Homosexuality has been illegal in Tanzania since colonial times. This legislation is still in force, and during the first 30 years of the HIV epidemic homosexuals were almost never mentioned in HIV prevention campaigns. Today, a growing number of homosexuals in the country have taken up the fight for equal health rights.
Growing involvement among homosexuals
"For nearly three decades there were practically no HIV-related research or prevention efforts in Africa targeting homosexual men. While HIV was very much considered a gay disease in the West, global HIV programming did not direct focus towards male same-sex relationships in Africa," says Kåre Moen, who is carrying out a research project on HIV and homosexual men in Dar es Salaam.
According to Dr Moen, in the context of public health and community medicine this is an almost unbelievably serious sin of omission.
In his work, the researcher has examined homosexual identities, practices and cultures in Tanzania, among other things, and has compiled an overview of how homosexual men are affected by and relate to HIV. He is currently researching how homosexual men in Dar es Salaam are working to prevent HIV.
Twenty-two per cent of homosexual men in Dar es Salaam are HIV positive. The authorities have kept a low profile with regard to this group because, among other things, they consider HIV information campaigns to be an acknowledgement of the homosexual lifestyle.
"We are seeing a rising level of involvement among homosexual men in Tanzania when it comes to rights-related and health issues, and in recent years several organisations promoting homosexuals' health and rights have emerged," says Dr Moen.
"A common denominator for a range of HIV programmes and campaigns in Africa is that they have not addressed the specific challenges facing homosexuals. They have focused exclusively on HIV infection among heterosexuals."
The researcher has closely followed the activities of grassroots organisations fighting for homosexuals' health and rights. He is trained in both medicine and anthropology, and is using anthropological research methods in this project, primarily participant observation and qualitative interviews.
"This is also community action research, where one of the aims is to help to bring together various actors and their different perspectives, knowledge and insights. We would like to find out how grassroots groups formed by and targeting homosexuals think and work, the challenges they are facing, and what experience and insight they possess that can be useful for HIV prevention activities in general."
The number of organisations for homosexuals in Dar es Salaam is rapidly expanding, and many of the members are themselves living with HIV.
"These organisations are becoming more open and more activist. Many members are teaching themselves about policy and medicine, and are acquiring competencies that they want to share with other homosexuals."
"In this project we are also working to forge contacts between organisations for homosexuals and professional health workers and national HIV measures. The aim is to incorporate perspectives from these organisations into the official HIV prevention programme."
Criticised from many quarters
Dr Moen emphasises that the objective of his research project is not to evaluate the activities of these groups, but to generate new knowledge about HIV and HIV prevention from the perspectives of "the relevant parties".
He also points out that the most successful global HIV prevention strategies have nearly always been those developed in collaboration between health experts on the one hand and the most affected social groups on the other.
"For HIV prevention measures to be successful, we are dependent on knowledge about what the HIV epidemic looks like from the perspective of those who are affected and about how HIV prevention can be tailored to their lives and situation in a meaningful manner."
The researcher says that it is important to keep in mind that these groups are denigrated and criticised from many quarters. Many work under difficult conditions. They are threatened, are subject to ridicule in the media and are accused of promoting homosexuality with their activities.
High price to pay for coming out
Many of the most visible activists in the groups with which Dr Moen has contact come from the lower socio-economic segment of the population. This is in part explained by the high price individuals pay for coming out as a homosexual in Tanzania.
"Those who have their own businesses or good jobs are afraid of losing them if they come out of the closet," explains Pade Edmont, chair of the board of the organisation SANA in Dar es Salaam. The primary objective of the group is to reduce HIV infection among men who have sex with men.
"We are working to ensure that all population groups have equal access to health care and information. Among other things, we identify 'gay-friendly' doctors and provide assistance for individuals who want testing and, if necessary, treatment. We also ensure that this is all done confidentially, when relevant."
"In addition, we are working actively with information activities, network-building and identifying new reports on issues of interest to homosexuals."
Mr Edmont says that the media often criticises their work. For example, their ability as homosexuals to give health advice to others is questioned.
"The tabloid press in Tanzania plays a strong role in stigmatising homosexuals. They often publish articles 'revealing' that someone is gay. Teachers or other professionals, for example, are 'outed'," he says.
Dr Moen adds that groups like SANA have life-critical experience and resources to be drawn upon and that they make an invaluable contribution to the fight against HIV.
"They convey the perspectives of a large group, many of whom are still dying of AIDS, even in Dar es Salaam where good treatment is available. Their strong commitment is also critical to success in preventing HIV infection and deaths," he concludes.
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More information about the research project is available online: www.forskningsradet.no/prosjek … /#/project/220807/no