Mackenzie Schiff & Ron MacInnis - Jul 13 2023
Supporting HIV Services for LGBTQ+ Communities and Key Populations Globally

© Hussain Ibrahim/HP+

Sixty-nine countries currently criminalise same-sex relations, 33 of which are in Africa. In May, Uganda’s President and Parliament passed an act intensifying and further embedding the country’s criminalisation of same-sex conduct. In Kenya, a Member of Parliament recently proposed the “Family Protection Bill,” amplifying existing criminalisation of homosexuality. Mali’s government is proposing legal system reforms including enshrining in the constitution a definition of marriage as the union of “one man and one woman” and making homosexuality unlawful in the national penal code. We’re seeing a backsliding trend as governments propose and adopt laws that criminalise same-sex activity, the penalties for which can be as severe as imprisonment and even capital punishment.

World leaders including U.S. President Biden and global organisations such as USAID, UNAIDS, PEPFAR, and the Global Fund have stepped up to condemn Uganda’s decision and argued for the rights of LGBTQ+ individuals.

When the rights of the LGBTQ+ community are threatened, it directly impacts access to essential health services. The threat is dire for ‘key populations’ -- gay men and other men who have sex with men, sex workers, transgender people, people who inject drugs, and prisoners. Each person who falls under this description is particularly vulnerable to HIV.

Despite the tremendous global progress in reducing HIV’s spread, we must remain vigilant in engaging the most vulnerable communities to secure their continued access to care.

Globally, 70% of new HIV infections in 2022 were key populations. Every day, 4000 people become newly infected with HIV. HIV-related deaths are preventable—effective tools exist to prevent, detect, and treat co-infections that may be fatal, and 68% of people living with HIV in 2021 achieved viral suppression.

Even as challenges continue to emerge, important progress has been made. For decades, Palladium has supported governments and stakeholders to fight HIV by improving discrimination and stigma-free access to healthcare, educating clinic staff, and building partner networks to advocate for healthcare access and delivery for members of key populations.

Critical to our work in promoting HIV epidemic control has been a fundamental understanding that men who have sex with men, transgender persons, and all key populations need to be formally engaged in developing and leading evidence-based HIV policies and standards of care in their communities. There’s no need to reinvent the wheel. Instead, we work with existing advocacy networks and mechanisms to promote local ownership and long-term sustainability, which in turn allows for faster, more sustainable impact.

In Nigeria, for example, Palladium—via the USAID-funded Health Policy Plus (HP+) project—supported the Lagos State government to expand its existing health insurance scheme and include people living with HIV and key populations in the scheme. Critical to the effort was the Network of People Living with HIV, who worked with the State Health Insurance Agency to secure the release of 750 million NGN (US $1.6 million) through the state’s health care provision funds for poor and vulnerable communities. As a result, people living with HIV were able to enrol in the State health insurance scheme and receive free HIV and health services at their preferred “one stop shop” facilities.

“This work was monumental to strengthen equity, human rights, and public health in Nigeria,” says Palladium Director of Health Systems, Dr Frances Ilika, especially following the country’s 2014 passage of the “Same-Sex Marriage (Prohibition) Bill” criminalising LGBTQ+ behaviour. Despite stigmatizing policies on the one hand, "the country took a major leap forward in ensuring people living with HIV would get coverage for care.”

The USAID-funded EpiC project, led by FHI360 with core partners including Palladium, is also leading activities with civil society organisations supporting key populations in Mali. Through EpiC, funding from PEFPAR’S Key Populations Investment Fund enabled identity-based organisations (e.g., LGBTQ+ groups) to access funding to conduct their own activities and directly offer services to their communities, with the aim of expanding access to high-quality HIV services to those most in need.

As the rights of key populations, especially sexual minorities, continue to be threatened, public health professionals should re-commit to ongoing and future collaboration with national and local stakeholders to secure rights and extend access to HIV care for the LGBTQ+ community.

For more information, contact