amfAR, The Foundation for AIDS Research

GRASSROOTS: The GMT Initiative Blog

amfAR's GMT Initiative supports grassroots organizations that respond to the devastating impact of HIV/AIDS among gay men, other men who have sex with men, and transgender individuals (collectively, GMT).

Grassroots Growth in Mexico

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Posted by Ben Clapham, September 3, 2014

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amfAR’s Ben Clapham (center) with CDIJ’s Amaranta (left) and Amaya (right).

I first visited Centro de Desarrollo e Investigación sobre Juventud, A.C. (CDIJ) in Campeche, Mexico, in mid-2012, shortly after the organization’s founding.  At the time, CDIJ consisted of a dedicated team of just three people, all under 30, who worked on a volunteer basis out of the director’s house. The grant they received from amfAR that year to support their work among Mayan GMT was their first ever outside funding, and I came to help the young organization develop strategies to increase their visibility. They were the essence of a grassroots GMT organization, and it was truly motivating to see this youth-led organization attempt to do so much with so few resources.

Due to this dedication and the effectiveness of their early efforts, CDIJ now receives funding not only from amfAR, but also from other international donors, including the Global Fund. More importantly, they are the first GMT organization in Mexico to sign a Memorandum of Understanding with the Ministry of Health. It states that the government will support and fund their work to improve GMT’s access to health services.

During a visit last week, I found myself seeing a whole new CDIJ. Upon my arrival, I was greeted at CDIJ’s new office space by a team that has more than tripled in size and that consists of a mix of paid and unpaid staff. They now have an office that looks like a gorgeous Mexican hacienda, complete with a sun-drenched terrace. When I first met the executive director, Antonio Maldonado, he was a little unsure about his new role, but he clearly possessed the motivation and desire for his work. Two years later it is as if I am meeting someone completely different. Antonio had every detail planned for my visit and he was leading his staff with confidence. “Antonio is a model for me. He has shown me that I am worth something and that I can and must help trans here in Campeche,” said Amaranta, CDIJ’s first trans staff member.

Generally, organizations focus on one population or the other, and CDIJ is one of few GMT organizations in the world that works closely with men who have sex with men and also has a strong trans-led program. The team has also established several other exciting programs. They provide HIV testing and counseling, host a support group for trans indigenous women, provide peer education and outreach to the community, and train healthcare workers at government-run facilities about how to address LGBT health needs.

I was so impressed by CDIJ’s growth in two short years. They truly represent what the GMT Initiative is all about—funding small, grassroots GMT organizations to increase their capacity so they can receive bigger grants from other international and local donors. I left Campeche feeling extremely proud to work at amfAR and be a part of a foundation where I get to experience these small but ever-so-important victories.

GMT Advocates Get Active at IAC

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Posted by Ben Clapham, August  4, 2014

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Simon Cazal, executive director of SOMOSGAY, a GMT Initiative grantee partner in Paraguay, presents during the International AIDS Conference.

When I arrived in Melbourne, Australia, for the International AIDS Conference (IAC), the mood was quite somber due to the tragic downing of Malaysian Airlines flight MH17, which had delegates travelling to the conference on board. But despite the loss, the conference went on, and there was even a sense of energy and excitement among the GMT activists who were present.

At the 2012 IAC in Washington, D.C., GMT issues were not very well represented, but this year there were many more sessions addressing GMT. This inspired a sense of accomplishment among the GMT delegates, whose intense advocacy efforts helped to bring about this change.

I had the pleasure of organizing one of those GMT sessions with Michael Joyner, director of ViiV Healthcare’s Positive Action program, which funds amfAR’s Evidence in Action program. The session, "Evidence in Action: Creating Evidence-Based Programming for Men Who Have Sex with Men and Transgender People," took place in the Global Village—an area of the conference center that houses community  networking zones, booths for community organizations, and stages for fashion shows and cultural performances. Fittingly, the session attendees were mostly community activists and program implementers.

