Gay Botswana News & Reports 2004-10

BBC Report 1998: Africa is Dying of AIDS–Botswana Worst Hit

1 Botswana: Is there hope in ‘Vision 2016’? 5/04

2 Botswana Gays Rejoice As Opponents See Red 11/06

3 Botswana refuses to register gay advocacy group 12/07

4 African lesbian conference demands equal rights 2/08

5 Is homosexuality by choice? 12/08

6 HIV Prevalence, Risks for HIV Infection, and Human Rights 4/09

7 Members of a banned gay organisation in are suing the government 4/09

8 Government To Meet Botswana Homosexuals In Court 5/09

9 Rights Not Rescue 7/09

10 AG orders NACA to disregard BONELA’s findings on HIV among gays 12/09

11 Status of TDF2 Study of Pre-Exposure Prophylaxis for HIV Prevention 12/09

12 HIV Prevalence, Risks for HIV Infection, and Human Rights among MSM 2/10

13 Sexual Minorities Demand Inclusive Health Care 2/10

13a Bonela to Present Findings of Access to Health By ‘Gays’ 3/10

14 Botswana stops MSM HIV/AIDS prevention 4/10

15 Bisexual concurrency, partnerships, and HIV among So African MSM 4/10

16 Bonela Scores For Gays And Lesbians 5/10

17 Homosexuality a ‘Sickness Mostly of Our Own Making’ 6/10

18 Botswana Ex-President in Plea Over Homosexuals 10/10

19 Glad To Be Gay 11/10

1 – Botswana: Is there hope in ‘Vision 2016’?

May 26, 2004 – Behind the Mask

by Daniel Somerville

The government of Botswana has issued a bold vision statement for the nation called Vision 2016. It promises all citizens safety, security, freedom of expression and a tolerant nation, but how will this help LGBT people if they don’t lobby around their rights within the framework of the vision.

The work of defining Vision 2016 began in August 1996 with a nine person Presidential Task Group. They produced a booklet entitled "A Framework for a Long Term Vision for Botswana". The Vision 2016 describes a national manifesto for the people of Botswana and it claims to reflect the views of many different parts of Botswana’s society.

"The development plans of Botswana," Vision 2016 states, "have always been based upon the four national principles, which are Democracy, Development, Self-reliance and Unity. These principles are still valid today, and must be re-focused to embrace change and relate to Botswana’s current level of development."

In describing a fifth principle, that of "Botho" (a Setswana word for respect, good manners) the Vision states that, "Botho as a concept must stretch to its utmost limits the largeness of the spirit of all Batswana. It must permeate every aspect of our lives, like the air we breathe, so that no Motswana will rest easy knowing that another is in need."

These bold words of inclusivity would seem to be opening the doors for LGBT lobbying; laying the ground for successful change in legislation that outlaws homosexuality in Botswana. However, Legabibo, the country’s LGBT group are dispersed and virtually none functioning. "It is very hard to get hold of them," one activist told me. "Because they have no office space and no permanent staff. The law prevents them from registering as an organisation, which has left them pretty helpless."

At the All Africa conference in Johannesburg earlier this year, representatives from Botswana admitted that the registration issue was just one part of the problem. "Lesbian and gay people in Botswana are not really interested in organising. If we throw a party then they will all turn up, but try to stage a rally or a meeting to discuss serious issues and there will be no more than a handful." Activists working in the field of HIV/Aids in Botswana admit that accessing MSMs (men who have sex with men) is a big problem. "The government do not include same sex behaviour in their information. But how can they when homosexuality is outlawed – it is a catch 22 situation. They know there is a problem but there is no-one to deal with, not the government nor the LGBT community."

One of the reasons sited for the lack of an effective LGBT lobby is insidiously personal according to another activist in Gaborone. "The gay scene is young, young as in not long established, but also young as in, populated by mostly young people – there is a lot of gossip, bitchiness and in fighting, usually caused by the fact that many of them have been in relationships with each other. It is a very small community."

So will the opportunities presented by Vision 2016 be lost? The document, aside from promising better schooling and business opportunities as well as better access to communication tools, housing and better wages also declares, "By the year 2016, Botswana will be a compassionate and caring nation." Not only in relation specifically to poverty eradication but also claiming that the negative impact of the AIDS epidemic in Botswana will have been halted and reversed.

If only in the arena of HIV being halted, that will never be possible unless MSMs are included in government programmes and with regard to health care the document also promises access to health care for all. This alone is an inroad for LGBT activists.
On safety and security there is also an interesting statement in the Vision that without doubt can be applied to LGBT rights. "By the year 2016, Botswana will be a safe and secure nation. Violent crime will have been eliminated, and there will be full protection of individual rights."

