amfAR, The Foundation for AIDS Research

Center for the Development of People (CEDEP) – Malawi

Performing advocacy and outreach to improve healthcare and HIV prevention for GMT

“Same-sex relations are criminalized and highly stigmatized in Malawian society, resulting in MSM being forced to remain ‘invisible’ or ‘underground.’ Although HIV prevalence is high amongst MSM, criminal law prevents health services from meeting their particular needs. But CEDEP has achieved positive results through its advocacy work. For the first time in the history of HIV/AIDS in Malawi, The National AIDS Commission wants to support MSM HIV/AIDS peer education programs. And MSM are now included in HIV/AIDS national policy documents.”— Gift Trapence, director of CEDEP

Strategies:

1. Train peer educators to perform mass outreach to educate GMT about sexual health and HIV

2. Advocate for the rights of sexual minority groups in Malawi

3. Educate healthcare providers about GMT-specific health needs and improve GMT’s access to care

4. Perform bio-behavioral research that informs the program outreach and advocacy efforts

5. Distribute condoms and lubricant

CEDEP client learns about HIV prevention.jpg
A CEDEP client learns about HIV prevention. (Photo: Tachman)

The Center for the Development of People (CEDEP) was founded in 2005 to address the needs of sexual minorities in Malawi, where same sex sexual  conduct is illegal and where, according to a 2009 report by the U.S. Department of State, “34 percent of gay men in the country had been blackmailed or denied services such as housing or healthcare due to their sexual orientation.”  No large-scale studies have been completed to assess HIV rates among GMT in Malawi, but in 2008, CEDEP performed a study among 200 MSM in the city of Blantyre. Twenty-one percent of the participants were HIV positive—approximately double the rate among the general population—and 95 percent did not previously know their status. The men also reported low and inconsistent condom use, little knowledge about how to protect themselves from HIV, and a reluctance to reveal their sexual orientation to healthcare staff for fear of discrimination.

That year CEDEP began receiving amfAR funding to develop the country’s first GMT peer education program and its first program to educate healthcare providers about GMT-specific health needs. A follow-up study in 2012 in Blantyre— where CEDEP has performed extensive outreach among both GMT and healthcare providers— reported that the HIV rate in MSM had dropped to 12.5 percent, that 56 percent of the respondents had been tested for HIV, and 24 percent had been tested more than once in the past year.

amfAR has not only funded CEDEP’s outreach programs, but also contributed to the organization’s advocacy  and leadership efforts through advocacy training sessions.  When CEDEP began its advocacy work, the Malawian government refused to perform HIV outreach targeting GMT, arguing that the GMT population in Malawi was statistically insignificant and that GMT HIV needs did not differ from the needs of heterosexuals. And the frequent arrests of GMT for their sexual orientation caused GMT who were aware that they were at risk to fear seeking the HIV care they needed. In December 2009, a young GMT couple was arrested for “unnatural acts” after holding an engagement party.  They were sentenced to 14 years hard labor. Although its offices had just been raided and shut down by the police, CEDEP began advocating for the couple’s release, eventually garnering international attention and support. In 2010, after meeting with the Secretary General of the United Nations, President Bingu wa Mutharika pardoned the men “on humanitarian grounds.”

In 2012, thanks in part to CEDEP’s efforts, President Joyce Banda suspended the laws criminalizing homosexuality. The government then began using research performed by CEDEP to justify officially including GMT in its national HIV strategy and is currently funding the first ever national population study of GMT , which should greatly improve the ability to understand and address their health needs. “Where there is credible data from research, it is very easy to advocate and achieve results,” says Trapence.

Today, the arrests have stopped and CEDEP has five offices open in cities across Malawi, where it focuses its outreach efforts. CEDEP’s peer educators also use mass text messages and social networking to extend their reach to more rural areas. CEDEP reports that the uptake of condom use and HIV prevention knowledge amongst GMT has been high and that healthcare providers in the cities of Mzuzu, Blantyre, and Lilongwe have been effectively trained about the health needs and rights of GMT.

However, the law criminalizing homosexuality still stands and Trapence cautions that the President’s suspension of enforcing it “is just temporary relief.” Advocacy must continue to push the government to actually repeal the law. “MSM are still afraid of the discriminatory laws and this affects their visibility and ability to access the health services,” he says. “The suspension of the law depends on the good will of the government, and the law can still be applied if that good will is not there.”