Despite pledges for healthcare access for all, many groups in Tanzania face discrimination.
When Mohammed*, a 24-year-old gay man in Dar es Salaam, Tanzania, went to a government hospital for treatment for a sexually transmitted infection that he believed was anal gonorrhea, the doctor's response was hostile. "But how? You're a man. How is it that you have gonorrhea behind, rather than in front?"
Mohammed explained that he has sex with men. "This is a big sin before God", the doctor replied. "Your illness is a result of your own choices." Turned away, Mohammed was forced to seek treatment at an expensive private clinic.
Access for all
This week, African leaders are meeting in Abuja, Nigeria, for an African Union (AU) special summit on HIV, tuberculosis and malaria.
The summit will review the status of African governments' national responses to HIV and other infectious diseases, and discuss strategies to enhance the continent's approach.
The summit's conference note particularly refers to the need to ensure universal access to treatment for "the poor and most marginalised people".
Though many African countries have made great strides in tackling HIV, the AU correctly recognises that some of the most marginalised people continue to fall through the cracks.
These include 'key populations' - those most at risk of being infected with or transmitting HIV, including sex workers, men who have sex with men (MSM), and people who inject drugs.
In Tanzania, Mohammed's experience of discriminatory treatment in the health sector is disturbingly common.
I found many such cases when researching a recent report by Human Rights Watch and the Wake Up and Step Forward Coalition, a Tanzanian network for MSM.
The AU's 2012 Roadmap on AIDS, Tuberculosis and Malaria points out that discrimination in the healthcare sector results in inequitable access to treatment and care for key populations. Tanzania's government, too, has begun to acknowledge the problem of stigma and discrimination in the healthcare sector.
It has taken initial steps to make treatment more accessible to key populations, but health workers continue to discriminate and abuse patients, compromising their right to the highest attainable standard of health.
Key populations in Tanzania face obstacles in accessing treatment due to health workers' personal bias, as in Mohammed's case, but also due to structural barriers. Mwamini K., a sex worker, said nurses refused her treatment for a sexually-transmitted infection (STI) because she could not bring her "partner".
Some public hospitals require a patient to bring one's partner with them before they can obtain STI treatment or even testing, scaring away sex workers and men who have sex with men.
State agents' actions thus systematically undermine Tanzania's National Multi-sectoral Strategic Framework on HIV/AIDS, which recognises the need to address HIV among key populations.
The framework pledges to "build partnerships between government and CSOs [civil society organisations] working with vulnerable populations to advocate for their empowerment and protection".
Yet police arrested a gay man in Dar es Salaam simply for trying to organise a seminar on HIV for men who have sex with men. In this context, it is difficult to speak of "empowerment," much less a "partnership" between key populations and the government.
Partners in protection
In some regards, Tanzania is ahead of the game. Its methadone clinics - among the first in sub-Saharan Africa - have been lauded for providing friendly services to people who inject drugs. Tanzania's AIDS Commission, TACAIDS, has established a working group to better address key populations' needs.
But in order to save lives, it is critical that the Tanzanian government makes it an urgent priority to ensure that all health personnel are trained to provide non-stigmatising treatment to sex workers, MSM, and people who inject drugs. And those who fail to provide such treatment should be held accountable.
Tanzania's health ministry should also bring the police on board - making them a partner in the protection of key populations, rather than an abusive force that drives vulnerable groups further underground.
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The AU Special Summit on HIV, Tuberculosis and Malaria can play a role in setting Tanzania, and other countries in which key populations continue to experience stigma and discrimination, on the right path.
It should adopt concrete strategies to address the HIV epidemic among key populations in Africa, and should emphasise the protection of their human rights.
A 2006 African Common Position on HIV/AIDS - one of the documents being reviewed at this week's summit - pledged to "Put people at the centre of the HIV and AIDS response, especially vulnerable people (e.g. the poor; women, young people; orphans and vulnerable children; men who have sex with men; migrants; prisoners; sex workers; the disabled, people affected by conflicts; and Injection Drug Users (IDUs)."
In Tanzania, where key populations are still largely sidelined, it's time that such pledges come to fruition.
*All names have been changed.
Neela Ghoshal is a Human Rights Watch researcher based in Nairobi. Follow her on Twitter @NeelaGhoshal.