Evidence in Action was established in 2012. As part of the program, grantee organizations work with local researchers with expertise in GMT HIV programming to conduct formalized evaluations of their programs. Through this process, the grantees produce official data on the success of their programs, which can help them get increased funding and reproduce their effective strategies on a larger scale. In addition to Michael and me, our panel included representatives from participating GMT Initiative grantee partners and their evaluators from Belize, Paraguay, El Salvador, and Grenada.

This was the first time that participants in the program presented their results, and we were very curious to see how the relationships between the community implementing partners and the researchers had worked. I was very pleased to hear that the experiences had been quite positive, and that the data showed that the organizational capacity of our community partners had improved, allowing them to broaden the impact of their services.

For example, C-NET+,  an organization in Belize, presented data showing that their home care program was able to expand to provide care to more than 50 GMT living with HIV, and that the patients in the program had a 100% adherence rate to their antiretroviral therapy. Previously, it had been difficult to get GMT to allow the outreach workers into their homes due to the extremely harsh stigma and discrimination in Belize surrounding HIV and homosexuality. SOMOSGAY, in Paraguay, presented data showing that their outreach and testing services resulted in a 20% increase in the number of GMT getting tested for HIV in Asuncion.

What is most exciting is that this data was created by and for the community. Unfortunately, too often, outside researchers come into community settings to gather data about GMT that then becomes “theirs.” They do not share it with the community, and it has little impact on their lives. The unique aspect of Evidence in Action is that the communities on the ground that need the data most for their advocacy and fundraising efforts have ownership of it. The community partners who participated in the session told me that this data represents far more than just indicators and results for a project. As Eric Castellanos, executive director  of C-NET+,  said, “This data legitimizes our existence as advocates fighting for the rights and health of gay men, other men who have sex with men, and transgender people.”

Dr. Paul Semugoma Discusses His Fight for LGBT Rights in Uganda

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Posted by Lucile Scott, July 10, 2014

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Dr. Paul Semugoma and Amirah Sequeira from the Student Global AIDS Campaign during amfAR’s “Making AIDS History: From Science to Solutions” event on Capitol Hill

Dr. Paul Semugoma will be honored by amfAR, the International AIDS Society and the Elizabeth Taylor AIDS Foundation with the 2014 Elizabeth Taylor Human Rights Award at the 20th International AIDS Conference in Melbourne, Australia, July 20. The award recognizes exemplary efforts to advance human rights in the field of HIV and AIDS.

Dr. Paul, as he is known to patients and friends, was among the first physicians in Uganda to provide HIV care and education for MSM. In 2009, he publicly opposed Uganda’s Anti-Homosexuality Bill after it was introduced in Parliament.  The bill, which was signed into law earlier this year, punishes same-sex sexual activity with life in prison and criminalizes the promotion of homosexuality—a category that includes providing HIV services that target LGBT. Due to his work advocating for LGBT rights, Dr. Paul was placed on a Ugandan “wanted list,” and in 2012 fear for his safety caused him to move to South Africa with his partner. This February, shortly after the Anti-Homosexuality Bill became law, he was detained at a Johannesburg airport and nearly deported back to Uganda, prompting an outpouring of support from LGBT advocates worldwide. In April, Dr. Paul spoke on a panel atMaking AIDS History: From Science to Solutions,” an amfAR-sponsored briefing on Capitol Hill. The following is excerpted from that event.

amfAR: Why did you begin addressing HIV among MSM in Uganda at a time when few other advocates or doctors were doing so?

Dr. Paul Semugona: When I started practicing medicine in Uganda, people really didn’t believe that HIV was a problem among MSM, and MSM were told that you get HIV from women, so they thought they were okay. Through a process of self-teaching, I realized that I had a big problem because I identified with a community that had no knowledge of a very big problem—HIV. So I made a program for my people in my country, Uganda.

amfAR: How has the Anti-Homosexuality Law impacted the ability of MSM to access HIV treatment and care in Uganda?

