by Thuthukile Mbatha, Spotlight
June 2017 saw the launch of South Africa’s first Lesbian Gay Bisexual Transgender Queer Intersex Asexual Plus (LGBTQIA+) HIV Plan 2017-2022.
The plan, which was launched under the banner of the South African National AIDS Council, seeks to address some of the many issues affecting the various communities that are part of the LGBTQIA+ community, with all their varied and unique needs. However, nine months have passed, and still there has been no meaningful attempt to implement the plan.
Luckyboy Mkhondwana is the National Training Co-ordinator at the Treatment Action Campaign, and a long-time campaigner and advocate for the rights of the LGBTQIA+ community. He took Spotlight through the gaps that exist in the policy and its implementation.
Do you think that the Sexual and Reproductive Health Rights (SRHR) needs of queer folk are addressed in the public health sector?
No, there are a lot of gaps that need to be addressed. For instance, if a lesbian woman misses her period and goes to a public clinic to find out about the possible cause of the delay, she will be asked about the last time she had sex, and a pregnancy test would be done on her. This is unfair, and disrespectful to her sexual orientation.
Moreover, the judgement received by gay men when they go to public health clinics for screening and treatment of sexually transmitted diseases (STIs) discourages them from going back to the clinic when sick. For instance, if a gay man has warts on the anus, it is not easy to seek medical help, because some healthcare providers will judge him – especially since they are used to seeing warts on the genitals, not on the anus. This has led to many gay men living with untreated STIs. The only clinics that are sensitised to offer non-judgmental health services are the facilities that work with organisations such as the Anova Health Institute; which are not accessible to all gay men, due to where they are located.
Would you say the LGBTQIA+ HIV Plan 2017-2022 addresses the needs of queer folk?
I think the plan is a good document, full of promise – but there is no implementation. It has been nine months, but we have not seen anything on the ground. I am curious to know what they will report on, when it is time for review.
What should be the specific SRHR priorities for queer folk?
The LGBTQIA+I HIV Plan seeks to offer a core package of health services, and it includes confidentiality. However, that is not practised on the ground. If a trans woman visits a clinic, the healthcare providers usually call their peers to stare at the trans woman. They look at her as if she is in a circus, because she is wearing female clothes. There is a good chance that the nurse assisting the trans woman would disclose to his or her colleagues the reason for her visit.
The plan further suggests that the LGBTQIA+ community should have access to HIV-prevention tools; whereas in reality, only a few have access to tools such as Pre-Exposure Prophylaxis (PrEP). If one lives far from the Anova Health Institute centres, one cannot access such services.
There are no lubricants for the trans women and men who have sex with men (MSM) communities. These should be freely available in public health facilities, just as male condoms are easily accessible. A 500ml bottle of lubricant costs R85 or more in a pharmacy, and not all can afford to buy it.
One of the goals of the plan is to reduce HIV prevalence and incidence rates. It continues to highlight the importance of increased access to HIV prevention tools. However, it is very difficult to gain access to dental dams, finger cots and PrEP in the public sector, to protect against new HIV infections.
A dental dam, like a condom, is a barrier method. It is a thin, square piece of rubber which is placed over the labia or anus during oral-vaginal or oral-anal intercourse. Dental dams are most often made of thin latex rubber; however, for those allergic to latex, they are also available in silicone.
A finger cot is a ‘glove’ that covers only one finger. It is basically a ‘finger condom’. Finger cots are often recommended as a safer sex device for fingering.
Access to Human Papilloma Virus and screening is difficult for some lesbian women and trans men who have not gone for gender reassignment. When they go for a Pap smear test, they are asked why they require such services, because they are men. Healthcare providers judge them based on how they look. You may find that some had previously engaged in sexual intercourse with heterosexual men, meaning they too are at risk of contracting the two diseases.
In general, all service providers must be sensitised and taught how to address queer folk. The assumption that we are all either women or men is offensive. Gender non-binary groups are usually the victims of that offense.
An investment in mental health is key to the provision of SRHR, because the two are linked. There is a great demand for psychosocial support among queer folk, since they endure much discrimination at home, in their workplaces, and in their societies in general. A number of them engage in reckless behaviour, including substance abuse and casual sex, to numb the pain. This kind of behaviour poses a threat to their health, since it exposes them to the risk of HIV infection.
Lastly, the plan stresses the importance of recruiting LGBTQIA+ communities through peer educators. However, no recruitment has happened on the ground. Even when it comes to HIV testing, only the non-profit organisations visit LGBTQIA+ spaces to offer the services to them.
Can we say that all queer folk would have similar SRHR needs?
No, [the solutions to] our needs need to be tailor-made to suit each individual. Not every woman wants contraception; queer women need dental dams or finger cots, whereas a trans woman may need a lubricant. Also, the SRHR needs of one trans woman could differ from those of another trans woman, just as heterosexual women may have different preferred contraceptives.
What are the biggest challenges for queer folk trying to access health care in clinics and hospitals?
Stigma and discrimination prevent a lot of people from accessing healthcare services. This is the major barrier for queer folk.
What would you change tomorrow if you had the power, in terms of SRHR for queer folk?
I would ensure that the individual SRHR needs of queer folk are prioritised – I wouldn’t assume that a one-size-fits-all approach will work. I would ensure that healthcare providers are properly sensitised, and that I would be able to go to a clinic and get everything that I need, without fear of being judged.
What is TAC doing to address the SRHR needs of queer folk?
We have an LGBTQIA+ sector in seven provinces. We have been struggling to get funding for LGBTQIA+ advocacy work; however, we have incorporated LGBTQIA+ work in most of our work and campaigns, including treatment literacy programmes. Funders prefer funding service-provider organisations, because they can quantify how many queer folk they have reached, recruited and assisted; whereas advocacy is hard to quantify.