In the face of these hostile conditions, advocacy organisations are working alongside MSM communities to support men who have sex with men through free HIV and STI testing, psychosocial support groups, and HIV care and treatment programmes. They are also working to address policy barriers at the regional, national, and subnational levels. These barriers range from the national laws that criminalise same-sex behaviours to policies that guide the operation of local health clinics. Addressing these barriers and advocating for policy change alongside impacted communities is the only way to achieve meaningful and lasting change and to ensure that MSM’s rights are respected and that they have access to the healthcare and HIV-related services they need.
In 2013, African Men for Sexual Health and Rights (AMSHeR), partnered with the United Nations Development Programme (UNDP), the Southern African AIDS Trust (SAT), and the USAID-funded Health Policy Project (HPP). The partnership implemented a regional project in seven countries(Ghana, Malawi, Tanzania, Zambia, Togo, Cameroon and Mozambique), throughout sub-Saharan Africa to increase access to healthcare and HIV-related services among men who have sex with men (MSM) through policy advocacy named UTETEZI (meaning advocacy in Swahili), the project focused on partnerships to maximize resources for advocacy purposes, coordinate advocacy strategies, and harmonise advocacy activities with the following aims:
- To increase and strengthen capacity for MSM and lesbian, gay, bisexual, transgender, and intersex (LGBT)– focused advocacy for policy change at the regional, national, and subnational levels
- To develop and sustain relationships among government, healthcare providers, and civil society organisations to work together to improve access to HIV-related social services through policy development and eventual implementation, as well as other policy-related activities
- To strengthen the capacity of MSM/LGBT organisations to devise and implement results-oriented advocacy initiatives for policy change
- To increase knowledge and expertise among MSM/LGBT communities to strengthen capacity on health and rights programming.
Throughout sub-Saharan Africa, stigma and discrimination have led to increasingly hostile environments for men who have sex with men (MSM). In many places, stigma and discrimination toward MSM have not only become social and cultural norms, but have been legitimised by regional, national, and/or subnational policies. Of the 76 countries around the world that criminalise same-sex sexual behaviour, 35 are within Africa (ILGA, 2015). These laws and other discriminatory practices and policies force an already marginalized community further underground, threatening their human rights, limiting their access to health services, and increasing their risk of sexually transmitted infections (STIs), HIV, mental health conditions, poor nutrition, and other health-related disparities (Population Council, 2014). Among other offenses, MSM throughout sub-Saharan Africa report arbitrary arrests by law enforcement, physical violence, and denial of health services, housing, and educational opportunities (Population Council, 2014).
The UTETEZI Project’s work led to the formation of advocacy working groups in seven countries; identified of more than a dozen policy areas to address, ranging from the ministry level to the organisational level; HIV and healthcare access issues, trained key stakeholders in policy and advocacy, developed local policy advocacy frameworks and ultimately led to the, formation of a broad-based coalition of allies to advance policy related to MSM health through advocacy efforts.
These Advocacy working groups supported the implementation of the policy interventions that were identified—interventions informed by community-based directives and international guidelines and best practices. While progress on some policy issues can take years to accomplish, these initial efforts have proven to be important factors for future change.
The UTETEZI Project is just one example of how global and regional stakeholders can work together to make a difference at the country level. Its uniqueness lies in the breadth of partners the approach seeks to engage and its focus on bottom-up advocacy for policy change:
Diverse stakeholders: UTETEZI encourages advocates to expand their circle of stakeholders, seeking out nontraditional allies who are advocates for similar issues, such as women’s groups or sex workers. By combining efforts and forging relationships that have a broader impact on communities and policy, advocates are able to increase their leverage and influence. UTETEZI also emphasises the importance of building advocacy for policy change campaigns from local actors.
Nothing about us without us: At the center of the UTETEZI approach is the inclusion of affected communities from the outset of any advocacy for policy change. The UTETEZI Project conducted a series of community dialogues where MSM; lesbian, gay, bisexual, transgender, and intersex individuals (LGBT); sex workers; and other stakeholders identified issues, and then worked together to prioritise those issues and make recommendations on how to address them. No one knows the community needs better than community members!
Informed interventions: The UTETEZI Project encourages advocates to develop interventions informed by international guidelines and best practices, community-based directives, and the experiences of local and regional allies.
Based on the UTETEZI Project curriculum, Advocacy for Improved Access to Services for MSM: A Workshop Curriculum for a Multi-Stakeholder Policy Advocacy Project, this advocacy for policy change guide is designed for use by MSM groups, community-based organisations (CBOs), civil society organisations (CSOs), and individuals working in HIV and MSM health to help them advocate regionally, nationally, and locally for improved HIV and health-related MSM policies. In particular, this guide can serve as an important tool for CSOs working on MSM issues in hostile legal environments.