Combine the concept of individual rights with the further claim that Botswana will be a "moral and tolerant nation" with "tolerant social attitudes towards people of different cultures, ethnic traditions, religions or disabilities" and there is certainly scope for making a good argument for the emancipation of LGBT people in Botswana. However, the sting in the tale comes at the end. "By the year 2016, Botswana will be a united and proud nation, sharing common ideals, goals and symbols. Society will be under-pinned by resilient family values with a strong sense of tradition and pride in its history."

Those resilient family values and the sense of tradition will surely be the tools of oppression for those intent on excluding LGBT people from the framework of Botswana’s society. None the less, the document should bring hope. All that is needed now are the activists willing to engage in the fight. Surely the government will not necessarily interpret voluntarily the Vision 2016 to the advantage of LGBT people but at the very least it can be seen as an invitation to LGBT community to begin to organise using the wording of the Vision itself.

2 – Botswana Gays Rejoice As Opponents See Red

17 November 2006 – Mmegi/The Reporter (Gaborone)

by Tuduetso Setsiba

Early this week the South African parliament made history and passed a bill that ushers in a law that recognizes same sex marriages. This development, the first of its kind in Africa has generated a lot of excitement amongst the gay community and human rights organizations in Botswana.

LEGABIBO, an organization of Gays and lesbians in Botswana has applauded South Africans for passing the law despite the fact that homosexuality and lesbianism remains a taboo in the country. An exhilarated coordinator of LEGABIBO, Skipa Moepi said the law is long overdue in Botswana. She lameted that their attempts to seek recognition of gays and lesbians have been thwarted as Botswana is said not to be ready for same-sex relationships.

"This is frustrating as homosexuality has always existed in Botswana. We suppressed it because we are such a secretive society," she said. She lamented that they cannot register LEGABIBO because the Constitution does not recognise them. " It is even difficult for homosexuals to access medical facilities as they are discriminated," she said. Moepi’s sentiments have been echoed by the director of Botswana Network of Ethics, Law and AIDS (BONELA), Christine Stegling who emphasised the necessity of passing out a law that recognise gay and lesbian marriages. She said this would be an indication of Botswana’s commitment to human rights and fighting discrimination. Stegling said that her organisation takes a stand against discrimination of people, including on the grounds of sexual orientation. She said they advocate for tolerance and acceptance for the different people who make up Botswana’s population. These includes recognising the rights of people identified as non-heterosexual.

"But it is also important to note that the current discrimination and marginalisation faced by the non-heterosexual community needs to be addressed in general, not just the issue of marriage," she said. She warned that if gay people continue to feel marginalised or discriminated, they will not feel comfortable to seek HIV treatment in public health services or the tools that might prevent HIV. The strategies to fight the HIV/AIDS pandemic must include everyone, including people of non-heterosexual orientation and recognising their right to equality," said Stegling. Contrary to Stegling’s sentiments, Reverend John Philip is worried that abomination seems to be taking toll in the society. "I’m worried that this might open the floodgates for other sinful acts. Passing such a law might result in requests for group marriages and other weird acts.

In fact, I would not be surprised if tomorrow one might suggest that they should be allowed marry a tree," he said. Phillip is worried that as neighbours of South Africa, Botswana might feel pressured to follow suit and pass a law to legalise same sex relationships. He called on Batswana to seek their identity and uphold their morals as a nation. He fears that South Africa might have passed the law to be labelled the first country in Africa to legislate for same sex marriages.

"Sometimes keeping up with the so called civilisation can lead people astray," he said. He added that laws allowing same sex marriages clearly indicate that mankind has strayed from the will of God. Apart from the biblical rejection of such laws, Philip argues that even the biological set up of man kind dictates that a man should marry a woman. "The body of a man has been designed for a woman and vice versa," said Philip. Jaya Kumar of NIIT abhors the idea of passing laws to allow same sex marriages. She argues that there is no culture that entertains such a practice. People should stick to their practices and norms, they should not be swayed by whatever comes their way," she said. She warned Batswana to stay away from such a law and implored them to copy only what is good. Lucy Gaetsewe of Oodi is worried that Botswana might copy what South Africa has done. She detests gay and lesbian marriages and feels that it should not be welcome in any society.

However, Emily Kwapa supports same sex marriages. She argues that whether they are allowed to marry or not, homosexuals shall continue with their relationships.

"Monitoring such people is difficult. We cannot stop them from dating so it is best that we allow them to marry," she said. Keneilwe Kgari shares the same sentiments as Kwape. She feels that society wants to selfishly protect their feelings and that of their families at the expense of gay people. In most cases, people are worried about their children whom they fear might copy the practice," she said. Kgari hailed the South African Parliament for passing such a law for same sex marriage. She argued that many people have not chosen to be gay. In any case it does not mean that when a majority of people reject an idea, it means that there is something wrong with it," she said.