Dr. Paul: My friends are being arrested. The clinics where they go to get drugs are getting raided for promoting homosexuality. The doctors who are supposed to look after them are getting guidelines from the government that they are not supposed to promote homosexuality, so they will not tell MSM that getting HIV is a problem in the community, and they will not give them condoms or lubricant. MSM are being denied knowledge, being denied health, and being denied advocacy. But we can’t stop talking about the link between HIV and gay sexuality. Please don’t keep quiet. Silence is death. We are not promoting homosexuality. We are trying to control a disease, a virus.

amfAR: Could you describe your current work at Anova Health Institute in Johannesburg?

Dr. Paul: In South Africa, there is still a lot of stigma and discrimination towards gay men, but our patients know they can talk to their doctor about their experiences. We are given space where we can access medicines and care and protect our partners. All the advances happening in HIV in the world are accessible here at home. It gives me a belief that something like that can happen even in a country like Uganda. Uganda is not a good place to be as a gay person, but I am a gay African, and I will not let them take that identity away from me.

 

Trans Advocates Discuss Why They Are Attending GMT Advocacy Exchange in Nepal

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Posted By Lucile Scott, June 9, 2014

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A community gathering for Blue Diamond Society members

Seven advocates from three GMT Initiative grantee partners based in Thailand and South Africa are traveling to Nepal next week for an amfAR-sponsored advocacy exchange with The Blue Diamond Society (BDS), Nepal’s largest LGBT organization, and the Federation of Sexual and Gender Minorities, Nepal (FSGMN). BDS and FSGMN spearheaded the advocacy efforts that resulted in a 2007 Supreme Court decision declaring self-determination, not a medical diagnosis or other criteria, as the sole determinant for a person’s legal gender identity. As part of implementing that decision, last year Nepal became one of the few countries in the world to officially offer a third gender option on its citizenship documents.

The advocacy exchange is part of the GMT Initiative’s Advocacy in Action program, which, with support from the Arcus Foundation, provides funding, technical support, and advocacy training to four trans-focused community organizations to help them build their capacity to improve health and human rights policies for trans individuals in their countries. The visiting activists from the Health and Opportunity Network (HON), the Thai Transgender Alliance (ThaiTGA), and Transgender and Intersex Africa (TIA) will receive media and advocacy training from Nepali advocates and meet with members of the Nepali government to better understand all the steps and elements necessary to implement policies that recognize gender minorities. Below, three of the participating activists discuss trans rights in their countries and why they want to take part in the upcoming advocacy exchange.

Basu-portraitBasu Guragain, 28, Project Director of the Kathmandu Office of the Federation of Sexual and Gender Minorities, Nepal (FSGMN)

“Nepal has made impressive gains in rights for trans individuals, and I am convinced that these advances must be shared with affected persons everywhere to advance the rights of LGBT. The groundbreaking progress in Nepal was largely due to the relentless advocacy of the Blue Diamond Society’s former director, Mr. Sunil Babu Pant, who enlisted the help and support of students, legislators, national and international organizations, LGBT communities and organizations, and concerned citizens who supported the change at great personal peril. 

The third-gender identity rulings are a monumental step forward in laying the groundwork for change, but have yet to have a substantial effect on the daily lives of trans persons in Nepal, who still face widespread and blatant discrimination in health, education, legal, and social services. But my determination to make self-identification easier for every member of gender minorities has only increased. As a gay man, it is also about my future, because the issues are very much the same for trans and gay people in Nepal and we are very much together as an LGBT movement.”

Kath portraitKath Khangpiboon, 27, Co-founder and Working Group Member of the Thai Transgender Alliance (ThaiTGA)

“Thai society expects all us trans people to be alike—funny, devoid of substance, obsessed with sex, an expert in sexual techniques, prone to lying, unable to have true love, perverted, and so on. If a trans person chooses to live her life in a way that differs from these societal prejudices, she will be heavily marginalized, or one might say, left at the edge of the margin and about to fall off the page—denied employment, impoverished, confused, devoid of rights, and without a way out.

