As people were pinning the little red ribbon on their chests on World AIDS Day last week to express solidarity with those who have been deeply affected or are infected with HIV, I took time out to pause, for a minute, and think.
Twenty-two years have passed since the first World AIDS Day was observed in 1988. Several millions of people have died, gotten infected or were rendered more vulnerable to HIV, and the numbers have not stopped increasing. Yet over the years, we have heard African heads of states report progress in the fight against the epidemic: The ‘successful’ sensitization campaigns, the ‘free’ availability of anti-retroviral medicine; the implementation of new policies committing governments to act more. We have also heard about the criminalization of people’s identities, practises and HIV status – they indeed did a lot. But, how did their action help in curbing the epidemic and saving lives?
Besides being the epicentre of the HIV epidemic, Sub-Saharan Africa is also famous for either embracing or developing ideologies that are counter-productive to the fight against HIV and AIDS. A culture of denial – as opposed to a culture of realism, scientific evidence, and the strict application of fundamental human rights principles – has formed the framework within which policies and interventions aiming at curbing the epidemic are developed. Most notably in the range of denials: African governments across the continent have officially ‘disappeared’ the existence of three highly vulnerable populations – sex workers, people who inject drugs, and gay and other men who have sex with men (MSM) – from laws which aim to protect rights, and from HIV interventions aiming at fighting the epidemic. Where African governments have acknowledged these populations in national AIDS policies, too frequently this has been merely to meet requirements to access HIV funding from donors such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). Apart from South Africa and Senegal, no other African country has utilized GFATM funding to target MSM in HIV interventions despite their inclusion in national AIDS plans and GFATM funding applications.
Based on recent authoritative research conducted by the John Hopkins School of Public Health (JHSPH), HIV prevalence rates among gay men and other men who have sex with men (MSM) in middle- and low-income countries could be as much as 20 times higher than the rates in the general population. In a country like Senegal, with less than a one per cent prevalence rate in the general population, research by the Population Council found a prevalence rate of over 21.5 per cent amongst MSM. Similar disproportionate results were found in MSM populations in other parts of the continent such as Kenya, Malawi, Ghana, Uganda and South Africa. Governmental neglect and lack of equal human rights protections for gay men and transgender people has exacerbated the situation.
Curbing the epidemic
An enabling legal and policy environment to ensure the uptake and provision of HIV prevention, treatment and care services is key to curbing the epidemic. For MSM and transgender people on the continent, the legal and policy environment is far from enabling, thus limiting the access and enjoyment of these services. Over two-thirds of African countries still criminalize sexual activities between males, carrying penalties varying from a few months in jail to death by stoning. While a human rights approach dictates a move towards putting in place protective measures to enable greater access to services, the tendencies in most African countries has been to introduce new laws, or to tighten already existing restrictive laws and policies. In this regard, countries like Burundi and the Democratic Republic of Congo have attempted to introduce sodomy laws in their criminal code, whiles countries such as Nigeria and Uganda have attempted to tighten already-existing laws by expanding the scope and increasing the penalties for engaging in same-sex sexual acts.
The increase of legislation criminalizing same-sex practices, coupled with the increasing sentiments of intolerance that they inspire, certainly does not contribute to the eradication of the pandemic. In fact, these laws and policies and the ensuing practises have helped to restrict access to HIV and AIDS prevention, treatment, care and support services to MSM and transgender people. In recent years, various accounts of human rights violations resulting from these laws and directly stopping MSM and transgender people from accessing HIV prevention, treatment and care services were documented. From the mass arrests of gay men in Cameroon (resulting in the death of one of them due to denial of AIDS medication despite his visible need for attention), to the arrests and sentencing of activists working to provide and advocate for HIV services to MSM in Dakar, and the forced testing of alleged gay men in Egypt, many African states failed to meet their human rights commitment in the context of the fight against HIV.
Realizing our rights
All African governments have signed and ratified a range of Declarations, Covenants and Treaties that guarantee the full enjoyment of all human rights, including the rights to the highest attainable standard of health by everyone. Although the realization of these rights is still out of reach for many Africans, it is even harder to attain by MSM and transgender people in the context of state sponsored homophobia and transphobia. The level of attention given and protection afforded to MSM and transgender populations should be the yardstick for measuring state commitments to human rights and the fight against HIV. A commitment to respecting human rights principles in the context of the fight against HIV is not only through the ratification of treaties, it is also and most importantly by ensuring that everyone, and especially the minorities, enjoy access to adequate and equitable services.
So remember that is the red ribbon is not only a must-have fashion item aimed at portraying your social consciousness. It epitomizes the solidarity with people affected and infected by HIV, including MSM and transgender people in Africa. It represents a commitment that you are making to work to ensure that your government’s performance in providing HIV is not just assessed by the number of condoms it has made available but also on the steps taken by your government to foster an environment that is enabling for equitable access to HIV services by all. Always remember that the red ribbon, although just a sign, signals an aspiration for a life free of stigma and discrimination. We all deserve this. Let’s all work to make it happen.
Joel Nana is the Executive Director of African Men for Sexual Health and Rights.
This article was previously published on Pambazuka and Black Looks.