3 – Botswana refuses to register gay advocacy group

7th December 2007 – PinkNews

by staff writer

The department of civil and national registration in Botswana faces legal action after it refused to register a group called the Lesbians, Gays and Bisexuals of Botswana (LeGaBiBo). The country’s Attorney General has been informed that lawyers for the group intend to sue the government, reports Mmegi Online. The registration was refused because LEGABIBO was ruled to be contrary to the Botswana penal code, which outlaws male and female homosexual acts. The gay group cannot legally raise funds unless it is registered.

The registrar has powers to refuse registration of any local society "when it appears to him or her that the proposed society’s objectives are likely to be used for an unlawful purpose, thus disturbing the country’s peace, welfare and good order," according to Mmegi Online. LEGABIBO’s lawyers argue that the group was constituted to advocate for greater rights for gay, lesbian and bisexual people in Botswana through policy consultation and tackling public health issues.

The group’s constitution, adopted in August 1998, reads: "The Lesbians, Gays and Bisexuals of Botswana (LEGABIBO) Charter was drafted in response to those amendments to the Botswana Penal Code, which came into effect on the 30th April 1998 and extended the seven year maximum penalty, for men caught engaging in same-sex sexual relations, to women as well. It is hoped that this Carter will help to break down the negative image, and counter the prejudice and discrimination, currently facing the lesbian, gay and bisexual community in Botswana. We, the Community, are rejected, victimised, assaulted and blackmailed. This is because of societal myths and because homosexuality is a taboo subject in our culture. We face stigmatisation and prejudice from family members, friends, and society in general. The Charter calls for tolerance and understanding by the Government and people of Botswana, in order to counteract the prejudice and discrimination we face."

The notice of LEGABIBO’s intention to sue the government for refusing to register their organisation says the decision was improper and unlawful. "Claimant holds the firm view that this matter implicates a whole array of constitutional rights and protections not least of which are the right to freedom of expression, freedom of association as well as the right to the equal protection of the law," it reads.

4 – African lesbian conference demands equal rights

27th February 2008 – PinkNews

by staff writer

Lesbians from across Africa have held a conference in Mozambique to highlight the homophobia and prejudice they face across the continent. Most nations in Africa criminalise same-sex relationships and in some countries gay people can be put to death. The Coalition of African Lesbians conference was attended by more than 100 delegates.

Women from 14 African countries gathered in Namibia’s capital Windhoek in August 2004 to develop the Coalition of African Lesbians. Lesbian organisations and a number of individual women from Sierra Leone, Ghana, Nigeria, Liberia, Rwanda, Kenya, Uganda, Tanzania, Zambia, Zimbabwe, Botswana, South Africa, Mozambique and Namibia are members of the organisation. "Our main goal is that lesbian and homosexuality can no longer be seen as a criminal offence," the group’s director and conference spokeswoman Fikile Vilakazi told Reuters. "You should not be arrested and charged for how you use your own body."

The coalition lobbies for political, legal social, sexual, cultural and economic rights of African lesbians by engaging strategically with African and international structures and allies and to eradicate stigma and discrimination against lesbians. South Africa, one of the few countries on the continent where gay men and lesbians are allowed to marry and legally protected from discrimination, has been rocked by several murders of prominent lesbian activists.

Sizakele Sigasa, 34, an activist for HIV/AIDS and LGBT rights, and Salome Masooa, 24, were discovered dead at field in Soweto, Johannesburg, on July 8th. They had both been shot and, it is suspected, raped.

On 22nd July Thokozane Qwabe, 23, was found in a field in Ladysmith, KwaZulu-Natal with multiple head wounds. She was naked and it is thought she was also raped.

5 – Is homosexuality by choice?

13 December 2008 – Sunday Standard

by Angela Mdlalani

With homosexuality being regarded as a “disease” and immoral in many communities throughout Botswana, many, however, believe that Gaborone is turning into a “gay haven.” Many people have come out of the closet with their sexual orientation and are easing down to the feel of being homosexual. However, some even believe they can be oriented to “turn gay”. Letso, (not her real name) says she chose to date women because she was “fed up” with men. “Men abuse women’s feelings and use us; my relationships never worked out and I got tired and decided to experiment with lesbianism.”

The final year university student says she now considers herself lesbian, and rules out bisexuality as she says she only dated men in her past. “It’s just like when one transforms to a new faith, they will be recognized with their new religion, not the old,” she said sternly. Letso reveals that she has been dating women since the beginning of this year, and has only been out with two women already. She reveals that her first homosexual relationship did not work out and she attributes it to inexperience. “It was a first; I was used to dating men and the adaptation took just a bit longer.”

Asked whether she had had feelings for women before, she sinks into deep thought before rolling her eyes to a “maybe”. She admits confusion on the issue because, as she says, “some things are rarely in the open and have to be probed. I had to go through an array of unsuccessful relationships to open my eyes and heart to a possible truth.” Letso said she had to sit down and think deep on what was going wrong in her love life before realizing she was meant to date within the same sex. Although she refuses to disclose whether she initially had feelings for women before, she proudly says she believes in orientation. “I can easily introduce one to the gay life and they will be hooked,” she says.

