Hailed as a milestone in South Africa’s response to HIV, sexually transmitted infections (STIs) and tuberculosis, a national plan focusing specifically on lesbian, gay, bisexual, trans and intersex (LGBTI) people was announced last week.
The goal is to reduce HIV infections by 63% in LGBTI communities by 2022. It was included as part of the broader national strategic plan to run to 2022 and is meant to be a guide for HIV and STI prevention, care and treatment “for all members of the LGBTI populations in South Africa, inclusive of all sexual minorities”.
The development of the plan was spearheaded by the South African National Aids Council (Sanac), together with representatives of the LGBTI sector, government and civil society organisations.
“This has been 10 years in the making, so we are very excited,” said Sanac chairperson Steve Letsike. “This is not only talking about behaviours, but also addressing social and structural challenges.”
Health Minister Aaron Motsoaledi said that, despite progress, LGBTI people in South Africa are still stigmatised. The result is that, “more often than not”, members of the LGBTI community did not get the same attention when the country responded to HIV, tuberculosis and sexually transmitted infections.
“The LGBTI HIV Plan brings us closer to a world in which members of the LGBTI populations can realise their health and human rights in an environment that is affirming of their sexual orientations, gender identities and gender expressions,” said the minister.
A recent report, Diversity in Human Sexuality by the Academy of Science of South Africa, found that the stigmatisation of homosexuality has made public health interventions, particularly with respect to HIV prevention and treatment, difficult to implement effectively.
To redress this, the plan goes much further than health. It wants five “interlinked service packages” to be implemented: health; empowerment (addressing social and economic factors that restrict economic opportunities); psychosocial support (to reduce internalised and external stigma and discrimination); human rights (mechanisms to deal with such abuses); and evaluation (to develop a plan to deliver services).
“More exciting” for the minister is that the plan endorses the provision of PrEP — pre-exposure prophylaxis for HIV-negative men who have sex with men (MSM), including gay and bisexual men — which, studies have shown, can reduce a person’s risk of HIV infection by more than 90%, depending on how well it’s taken.
Compared with the rest of the adult population, MSM and transgender people remain 19 and 49 times more likely to contract HIV, respectively, says the plan.
To reduce HIV infections by 63%, the framework wants 90% of MSM and trans women who test HIV negative to get combination prevention packages, including PrEP.
This would mean 5 000 MSM and transgender people on PrEP.
Letsike concedes that 5 000 people in five years is “relatively low”.
“It is also important to note that the provision of PrEP is only one of the prevention approaches and that this is only a pilot, not a national rollout,” she says.
The four pilot sites are in Pretoria, Johannesburg, Cape Town and KwaZulu-Natal.
“We will collate data from these sites to see whether there is a need to adjust these targets. This will be done as part of our mid-term review,” says Letsike.
Department of health spokesperson Popo Maja said: “The LGBTI plan has been costed and various sources of funds will be used to implement the plan over the next few years.”
These funders, Mojo added, are the United States President’s Emergency Plan for Aids Relief and the Global Fund to Fight Aids, Tuberculosis and Malaria.
Says Letsike: “Our goal is to ensure the provision of adequate healthcare to everyone, regardless of sexual orientation and gender identity. And with this plan, we now have something to hold the government accountable to.”
Carl Collison is the Other Foundation’s Rainbow Fellow at the Mail & Guardian