Why gays have problems with health care in Africa

Providing prisoners, sex workers, adolescents and men who have sex with men with sexual and reproductive health services has been advocated by the World Health Organisation and the United Nations and several other international bodies. As a result, most national governments have heeded this advice and cater for these groups, known as key populations.

In Malawi men who have sex with men can access healthcare services but they do not always get adequate treatment, care and support.

In Malawi men who have sex with men can access healthcare services but they do not always get adequate treatment, care and support.

One critical part of accessing quality and effective sexual and reproductive health services is to strengthen HIV prevention and to provide everyone with access to HIV treatment, care and support.

But, in many African countries, knowledge to guide HIV programming for men who have sex with men is only just developing. And when there are guidelines, the services are not always available. This means that many people in these key populations do not get the services they need.

Mixed messages

The Malawian National HIV Prevention Strategy specifically acknowledges that these populations must be targeted in its HIV programming. But homosexuality is still a crime in the country. And even though there is a moratorium on criminalising male-male sexual relationships, men who have sex with men have difficulty getting access to health services.

Tanzania also criminalises homosexuality. It has nevertheless started to implement different harm-reduction HIV interventions for key populations, including men who have sex with men. An estimated 15% of men who have sex with men are HIV positive in the country. The figure is double in the country’s capital Dar es Salaam.

The figures are similar in Malawi, where the crude HIV prevalence is 15.4%. Just over 90% of the HIV infections were reported as previously undiagnosed.

Inconsistent services

Several studies on men who have sex with men have been done in Malawi and Tanzania.

One in Malawi reflects the negative general public attitudes towards these men. Many of the studies also show that stigma and discrimination are common.

The research shows that there is still a low uptake of HIV prevention and health services among these men. They fear seeking health services and disclosing their sexual orientation because of discrimination. Another study, which corroborates this, shows that only 9% of men who have sex with men in Malawi disclosed their sexual practices to a health care provider.

Our study shows that only 18% of the men who have sex with men that were interviewed said they were exposed to HIV prevention messages that were relevant to them.

While some men are aware of the HIV risks, they believed that within their wider community there is a general lack of HIV information for men who have sex with men, low awareness of the appropriate prevention and low perception of risks related to HIV infection.

Although health workers said they provided services to everyone without regard of sexual orientation, the men interviewed in our study said they experienced constrained access to services.

Health care providers themselves face a number of challenges. One is their concern about adverse repercussions if they provide services to men in same sex sexual relationships.

Another is that they lack awareness. We asked health workers how capable they were at establishing the sexual history of their patients. This would include asking questions about a person’s sexual orientation and sexual practices so that they could better understand the individual’s risk and what clinical care was needed. This was clearly an area of great difficulty.

Our experience as a medical school testifies that our graduates may not be ready to take down the sexual history of their patients in a nonjudgmental way. This clearly will have an impact on their ability to provide sexual reproductive and health services.

This observation is anecdotal and more work is required to quantify the extent to which this a major limitation in clinical management. We will be doing more research into:

  • What affects these men from accessing the health system?
  • How can the systems and access be improved?
  • What interventions exist and how can they be used in the two countries?
  • What is the best way to communicate with these men?

Conducting a similar study in Malawi and Tanzania will allow the researchers to cross-fertilise their expertise and share the lessons learnt, which would strengthen the findings.

  • Adamson S. Muula is Professor of Epidemiology and Public Health, University of Malawi
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51 thoughts on “Why gays have problems with health care in Africa”

  1. wasoka says:

    zopusa ndinso za nyasi.mwamuna ndi mkazi otsati mwamuna ndi mwamuna nzake thats rubbish.a malawi tiyeni tisunge chikhalidwe ndinso tiziphemphera .tikayang’isisa ku mayiko kumene akulimbikitsa zimene ayi sapemphera.

  2. Lettuss says:

    Seriously, I hardly find a suitable term through which I can describe the Idiocy of this calibar.. U mean a normal human being can sexually desire a fellow of the same sex. Imagine how rough, rigid & hard the skin of my fellow man is..Just a minute, think of kissing thick lips of mphongo inzako with beards & moustache around them….damn!!!! so disgusting.
    Ladies…how can u feel foreplaying with a fellow then ending up with a sex toy just to get aroused. The presence of those toys & vibrators shows how desperate u are for that natural stuf in men’s trousers. Stupidity to the maximum. Its natural to have sex with someone of opposite sex not otherwise.
    Even brainless ants and butterflies knows the truth of sex & they know to distinguish between males from females among themselves. Nde kuli bwanj munthu. Let the azungus do it coz they r used to that foolishness & all they want is to bringforth this nasty act through gradual human rights teachings hence brainwashing many. If its poverty let it be than indulging yourself into soldomy. I cry for U Africa in general & my Malawi in particular.

