Tag Archives: Human Rights

HIV and MSM Abroad: The Fenway Institute’s Work in Malawi

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In December of 2011, staff from The Fenway Institute collaborated with Johns Hopkins School of Public Health and the Centre for the Development for People to train Health Care Workers and Peer Educators in Malawi on working with MSM and preventing HIV in this vulnerable population. Fenway Health’s Medical Director of Behavioral Health, Kevin Kapila, shares his experience.

When I first learned about the possibility of conducting trainings for medical providers in Malawi, like many Americans I did not know much about this landlocked country in southeast Africa. I knew, like most gay men, that Madonna had adopted a child from Malawi, and was also aware of the gay couple that was sentenced to 14 years hard labor for having an engagement ceremony.

I did some research and found out that Malawi faces a lot of challenges—it is the second poorest country in the world, 11% of its population is infected with HIV, and over 50,000 people a year in Malawi die from HIV/AIDS. Malawi is also known as the “warm heart of Africa,” because of the kindness of its people, which from our experience there is most definitely true.

A view from the car on trip from Lilongwe to Blantyre

The Fenway Institute was invited to take part in trainings in Malawi that took place in early December of 2011. The trainings focused on educating health care workers and peer educators to meet the needs of men who have sex with men (MSM) and help prevent HIV in this vulnerable population. As one of Fenway Health’s medical providers, I was honored to be part of these trainings that will hopefully create positive change for Malawi’s MSM. The trainings were done in collaboration with Johns Hopkins School of Public Health and The Centre for the Development of People (this is a human rights organization focused on the needs of the LGBT community in Malawi.) The trip was funded by a grant from AmFAR. The team from Fenway included Rodney VanDerwarker, MPH (Administrative Director of The Fenway Institute); Marcy Gelman NP,MPH (Associate Director for Clinical Research); and Kevin Kapila, MD (Medical Director of Behavioral Health and primary care provider.)

Preparation for these trainings started months in advance, with multiple conference calls with Johns Hopkins and our colleagues in Malawi. We were able to put together a two-day training program for health care providers and a one-day training for peer educators. There were many challenges that had to be overcome, including the lack of resources and many negative perceptions about men who have sex with men.

The team meets in Lilongwe after two long days of travel

We left Boston and after almost two days of travel landed in Lilongwe, the capital of Malawi. We met Stefan Baral from Johns Hopkins and Gift Trapence from CEDEP and began the five-hour drive from Lilongwe to Blantyre. This was not an easy drive on this two-lane highway that was populated by cars, bikes, pedestrians and goats. The trip did allow us to appreciate the beauty of the country and connect with each other and discuss the upcoming trainings.

The first day of the trainings was attended by over 20 representatives from different health service providers in Malawi. Stefan Baral presented on human rights and epidemiology. Rodney VanDerwarker talked about the Fenway Health model of care. Marcy Gelman gave a presentation on how to take a sexual history from MSM, which was followed by role-playing exercises. Marcy had a difficult challenge, as this was is the first time many of the providers had been exposed to some of this information in a culture where gay and bisexual men are not accepted. We were prepared for the possibility this would not go over well, but Marcy’s extensive preparation in regards to the cultural issues, well thought out presentation, and stellar execution of the material went over very well. There was active participation from the audience and the first day ended well.

Marcy and Rodney preparing on Day One.

Marcy started the second day of training with continued education on identifying, screening, and treating the different sexually transmitted infection that commonly occur in MSM. I was the presenter for the second half of the morning and the afternoon sessions, and started with going over the use of condoms and lubricants, which are in short supply in Malawi. 

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Health Care and Human Rights for LGBT People: A Critical Focus for Our Work

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A person cannot live a full, healthy life when they are unable to experience real human rights or freely express who they are.

Before his untimely death, Jonathan Mann, founder of the UN AIDS program, educated us on the strong link between the concepts of health and human rights. Mann demonstrated how stigma and discrimination are deeply connected to limitations and barriers to sensitive, humane care. In his book Health and Human Rights: A Reader, Mann explains that “Discrimination against ethnic, religious, and racial minorities, as well as on account of gender, political opinion, or immigration status, compromises or threatens the health and well-being and, all too often, the very lives of millions. In its most extreme forms, prejudice or the devaluation of human beings because they are classified as “other” has led to apartheid, ethnic cleansing, and genocide. Discriminatory practices threaten physical and mental health and result in the denial of access to care, inappropriate therapies, or inferior care.”

The same connection can be drawn from the Institute of Medicine’s recent report on the Health of Lesbian, Gay, Bisexual and Transgender People, a publication which represents a landmark step towards LGBT health awareness. Also in Healthy People 2020, the Surgeon General describes how many of the health disparities noted among LGBT people stem directly from stigma and discrimination.

Tyler Clementi is a recent, and tragic example of how prejudice and stigma can hurt LGBT Americans.

A person cannot live a full, healthy life when they are unable to experience real human rights or freely express who they are. Recent examples of bullying are too numerous to cite, the most prominent being Tyler Clementi who jumped to his death from the George Washington bridge after classmates filmed him having sex with another man and posted the video online. And the connection between health and human rights is not limited by national borders. In Senegal in 2008, nine male HIV prevention workers were imprisoned for “acts against nature” prohibited by Senegalese law. Subsequent study showed that this singular event had a chilling effect on HIV prevention activities among Senegalese men who have sex with men (MSM). The majority of service providers suspended HIV prevention work with MSM out of fear for their own safety, and those who continued to provide services noticed a sharp decline in MSM participation. The study concluded that an effective response to the HIV epidemic in Senegal should include active work to decrease enforcement of this law (…or eliminate it!).

In our context, LGBT health education, a core principle is the recognition of how difficult it is to be LGBT and not feel the impact of reports of institutionalized and individual violence and discrimination, even when they take place at a great distance from home. In thinking about what we teach about LGBT health to health care organizations, schools, and other institutions, our work to improve health must start with identifying situations that jeopardize the safety and comfort of the individual to authentically express basic human desire.

It is for this reason that we cannot overstate the importance of recent statements by President Obama, Hillary Clinton, and the United Nations on this topic.

President Obama’s presidential directive International Initiatives to Advance the Human Rights of Lesbian, Gay, Bisexual, and Transgender (LGBT) Persons directs U.S. agencies to:

  • Combat the criminalization of LGBT status or conduct abroad.
  • Protect vulnerable LGBT refugees and asylum seekers.
  • Leverage foreign assistance to protect human rights and advance nondiscrimination.
  • Ensure swift and meaningful U.S. responses to human rights abuses of LGBT persons abroad.
  • Engage International Organizations in the fight against LGBT discrimination.
  • Report on the U.S. government’s progress

Speaking in Paris, Secretary Clinton unequivocally stated to the international community that, “Like being a woman, like being a racial, religious, tribal, or ethnic minority, being LGBT does not make you less human. And that is why gay rights are human rights, and human rights are gay rights.”

The United Nations just recently issued its first report on LGBT rights from the UN office of the High Commissioner for Human Rights (OHCHR) in Geneva. It outlines “a pattern of human rights violations… that demands a response,” and says governments have too often overlooked violence and discrimination based on sexual orientation and gender identity.

Violence against LGBT persons tends to be especially vicious compared to other bias-motivated crimes.

 

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