Photo: IRIN

Locked in the closet

NAIROBI,� – More than two-thirds of African countries have laws criminalizing homosexual acts,�and despite accounting for a significant percentage of new infections in many countries, men who have sex with men tend to be left out of the HIV response.

“[They] are going underground; they are hiding themselves and continuing to fuel the epidemic,” UNAIDS executive director Mich�l Sidib� told IRIN/PlusNews recently. “We need to make sure these vulnerable groups have the same rights everyone enjoys: access to information, care and prevention for them and their families.”

IRIN/PlusNews has compiled a short list of human rights violations against gay Africans:

Malawi – On 28 December 2009, soon after a traditional engagement ceremony, Steven Monjeza and Tiwonge Chimbalanga were arrested and charged with “unnatural offenses”, which carries a maximum prison term of 14 years, and “indecent practices between males”, which carries five years.

The men deny that they have had sexual relations, but the state prosecutor has applied for them to be sent to hospital to prove they have had sex, which rights activists and their lawyers say would violate their constitutional right to dignity. The trial has been postponed until 25 January 2010.

Uganda – In October 2009, David Bahati, parliamentary representative of the ruling party, tabled the Anti-homosexuality Bill (2009), a private member’s Bill. It proposes, among other things, the death sentence for the crime of “aggravated homosexuality” when an HIV-positive person engages in homosexual sex with someone disabled or below the age of 18.

Homosexuality is illegal in Uganda and punishable by a maximum sentence of life in prison.

AIDS advocates and human rights groups have strongly criticized the Bill as violating the privacy of gay people, and after pressure from several international leaders, President Yoweri Museveni has distanced himself from it, reducing the likelihood that it will be passed in its current form.

Nevertheless, a local tabloid, The Red Pepper, routinely releases lists of alleged Ugandan homosexuals.

Tanzania – In May 2009, a local newspaper, Ijumaa, featured a photograph of two men in bed together with the headline, “Caught Live!” A report by several gay rights groups�noted that the accompanying article included derogatory and discriminatory language about men who have sex with men.

An Ijumaa reporter, accompanied by three policemen, had followed the men from the street into a private hotel, where they had invaded their room and taken the photographs that later appeared in the newspaper.

According to the International Gay and Lesbian Human Rights Commission, more than 40 gay and lesbian activists in Tanzania were arrested on charges of debauchery in 2009.

Burundi – In April 2009, President Pierre Nkurunziza signed into law a bill criminalizing homosexuality for the first time in Burundi’s history. Anyone found guilty of engaging in homosexual activity faces imprisonment for two to three years and a fine of up to US$80.

Paradoxically, other articles in the same legislation take steps to protect human rights, including abolition of the death penalty and the outlawing of torture, genocide, war crimes and crimes against humanity.

Senegal – In December 2008, the Senegalese government arrested nine men involved in providing HIV prevention, care and treatment services to the country’s lesbian, gay, bisexual and transgender community.

The men were later sentenced to eight years in prison on charges of “membership of a criminal organization and engaging in acts against the order of nature”, but in April 2009 an appeals court overturned this verdict.

Arrests for homosexual activity are not uncommon in Senegal; in August 2008 two men were arrested at their home in Dakar and charged with “homosexual marriage” and acts against the order of nature. According to rights groups, a total of 30 men were arrested on charges of homosexuality in 2009.

Egypt – In May 2008, a court in the Egyptian capital, Cairo, convicted five HIV-positive men of “habitual practice of debauchery”, a phrase that encompasses consensual sexual acts between men.

The convictions were part of a crackdown on people living with HIV/AIDS, during which 12 men suspected of being HIV-positive were arrested; while in custody, they were subjected to HIV tests and anal examinations to determine whether they had had sex with other men. Earlier in the crackdown, in January 2008, four HIV-positive men sentenced to one-year prison terms for debauchery.

Gambia – In May 2008, Gambian President Yahya Jammeh gave gay people 24 hours’ notice to leave the country. He promised stricter laws on homosexuality than in Iran, and threatened to behead any gay people discovered in the country.

Jammeh’s statements were thought to have been in response to a number of Senegalese gay men fleeing across the border into Gambia to escape persecution in their own country.

South Africa – In April 2008, Eudy Simelane, the openly gay star of South Africa’s Banyana Banyana national female football squad, was found murdered in a park on the outskirts of Johannesburg. She had been gang-raped and brutally beaten before being stabbed to death.