  3. Akazi Ndi Amuna Mdziko Lathu Ambiri Ndi Akazi,osakwatira Mwamunamzako Ayi ;osangokwatira Akazi Khumi Kuti Chibaba Chitheretubwa? Akazinso Nanu Amuna Tilipo Pangani Timagulu Nkumupeza Dolo Ngati Ine Nkukatira Nonsenu,

  4. Munthu says:


  5. malili says:

    Kodi iwowa akupanga zopusawa anabadwa kuchokera kwa mamuna ndi mamuna???? Owerenga mau watchout nthawi yatha. Matsoka ena pa malawi pano mukutipatsa ndinu mukutsutsana ndi mau a Mulungu, nchifukwa chake Mulungu wayan’gana kumbali wangoti asiyeni A mathanyulawa tiwaonere sinanga woyamba ndi President amene. Komatu amene tili Akhristu ochepafe tisatope!!! Abraham anamufunsa mulungu kodi mutapezamo anthu 50 okha olungama mudzaonongabe Mulungu anati ayi…. Ochepa lets pray hard for our Nation God always punishes the weaked.

  6. Isaac says:

    I am suprised as to why the so called Dr who wrote this article for his own gain while promoting the satanic agenda in the name of human rights married a woman and even why his father married his mother isn’t that a reason enough for him to know why this malpractice is not a welcome move in Africa? why is it that your sisters got married to brother in law ? Men shame on you Dr. Did you send a copy of this nosense to your father? what was the comment or the complement like? learn from him it seems your head is just a big box carrying a very small brain……… Educated salvage

  7. chinkombaleza gumanyundo gowa says:

    Izi zimandinyasa ndipo sindifuna kuzimva. why did God created a woman instead of another man? He had a purpose which we need to fulfill. Read Romans Chapter 1 from versus 18 to the end of the chapter. You will learn more about the wrath of god on these matters.
    God have Mercy.

  8. Atate says:

    take a serious care on this.

  9. kondwani says:

    If Malawi was able to assist nachipanti in hospital…. Men having sex with men are most welcome in this country…… Hands up Malawi…. The boma shud move towards orientation and training of front line health workers on specific health needs of these men

  10. gilbert says:

    why posting such phonographic pictures to the public? you want every one to see including our young ones. what are we building in our children? our country was not like this in the old times. our forefathers were laying a good foundation for us but we are destroying it with these unnecessary pictures which put our young ones at risk. let us put technology into good use so that we shape our children into good and responsible citizens. may the good Lord protect us and Lead us into Hi s direction.

  11. Kabilaboza Kabuka says:

    kodi pachithuzipa mwanakazi ndi yuti? shame on you all gays and those who support you

  12. GAMAH says:

    Ine agalu amenewa nde akundikwana bwanji nanu anyasa Times muziwona zolemba plz!!!!!! Mutisanzitsa manyi anuwa akununkha …………….Shit!!!

  13. zautsilu basi….nyasi zanuzo komweko

  14. julius phiri says:

    Anthuwa sauzidwa chilungamo munthu ali mabowo 7 ndipo mabowo 5 ali kumutu kwamuthu mabowo 2 ndimaliseche ndipo bowo lililonse la maliseche lili ndi tchito yake lina limatulusa zonyasa za mimba mwamunthu ndipo sitingalowesepo maliseche athu pokhapokha ngati tikudwala misala maliaeche amwamuna ali ndi malo ake chimodzimodzi maliseche amkazi sopano asamapusise anthu

  15. wakulu says:

    Bible is alredy said about dat!

  16. tk says:


  17. Modicai Longwe says:

    Ngakhale nsima imakoma ndi ndiwo osati mgaiwa wokhawokha. Akazi onsewa akuchita kusowa amuna basi nkumalimbana ndimathanyula. Zopusa. Sindinamvepo kuti ma gay apatsana mimba. Olo kumva kuti mwamuna wina ali ku marternity.

  18. Ernest says:

    Men, you must not have sexual relations with another man as with a woman. That is a terrible sin. Leviticus 18;22

    That’s taking God’s silence for granted.

    Mutipweteketsatu guys.

  19. Macdonald says:

    Makondamakonda chitsiru chidakonda umve, Munthu adakondanso za umunthu.

  20. ojere says:


  21. Kelvin says:

    Anthu awa akipodi ithink ndi olumala azibwera kuchipatala uthenga wa hiv palibe sakudziwa.mwana wa 8 yrs talks about it. Ngati amathanyula sadziwa za izi it is by choice.

  22. gontomois says:

    ISIS please come and behead this mother fucn bustards, oh nooooooooooooooo, cant belive my eyes!!!!!!!!!!!!!!!!!

  23. Mbuya says:

    To kiss ur fellow male or women ndi nyasi i cant do dat

  24. Mbuya says:

    Thats in human mmene imakomela ndiye uzikalowetsa kumabi

  25. nyamayaphwisa says:

    To hell with this, how can you enjoy sex without a vagina, How can you enjoy sex without a pennis? Truly this is bullshit , cant you think why God created this organs for,

  26. Nankununkha sadzimva says:

    Professor, the study found that homosexuals are given wrong information on HIV prevention. Would you mention the exact wrong information . My understanding is that at this stage the health professionals and other outlets such as media have managed to disseminate HIV prevention messages, using various means, which are basically about avoiding contact with bodily fluids especially with open skin/mucous membranes Does this messages segregate? I choose to differ. I may want to read your study design.

