In Nigeria since the introduction of an anti-homosexuality law in 2014 which criminalises LGBT people, increasing homophobia has been having a negative impact on the HIV response.
According to Premium Times, the Same Sex Marriage (Prohibition) Act has resulted in an increase in violence against lesbian, gay, bisexual and transgender people (LGBT), including police brutality.
Effanga (name changed), 29, from Cross River, is a man who has sex with men. He says: "Because of the government's homophobic law, most of us cannot access health services even though we are at a higher risk of HIV. We are afraid of being arrested and thrown into jail as the law sees us as criminals. So, we do not disclose our sexual preference to health workers."
On International Day Against Homophobia and Transphobia (17 May), activists are putting the spotlight on this discriminatory law which violates human rights, and creates barriers to LGBT people accessing HIV prevention and treatment services.
In Nigeria, according to the UNAIDS Gap Report, 10 per cent of all new HIV infections are in men who have sex with men, and 17 per cent of men who have sex with men are living with HIV. The report also states that men who have sex with men are 19 times more likely to be infected with HIV than other adult men.
The Nigerian government must ensure that every citizen affected by HIV is allowed to access essential HIV services irrespective of sexual orientation. This is in line with goal three of the sustainable development goals to ensure healthy lives for all and fits in with the overall theme of the global goals to 'leave no one behind'.
In March 2016, the Nigerian government signed into law a new version of the HIV/AIDS Anti-Discrimination Act, which was first introduced in 2014. The law is meant to prevent HIV-related discrimination and ensure access to healthcare and other services. It also provides protection of the human rights and dignity of people affected by HIV in Nigeria. The revised version was developed in collaboration with the AIDS Healthcare Foundation and is supposed to be easier to understand, helping tackle stigma and discrimination against people living with HIV, which has remained high.
Dr Bilali Camara, UNAIDS country director, said: "Zero discrimination is pivotal in ending AIDS by 2030. This popular [new] version of the Anti-Discrimination Act 2014 will support the zero discrimination targets directly."
The national secretary of the Network of People Living with HIV/AIDS, Abdulkadir Ibrahim, said: "The law will ensure the rights and dignity of members is fully respected."
However, the 2014 anti-homosexuality act prohibiting all forms of same-sex sexual activity remains, with a penalty of 14 years imprisonment for defaulters. This law - which encourages homophobia - provides direct conflict with the very aim of the anti-discrimination law.
How to ensure healthy lives for all
Some Nigerians are left wondering how the government intends to achieve goal three of the sustainable development goals, especially when criminalisation of LGBT people presents major barriers to them accessing health services. One of the targets of goal three is to provide universal access to sexual and reproductive healthcare services without discrimination. But the question remains, how can the Nigerian government achieve this under their current homophobic law?
Dr Tunde Ajilagba, a health activist, says: "The Nigerian government has been insincere in its approach to end discrimination of people living with HIV, especially men who have sex with men, and so might not achieve goal three of the SDGs by 2030.
"The government should first accept that these people are in our midst and are part of us; then tailor programmes that will address their population instead of criminalising them. The continual denial of the existence of this group is wrong because many of them cannot access HIV health services and this drives new HIV infections."
Holding the government accountable
Everyone - including LGBT people - has a human right to access the essential HIV services and healthcare they might need.
In theory, the Nigerian government has maintained its commitment to improving the health of Nigerians and getting to zero new HIV infections, zero AIDS-related deaths and zero discrimination by 2030. It has promised to commit funds to the health sector, build new hospitals and stop discrimination of people living with HIV which is the reason for the simplified version of the anti-HIV discrimination law. If it is achieved, Nigeria could serve as a model for other African countries, but that is a big 'if' when the anti-homosexuality act remains law.
The International Day Against Homophobia and Transphobia is an opportunity to hold the Nigerian government to account as it begins working towards the sustainable development goals. It is a chance to find out how they plan to achieve universal health coverage in Nigeria, so that it really does include everyone, regardless of their sexual orientation and gender identity.
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