Beyond the rainbow: LGBTQI+ rights and health in Eastern and Southern Africa

October is Africa Pride Month – marking 35 years of celebrating diverse identities on the continent and a moment to reflect on the progress made and the continuous threats towards securing rights, health and choices for all. While vibrant parades and joyous gatherings dominate in many parts of the world, the reality for many of Africa's LGBTQ+ community remains one of inequality.

A life in shadows

Tremendous progress has been made in ensuring greater equality for LGBTQ+ people in some countries. However, in a few others harmful laws and policies that criminalize same-sex relationships, often with severe implications, are being passed. These laws not only punish individuals for their sexual orientation and gender identity but also perpetuate a culture of fear and secrecy. Societal stigma compounds the problem, leading to widespread discrimination and violence. Often ostracized from families and communities, LGBTQ+ individuals lose their support systems and even economic opportunities. This exclusion forces many into hiding – into the shadows – increasing their risk of violence, marginalization from their families and societies, limiting access to vital sexual and reproductive health services, including HIV prevention and treatment, which threatens the goal of ending AIDS as a public health threat by 2030.

A call for gender-inclusive health services

Together, we must do more to better understand and meet the needs of populations left behind, in particular for transgender and intersex people. Available data highlights that transgender and gender-diverse women, as well as lesbians, are more likely to experience higher rates of violence, alcohol and substance abuse compared to the general population. The health-related rights, including the sexual and reproductive health rights and needs of LGBTQ+ people are critical, yet they are often overlooked. A limited understanding of existing laws and policies, societal and individual norms and attitudes, give rise to stigma and discrimination in some healthcare settings that can result in judgemental attitudes and general lack of understanding of the health care needs of LGBTQ+ people.

Applying a PRIDE approach to health care services can have far reaching positive impacts on the health and wellbeing of all, and in particular LGBTQ+ individuals.

What is a PRIDE approach?

• PEOPLE – It places the needs of people at the centre of everything we do.
• RESPECTFUL – It provides services that are respectful and responsive to the rights and choices of all.
• INTEGRATED – It includes services that are integrated, combining the prevention and treatment of diseases with a sex positive approach and a focus on the health and wellbeing of the person in their totality.
• DIVERSITY – It includes services that recognize diversity and are inclusive of all.
• ENABLED – The services it offers are enabled by policies driven by fundamental human rights, including the right to health and sexual and reproductive rights; they counteract biases, stigma and discrimination, thereby increasing trust in the health care system.

Empowering communities for better health outcomes

A community-led approach is fundamental in ensuring a PRIDE approach to health care systems. The inclusion and involvement of communities in designing, delivering, advocating for and evaluating health services is essential. Community-led initiatives built on the lived experiences of LGBTQ+ people have proven to be highly effective.

Peers drawn from within the community can navigate the complex healthcare system, empower their peers and build trust through shared understanding. This shared experience allows them to offer relevant information and address specific concerns in a sensitive and affirming manner that leads to better health outcomes and stronger sense of wellbeing.

Towards a more just future

A PRIDE approach can only be achieved if it is enabled by the principles of equality and non-discrimination that are at the heart of human rights and public health. Everyone, regardless of their sexual orientation and gender identity, is entitled to their human rights, including the right to privacy, the right to be treated as equal before the law, the right to health, sexual and reproductive rights, and the right to protection from discrimination.

Legal protections aligned with international human rights standards are crucial to advance the health and wellbeing of LGBTQ+. While several countries such as Angola, Botswana, Madagascar, Mauritius, Mozambique, Namibia, Rwanda and South Africa have decriminalized same sex relations, governments, professional associations of health care workers, faith based, traditional, rights-based and community-based organizations must do more to address societal attitudes and promote diversity and inclusion.

Pride beyond October

Pride is not just a month-long celebration, it's a reminder and call to action that we should continuously strive to educate and promote respect for the rights and freedoms of all. Collectively, UNAIDS and UNFPA remain committed to support national and community-led actions towards increasing access to information and services for key populations in our region using innovative approaches for advancing the sexual and reproductive health and rights of key populations.

Through the Joint United Nations Regional Programme 2gether 4 SRHR implemented by our agencies, we supported the finalization of the SADC Parliamentary Forum Minimum Standards for the protection of the SRHR of key populations in the SADC region which is comprehensive SADC Guidance Document on Key Populations on the minimum threshold of acceptable protection for key populations, and include reducing stigma and discrimination, ending violence against key populations, monitoring and reforming laws and policies, and ensuring access to information and services. In accordance with the Global Coalition Roadmap and the SADC Key Population Strategy, the guide is intended to assist Member States scale up their programmes for key populations and provides guidance supported by case studies from the SADC region. Areas for guidance include developing minimum service packages; developing a scale-up plan; differentiated service delivery and integration; and resource mobilization and sustainability.

The programme also supported work with civil society on addressing the needs of key populations through peer-led interventions, including drop-in centres, outreach activities, mobile services and linking and referral to public health facilities, which have resulted in some progress towards attaining the SRH rights for these key populations.

Furthermore, South Africa and Kenya tested models of service provision for key populations that have yielded valuable insights.

We will continue to work together with governments, the community and other stakeholders to advance rights for all, where no one is left behind, and to advocate for a world in which all people can achieve their full health and wellbeing, free of violence, stigma and discrimination. These are the basic tenets of regional commitments such as the SADC regional strategy for HIV prevention, treatment and care and sexual and reproductive health and rights among key populations, resolution 275 of the African Commission on Human and People's rights, the Maputo Plan of Action, and they are fundamental principles core to the Sustainable Development Goals, including to end AIDS as a public health threat by 2030.

For resources and stories about LGBTQ+ in our region, visit the SRHR knowledge hub on www.2gether4SRHR.org. For information about pride month events throughout the month of October visit Pride of Africa.