MSM rarely access healthcare

Since 2012 some Zambian organisations have been championing for the provision of healthcare services for men who have sex with men (MSM). Many MSM community members avoid these services or health centres for fear of being exposed. MSM are usually vulnerable to rejection by family and community, stress and depression, and the abuse and misuse of alcohol – often because of this rejection. These factors are understood to compound risky sexual behaviour.

The year 2016 saw an influx in Key Populations Health Programming in Zambia by International Non-Governmental Organisations (INGOs). Meanwhile, small-scale and discrete referral systems between carefully identified and trained healthcare providers, and the existing few LGBT+ organisations have been ongoing. These local Community Based Organisations (CBOs) continue to advocate for healthcare access by different key population (KP) groups.

International and local organisations have been attending to the healthcare of LGBT+ communities on a referral basis. The number of MSM who seek healthcare services remain low, according to current statistics shared by an employee working with KPs in Lusaka.

At the time of going to press, three men who self-identify as MSM still think it is too risky to visit existing MSM-friendly health centres. The issue of perceived stigma and discrimination by healthcare providers remains a major hindrance to accessing and utilising health services as a self-identifying MSM in Zambia. Many prefer not to reveal their sexual orientation or sexual behaviour.

As a Key Correspondent Reuben Silungwe questioned the three about their approach to accessing healthcare services either as self-identifying MSM or under the camouflage of heterosexuality. *Sonny Siwelwa 27, *Boyd Tembo 25, and *Bwalya Mutale 22 share their experiences.

Reuben Silungwe: When did you last access sexual and reproductive healthcare services as a self-identifying gay, bisexual man or MSM?

Sonny Siwelwa: That is a difficult question to answer. One, because I do not access healthcare services as a gay man. I visit healthcare centres or VCT (Voluntary Counselling and Testing) stands whenever there is an outreach campaign in a particular area.

Boyd Tembo: It is impossible because my family does not know that I am gay. I look like any other man and so whenever I want to access (sexual and reproductive) services, I pretend to be heterosexual. You know what it means if you are outed by someone you do not know and even worse (someone) who knows you.

Bwalya Mutale: I never accessed healthcare services as a gay man because I did not know there were such services existed ‘til I asked for help from you (in December 2017). That was the first time I heard I could be attended to as a gay man without being exposed.

RS: Is it ever necessary to identify as a gay or bisexual person when accessing sexual and reproductive healthcare (SRH) services from any healthcare centre or outreach activity?

SS: I do not think it is clever to do so in our country. As you may know, it is illegal to be gay. If you are to tell the nurse or doctor that you are gay, you are simply asking for trouble.

BT: I agree with Sonny, I visited a clinic once in 2012 because I had problems after engaging in sexual intercourse. I tried not to reveal why I had problems in my bottom area (anus). I realised they were not going to treat me if I kept hiding. After they kept insisting I revealed all the information and finally told them the truth. But then they started scolding, verbally abusing and laughing at me. The good thing is that I was treated at the end. But I will never again reveal that I am gay in exchange for treatment. It was humiliating and embarrassing. I still blame myself.

BM: It depends as to where you go to access health services, like where you referred me to, everyone was ready to attend to me and I did not experience bad treatment. The staff at the clinic knew what they were doing. But then I know that those who go to government clinics may not be given the same treatment and attitude.

RS: How many times have you accessed voluntary counselling and testing? How important is VCT and STI screening in your health?

BT: Like anybody else, I think we cannot ignore our health just because we are gay men and fear being mistreated. We are also human beings and we can contract STIs like anybody. The problem is we fear too much and in my case, if I did not know you, I would have not gone to the clinic or hospital. I rarely go for VCT because I fear being mistreated if they find out I am gay or testing HIV+.

SS: I think now and then we engage in unprotected sex, so it is important to test often for HIV and STIs. In my case, whenever I go for VCT, I go there as a straight person. So whenever I am asked if I had sex with a female, I respond with a definite and convincing yes to avoid too many follow-up questions and risk exposing myself as gay. You know that it is illegal and the person asking you questions may report you to the police.

RS: Have you suffered from major stress or depression? How did you manage the condition?

SS: I am not sure but I think it is stressful living life as a closeted gay man. The fear of rejection and being exposed is an everyday reality. I have never asked for help because I do not think I have had depression.

BT: I do not think I have suffered from depression. From time to time, I feel low, I do not know if that is a sign of depression. I have also not been treated for being stressed or being depressed.

BM: I am currently recovering and relapsing into depression I think. My life is unpredictable. I get moody at times and feel very low. There is so much to think about as a gay man. The anxiety is real. I have never gone to clinic or hospital for this.

* The names of the local NGOs, CBOs and interviewees have been withheld for security reasons