She, however, is cagey and does not reveal whether she was introduced and trained in the homosexual world. Though she has been dating women for only a year now, she reveals that she is happy with her love life and certain she will not “turn straight” again. She chuckles, “I love the life; it’s free and fun.”

Caine Youngman, board president of LeGaBiBo (Lesbians, Gays and Bisexual people of Botswana) asserts that the term “turn” is strong to be used simultaneously with sexual orientation. He says there is a difference between heterosexual sex and being heterosexual, citing that homosexual people can indulge in heterosexual sex and heterosexual people can also practice homosexual sex but that’s not changing their sexual orientation. Youngman avows that his opinions are based on his personal experience, experiences of those around him, available literature and the confessions from different people.

“No, I do not believe that one can turn just like that. There are some institutions who call themselves “Ex-gay”. They believe they can turn gay people into heterosexuals. The results are questionable since some people say they just choose to ignore their emotions. I have a friend who was a member of such an institution who had to go under shock therapy as part of his transformation. He is still a gay man,” says Youngman. He reiterated that with sexuality, it is emotions (feelings) that are involved, adding that with bisexuality, a person is both physically and emotionally attracted to people of the same sex, stating that there are straining situations that lead people to indulging in homosexual sex.

“A population of men isolated from the opposite gender for a long time in boarding school, military institutions or prison will find a way to sexually satisfy themselves to the best of the situation at hand. This doesn’t mean they are gay or bisexuals. They are just heterosexuals practicing homosexual sex due to the situation at hand. With most, once they leave that place, they will stick to their preferred orientation.” Youngman says according to his knowledge, “ordinary bisexuals” are born bisexual and do not choose their lifestyle. But he also affirmed that people are sometimes termed as bisexuals because they get physical and sexual with people of different sexes and same sexes, adding that at times situations could compel people to get involved with both sexes (not necessarily at the same time).

Says Youngman, “It’s because they are usually forced by circumstances; some experienced dire heartaches, so to avoid more emotional pain they turn to the other sex.” He further said that some people do it to get clarity on their sexuality. In neighbouring South Africa, a study conducted between 2003 and 2007 by the South African Social Attitudes Survey (SASAS) has revealed that over 80 percent of the population believes that same sex relationships are always wrong; despite it having been legalized and even gay marriages now being recognized by law. The study exhibits that negative attitudes between lesbians and gays are widespread in South Africa.

Meanwhile, in Botswana, homosexuality is considered illegal and LeGaBiBo, the first organization advocating for homosexual result has been in existence for almost 10 years now, but the organization has not been registered with the Registrar of Societies under the pretext that registering such an organisation is an act of aiding and abetting the commission of an illegal act as defined under Section 164 of the Penal Code, whose effect criminalises homosexuality.

6 – HIV Prevalence, Risks for HIV Infection, and Human Rights among Men Who Have Sex with Men (MSM) in Malawi, Namibia, and Botswana

April 2009 –

by Stefan Baral1,7*, Gift Trapence2, Felistus Motimedi3, Eric Umar4, Scholastika Iipinge5, Friedel Dausab6, Chris Beyrer1
(1 Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America, 2 Center for the Development of People, Blantyre, Malawi, 3 Botswana Network on Ethics, Law, and HIV/AIDS, Gaborone, Botswana, 4 Department of Community Health, University of Malawi,-College of Medicine, Blantyre, Malawi, 5 HIV/AIDS Coordinator, University of Namibia, Windhoek, Namibia, 6 The Rainbow Project, Windhoek, Namibia, 7 Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada)

In the generalized epidemics of HIV in southern Sub-Saharan Africa, men who have sex with men have been largely excluded from HIV surveillance and research. Epidemiologic data for MSM in southern Africa are among the sparsest globally, and HIV risk among these men has yet to be characterized in the majority of countries.

A cross-sectional anonymous probe of 537 men recruited with non-probability sampling among men who reported ever having had sex with another man in Malawi, Namibia, and Botswana using a structured survey instrument and HIV screening with the OraQuick© rapid test kit.

Principal Findings
The HIV prevalence among those between the ages of 18 and 23 was 8.3% (20/241); 20.0% (42/210) among those 24–29; and 35.7% (30/84) among those older than 30 for an overall prevalence of 17.4% (95% CI 14.4–20.8). In multivariate logistic regressions, being older than 25 (aOR 4.0, 95% CI 2.0–8.0), and not always wearing condoms during sex (aOR 2.6, 95% CI 1.3–4.9) were significantly associated with being HIV-positive. Sexual concurrency was common with 16.6% having ongoing concurrent stable relationships with a man and a woman and 53.7% had both male and female sexual partners in proceeding 6 months. Unprotected anal intercourse was common and the use of petroleum-based lubricants was also common when using condoms. Human rights abuses, including blackmail and denial of housing and health care was prevalent with 42.1% (222/527) reporting at least one abuse.

