What was done?
In the four countries, all the SHARP partners engaged in advocacy at community and national levels and many were involved at regional and global levels. Particular efforts were made to contribute to the sensitisation of decision-makers, healthcare workers and law enforcement agents.
In all countries SHARP partners are directly participating in national processes to develop guidelines and/or plans to address the needs of key populations. In Kenya, Tanzania and Uganda key populations are now formally represented on the Global Fund Country Coordinating Mechanism (CCM). They are able to directly contribute and inform national HIV plans and Global Fund country concept notes. In Kenya one of the partners is now a Global Fund implementing partner.
Advocacy is required in order to make the case for evidence- and human rights-based public health interventions targeting men who have sex with men (MSM). The advocacy conducted under the SHARP programme aimed to protect the rights of MSM, while also increasing the space in which community-based organisations (CBOs) could reach and empower MSM and link them to quality HIV, Sexual and Reproductive Health and Rights (SHRH) and other services.
Challenges faced and limitations of our approach
While all four SHARP countries acknowledge officially or unofficially MSM as a target group in national HIV or health strategies and plans, none of the SHARP countries have succeeded in making tangible inroads into addressing the HIV and broader health needs of MSM.
In addition, renewed anti-homosexuality sentiment, pushed by social conservatism, religious convictions, politics and other factors, sweeping over Africa resulted in new draconian legislation in Nigeria and Uganda. In February 2014 Uganda enacted the Anti-Homosexuality Act (AHA) which heightened the safety and security risks of all individuals and organisations working with and benefiting from SHARP across the region.
All the partners continue to face significant barriers to being able to advocate for the health and rights of MSM and much advocacy and lobbying with decision makers needs to happen privately. Even advocating for basic commodities (such as appropriate condoms and condom compatible lubricants) or supplying basic information on health, Sexually Transmitted Infections (STIs) and HIV specifically targeted at MSM carries risks of being deemed to be ‘promoting homosexuality’.
However, with increased visibility and equipped with impressive reach and service-delivery, SHARP partners are increasingly being seen to bring considerable expertise and add value to national HIV responses.
The Constitutional Court struck down the Anti-Homosexuality Act in August 2014 in a case brought by the Human Rights Awareness and Promotion Forum (HRAPF) and the Civil Society Coalition on Human Rights and Constitutional Law (CSCHRCL). Two of the appellants in this case, Frank Mugisha and Pepe Onziema are Sexual Minorities Uganda (SMUG) staff members. In all other countries SHARP partners continue to lobby and advocate against proposed legislation that threatens to take away their rights and in favour of the enactment of human rights-based laws and policies that protect the rights of MSM to access HIV and health without fear or discrimination.
In order to document human rights-related barriers in accessing HIV and health services and other human rights violations SHARP piloted Rights-Evidence-ACTion (REAct) in Uganda. REAct is a community-based system, developed by the Alliance, for monitoring and responding to human rights-related barriers in accessing HIV and health services. In addition to documenting human rights violations it is also able to provide individual responses. The data gathered by REAct is then used to inform quality human rights-based HIV programming, policy and advocacy at national, regional and global levels.
SMUG, who led the implementation of REAct in Uganda, have also played a key role in providing south-to-south capacity building and sharing their experiences and lessons from implementing REAct. SMUG have supported the adaptation, training and roll-out of REAct to our SHARP partners in Zimbabwe; the Alliance’s Link Up partners in Uganda and Burundi and partners from the KP Connect programme in South Africa.
In response to the lack of MSM-tailored Information, Education and Communication (IEC), the Alliance in partnership with Health4Men developed Afya4Men.info. This unique and important website contains clearly written comprehensive sexual health information targeted to their specific needs. Afya4men.info seeks to address the lack of locally-relevant health information available to MSM in hostile and challenging environments.
In April 2014 police raided Men Against AIDS Youth Group Organisation’s (MAAYGO) offices confiscating their computers and Information, Education and Communication materials. They arrested the director and finance officer, and one organisational member for ‘illegally promoting homosexuality’.
As a result, from June 2014, MAAYGO started engaging local chiefs and various branches of local government to create a shared understanding of the crucial role the CBO is playing in the national HIV prevention and treatment response. These meetings have been expanded to raise awareness among community groups, youth groups, village elders and health care workers on a quarterly basis.
In January 2015, MAAYGO met with the Nyanza region Police Provincial Officer (PPO). It presented evidence on how when law enforcement agencies harass men who have sex with men (MSM) and their service organisations it creates barriers to the HIV response among MSM and broader populations. From this meeting a partnership developed and MAAYGO soon started a psychosocial support group for police officers living with HIV. It also delivers monthly sensitisation to police officers and training about HIV and sexual and reproductive health at the Police Regional Training Centre.
In return the police provide security at MAAYGO outreaches. All moonlight outreaches are now supported by two police officers (not in uniform) to ensure that MAAYGO services can be accessed safely by the community.
- Deep-rooted homophobic stigma and discrimination act as barriers to:
- Meaningful engagement in national processes and platforms
- Developing strategic partnerships and building links to public health systems
- Responding to threats takes up considerable time and resources, thereby distracting LGBT organisations from advocating for the health and rights of MSM
- LGBT organisations are building an impressive evidence-base on the negative impact of criminalisation and homophobic stigma and discrimination
- LGBT organisations have the trust of large sections of the MSM community and are well placed to represent the communities’ experiences and needs.