ThaiTGA is a network that unites all transgender activists working to address the needs of the trans community in Thailand. But in addition to working together, it is very important for the community to work with other stakeholders to have effective policies and programs. I hope that through the amfAR program, I will get the opportunity to share the experiences I have gained through my work and to learn about working collaboratively with other stakeholders and partners on behalf of my community.”

Nthabza 1Nthabiseng Mokoena, 26, Advocacy Coordinator of Transgender and Intersex Africa (TIA)

“South Africa is said to be the most progressive country on the continent in terms of LGBT rights. We have a very inclusive constitution that does not allow for discrimination on the basis of gender, sex, or sexual orientation, but the biggest obstacle is the lack of implementation of these laws by state bodies. Also, the law regarding trans people requires letters from two medical service providers to officially change your gender, but only three hospitals in the country offer full gender affirming services. At one of the hospitals, there is a 20-year-long waiting list for the services.

I am very gender non-conforming. People call me names and often threaten my partner because she is with me, and I do not feel safe in my own neighborhood. I am advocating for people that are going through the same challenges, because I envision an Africa where people will be free to express their gender without any fear of discrimination. I am privileged to be part of this exchange. Hopefully we will be able to implement strategies in South Africa similar to those used by BDS.”

Tebogo.JPGTebogo Nkona, 27, Founder and Director of Transgender and Intersex Africa (TIA)

“I am a post op transman and I am passionate about trans and intersex rights. In South Africa, our laws claim to protect us, but in reality trans people do not have rights and have no place to go except to trans organizations. Issues of discrimination and injustice towards trans people affect me in a terrible way. Being discriminated against means you do not belong, you don't get recognition or equal opportunities, like you simply do not exist. So I find it to be my responsibility to make the trans voice heard and to be the fighter and frontline activist in my country. If I don’t fight for acceptance of my gender identity, who will? If I don’t demand equal rights, who will? It is about my future, my protection, and my health.

We are going to Nepal to learn from our colleagues how they managed to successfully influence their local policies and attitudes. It is a great opportunity for a young organization like ours, and we are looking forward to sharing our experiences and learning from our friends in Nepal.”

The GMT Advocacy Exchange Program Visits Argentina

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Posted by Ben Clapham, May 27, 2014

Last week, I arrived in Buenos Aires, Argentina, with my colleagues Elias and Nairobi from GMT Initiative grantee partner Comunidad de Trans y Travestis Trabajadoras Sexuales Dominicana (COTRAVETD) in the Dominican Republic for an advocacy exchange visit with the Federacion Argentina de Lesbianas, Gays, Bisexuales y Trans (FALGBT). Our advocacy exchanges are designed to allow newer GMT organizations to learn skills and strategies from organizations that have successfully advocated for greater health and human rights for LGBT.

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(From left to right) Nairobi Castillo, director of COTRAVETD; Marcela Romero, president of REDLACTRANS; and Esteban Paulin, president of FALGBT meet during the advocacy exchange.

FALGBT is a consortium of more than 60 LGBT organizations from across Argentina, and it was the catalyst for the passage of the bill that legalized same-sex marriages in Argentina in 2010, as well as for the groundbreaking 2012 Gender Identity Law that made it the first country in the world to allow people to change their name and sex on official documents without getting approval from a judge or doctor. “The Marriage Equality Bill had to be passed first, because Argentines can understand same-sex marriage. A law that promotes gender identity is very abstract and hard for people to grasp,” said Esteban Paulin, president of FALBGT, while discussing the coalition’s strategy.

In the Dominican Republic, on the other hand, trans individuals have very few health or human rights and little access to HIV care and other health services. “In my country, there are strong religious beliefs, and we are still a very macho society,” said Nairobi, the director of COTRAVETD, which is a trans-focused organization. “The road will be long to passing a law that will allow the sex on my passport to match the gender that I live, but I know together we will make it happen.”