MSM are a high-risk group for HIV infection and human rights abuses in Malawi, Namibia, and Botswana. Concurrency of sexual partnerships with partners of both genders may play important roles in HIV spread in these populations. Further epidemiologic and evaluative research is needed to assess the contribution of MSM to southern Africa’s HIV epidemics and how best to mitigate this. These countries should initiate and adequately fund evidence-based and targeted HIV prevention programs for MSM.

Citation: Baral S, Trapence G, Motimedi F, Umar E, Iipinge S, et al. (2009) HIV Prevalence, Risks for HIV Infection, and Human Rights among Men Who Have Sex with Men (MSM) in Malawi, Namibia, and Botswana. PLoS ONE 4(3): e4997. doi:10.1371/journal.pone.0004997

Editor: Lisa F. P. Ng, Singapore Immunology Network, Singapore

Received: December 21, 2008; Accepted: March 4, 2009; Published: March 26, 2009

Copyright: © 2009 Baral et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: This study was supported by the Sexual Health and Rights Project (SHARP) of the Open Society Institute and the Open Society Initiative for Southern Africa (OSISA). The decision to publish was made by the community partners and not the funders. Publication costs were offset by a grant from The Himmelfarb Family Foundation to the Center for Public Health and Human Rights.

Competing interests: The authors have declared that no competing interests exist.

* E-mail:

While southern Sub-Saharan Africa has long been the most HIV/AIDS affected region globally, it has been arguably the most understudied for the risk of HIV associated with male to male sexual contact [1]–[3] The crude characterization of these epidemics as generalized and driven by heterosexual risks has obscured the component of Southern Africa’s epidemics which may be due to risks among men who have sex with men (MSM). The marked homophobia, discrimination, and criminalization of same-sex behavior in much of Africa have likely limited investigation among these men. [4], [5]. Data regarding the prevalence of MSM in the region are among the sparsest globally, but there is evidence that male to male sexual contact is a reality on this continent as on all others [2]. To date, there have been published papers from only Senegal and Kenya describing HIV risk and prevalence among MSM in Africa [6], [7]. However, a systematic review found studies from other African countries either not presenting HIV prevalence data or studies that to-date have only been presented as abstracts [3]. These studies suggest that African MSM are at substantial risk for HIV infection, and that they have been markedly underserved and marginalized. Reported HIV rates, where available, have been higher than among other men of reproductive age in the same populations, yet these men tend to have limited knowledge of the health related risks of anal intercourse [8]–[10]. The lack of data on MSM and HIV are paradoxically the most marked for the world’s highest prevalence zone; the southern region of Sub-Saharan Africa. No published studies have reported HIV prevalence among MSM in Namibia, Malawi, and Botswana, three profoundly HIV/AIDS affected southern states. MSM have not been included in the HIV/AIDS strategies in these countries and same sex behavior among consenting adults is criminalized in all three states in 2008.

Concurrency of sexual relationships has been posited by several groups as a key driver of the high rates of prevalence in the southern African region [11], [12]. Yet concurrency of same and opposite sex partners has been little studied, and may play important roles as well.

To address these lack of HIV prevalence and risk and rights data among MSM in these states, and to support the emerging community groups advocating for recognition and health services for these men, our collaborative group developed a technically simple epidemiology and human rights study protocol which could be implemented by LGBT (Lesbian, Gay, Bisexual, and Transgender) rights groups with minimal cost, and with maximum protection for participants. The results presented here are the first epidemiologic probe of HIV among MSM in Namibia, Botswana, and Malawi.

Study Area

This study was completed in Blantyre and Lilongwe in Malawi, Windhoek, Namibia, and Gaborone, Botswana. These countries were chosen based on being within the encashment area of the Open Society Initiative for Southern Africa, having generalized HIV epidemics, no data available characterizing HIV risk among MSM, and having community-based organizations that were keen and able to collaborate on a study characterizing MSM in their community.
Study population and sampling methods

Eligible participants were 18 years old or older, had a history of ever having had anal intercourse with another man, and were able to give verbal informed consent for HIV screening in local languages. Inclusion criteria were not based on sexual orientation or identity, frequency of sexual contacts, previous HIV testing, or known HIV serostatus. Given the hidden nature of MSM in these communities, participants were recruited by in-country community-based organizations (CBO) with experience working with gay, bisexual, and other MSM. In-country technical support was provided as requested by the CBOs. In Namibia, investigators from the University of Namibia HIV/AIDS unit played a central role in providing ongoing support for this work. Similarly, researchers from the Malawi College of Medicine supported the Malawian CBO. The study staff was provided on–site training in outreach and recruitment, obtaining informed consent, and in interviewing techniques. The study was anonymous, confidential, and no written communications were shared with participants to minimize the risk of disclosure of MSM status. Sample size calculations were based measuring risk associated with unprotected anal intercourse (UAI). Assuming that UAI increases risk of HIV transmission by approximately 80% with a significance level of 0.05 and a power of 80%, the minimum necessary sample size was 150 men[13]. Rounding up, the planned sample size was 200 for each of the three sites for a total of 600 men.

