Hope for sexual minorities’ access to HIV services in hostile contexts

The launch of a US$11.4 million programme in Southern Africa is renewing hope for stigmatised key populations affected by HIV.

The launch of a US$11.4 million programme in Southern Africa is renewing hope for stigmatised key populations affected by HIV.

The ‘Key Populations – Representation, Evidence and Attitude Change for Health Impact’ (KP REACH) is supported by the Global Fund to fight Aids, Tuberculosis and Malaria and was launched on 2 December at the International Conference on AIDS and STIs in Africa in Harare, Zimbabwe.

Sexual minorities in hostile environments

In many countries key populations affected by HIV, especially men who have sex with men and transgender people, operate in highly restrictive and hostile environments, facing harassment and at times death threats. Living in such a context can be traumatizing, and the high societal stigma faced by many sexual minorities can result in lack of access to HIV prevention, care, and treatment support, as well as increased alcohol and substance abuse.

Chesterfield Samba, director of Gays and Lesbians Association of Zimbabwe (GALZ), said: “Our journey of 25 years to support transgender groups has been mostly filled with sorrows, troubles and few successes due to the hostile environment we operate in. The legal environment has been quite challenging and we have been having most of our members facing harassment despite clauses in our constitution and laws protecting such key groups.” At least 44 members of GALZ were arrested at a constitution workshop in August 2012.

Finding funding to address these issues is often challenging. “We are involved in Global Fund concept note developments highlighting our issues in the country coordinating mechanisms, but when the funds are disbursed, we are left out,” Samba said.

Other key groups who are also being let down in the HIV response include people in prison, people who inject drugs, and sex workers. Failure to provide services to these population groups threatens global progress on the HIV response.

New programme tackles HIV among the marginalised

With the KP-REACH initiative there is an opportunity to address some of these long-standing issues. The programme was conceived and formulated by key population networks and NGOs in Southern Africa to address the high levels of HIV infection among sex workers, men who have sex with men, transgender people and women who have sex with women. Eight countries, accounting for 81 percent of people living with HIV in sub-Saharan Africa, are in the programme: Botswana, Lesotho, Malawi, Namibia, South Africa, Swaziland, Zambia and Zimbabwe.

The programme is being led by the Humanist Institute for Cooperation with developing countries (HIVOS), along with a number of partners. Sithembile Chiware, programme director, said: “We aim to invest in and support a genuinely KP-led approach to tackling high levels of HIV infection.”

KP-REACH has been developed out of a collaborative association and includes four regional KP networks: African Men Sexual Health and Rights, African Sex Worker Alliance, Coalition of African Lesbians and the newly formed Southern Africa Trans Forum. Chiware said: “The process has been led by the regional office of HIVOS, together with the International HIV/AIDS Alliance and Positive Vibes. The other partners are M&C Saatchi World Services, SAfAIDS and Southern African AIDS Trust.”

Key populations response and concerns

Cynthia Mwase, who heads the Africa and Middle East department at the Global Fund, said: “Supporting key populations will focus on: new eligibility criteria for country coordinating mechanisms; an inclusive country dialogue approach; better data; support from the Global Fund’s community, rights and gender department for meaningful engagement; South-to-South technical assistance to community groups to strengthen their engagement; and support to key population networks for national and regional capacity building.”

Key populations groups are welcoming the new support and many of those who attended the ICASA conference are confident that a new chapter could be opening, which will see their rights and health issues being fully addressed.

Denis Wamala, from Icebreakers Uganda, said: “l think this is a good initiative as far as strengthening key population networks in Africa is concerned. I believe this is an initiative which the Global Fund should consider expanding beyond southern Africa to other parts of Africa.”

Read: new report on violation of women’s sexual and reproductive health rights