  27. Mulungu polenga Adam ndi hava adali ndi cholinga

  28. Sarah says:

    A brave and valuable study – I applaud it. Why this hatred of homosexuals in this country? The bible tells us that infidelity is wrong and people don’t seem to mind that there is plenty of that around!

    ‘Let marriage be held in honor among all, and let the marriage bed be undefiled, for God will judge the sexually immoral and adulterous’. Hebrews 13: 14

    Everyone deserves access to healthcare.

  29. ZIKWI says:


  30. Mtumbuka says:

    let us castrate these dogs first,, then kill them all because they dont deserve to live on earth

  31. Bandawe says:

    Let them die if they don’t care, which support will they need with their pervert way of life.

    Let them beggin to think like human beings they will know that the woman private parts were created for their private parts not what they do.

  32. Yaya kumudzi says:


  33. Austin says:

    Bull shit!

  34. Time will tell says:

    Wameta zindevu kwambiriyo kukhala ngati nde mamuna pa dual imeneyi. Ngati pali gay wina ntafunsako kodi kodi ogonedwa nawe umamva kukoma kuthako? Kapena akamaliza wina mmasinthana kuti nawe uzikeko?

  35. ma-gay amandinyans says:

    Chotsani ziwandazi- bwezeranipo picture ya Miss Asedi ndi wokongola. Awa akundinyansa ine

  36. kudya says:

    Wats the point in the story?zausilu basi

  37. komko says:

    A Malawi chonde konyerera nkonyetera basi sukungasanduke kokodzera Chifukwa choti azungu atipatse ndalama.

  38. komko says:

    Inu musatinyase mayo nkhani imeneyi.Mulungu salalenge anthu ngakhale ziweto kuti zizikwatana konyerera. This is not an issue please. Anthu awa akudwala. Mentally ill athandizeni moyenelera. Don’t promote their psychological sickness please.

  39. Souja says:

    Ummmh nyasi,kiss kapena kukutana mano..

  40. Here we go again says:

    Let them die we don’t need then in Malawi,men sleeping with men do you still call it sex? Hell no! That is sodomy, even God condemn such act, no issue

  41. Chilungamo says:

    IWE MULA NDI NYASANET osamsila ma photo anuwa. You are sending wrong msgs to our children. THANK YOU.

  42. Professor Dr. James Napwiri Phiri says:

    Professor Adamson Muula,

    Much as you have given preliminary statistics, your piece of work lacks conclusive substance.

    1. Preventive measures taken to prevent HIV/ AIDS between people of the same sex or even of different sex are not necessarily different. You still need to use a condom whether you are fucking a pussy or an ass hole. Sex remains sex regardless of any sexual orientation and measures must be taken to circumvent the transmission of virus.

    2. Globally, HIV has spread so rapidly through heterosex and not homosex

    3. 70% of HIV infection in the world is found in the sub Saharan region where homosexuality is not a common practice. This shows heterosex is the major method of spreading the virus.

    4. Oral sex has less transmission rate than vaginal or anal sex even among heterosexuals

    5. People are being brain washed that by legalising homosexuality, HIV infection will be reduced. No !!! The major reason that sub saharan region has high prevalence of HIV infection is because of POVERTY

    6. In developed countries, many people have unprotected sex and they are usually worried about STIs because they have all the resources to prevent and treat ailments.

    Professor Muula, here in Malawi, we train medical doctors and fail to employ them when we have a scarcity of medical personnel. So the priority is to legalise homosexuality!! Priorities upside down. To hell with mathanyula government

  43. Mzungumbuli says:

    Izi zikuyenela kuchitika m’masiku ano otsiriza, koma tsoka kwa iye wokwanilitsa malembawo.History repeats itself, it was the same thing even during the time of Lot, anthu anakwatira ndipo anakwatiwa koma onse anatha pysiti. Chitani zimene mufuna koma mau a Mulungu sazapita pachabe. Truth will remain Truth even if rejected by many. Evil will remain evil even if accepted by many

  44. malawi says:

    Malawians what kind of punishment do you want from God for you to stop these monster like behaviours?

  45. Michael Simon says:

    Thank you, Adamson. Can you make your research available to religious leaders like Zac Kawalala and others who are against the idea of government providing health services to this group?

  46. Arthur says:

    Stupid Doctor, there are many people suffering from serious diseases and not awa amene amachita kufuna kudwalawa. Akudziwa okha kuti umathanyula ndi ufiti koma iwo basi mutu peyapeya….zautsilu! Tiyeni tithandize azimayi amene akudwala cancer osati zautsilu izi, Sodom di Gomorah

  47. mtate mike rsa says:


  48. This total madness why africa

  49. Rodgers Banda says:

    This modern system of men-to-men sexual immortality is only for few mentally disturbed humans and descriminating them in all sectors is not sin. There no society on face earth that supports such indecent act.
    This accepts anything one need to do provided it is accepted by community in conjunction with government. Is this indecent act accepted in our communities? Noooo! Such people should be treated brain abnormalities as well.

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