Given the lack of gay venues, recruitment was done through snowball sampling. In Malawi, 20 seeds were identified by the local CBO, Center for Development of People (CEDEP), and each of the seeds recruited either 9 or 10 participants resulting in a total sample size of 202. In Namibia, 20 seeds were identified by the local CBO, the Rainbow Project (TRP) and through chain-referral recruited 20 participants each for a total sample size of 218. In Botswana, the partner was the Botswana Network on Ethics, Law, and HIV/AIDS (BONELA), who recruited 10 seeds. However, ultimately only 117 MSM were accrued in Botswana because of difficulty in accessing this population and significant delays in the local approval processes.

HIV Screening
Saliva samples were obtained for anonymous rapid HIV screening among interviewees. Oral fluid HIV was done testing using the OraSure Oraquick HIV-1/2 kit (Orasure Technologies, Bethlehem, PA, USA), licensed by the US FDA, with a sensitivity of 99.1% for oral fluid (compared to 99.7% with serum), and a specificity of 99.6% with oral fluid (compared to 99.9% with serum) [14]. This HIV screen was for study purposes, not for confirmative diagnosis of HIV infection: participants were encouraged to seek appropriate venues for HIV counseling and testing.
Study Instrument and Interviews

A short structured survey instrument containing 45 questions was developed with a modified Delphi Method including experts in determinants of health, HIV epidemiology, and human rights. The instrument was piloted with MSM CBO members in each of the countries, and revised and locally adapted. Interviews took approximately 25 minutes to complete, and collected no identifiable information. After the interview, the oral fluid sample was obtained and the study participants were remunerated at different levels (between 5–10 USD) as determined by the partner CBO for their time and transportation costs. To maintain confidentiality and anonymity of the participants in the study, two separate rooms were required to ensure that the person reading the test result did not make direct contact with the respondent. Instead, non-traceable alphanumeric participant codes linked the HIV screening data to the surveys.

Statistical Analysis
Survey instruments were linked anonymously to HIV testing results using participant codes. Data were doubly entered into Microsoft Excel and subsequently imported to Stata 9.2 for analysis[15]. Univariate analyses included two-sample tests for differences in proportions, ?2 tests of independence, and logistic regression assessing the relationship between risk factors and HIV status. Backward elimination with a p-value set to 0.1 was used to determine which variables were included in the multivariate model. .In the multivariate logistic regression models, variables that were significantly (p<0.05) or moderately significantly (p<0.1) associated with HIV status were reported by presenting adjusted odds ratios (aOR) with 95% confidence intervals.

The study was approved by the Institutional Review Board of the Johns Hopkins Bloomberg School of Public Health and the University of Namibia, and the Ministry of Health in Botswana. Ethics approval was also sought from the National AIDS Council (NAC) in Malawi. While receipt of the application was confirmed on numerous occasions over many months, no answer was given. A thorough consultation with the MSM community in Malawi demonstrated overwhelming support to move forward with the study. And since the protocol was identical to that approved by the two other in-country human subjects committees, CEDEP employed an internal review mechanism and approved the study.

Sociodemographics and Sexual Practices of study participants

The participants tended to be young overall with mean ages of 24–26 in each of the three countries (Table 1). The majority had at least a secondary education, and approximately half were currently employed. There were high levels of bisexual concurrency observed, defined as concurrent regular partnerships with both men and women, but was most common in Malawi (p<0.05).

In all three countries, MSM had more male sexual partners than female sexual partners with a mean of between 1–1.5 female sexual partners in last 6 months, again positively skewed. MSM reported medians of between 3–4 male sexual partners over the preceding 6 months, though the distributions were positively skewed for all three countries with a minority of men reporting large number of male partners. Active bisexual practices–both male and female sexual partners in the same time frame was common across all three countries, but again, was most common in Malawi (p<0.05).

Disclosure of sexual orientation to family was more common in both Namibia and Botswana than Malawi (p<0.05). In Malawi, less than 10% of respondents disclosed their sexual orientation at any interaction with a health care worker, and the rate was below 25% in both Namibia and Botswana.

8.7% (38/435) of MSM admitted to injecting drugs, but more participants refused to answer this question than any other (18.1% – 97/536). The total sample size varied because participants refused to answer certain questions of the survey instrument.

