Sexual Orientation, Violence and AIDS in Africa

1. Sexual Orientation, Violence and AIDS in Africa Chukwuemeka Anyamele, (Research Triangle Institute) Ronald Lwabaayi, (Livelihood Development International) Tuu-Van Nguyen, (University of Sussex) Hans Binswanger (World Bank)

2. The hidden epidemics • Of AIDS fueled by sex between men • Of violence against MSM from lower classes who cannot or do not want to hide • In Africa it has not been politically correct to talk about or study sexual minorities • Official HIV/AIDS and crime statistics reflect neither of these epidemics • All evidence comes from small case studies, surveys, and the experience of MSM who are starting to speak out

3. 2002 WHO World Report on Violence and Health • Sexual violence against men takes place in homes, schools, on the street, in the military, during wars, in prison, and at police posts • 3.6 percent of men report such violence in Namibia, 20 percent in Peru • Forced sexual initiation during adolescence common for both men and women, but more for women • Ranges from 6. 4 % of men in South African study to 30 percent in Cameroon study

4. The Study of 250 MSM in Dakar • Lives characterized by rejection and violence • Half verbally abused by family members • A fourth forced to move in the last 12 months • 37 percent forced to have sex in last 12 months • 13 percent have been raped by a policeman

5. Discrimination and Violence inSouthern and Eastern Africa

6. Other Social Risks

7. Sexual Behavior in Senegal Study • Mean age of sample: 25 years • Mean age at first sexual contact: 15 years • One third of sample: • First male sexual encounter with family member • Vast majority have had sex with women • of these 88 % had vaginal sex, 25 % anal sex • 13 % are married, 25 % have children • Good condom knowledge, low use, even in anal sex • Most reporting having had STI • But scared of seeking medical care

8. The HIV/AIDS Bridges Between MSM/WSW and the General Population MSM/WSW LGBTI Special Groups Population Risk of being subject to violence due to sexual orientation MSM: Men who have Sex with Men Non-existent LGBTI: Lesbian, Gay, Bisexual, Transgender and Intersex people Medium Special Groups: e.g. Inmates of correctional institutions High Spillover of HIV/AIDS Very High

9. HIV/AIDS in Sexual MinoritiesIn Eastern and Southern Africa

10. HIV/AIDS • Given their high risk, the prevalence of HIV/AIDS is significantly worse among MSM • In Senegal it is 21 percent among MSM, while less than 2 percent in the general population • There is a significant spillover of the HIV epidemic to their women and their children • HIV-positive MSMs face a double stigma • They will be even more isolated than AIDS victims in general, and may face terminal illness and death alone

11. In spite of these facts, in most African countries there are only tiny prevention, care or treatment programs that reach sexual minorities This is unacceptable for them as well as the population at large

12. The agreed elements of a strategy • Developed over many years by different actors • Agreed at International AIDS Conference in Bangkok, five or six years ago • Based on Human Rights and Empowerment • Going well beyond HIV and AIDS • With specific components focused on prevention, treatment, care and support

13. Three prevention models need to be applied together • The epidemiological-behavioral model centered on perceptions and behaviors, seeks to alter such behaviors through interventions addressing information, risk perception, perception of control over one's behavior, self-confidence, and the attitudes of different population groups to the HIV disease • The anthropological-cultural model focuses on meanings of behavior, change codes and values that enhance risks and impede preventive behaviors. It calls for the design of interventions to the various identity sub-groups based on a thorough understanding of these meanings • The political-economic or empowerment model seeks to reduce social, rather than individual, vulnerability. It sees the roots of the epidemic in structural (i.e., class, gender, and lifestyle) inequality. It calls for LGBTI groups to organize, press for their rights and organize their own fight against violence and AIDS.

14. Why are LGBTI Organizations Needed • To spread information, reduce stigma, provide a social safety net, and fight against violence from the population and the police • Given stigma, secrecy, service delivery from public sector or NGOS cannot reach MSMs and WSWs • A global review showed that only where LGBTIs are organized is there any HIV/AIDS prevention and care program among MSMs and WSWs

15. Three Key Actors The State • To focus HIV/AIDS prevention messages on sex: vaginal, anal, oral • To improve the climate and legislation in support of human rights and prevention of violence NGOs • To spread the messages • To advocate for human rights • To provide health and other services to special populations LGBTI Associations • At the core of targeted prevention efforts, care, treatment and livelihood development, • Advocacy for and defense of their own human rights • Put pressure on states and civil society