Fonds and Love Alliance, RAWO is now providing a model for comprehensive sexual and reproductive health programming for LBQ women and decrease new HIV infections.

“With the funding we managed to increase our work outside Harare and also incorporate Bulawayo the second metropolitan, Masvingo and Chinhoyi which is like virgin land in key populations organising,” Chard said.

Participants from key populations attending a workshop on sexual and reproductive health rights for the least served populations also shared their concerns.

“Sexual and reproductive health services for the least served populations is limited and only found in city centres,” said Bee Polan Chihera, an intersex rights activist.

“There is minimum health service package for the least served populations and hormonal therapy should be available for these people.”

Trans Smart Trust programmes coordinator Edith Mukarati said stigma and discrimination has had a negative impact on the wellbeing of key and vulnerable populations.

“Key and vulnerable populations face stigma and discrimination when accessing public health services and facilities,” said Mukarati.

“Health personnel are not responsive to key and vulnerable populations, including transgender people, men who have sex with men as well as people who use and inject drugs.

“Syringes are not available for people who use and inject drugs, so there is need to come up with needle and syringe programmes to prevent people who inject drugs from getting blood-borne viruses such as HIV and Aids, hepatitis C and hepatitis B.”

Mukarati said apart from lack of sexual transmitted infection (STI) screening services for people who use and inject drugs, there is need to make available information on STIs to key and vulnerable populations.

Onward Gibson Chironda, representing Community Driven Health Interventions for KPs in Zimbabwe — a consortium of key population groups — said some CSOs were providing key population-friendly health services in the form of mobile clinics.

He said in Harare, key and vulnerable populations can access health services at Wilkins and Pangaea Zimbabwe Aids Trust supported clinics dotted across the capital.

Presenting a paper titled Legal Environment and Key Populations Programming, Fanuel Ncube from the National Aids Council (NAC) told journalists attending a workshop in Chinhoyi recently that there were a number of punitive or coercive provisions in some laws acting as barriers to effective response to HIV.

“For instance, provisions in the Criminal Law (Codification and Reform) Act that criminalise sex between men and criminalise aspects of sex work block access to services for key populations,” Ncube said.

“The Constitution and various health and sectoral laws and policies, including the National HIV and Aids Policy, seek to promote the health rights of all people.

“However, resource constraints and in many instances practice by health service providers and lack of relevant targeted advocacy directed at policy makers and health personnel mean that policies are not always fully implemented and, in some cases, do not adequately provide for individual patient’s rights as well as access to appropriate HIV prevention, treatment, care and support.”

Ncube said HIV-related stigma and discrimination linked to gaps in laws, policies, practices, religious and cultural beliefs was found to exacerbate the negative impacts of HIV.

“The climate of stigma and discrimination surrounding HIV and Aids can make public acknowledgement of one’s HIV status difficult and risky for the vulnerable and key populations,” he said.

“Stigma and discrimination remains a concern among the key populations and including people living with tuberculosis.”

Ncube queried Section 56 of the constitution which says “All persons are equal before the law and have the right to equal protection and benefit of the law”, arguing that could it be used to justify discriminating against certain classes of persons.

As part of its HIV intervention programmes, NAC under the key population component uses the peer-led approach which involves sex workers, transgender, men who have sex with men and prisoners.

Despite steps forward in involving vulnerable and key populations in HIV programming, the enduring stigma and discrimination that the LGBT community faces in Zimbabwe has resulted in Square and people of his generation leading an isolated life.

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