In the pooled analysis, 44.7% (238/533) had used the internet to find a male sexual partner in the last 6 months, with the highest rates being in Botswana (p<0.05). Across all three sites, the biggest self-reported risk to one’s health was from HIV/AIDS, though 8.0% of the participants considered violence as the most important threat to their personal health. Compared to Malawi and Botswana, MSM in Namibia were less likely to consider HIV/AIDS as the biggest threat to their health (p<0.05), and most likely to consider violence as the single biggest threat to their health (p<0.05).

HIV Related Knowledge
Men were more likely to have received any information about how to prevent HIV infection from women than from men in all three sites (p<0.05) (Table 2). Men were more likely to know that HIV can be transmitted by vaginal intercourse than by anal intercourse in both Botswana and Malawi (p<0.05). In the pooled analysis, 85.3% (44/516) knew that HIV could be transmitted through injecting drug use. Only 70.3% of men in Malawi knew that HIV could be transmitted by these three modalities, whereas this was again higher in Botswana and Namibia (p<0.05), predominantly because of the dearth of knowledge about IDU.

Always using condoms among MSM with male or female partners was equivocal in Malawi and Botswana, but in Namibia, MSM were more likely to use condoms with men than women (p<0.01). In Namibia and Botswana, MSM were more likely to always use condoms with casual partners as compared to their regular sexual partners (p<0.05), whereas condom use between casual and regular partners was equivalent in Malawi. Of those who used lubricants during anal intercourse, a minority (38.2%, 130/340) overall used water-based lubricants as compared to petroleum-based products including petroleum jelly, fatty and body creams, with highest rates of WBL use in Botswana (50.7%, 36/71, p<0.05). Finally, only 3.3% (13/389) of the study sample were practicing safe anal sex as defined by always using condoms and water-based lubricants.

Transactional sex, as defined by anal intercourse in exchange for money or gifts with a casual partner, was common across all three sites. Overall, it was more common in Malawi (62.6% – 124/198), then Namibia (37.3%-81/217), and least prevalent in Botswana (29.3% – 34/116) (p<0.05). In Malawi, the sample was more likely to have received money/gifts for anal intercourse, but this difference was not found in the sample in Namibia or Botswana. MSM had been most commonly previously tested for HIV in Botswana (82.9% 97/117), followed by Namibia (59.4%- 129/217), and then Malawi (35.2% 69/196) (p<0.05). 18.5% (40/216) of MSM had ever been told by a health care worker that they had a STI in Namibia, whereas 8.5% (17/199) of MSM in Malawi had received this diagnosis similar to 9.4% (11/117) of MSM in Botswana.

Human Rights Contexts
Human rights abuses among MSM in the study sample were prevalent across all three countries. Between 5–10%, depending on the site, of the study participants had been denied housing in the past for reasons other than the ability to pay (Table 3). Being afraid to seek health services because of sexual orientation was reported by 17.6% (35/199) in Malawi, 18.3% (40/218) in Namibia, and 20.5% (24/117) in Botswana. While having been denied health care was less common with a pooled prevalence of 5.1% (27/533), disclosing sexual orientation to a health care worker was significantly associated with having been denied health care (OR 4.2,95% CI 1.9–9.3).

MSM reported being afraid to walk down streets in their own community most commonly in Botswana , but also to a lesser extent in Malawi and in Namibia (p<0.05). Overall 42.1% (222/527) of MSM answered yes to any of these markers of human rights violation. 12.2% (65/533) of the total sample indicated that they had been physically abused by a government or police official, with the highest rates in Namibia (p<0.05). Finally, 11.4% (61/534) of the sample reported ever having been raped by another man, with similar rates across the three sites.

Blackmail or extortion on the basis of sexual orientation or behavior was quite prevalent in the sample with an overall rate of 21.2%. In the pooled analysis, univariate associations with blackmail included having either paid or received money or gifts for casual sex (p<0.01); having told a member of the family of one’s sexual orientation (p<0.01); and having a told a clinic or health care worker of one’s sexual orientation (p<0.05), and not having had an HIV test in the preceding 6 months (p = 0.06) (data not shown). Multivariate analysis was completed adjusting for these covariates and blackmail was significantly associated with having taken part in transactional sex (aOR 2.5,95%CI 1.6–3.8), not having had a HIV test in last 6 months (aOR 0.56,95%CI 0.3–1.0), having disclosed same sex behavior to a member of the immediate or extended family (aOR 2.3,95% CI 1.4–3.6), but not to health care workers (aOR 0.9,95%CI 0.5–1.6).

Associations with HIV Infection
The overall HIV prevalence was 17.4% (93/536); however, there was significant variation of HIV prevalence with increasing age (Table 4). The HIV prevalence among those between the age of 18 and 23 was 8.3% (20/241), then 20.0% (42/210) among those 24–29, and 35.7% (30/84) among those older than 30. Overall, 23.7% (22/93) were aware of their HIV status, though this varied significantly between countries (p<0.05). In Malawi, more than 95% were unaware of their status, whereas in Botswana 76.3% were unaware and in Namibia, 41.8% were unaware of their status.