What was most striking during our visit was the relative cohesion in Argentina between trans-focused groups and groups that primarily focus on gay or lesbian issues. In many countries, these organizations pursue their own separate advocacy agendas and do not have a coordinated response. “The important thing was unity. The trans community didn’t see or feel the necessity for marriage equality. We wanted and needed a law that recognized our gender identity,” said Marcela Romero, director of Asociación de Travestis, Transexuales, Transgéneros Argentinas (ATTTA), a GMT Initiative grantee partner that is part of FALGBT. “However, we understood that due to popular opinion, the marriage bill would need to come first, so we decided to support the gay and lesbian groups, knowing that after the marriage bill, they would support us for the gender identity bill.”

Two UNAIDS employees discuss the UN strategies that facilitated the passage of Argentina’s Marriage Equality and Gender Identity Bills with members of COTRAVETD and FALGBT. 
Two UNAIDS employees discuss the UN strategies that facilitated the passage of Argentina’s Marriage Equality and Gender Identity Bills with members of COTRAVETD and FALGBT.

The week spent in Buenos Aires equipped COTRAVETD with a foundation of ideas and advocacy and coalition-building strategies that can be adapted to the Dominican context.  “The LGBT coalition in the Dominican Republic needs to become better organized and to have the same goal agreed upon by lesbians, gay men, bisexuals, and the trans community before we can launch an appeal for legal change,” said Elias, the technical advisor for COTRAVETD.  It was also an inspiring visit, and during our final night together, over a delicious steak, Nairobi told Elias and me, “I, Nairobi, will not stop until we have the same protections for LGBT people in the Dominican Republic that they have here in Argentina!”

International Day Against Homophobia and Transphobia Is May 17

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Posted by Lucile Scott on May 16, 2014

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Silueta X will hold its Guayaquil Kiss-In at the Plaza San Francisco.

May 17 marks the 10th anniversary of International Day Against Homophobia and Transphobia (IDAHOT). IDAHOT was launched in 2004 to increase awareness about the violence and discrimination LGBT people face each day. To observe the day, LGBT groups and advocates worldwide organize events to oppose discrimination, garner media attention, network, and mobilize new constituencies. Each year the day’s scope and impact has grown, and last year events took place in nearly 120 countries around the globe. Below is what several GMT Initiative grantee partners will be up to on Saturday. Find a listing of events near you or get ideas for organizing an event of your own here.

  Asociación Silueta X in Guayaquil, Ecuador, is holding simultaneous public Kiss-Ins in Guayaquil and the city of Cuenca to raise awareness about homophobia and transphobia. “As Martin Luther King said, ‘Civil disobedience, not violence,’” says Silueta X founder Diane Rodriguez. “The Kiss-Ins are a peaceful reaction to the murders and violence in the LGBT community. One of our posters will say, ‘Bring Back our Murdered Trans Girls,’ and another will say, ‘A kiss to the mayors of Guayaquil and Cuenca, so they will approve our anti-discrimination bills.”

SEROvie in Port-au-Prince, Haiti, has organized a day full of artistic events condemning homophobia and transphobia. The planned activities include plays, public speeches against gender-based violence, LGBT film screenings, and a concert. “For SEROvie, IDAHOT is a day of reflection and collective action against the exclusion of LGBT people, and a day to promote the recognition of our human rights with respect to our sexual orientation and gender identity,” says Steeve Laguerre, executive director of SEROvie.

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ThaiTGA’s IDAHOT conference will take place at the Bangkok Art and Culture Center.

