Investigating the Impact of Human Rights Violations on Access to HIV Prevention & Treatment Services For Men Who Have Sex With Men in Africa
Background: Currently, there are 76 countries worldwide with laws criminalizing homosexuality, and nearly half of these countries are located in Africa. These laws are of particular public health significance because they incite stigma, discrimination, overt acts of violence, and a variety of other human rights violations towards MSM. The purpose of this review is to contextualize the extent to which criminalization of homosexuality and human rights violations impact access to HIV-related healthcare and risk for HIV infection among MSM in African countries and to compare these findings within and between the various regions of Africa.
Methods: One hundred twenty-two relevant research articles and reviews were identified through PubMed using four major concepts: 1) African Countries & Regions, 2) Sexual Identity & Same-Sex Practices (specifically gay, bisexual, and other MSM), 3) HIV prevalence and behavioral risks, and 4) Human Rights Violations and Laws Criminalizing Homosexuality.
Results: Reports of human rights violations experienced by MSM due to sexuality and same-sex practices in North, West, East, and Southern Africa vary by country, region, and occasionally presence and absence of laws criminalizing homosexuality. Collectively, this literature reveals a trend towards MSM experiencing human rights violations and being unable or afraid to access HIV prevention and treatment services, which likely accounts for low general HIV knowledge and perceptions of risk and numerous behavioral risks exhibited by MSM in every region of Africa. Laws criminalizing homosexuality also hinder health professionals and LGBT-serving organizations from providing HIV-related services to MSM. Most importantly, this literature reveals a growing body of evidence to suggest a strong correlation between HIV infection and MSM experiencing a variety of human rights violations.
Conclusions: Laws criminalizing homosexuality in Africa promote stigma, discrimination, overt acts of violence, and other human rights violations, which ultimately deter MSM from accessing HIV prevention and treatment services and put them at greater risk for HIV infection. However, decriminalizing homosexuality is not enough to increase access to HIV-related healthcare. A combination of social and legal reforms in addition to scale-up of MSM-specific biobehavioral interventions are needed to effectively change the course of HIV epidemics disproportionately burdening MSM in Africa.