Rainbow Platforms, Monochrome Regimes

From originating couples’ testing a standard of care to initiating HIV vaccine research in Rwanda, PSF has a habit of breaking ground.  I guess it shouldn’t be a surprise that Rwanda’s first-ever survey of MSM* was also conducted by PSF just this past year.  I’m beyond excited.  While I’m not directly involved in the MSM study, I’m extremely proud to be working with an organization that is engaging with LGBTQ health in Africa.  It’s a difficult subject, one fraught with political peril, and something I’ve been interested in since I was undergraduate.

In the countries surrounding Rwanda, same-sex sexual activity is punishable by several years’ imprisonment, life imprisonment, corporal punishment, or death.  By contrast, the Rwandan government has not created any legislation explicitly criminalizing homosexuality.  Instead, the official policy is one of complete denial.  When PSF approached the Rwandan Biomedical Committee with their proposal for MSM research, they were given permission to proceed, but they were also laughingly told that they wouldn’t find any MSM in Rwanda.  Since then, more than 1,000 men have been interviewed and about 400 study participants have been enrolled. The goal of the study is just to get a handle on MSM networks and health behaviors while providing STI testing and some basic health services, but it will serve as groundwork for broader initiatives in the future.

I knew the study was going on but I didn’t meet the MSM research team until just last week.  The founder of PSF arrived from Zambia to check on our progress and brought with her a young man I’ll refer to as David.  David is a Zambian activist for LGBTQ rights.  He works with an NGO that promotes LGBTQ health and supports what he referred to as the “rainbow platform,” candidates who run for public office in Zambia with the explicit intent to de-criminalize homosexuality nationwide.  The night he arrived we all had dinner – him, the MSM study team, the founder of PSF, several other senior staff, the other summer interns and myself – and we talked uninhibited about our mutual ambition to bring the issue of LGBTQ health to light in southeastern Africa.  As Peace Corps Volunteer, I sat on my opinions about homosexuality for fear of alienating myself from people in my village.  Talking to David, I felt as if five years’ worth of weight was being lifted.

Before leaving PSF the following Thursday, David made a small speech to express his thanks.  He said he had come to Rwanda to learn how PSF is engaging with the issue of LGBTQ stigmatization and persecution and that he is excited by the work we are doing.  He said, “In Africa, many people think that the HIV epidemic can be stopped by simply treating members of the ‘general population’ – the heterosexual population – and that the rest of us can be ignored because we are a minority. But the situation is more fluid than that. There are married men who are also members of our community.  There are people who move in and out of our community.  We are not an isolated group – we are part of the population too, and if you don’t attend the needs of MSM and other LGBTQ people, you may as well do nothing at all.”

I couldn't have said it better.

*MSM stands for “men who have sex with men.” While the terms “gay” and “homosexual” may be commonplace in the U.S., such terms carry little meaning in countries where homosexuality is neither condoned nor acknowledged, and where gay culture and networks remain thoroughly underground.  Furthermore, in public health research, sexual behaviors often take primacy over how a person identifies because behaviors directly cause things like the transmission of HIV.