Mozambique – Ivan Campos, 25, and Walter Evaristo, 29, are Mozambican activists who work to defend the human rights of lesbian, gay, bisexual, and transgender (LGBT) people in the country.
Report by Mateus Fotine, [email protected], Contributing Writer
Both activists say LGBT people in Mozambique, as in many African countries, face more barriers than the rest of the population when accessing health services due to stigma and discrimination.
“Instead of the nurse worrying about diagnosing the illness that brought me to the hospital, he asked questions about my sexual orientation”, Campos recalled of a visit to a health center in Maputo in 2011. “Let’s assume that I went to a health center to take an HIV test and, having been treated in a hostile way, when I test positive, will I return to start the treatment? Of course not”.
Evaristo, a gay man who works for LAMBDA, the biggest LGBT organization in the country, said a doctor refused to see him at a health center in Pemba in 2014 because the doctor “doesn’t look after men who have sex with men”. “I started laughing because I was incredulous. We see people not returning to hospitals because of this”, he explained.
Although Mozambique decriminalized homosexuality in 2015, social hostilities still plague gender and sexual minorities.
Inclusion must ensure effective access to treatment
In 2016, the Government of Mozambique, through the Ministry of Health, created a document entitled Guideline for the Integration of HIV/AIDS Prevention, Care and Treatment Services for the Key Population in the Health Sector.
The central objective was to guarantee greater access to health care, early diagnosis, and timely initiation of treatment for key populations including women sex workers, men who have sex with men [MSM], people who inject drugs, and prisoners.
Campos, who works with Kutchintxa, an organization that defends the human rights of LGBT people in Mozambique, identifies as a gay man. He said the guidelines are progressive in theory but fall short in practice.
“It is not enough to create guidelines for key populations and include LGBT people,” he said. “It is necessary that, in practice, there is service that responds to the specific needs of each group.”
Evaristo has yet to experience this sort of inclusive service. “Once, in a medical consultation, the nurse used religion to try to convince me that I was sinning, that I could not continue living like this, and that I was sick because of my sexual choices resulting from my sexual orientation,” he said. “They demonize homosexuality as if it were the greatest sin in the world.”
Evaristo said such demonization often brings dire consequences. “We barely go a month without hearing that a member [of the LGBT community] has lost his life to HIV due to lack of care,” he said.
António Mathe is coordinator of the Public Participation pillar at the Citizen’s Observatory for Health (OCS), a Mozambican NGO that defends the human and health rights of vulnerable and marginalized groups, including LGBT people. He says there is very little public funding in the health sector to meet the specific needs of LGBT people.
“The big gain so far has to do with the availability of lubricating gel [lube] as an essential item. For the rest, concrete questions about financing are not visible,” he said.
Lube is an effective preventive tool in the control of HIV cases among MSM, as it facilitates condom usage, promoting safer anal sex.
Advocacy in public hospitals
OCS uses awareness and sensitization campaigns to influence decision-making processes within the National Health System. They also monitor health services with community activists of different sexual orientations to ensure their inclusion.
Campos does similar work with Kutchintxa but says “the Ministry of Health needs to be more proactive, no longer treating LGBT people as numbers and a fundraising mechanism to secure global HIV-prevention grants”. “When we go out into the streets, we would like to be treated with respect and without labels because of our sexual orientation”, Evaristo added.
Mathe says the road to health equity is still long for LGBT people but celebrates important and recent achievements, such as the inclusion of LGBT activists at health centers that provide assistance and health care. Another achievement is the elimination of barriers to accessing hospitals based on “inappropriate” clothing and appearance.
Until 2020, when a ministerial order prohibited such discrimination, people who went to public hospitals wearing shorts, short skirts, tank tops, gym clothes, dreadlocks, slippers or barefoot did not receive health care because these displays “were considered ethical and moral barriers in public hospitals in Mozambique, without any legal basis”, explained Mathe.
OCS now monitors health centers to ensure compliance with the ministerial order. Despite some progress, Campos says healthcare providers are still discriminating against LGBT people.
“Sometimes when we go to the hospital, the health technician doesn’t attend to us or treats us badly because we are dressed differently than expected,” Campos said. “I believe that the secret to change is the inclusion of homosexuals in all sectors”, Evaristo added.
Health infrastructure needs to be improved
Evaristo and Campos maintain that health infrastructures are not inclusive and do little to guarantee the privacy of users.
“In the HIV testing sector, it’s supposed to be that patients enter through one door and, after the diagnosis, leave through another so that they are no longer seen with the rest of the users, but this is not what happens,” Campos explained. “When a patient takes 10 to 20 minutes for the test, other patients deduce that the test is positive,” Evaristo added.