Sunday, November 27, 2016

Tanzania, HIV and Gay men, what is happening?

What is happening in Tanzania?

That question has been late coming to me. Not been paying lots of attention. But, there are some very serious developments.

First thing that I heard was that some HIV prevention programs were being suspended. From a Reuters flash...., on 01 Nov 2016
“Tanzania has suspended community-based HIV/AIDS prevention programs for gay men, the health minister said on Monday, in the latest crackdown on the high-risk group. Ummy Mwalimu, Tanzania’s minister for health said the government had received reports that some local non-governmental organizations (NGOs) were promoting and normalizing same-sex relationships as part of their HIV programs. Gay sex is illegal in Tanzania and punishable by up to 30 years in prison…”
Of course gay sex is illegal in Tanzania. So is sex work. So is the use of injectiable drugs (Injection drug use), and of course, gay sex is not allowed in prison, where we drop human beings and tell them, see, you are now prisoners. For the next 20 years of your life, you are not supposed to have sex. No dreaming about it, no contact, no nothing. Because you are now prisoners...., see?

Seriously, we have had this debate since the beginning of the HIV epidemic. And, it is very important in a country like Tanzania. This is what the Wikipedia page on TZ and HIV says.
Tanzania faces a mature, generalized HIV epidemic. In 2011, an estimated 1.6 million Tanzanians were living with HIV/AIDS, with 1.3 million being age 15 or older. Based on 2011 data, AIDS has resulted in an estimated 1.3 million orphaned children.

Overall, the survey found that 5.1 percent of those tested were HIV positive. 
6.2 percent of women were HIV positive, against 3.8 percent of men. 
Such surveys are great. They give us an overall picture of the epidemic. Who is affected? How are they affected? How good or how bad are they able to access services?

But, there is a huge problem with them. Certain people will not tell you who they are....., simply because, as the reuters article points out, 
Gay sex is illegal in Tanzania and punishable by up to 30 years in prison…”
 So, although we know that HIV spreads by sex mainly, we are actually not going to ask people whether they have anal sex, or sex with men. We just assume that everyone has sex heterosexually (i.e, forgiving my bluntness for the sake of clarity, by putting a penis into a vagina)...., which of course is impossible. Gay people do exist on this earth. And, whether we do like it or not, they fall in love, or lust, and have sex with each other.

And, who will ask, in a country where prostitution is stigmatized and punished, whether one is a prostitute? And which sex worker is going to answer in the positive? Seriously?
Or the injection drug users? For goodness sake, they will not answer! Especially when you can potentially arrest them.

It was realised very early on in the epidemic of HIV, that there were certain populations which were hugely stigmatized, and very likely to have HIV and of course have HEAVY burdens of the virus. And, these populations were not going to be 'touched' by moral, lovely, cleaner than a white sheet HIV prevention and treatment programs. 

Anyway, despite this constraint, scientists and doctors, negotiate with the government so that they do studies like these. So, it has already been found that;
  • 34% of people who inject drugs in Dar-es-Salaam are HIV positive (against the 5.8% national average) 
  • 31.4% of Female sex workers (DSM) against the 6.8% avg of women in the country. 
  •  12.4% of men who have sex with men in DSM compared to 3.8% of men, nationally.
 The World Health Organisation calls these groups Key Populations in HIV. They are there. They will have the greatest burden of disease. And of course, it is hard to do something in HIV prevention amongst them, just like in other populations. That is normal....., or, it is usual, in Africa, and all over the world.

Problem is...., science is like HIV. The virus does not discriminate. In a population of all Tanzanians, the weakest link is the Key Populations. So, you cant control HIV in all the other populations while forgetting the key populations. So, you have to bite the bullet. 
The politicians have to be educated. The medical doctors have to be told the facts of life, and to put aside the 'morals'. The churches, and the mosques, they have to be educated also. Because HIV doesnt discriminate, and it is better to make sure that the sex worker is having safe sex, is protected from HIV or is under treatment, than start treating the 'innocent' child that is born by the sex worker.

But, for a very long time, a very long time, that is the way that we have acted. 

We so stigmatise certain individuals..... gay men, sex workers, prisoners, those who use drugs....., we actually just shrug our shoulders and say, they are to blame.....

And we forget our huge sex networks, and we forget that we might have sex with someone who was also in prison, or has sex with men who have sex with men..., or is a sex worker...

Just imagine, logically. Who do female sex workers have sex with?

Of course, they have sex with the upright standing gentlemen who drive by on the road and pick them up...., and then later go back to their church going wife.....!!!

Life is life. And what happens happens. HIV does not discriminate.

And, though we so griveously forget people in prison....., at least we try to give some of those like gay men, sex workers, drug users services..., and try to make sure that they have safe sex, safe drugs use, or even get treatment.


Because, protecting gay Tanzanians protects all Tanzanians in the long while.
It is a fact of life.

Protecting the vulnerable protects the whole population. 

And if we fail to protect the vulnerable....., the whole population is at risk.
So, Tanzania government, with its donors, has actually been giving HIV prevention and treatment to these populations. Because, as a government...., you take the broader view....

So, what has happened now?

We shall continue this....

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