Barriers to healthcare impenetrable for LGBT+ in Zambia

From a railway clinic, educating the community on LGBT+ health issues is as challenging as ever

Some of the barriers which have hampered access to health are discrimination, inequality and increasing unlawful detentions on trans diverse persons in Zambia from the LGBT+ community.

Zambia is on the path to achieving control of the HIV epidemic thanks to focused political commitment implemented over a decade. The key factors to epidemic control are numerous, including universal testing of high-risk groups, timely referral, access to quality prevention and treatment services, and linkage to and long-term retention in care. Achieving final epidemic control requires a coordinated and targeted approach that integrates the expected adoption of new World Health Organisation (WHO) treatment guidelines to treat all persons infected with HIV, regardless of CD4 count or clinical criteria.

However, further progress in Zambia is hampered by gaps in linking newly diagnosed persons to treatment, failure to retain patients on treatment, and ongoing sexual transmission. This is particularly true for young women. This also includes uniquely vulnerable parts of the population such as men who have sex with men (MSM) and commercial sex workers (CSW). Over half have not been tested for HIV, while HIV prevalence increased from 4.8% in girls who are 15-19 years old to 11.2% among young women who are 20-24 years old.

Community HIV care systems are critical for identifying at-risk populations, offering timely testing and referrals, and supporting adherence to treatment, but currently a chaotic patchwork of organisations offer testing without a harmonised strategy for linkage to treatment. This has resulted in frequent dropouts from the continuum of care. For instance, of the 151 000 new cases of HIV identified last year, only 59% were linked to care and only 52% initiated antiretroviral therapy (ART). In order to sustain epidemic control, there must be a seamless transition from community testing to prevention, care, and treatment systems.

Some of the barriers which have hampered access to health are discrimination, inequality and increasing unlawful detentions on trans diverse persons in Zambia from the LGBT+ community.

Trans diverse persons in Zambia have been oppressed and lack access to education, employment, housing and healthcare due to non-recognition of gender identity, legal environment, social norms and ultimately transphobic attitudes.

Addressing the health needs of trans diverse persons in Zambia is a contentious issue. Gender identity is not recognised causing these engagements to be regarded as same-sex relations – which are considered illegal. This results in efforts by government to provide services to this population to be seen as promoting unnatural acts.

In March this year the first ever facility-based healthcare sensitisation activity on harm reduction for gender minorities was held. This had a specific focus on HIV Prevention Messaging at a government facility. This was a unique event because as it was held under the radar. Even though it wasn’t publicised through traditional media the affected people from gender minority communities were free to come and test the facility’s services without fear of being stigmatised or discriminated against.

The approach was to invite 30 MSM and female sex workers to a peer-mobiliser meeting on the first day and they would each then invite 30 peers from their constituencies. The dialogue included how to improve protection, non-discrimination and no access to health services on the ground for members of the LGBT+ and sex worker communities. There was also conversation on how to better sensitise healthcare workers.

Railway clinic Sister in charge of providing information to community members

The meeting was stopped three times by officials from a special-branch government department.

An information session on how gender minorities can access healthcare services at the facility

Many challenges were encountered during this five-day activity. They were adamant that the session was promoting gay rights and wanted the participants arrested. They were unable to charge them because they were providing health education in harm reduction.

Stemming from this, the use of words like homosexual and sex workers were heavily censored throughout the activity, proving difficult to specifically address these topics. It’s also difficult to tell how inclusive the health services are going to be for trans diverse individuals if healthcare providers don’t acknowledge their existence.

Future opportunities were identified on how healthcare providers can work with the media to sensitise the general public to non-discriminatory approaches when it comes to providing health services. Further conversations were also conducted in meeting with local health authorities from the Ministry of Health on how to better create safe spaces within healthcare facilities for all LGBT+ persons and sex workers.




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