By Neela Ghoshal, HRW
"In short, we are dying," Victor, a 25-year-old gay man in Tanzania, summed up his story when we spoke in mid-2018. He had just outlined the litany of measures Tanzania's government had taken to deny lesbian, gay, bisexual and transgender (LGBT) people the right to the highest attainable standard of health – a right guaranteed to all under African and international law. "Because of government," Victor said, "LGBT people don't have a place to get training [on sexual health]. People don't get lubricants, they don't get condoms, they don't get services."
Victor was not exaggerating the impact of Tanzania's deliberate crackdown on LGBT people, which began in 2016 under the administration of President John Magufuli. Another gay activist reeled off names of several trans, gay, and bisexual Tanzanians who he said had died from HIV-related causes in the course of a year. The crackdown, he said, led some HIV-positive LGBT people to stay home, afraid to venture out to health clinics to pick up medication – especially trans women, who face particularly high risks of arrest, violence, and discrimination.
Human Rights Watch published a report on February 3 on Tanzania's anti-LGBT crackdown and its impact on the right to health. While Tanzania has criminalized same-sex conduct since British colonial times, we found that recent government policies have systematically dismantled a safety net that supported LGBT health as recently as 2015. Read more via AllAfrica
“If We Don’t Get Services, We Will Die”
Tanzania made international headlines in October 2018 when a regional official, Paul Makonda, claimed to have established a task force to round up all men suspected of being gay in the coastal city of Dar es Salaam, “test” them for homosexual conduct, and jail them for life. He called upon Tanzanians to send him text messages reporting anyone they suspected of being gay, and claimed to have received hundreds of such messages.
International pressure led the Tanzanian government to disavow the official’s comments. In a remarkable development given President John Magufuli’s demonstrable indifference to international opinion and the environment of hostility toward lesbian, gay, bisexual and transgender (LGBT) people that he has institutionalized, Magufuli affirmed in a meeting with World Bank officials that the government would end “discriminatory actions related to harassment and/or arrests” on the basis of sexual orientation.
Makonda’s threats did not bear out, but institutional homophobia continued to reign. In April 2019, with disregard to both freedom of association and the right to health, and in clear demonstration of Tanzania’s institutionalized homophobia, the government formally deregistered Community Health Education and Advocacy Services (CHESA), one of Tanzania’s most established organizations working to advance health and rights for LGBT people. The government reportedly accused CHESA of “promoting unethical acts.” In September 2019, the deputy home affairs minister called for arrests of LGBT people, in direct contradiction to the government’s commitment.
One of the most significant casualties of the government’s overt hostility to LGBT people is the right to the highest attainable standard of health, guaranteed under international treaties that Tanzania has ratified. Even in comparison to other countries that criminalize same-sex relations, Tanzania has become an outlier in its efforts to render LGBT-friendly health services inaccessible.
Until 2016, although same-sex conduct was criminalized, Tanzania’s health sector acknowledged and made some efforts to address the specific vulnerabilities of men who have sex with men and other groups considered to be “key populations,” meaning that public health initiatives should take particular efforts to address the needs of these groups as part of their national HIV prevention and treatment efforts. Government bodies included gay men and transgender people in discussions around HIV prevention and treatment. Tanzania’s overall approach to HIV and AIDS was considered largely successful, due to the fact that it was evidence-based and relatively inclusive.
In contrast, since 2016, the Ministry of Health has prohibited community-based organizations from conducting outreach on HIV prevention to men who have sex with men and other key populations, based on the pretext that such organizations are engaged in the “promotion of homosexuality.” The Ministry closed drop-in centers that provided HIV testing and other services to key populations, run in many cases by international agencies, asserting that these centers, too, were involved in “homosexuality promotional activities.” It banned the distribution of lubricant, an essential HIV prevention tool for key populations and for much of the wider public, including post-partum women.
The Health Ministry asserts that public health centers in Tanzania provide discrimination-free services to LGBT people and key populations and that there is no need for specialized services run by civil society organizations. Human Rights Watch research has found, however, that discrimination on the basis of sexual orientation and gender identity in government health centers is common.
The authorities have also undermined the right to health through a series of police raids on meetings and trainings organized by health and rights activists and their allies, arresting participants, including foreign lawyers, in an effort to silence and instill fear within activist communities as well as service provision groups and their beneficiaries. Among the activities shut down by police have been HIV education sessions, leading LGBT people to fear attending these potentially lifesaving workshops.