In June, Mozambique dropped a colonial-era law criminalising homosexual activities. The change passed relatively quietly in the southern African country. After all, no one had ever been convicted. The Guardian reports, however, that when 22-year-old Tony Andrea felt like he was coming down with malaria he went to a government health clinic, “the nurse told me, ‘People like you, you lie a lot … You don’t have malaria,'” he says.
The report says Andrea is gay and, despite the recently overturned prohibition, had always felt safe being open about his sexuality. He certainly never suspected it might interfere with his ability to access malaria treatment. He demanded treatment, but the incident left him shaken. “They are not at all prepared to take care of the LGBT community,” he said of public health workers.
The report says aside from being demoralising, discrimination against men who have sex with men is jeopardising government efforts to reduce the high incidence of HIV and Aids. At 11.5%, Mozambique has one of the 10 highest HIV rates in the world. But in Maputo, the capital, among men who have sex with men and are aged 25 years and older, that rate nearly triples to 33.8%. Without access to hospital testing and treatment services, the number will continue to rise. Some of those men also have sex with women, so the virus will spread more widely among the population.
The report says the ministry of health launched a three-year accelerated HIV response plan in 2013 and acknowledged that men who have sex with men are among the social groups that could “perpetuate the HIV epidemic if services are not provided for these hard-to-reach populations”.
Roberto Paulo is a programme officer for Lambda, the country’s only lesbian, gay, bisexual and transgender activist organisation, which offers a haven for those who have faced harassment at health centres. Paulo says transgender people have been refused services until they went home to change their clothes, while gay men have been denied treatment for anal sexually transmitted infections.
“In this hetero-normative society, it’s quite difficult for the LGBT person who needs services,” he says. “It’s quite difficult to leave home, to go to the hospitals.”
The report says a recent survey of men who have sex with men in three Mozambican cities underscores the fallout from this stigma. It found that as many as six out of 10 men who visited health centres in the past year left without getting an HIV test, despite the government’s prioritisation of HIV services in healthcare settings, especially for groups at heightened risk of infection.
The study found that some men were uncomfortable with disclosing their sexual practices – a prerequisite for being identified as at risk. “Men who have sex with men may be reluctant to disclose their sex practices to healthcare workers for fear of being stigmatised and discriminated against,” the researchers concluded.
These are missed opportunities, not only to get patients started on anti-retroviral therapy but also to shore up their knowledge about how to protect themselves and their future partners, and stem the spread of HIV.
Lambda is recommending LGBT-friendly clinics, and does regular sensitivity training for health workers. More significantly, Paulo says, the group worked with the government and other organisations to draft directrizes (guidelines) that health centres must adhere to when interacting with people from high-risk groups. Paulo hopes the directrizes, which were approved this month, “will open space to more and more people within the health sector”.
This is the first study to identify levels of recent HIV testing and associated factors among men who have sex with men (MSM) in Mozambique. Using data from Maputo (n = 493), Beira (n = 572), and Nampula/Nacala (n = 347), collected via respondent-driven sampling in 2011, and excluding those with prior known infection, we found that 30.4 % [95 % confidence interval (CI) 25.0–36.3 %], 42.1 % (95 % CI 36.8–47.3 %) and 29.8 % (95 % CI 22.9–36.9 %), respectively, had recently tested for HIV (≤12 months), while between three and five out of 10 MSM had never tested. A range of factors was associated with recent HIV testing such as familiarity with the modes of transmission, knowledge of antiretroviral treatment for HIV, contact with peer educators and awareness of partner serostatus; yet, surprisingly recent healthcare utilization was not associated with recent testing. Findings provide evidence that structural and behavioral interventions among MSM may play an important role in increasing HIV testing.