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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vincent mthinda

fire up on babylon


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.

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… Read more »
Himwemwe malepa manda

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,




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.

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… Read more »
chinkombaleza gumanyundo gowa
chinkombaleza gumanyundo gowa

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.


take a serious care on this.


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

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