Men Against AIDS Youth Group (MAAYGO) in Kisumu, Kenya, is hosting a luncheon, in partnership with the NYAWEK LGBTI coalition, for local opinion leaders, including police, village elders, and community sub chiefs and chiefs. The attendees will discuss ways to combat the stigma and discrimination that LGBT face. “We decided to organize this meeting instead of a protest because, as activists, we thought addressing the critical issue that homophobia and transphobia are increasing in Kenya with key opinion leaders one on one could have more impact and create change in society,” says MAAYGO’s Henry Victor Digolo.

Transgender and Intersex Africa (TIA) in Pretoria, South Africa helped organize an all-day community gathering on Johannesburg’s Constitution Hill that will include speakers, poets, and artists. “We cannot be truly free as a country when there are inequalities and violations against minority groups,” says Nthabiseng Mokoena, TIA’s advocacy coordinator. “Even though legislation in our country is progressive, we still live in a country where communities are not tolerant of gender diverse people, discrimination is still prevalent in health care facilities and transgender people still struggle to access employment and educational opportunities.”

The Thai Transgender Alliance (ThaiTGA) in Bangkok, Thailand, is hosting a conference titled Freedom of Expression to Gender Recognition on May 16 from 12:00 p.m. to 18:30 p.m. at the Bangkok Art and Culture Center, with co-hosts the Bangkok Metropolitan Administration, amfAR, and The Foundation for SOGI rights and Justice. The event will include remarks by Dr. Bhoodsadee Tamthai, deputy governor of Bangkok, and Poy Treechada, a famous trans celebrity. “Recently in Thailand, many trans women have been denied to access to nightclubs, bars, and restaurants, and to women's restrooms. In addition, there were a number of trans women rejected from employment due to stigma and prejudice towards trans identity,” says TGA’s Rena Janamnuaysook. “This event emphasizes the importance of the fundamental human rights of trans people in Thailand.”

Lessons from the Front Lines

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Posted by Kent Klindera May 2, 2014

Members of GMT-Initiative grantee partner Gender DynamiX at the 67 minutes of SHAME march in Cape Town, protesting hate crimes against LGBT (Photo: Gender DynamiX) 
Members of GMT-Initiative grantee partner Gender DynamiX at the 67 minutes of SHAME march in Cape Town, protesting hate crimes against LGBT (Photo: Gender DynamiX)

Today, amfAR launched Lessons from the Front Lines: Research Impact Analysis. The new report highlights how, using a relatively small budget, community-led research can powerfully impact community-based organizations’ response to HIV among GMT populations.  The studies also provide data and information about GMT that is lacking in many areas of the world where the population is highly marginalized and often criminalized. As many of you know, quality research data greatly strengthens advocacy efforts to reduce the great disparities in investment in HIV programming for GMT.

In this latest Lessons from the Front Lines report, we outline some of the most successful community-led research studies our grantee partners have implemented, using amfAR support, to improve HIV testing, treatment, and awareness among GMT in five regions—Africa, Asia-Pacific, the Caribbean, Eastern Europe and Central Asia, and Latin America. Highlights include: grantee partner Silueta X’s study of trans-specific health and human rights issues—the first of its kind in Ecuador; Jóvenes de la Vida Real’s look at male sex workers and their clients in the Dominican Republic; an investigation into the factors that prevent MSM sex workers in Vietnam from accessing health services, undertaken by the STDs/HIV/AIDS Prevention Center (SHAPC); Safe Pulse of Youth (SPY)’s survey of how satisfied LGBT in Serbia are with the health services they receive; and Gender DynamiX’s study of HIV knowledge, sexual behavior, and access to clinical services among 80 trans women in South Africa.

Engaging community organizations in the design, implementation, analysis, and presentation of research studies is essential to their success. These highlighted organizations have used the study results not only to improve their own programming, but also to successfully urge governments, donors, and health systems to increase the effectiveness of their HIV services for GMT. Lessons learned from these formative studies are also helping amfAR support “implementation science” research to develop scalable intervention models that will truly impact the HIV epidemic among GMT populations worldwide. Check it out today and pass it on!