Rights groups said the attack was likely to have been an incident of “corrective rape”, in which men rape lesbian women on the pretext of trying to “cure” them of their sexual orientation.

Since then there has been a spate of similar attacks on lesbian women in the country, but few ever reach the courts. According to a 2009 report by the NGO, ActionAid, there have been 31 recorded murders of lesbian women since 1998, with just three cases reaching the courts, and only one conviction.

Cameroon – In January 2008, a Cameroonian court sentenced three men accused of homosexuality to six months’ hard labour. Homosexual acts are punishable by up to five years in prison, and gay men are routinely imprisoned.

Although the penal code does not give the state the power to arraign someone unless the person was caught in flagrante delicto, rights groups say people suspected of being gay are often arrested in public restaurants and bars.

Nigeria - In August 2007, 18 men – all allegedly cross-dressers – were arrested in Bauchi State, a predominantly Muslim state in the north of the country; they were charged with sodomy, the charges were later changed to vagrancy or idleness. The men were eventually freed on bail, but in March 2009 the case was still pending.

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Photo: IRIN

JOHANNESBURG,� – A study finding that foreigners are about half as likely to fail antiretroviral (ARV) treatment as South African citizens attending the same Johannesburg clinic has challenged widely held assumptions about migrants’ ability to adhere to HIV/AIDS drug regimens.

South Africa hosts large numbers of asylum seekers, refugees and undocumented migrants from the rest of the continent, but HIV treatment requires almost 100 percent adherence to avoid the development of drug resistance, and it was thought that their high levels of mobility made these population groups poor candidates for treatment.

Until recently, only those with South African identity documents were eligible for ARV treatment at public sector facilities. Although the South African government has instructed public sector facilities to stop restricting ARVs to foreigners, many are still turned away and end up at non-governmental clinics such as Nazareth House, a Catholic mission in the Johannesburg suburb of Yeoville, which provides ARVs using funding from the US President’s Emergency Fund for AIDS Relief (PEPFAR).

Researchers at the University of the Witwatersrand’s Reproductive Health and HIV Research Unit, and its Forced Migration Studies Programme, reviewed the records of 431 South African, 568 foreign and 298 patients of unknown origin who enrolled in ARV treatment at Nazareth House between April 2004 and March 2007.

They found that although foreigners tended to start treatment with lower CD4 cell counts (a measure of immune system strength), they had fewer hospital admissions, missed fewer clinic appointments, were less likely to drop out of care, and had significantly better survival rates than South African patients.

“The good response to ART [antiretroviral treatment] among foreigners in this cohort is particularly surprising, given the obstacles they encounter in living in inner-city Johannesburg and in adhering to ART,” wrote the researchers in an article summarising their findings, published in the December 2009 issue of the International Journal of STD (Sexually Transmitted Disease) and AIDS (IJSA).

Jo Vearey, a researcher at the Forced Migration Studies Programme who worked on the study, speculated that the lower CD4 cell count among the foreign patients probably said something about “their journey to accessing treatment”, which in many cases would have started with being turned away from public health facilities.

Why foreigners were more likely to stick to their treatment was less clear. The IJSA article theorised that HIV-positive foreigners might have “a greater degree of tenacity and determination to obtain health care” than citizens.

It also noted that that “the natural history of HIV disease may differ in foreigners”, and that the spectrum of opportunistic diseases differed, with South Africans more likely to contract tuberculosis and foreigners more prone to Kaposi’s sarcoma.

“I think we need to do more qualitative research to understand [these findings],” said Vearey. “But it supports other findings about the resilience of migrant communities, [and] their stronger social networks. I think it’s something we need to learn from in terms of ART treatment � what characteristics do they have socially that enabled them to adhere better?”

Vearey suggested that countries like Zimbabwe, which accounted for most of the foreign patients at Nazareth House, also had a history of their governments being more open in discussing HIV and AIDS than South Africa’s, and this may have played a role in the different adherence rates.

The study findings will be used to support efforts by the United Nations High Commission for Refugees (UNHCR) and the Southern African HIV Clinicians Society to ensure that foreigners in South Africa and elsewhere receive the same access to ART as local residents.

“Health is such a political subject that when we can present evidence that challenges assumptions, it really does help,” said Vearey.

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