The office of the Gay and Lesbian Coallition Kenya

“I simply don’t understand what the problem is,” says Steven, a peer educator from Mtwapa, near Mombasa. “Why can’t they leave us alone to be what we want to be?”.

This simple wish seems a long way from coming true. Men who have sex with men face discrimination in employment, lack of freedom of association, hate speech and arbitrary arrest.

“For me it has been difficult,” says Steven. “People stigmatised me but everyone needs somewhere they can call home.”

The stigma that arises out of the criminalisation of sex between men seriously increases the risk of getting HIV. Such punitive legal environments are one of the major barriers to HIV prevention.

Until recently there was little safe sex information that acknowledged unprotected anal sex as being a high risk for HIV transmission. According to the Kenya National Strategic Plan men who have sex with men are one of the groups at highest risk of HIV.

However, there are few services provided for men who have sex with men. Ishtar is a member of the Kenya AIDS NGO consortium (KANCO) – a linking organisation of the Alliance. Ishtar are a health and social wellbeing organisation for men who have sex with men. Every month Voluntary Counselling and Testing (VCT) sessions are held at the Gay and Lesbian Coalition of Kenya Centre in Nairobi. Peer educators and open forums educate men on safe sex and offer condoms and lubricants.

Peter Njane is Ishtar’s director. “Our priority is for better referrals for medical care and for people to know their status.” One of the ways they do this is by working with Liverpool VCT a counselling, testing and treatment centre. They take mobile clinics for evening events where MSM meet.

These are the only specific health services for men who have sex with men in Nairobi. Men who attend government sexual health clinics are likely to be mistreated. This is acknowledged by the Government themselves.

“We realised partnership was needed to get together with members of the most at risk populations. Public opinion has yet to be convinced but we are dealing with high level policy and opinion leaders. We need to move with what is an evidence-based contribution to HIV infection,” says Dr Sobbie Mulindi, Deputy Director of the Coordination and Support at the National AIDS Control Council, Office of the President.

Poverty has an important effect on men who have sex with men and their experiences. Denis Nzioka is one of Kenya’s few open gay activists. “Men in the slums have a more difficult time than bourgeois gay men. Poverty perpetuates homophobia. Gay people have much to fear from the young man on the street who is jobless, has no future, no education and no hope in life.”

Stephen, a male sex worker

Poverty also drives men into sex work. Stephen has been a sex worker since he was 18 years old. Now at 35 and HIV positive he wants to create a better future for himself. “There are many more sex workers now because of the poverty. I come to Ishtar to make friends, get condoms, education and awareness of HIV.” Most of his clients though refuse to use the condoms.

One of the factors cited behind the growth in the anti-gay clampdown across Africa is fundamentalist religion. Denis Nziokla works for GALCK as a religious relations assistant. “One of the roadblocks keeping discrimination is religion. We need to engage with religious leaders and tell them to change what they are saying. Gay people are human beings.”

Beatrice plays with some dozens of toys on a matt on the floor. She giggles as she chases a flashing ball that rolls around her. Beatrice is a happy and cheeky 18-month-old toddler like any other in Zambia. In a few minutes she will have her lunch and then she will play with her paediatric psychologist. Then she will go home with her auntie with her ARV treatment and looking forward to coming back in two weeks’ time.

In a few years, Beatrice will go to school at Bwafwano Community Health Care centre, the same place where she receives her treatment and where she plays with other children who live with HIV or who have lost their parents to AIDS. From 5th grade, she will go on to pursue her studies in a mainstream school. But she will still receive financial support from Bwafwano for her school fees and materials and will keep coming here for treatment, counselling and to feel part of a larger family.

A different life

Things could have turned out very differently for Beatrice. If her auntie had not asked for the help of caregivers from Bwafwano to come home and assess her sister’s health, they might have never found out about Beatrice’s status. Without Bwafwano (and like many children living with HIV), the best Beatrice could have hoped for would have been to make it to a state-run clinic where she would receive treatment every two or three months. She would often feel weak in the weeks coming to the next visit and the prospects of ever being able to go to school would have been very remote at the lack of financial means. Psychological counselling and home care would have not been available to her.

The lack of an effective system of state-based referrals for free testing and provision of integrated services for pregnant women and women and their children is one of the most serious barriers to preventing the transmission of HIV and other diseases from mother to child in Zambia. In this context, mobilisation at the community level is simply essential to guaranteeing these services.

Reaching where the state can’t

Bwafwano showcases how integrated community responses in Zambia are reaching where the state can’t. The organisation provides free home care testing, care and support and integrated services for a community of over 50,000 in habitants in the outskirts of Lusaka.

Whenever a person, or a family is assessed at home for suspected HIV, TB or 6 other diseases, or comes to the Bwafwano clinic, a much wider assessment takes place, including social, psychosocial, economic and of livelihood prospects. Services in these areas are provided in the same place.

When pregnant women living with HIV receive treatment and counselling their husbands are also invited to receive it. When the baby is born, he or she also receives treatment, including paediatrician follow up and psychological support if needed. There is also counselling, income support and skills training for single mothers and children who have extra responsibilities at home due to one or both parents living with HIV.

“Helping one another”

Bwafwano is deeply rooted in the community, with which it has engaged to reduce stigma and create solutions to health and integration problems. As an illustration, Bwafwano was initially created as a home care organisation to support HIV positive people who were dying and to avoid exposure of people living with HIV to stigma. Today however, many of its beneficiaries come to the centre themselves with no fear of being stigmatised.

Alliance Zambia collaborates with Bwafwano and other community based organisations in Zambia in a project that aims to improve the access of women living with HIV who are pregnant or have young children to adequate care and support for them and their children. The project will help Bwafwano include provision of services for the prevention of mother to child transmission as part of their integrated programming, something they need badly.

As we leave Bwafuano with Beatrice’s smile still in our minds, we can imagine how she and the other children at the centre will progress in life. It is not just about the services they will benefit from as they grow older. It is about the sense that they are part of a community that has found in itself the way to support their children and give them a sense of aspiration and belonging.  Bwafwano means “helping one another”. How fitting can a name be!