Reaching Out to “Outcasts” in Ukraine’s Prisons: A Photo Essay

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The Penitentiary Initiative, a long-term GMT Initiative partner, based in Nikolaev, Ukraine, provides HIV outreach and social support in seven prisons in the Ukraine. Outreach workers visit each prison once or twice a month to work with three types of inmates: General inmates who are involved in an HIV prevention program, those living openly with HIV, and those deemed “outcasts” because of their real or perceived GMT sexual orientation. Outcasts are relegated to the worst jobs in the prison, targeted for physical and sexual abuse, and frequently humiliated.

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The Penitentiary Initiative provides all three groups with psychosocial support, HIV/AIDS education, self-confidence training, career training, and a safe place to gather and talk. It also trains the participants to provide HIV outreach to inmates who are not part of the program. With support from amfAR, The Penitentiary Initiative developed a manual that is guiding Ministry of Justice employees as they work to implement similar programs in other Ukrainian prisons. These are some of the participants from two of the prisons where the organization works, Colony 53 and Colony 93.

Photos and interviews by Chris Vail.

Delivering Results on LGBT Research in Kenya

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Posted by Kent Klindera March 31, 2014

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Kenyan LGBT activists discuss their community research priorities.

Last week in Nairobi, Kenya, amfAR hosted a meeting of lesbian, gay, bisexual and trans (LGBT) community activists, in partnership with the Gay and Lesbian Coalition of Kenya (GALCK) and the International AIDS Vaccine Initiative (IAVI). For a day and a half, we debated past, current, and future research being conducted on LGBT issues and HIV in Kenya, with the aim of developing a strategic LGBT research agenda for the future.  Although it was quite a successful meeting, what was most troubling to me was hearing about past experiences the activists had working with outside researchers.

Repeatedly, the community activists talked about academics “coming in” to work with the communities and then “going out” with their data to analyze, publish, and disseminate with little regard for the community they had investigated. One activist talked about how so many research studies had been conducted in his community, each assessing the needs or sexual behavior of the LGBT community, yet so little impact had actually come from the data. The activists said that community members were tired of talking to researchers about their needs, when no new programming to actually meet those needs arises.

At the meeting we discussed how to change that troubling paradigm by involving the community in study design and implementation. At the end, a core group of LGBT community activists formed a plan to help GALCK, IAVI, and amfAR both engage researchers in a research agenda focusing on the issues the community thinks are the most pressing, and also raise support for programming that addresses the real needs documented by that research.  Some of the questions comprising that new agenda include:

  • What is the relationship between homophobia/transphobia, anti-homosexuality laws, and the spread of HIV?

  • How can we best promote antiretroviral (ARV) adherence among LGBT living with HIV?  What factors inhibit adherence?

  • How does gender-based violence in LGBT communities link to HIV infection?

  • What are the health and human rights needs of lesbian, bi, and trans individuals? (All studies to date have focused on gay men and other men who have sex with men, with none looking at the rest of the community.)

  • Is it easier to “come out” now in society? If so, what are the factors that made it easier to do so?

  • After 10 years of activism in Kenya, what are the milestones in LGBT rights, what has been successful, and what is lacking?

  • What is the impact of new media, including social media, on LGBT Rights? 

For the first time, the discussions at this meeting were putting the activists in the driver’s seat to define their own research agenda, and what was interesting to me was how real and honest the discussion was They talked frankly about their communities’ needs, which primarily revolved around the pervasive homophobia and transphobia in society that inhibit their lives. Many recognized how internalized homophobia —the internalized shame associated with same sex attraction— helped fuel the external homophobia witnessed by all participants because when one is ashamed of oneself, it is very difficult to see the need to assist others. 

In June, we will be hosting another meeting in Kenya.  This time, researchers, community colleagues, and donors will meet to take this new research agenda forward and to develop strategies to link funding and programs for the LGBT community in Kenya to this agenda. 

