It's a cold April morning, yet tension at the Centre for the Development of People (CEDEP), a non-governmental organisation which advocates for the rights of sexual minority groups, makes it feel like a hot summer afternoon. The atmosphere in the reception area tells me that something serious has befallen the LGBTI community this morning.
"Guys, we need to avoid walking in groups today, as people are really wanting to assault us," says one of the youthful members of the group, who later introduces himself to me as Chrispin. I later learn that Kelvin Gomani, a prominent member of LGBTI society, has been assaulted by an angry mob on the grounds that he practices homosexuality.
Such ongoing hostility and discrimination against lesbian, gay, bisexual, transgender and intersex (LGBTI) people affects many areas of their lives, including causing barriers to accessing sexual and reproductive health services. It is an issue that the Malawian government must do much more to address.
Barriers to health services
Malawi is a party to both the Abuja Declaration and the Maputo Plan of Action that promote the rights to the access of sexual and reproductive health services for all people regardless of sexual orientation. In 2012, Malawi's government held a moratorium that suspended all anti-sodomy laws. Despite this, the country still registers high rates of inequalities in access to health services by LGBTI people, which puts them at higher risk of HIV infection.
When I interview Gomani, he tells me that some public health workers openly show their displeasure when assisting LGBTI people when they go to the health facilities to seek services.
He says: "I once had a sexual complication that needed medical attention. I was disappointed with the way the clinician at the health facility handled the situation. After the routine diagnosis process, he asked me if I was homosexual. When I said I was, he told me to go to the facility with my partner - a thing which is unrealistic."
Gomani adds that, every day, he lives under constant fear of assault from the general community. "With the high rates of homophobia and social disapproval of homosexuality in the country, one cannot go in the company of his partner to a health facility to seek services," he says.
Discrimination from health workers
HIV prevalence among the LGBTI community is 14 per cent, according to a 2013 report by the Malawi National Aids Commission and UNAIDS. This report paints a worrying picture that indicates little is known of the sexual health needs of this group.
According to Safari Mbewe, executive director of the Malawi Network of People Living with HIV, LGBTI people continue to face all forms of stigma and discrimination, including violence from the general population.
And the LGBTI community in Malawi continues to face challenges in accessing public health services because of high rates of homophobia towards LGBTI people by conservative health care workers.
"Everyone, whether they are homosexual, heterosexual, bisexual or intersex, has the right to sexual reproductive healthcare. That is why, as a country, we developed recommendations that do not leave anyone behind in the HIV and AIDS response," says Mbewe, in an interview.
But despite the government of Malawi signing a US$332 million grant with the Global Fund, which has a US$389,000 package for the promotion of sexual and reproductive services to LGBTI people, the conservative attitude of Malawian healthcare workers means LGBTI people are still not getting quality healthcare.
More training needed
Recently, CEDEP took part in a study into stigma, healthcare and access in Malawi, Namibia and Botswana. Executive director Gift Trapence says some respondents to the study reported that healthcare workers in Malawi openly showed their dislike to attending to men who have sex with men, which denies them their dignity and the right to quality health care.
"The findings of the study underscore the fact that there is need to train clinical care providers on how they can effectively work with the LGBTI community," says Trapence. "Most LGBTI people have, at some point, suffered violence. It is recommended that they know of the services they can get at health facilities, including post exposure prophylaxis."
Amakobe Sande, UNAIDS country director for Malawi, said stigma and discrimination remain a major challenge to the global HIV response. "The continuous marginalisation and stigmatisation against key populations [people most at risk of HIV infection] pushes them underground and creates barriers to HIV prevention and treatment service delivery," she said.
She added that the theme for International Zero Discrimination Day (1 March 2016) 'Individuality and Standout' and the Malawian theme 'Making Health Services Accessible to All' were appropriate and timely as the country was embarking on programmes to promote access to sexual health services for all.