23 March 2018

Africa: Anti-Homosexuality Laws Prevent Us from Achieving Universal Health Coverage

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analysis

Imagine being denied life-saving health services when you need them just because of who you are, and instead, imagine facing the threat of up to 14 years in prison. For far too long, this has been the reality in Kenya. But over the last few weeks, Kenya's high court has heard arguments challenging laws that target lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ) communities as being unconstitutional. In a landmark decision this week, the Court of Appeal overturned a court ruling making forced anal exams to determine homosexual activity legal. The Court ruled it was unconstitutional and a violation of human rights.

While we celebrate this progress, sections 162 and 165 of Kenya's Penal Code still make it a crime for same-sex couples to participate in any sexual activity that is "against the order of nature" whether in private or public. Opponents of the laws say they deny Kenyans basic human rights, while also justifying acts of violence against the community. I agree.

As a medical doctor and firm advocate that every person – no matter who they are and where they come from – deserves quality health services, I've seen just how these laws in Kenya, and across Africa, have fueled discrimination in our health system. Take Evelyne*, a transgender woman in Kenya. She has been ridiculed, humiliated, discriminated against, physically andf verbally abused by healthcare workers because she is not gender conforming.

This unfortunately is not uncommon for members of the LGBTIQ communiy across our continent who seek basic healthcare services. Reports have indicated that several healthcare workers have broken their professional code of confidentiality by alerting the police when they suspect a patient of being homosexual or transgender. Such treatment creates fear and propagates poor health seeking behaviors among the LGBTIQ community.

People who identify as LGBTIQ have unique health needs which are often ignored, and one of the significant medical risks to this population is avoidance of routine medical examination. Studies have shown, for example, that sexual minorities are more likely to seek health-related information online as compared to the rest of the population to inform their health care decisions. Since the information may be inaccurate, studies show it often produces anxiety and fear – further worsening their health. And the cycle of poor health continues.

Instead of protecting the "highest attainable standards of health" as a "fundamental right of every human being without discrimination" – as World Health Organization (WHO) Director General Dr. Tedros Adhanon recently reminded us is our duty – our laws encourage healthcare workers to break their professional code of ethics and conduct.

These laws also encourage violence, causing physical and mental harm. Late last year in Kenya the police commanded healthcare workers to brutalize two men by examining their anuses to "diagnose" homosexuality. This isn't unique to Kenya. The lesbian communities in Zimbabwe and Uganda – where homosexuality is also illegal – have reported cases of corrective rape in an attempt to "cure" their homosexuality. Such acts often result in physical and psychological trauma, not to mention unwanted pregnancy and sexually transmitted infections. In Uganda, trans-women have been paraded before the media and the public while being physically abused in an effort to shame them and instill fear.

The implication of such "treatments" are not only physical, carrying risks of venereal diseases, but also psychological. When the risk of suicide among sexual minorities is already up to three times higher than the rate among the heterosexual population, we must be extra sensitive to how our actions may further isolate and harm the health of our fellow citizens.

Economic injustices also further harm the ability of the LGBTIQ community to access quality health services. A WHO report on transgender persons showed that the lack of recognition by governments of trans people – as is the case across Africa – particularly in the form of denying or delaying access to government issued identity documents, results in challenges in getting jobs, and in accessing bank accounts, education institutions and health services.

Despite progress in Kenya granting transgender people the right to have a legal name, some members of the transgender community continue to face challenges in accessing social or economic services. This means that they cannot get jobs, cannot afford to live in dignified neighborhoods and therefore live in slums and often engage in transactional and risky sex to meet their needs.

Universal Health Coverage - a priority for the continent and the WHO - cannot be achieved if our health system is impeded by laws that allow for discrimination. We must get rid of outdated laws and develop clear policies and sensitization trainings for our healthcare workers, so we can better support the LGBTIQ community. Such trainings could help healthcare workers communicate with gender neutral terms and maintain awareness of how their negative attitudes could affect clinical judgement. Subjecting *Evelyne to higher risks of suicide, substance misuse and venereal diseases is uncalled for and inhumane. Decriminalizing these laws will ease disclosure of sexual orientation and facilitate access to health insurance and healthcare services specific to each group.

Let's hope that the recent decision in Kenya this week represents the start of a new shift for Africa.

*Evelyne's name has been changed.

Stellah Bosire is the CEO of the Kenya Medical Association and a 2018 Aspen Institute New Voices Fellow. She Chairs the Board of the National Gay Lesbian Human Rights Commission of Kenya.  Follow her on Twitter at @Lasterbosire.

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