The Impact of the Nigerian and Ugandan Anti-Gay Laws on Public Health

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Posted by John Power on March 18, 2014

Protestors in front of the of the Nigerian Consulate in New York during the March 7 Global Day of Action against the Nigerian anti-gay law. 
Protestors in front of the of the Nigerian Consulate in New York during the March 7 Global Day of Action against the Nigerian anti-gay law.

Studies have clearly shown that criminalizing same-sex sexual behavior poses an immense structural barrier to HIV prevention. It “drives men away from services, reduces the likelihood of disclosure of risks to providers and partners, and makes men vulnerable to blackmail,” Dr. Chris Beyrer, the current president-elect of the International AIDS Society, wrote in 2010. Indeed, Nigeria and Uganda’s new anti-gay laws are already proving that they will be extremely destructive to efforts to combat HIV. In both countries, same-sex behavior was already illegal, but the new laws increase the severity of the prison sentences faced by LGBT and criminalize organizations that serve them.

Reports indicate numerous LGBT Nigerians have been assaulted and arrested since its “Same-Sex Marriage Prohibition” law was signed in January. On February 25, days after a similar bill was signed into law, a major Ugandan tabloid published a list of “Uganda’s 200 Top Homos,” prompting fears of attacks and arrests among Ugandan LGBT. As a result, healthcare centers serving GMT have closed their doors in both countries amidst fears of mob attacks, leaving GMT without HIV treatment and prevention services. Furthermore, many GMT have gone into hiding and are afraid that they will be targeted at health centers.

Since these laws also criminalize LGBT organizations, activists and healthcare providers are uncertain how they will affect the organizations that continue to provide GMT with HIV services. Will the ten-year prison sentence for Nigerians who “make public show of same sex amorous relationships” apply to patients who disclose their identity as GMT to their doctor? Will Ugandan healthcare workers report HIV-positive GMT to the police, leading to life sentences? Will Ugandans who distribute condoms to GMT or the healthcare workers who treat them be punished with a seven-year prison term for “aiding or abetting of homosexuality”?

Although HIV is diminishing in other parts of the world, the epidemic is a growing problem in these two countries. The latest data show that Nigerian MSM have an HIV prevalence of 17.2%, compared to the nationwide prevalence of 4.1%. An estimated 13.7% of Ugandan MSM are HIV positive, compared to a 7% prevalence nationwide. Without reform, the new laws will only cause these rates to rise. This is especially devastating in light of the recent progress that both countries had made in addressing HIV among GMT. Nigeria, for example, had one of the few African governments that had developed robust MSM-specific HIV goals. These included reducing HIV prevalence among MSM from 17.2% to 8.5%, increasing MSM condom use from 52.8% to 80%, and increasing the percentage of MSM who have been tested for HIV in the past year from 31.5% to 50%. Unlike most other African governments, the Nigerian government even designed a package of HIV services for MSM, which it aimed to deliver to 80% of them by 2015.

However, new reports indicate that the Nigerian government will no longer monitor HIV among GMT, a sign that its GMT programs will also be brought to a halt. We should not allow ourselves to be fooled by Nigerian and Ugandan government officials who proclaim that anti-gay laws won’t set back the HIV response or cause GMT to be discriminated against in the healthcare setting. The new wave of discrimination has already begun.

Developments over the past three weeks have also shown that the laws’ effect extends beyond national borders. For example, activists in Kenya have been threatened by mob justice, and Kenya, the Democratic Republic of the Congo, Malawi, and other countries have all seen a reinvigorated flurry of movement toward similar anti-gay legislation. Since these are countries where GMT are also disproportionately affected by HIV, this type of legislation will only impose further barriers to the HIV response.

If governments across Africa don’t reverse their course and commit to delivering equitable healthcare to GMT, the consequences could be disastrous. The gravity of the moment requires immediate steps to protect the rights of GMT, a sharp push to monitor GMT health, and a concerted effort to repeal the anti-gay laws or overturn them in the courts.