Univariate predictors varied between countries and can been seen in Table 5. In the pooled analysis, increasing age, being employed, not always wearing condoms with men, casual and regular partner, having been diagnosed with an STI, and having had transactional sex were significantly associated with HIV (p<0.05). Furthermore, self-reporting as homosexual or bisexual compared to heterosexual was associated with HIV (p = 0.06). In the multivariate model, ever having been diagnosed with an STI, being older than 25 (aOR 4.0, 95% CI 2.0–8.0) and not always wearing condoms (aOR 2.6, 95% CI 1.3–4.9) were significantly associated with being infected with HIV in the pooled analysis (Table 6). Country-specific associations also included having been diagnosed with an STI was strongly linked to being HIV-positive (aOR 33.7, 95% CI 3.4–148.2) in Botswana and having used the internet to find male sexual partners in Malawi (aOR 3.6 95% CI1.0–13.7).

This is the first study to investigate HIV status and risks for HIV infection among MSM in Namibia, Botswana, and Malawi. It is also the first attempt, to our knowledge, to evaluate the human rights contexts among MSM and to link individual level rights abrogation to HIV biological outcomes in the African context.

Overall, HIV rates were substantial, and risks for HIV infection from sex with both were men and women were common. The participants were generally young, though there was a significant association between HIV and age. Excluding the few men above the age of 49, overall more than one-third (35.7%, 95%CI 26.3–46.4) of MSM between the ages of 30–49 were HIV infected. These data suggest that this is not a new epidemic of HIV among African MSM which is spreading more rapidly among younger MSM, as has been seen observed among MSM in other settings such as Russia [16]. Because younger men were much less likely to be HIV infected, prevention programs targeting younger MSM in these populations could have marked potential for avoiding future infections. All possible combinations of biomedical and behavioural interventions need to be evaluated including those directed at MSM who are already HIV seropositive[17]. While very little is known about the benefit of targeted HIV prevention programming among MSM in Africa, in other contexts these approaches are known to be very effective in decreasing unprotected anal intercourse (UAI) [18], [19]. Prevention research and optimization of existing prevention tools for MSM are a clear public health priority for Southern Africa.

Approximately two-thirds of MSM had received any information about preventing HIV infection from other men, which was higher than expected. However, given that these men were largely recruited from within the same networks of men who are served by these CBOs, this likely overestimates the men exposed to this information in each country. Basic knowledge and condom access and availability are necessary for increased condom usage, but not sufficient. Recent studies have demonstrated that African MSM are less likely to have UAI if they use water-based lubricants (WBL), have been counseled about the risks of UAI, and more likely to have UAI if they regularly drink alcohol or do not know that HIV can be transmitted via anal intercourse [8], [10]. Understanding condom use among MSM in the African context is especially relevant as in all three countries, not always wearing condoms was highly predictive of being HIV positive. If safe sex is defined as the usage of WBL in addition to always wearing condoms, then less than 1 in 20 MSM practiced safe sex in this study. The more common use of oil-based products, including vaseline and body/fatty creams appears partly due to cost and partly to availability. Increasing the availability of affordable and practical WBL should be a key focus of prevention strategies.

A significant proportion of MSM self-identified as either heterosexual or bisexual, and many were married or had at least one female sexual partner in the preceding six months. These results were consistent with a previous knowledge, attitudes, and perceptions study of MSM in Malawi[20]. Concurrency of sexual relationships, which has been posited by many investigators as a key driver of heterosexual transmission in this region, appears to be relevant to MSM as well[11], [12]. Some 17% of men overall were in concurrent stable relationships with men and women and over half of the respondents had both male and female sexual partners in previous 6 months, suggesting that concurrency of sexual relationships which include both same and opposite sex partnerships may be an under—appreciated component of HIV spread in this region.

Approximately one tenth of men reported the injection of illegal drugs. There is an increasing appreciation that IDU behavior is also a reality in the African context, and more work is needed to better characterize this risk and its relationship to sexual risk exposures among African men [21].

The use of the internet to find male sexual partners was common across all three countries with nearly half of the respondents reporting using the internet for this purpose. In settings where homosexuality is criminalized and the police harass MSM, with no open venues for gay people to congregate, the internet has preceded the development of openly gay physical venues. Given the hidden nature of this population, the internet may represent a powerful tool in efficiently accessing and delivering HIV prevention education to these men [22].

Self-reported sexual orientation as homosexual or bisexual compared to heterosexual was significantly associated with HIV. While not explored here, this differential risk between identities may relate to sexual positioning, and will be relevant to HIV prevention programming [23]. Disclosure of sexual orientation to either any one member of their immediate or extended family, or any one health care worker was very low. These are hidden populations of men, currently only accessible for study and prevention programming through sexual and social networks with other MSM. In Kenya, where being MSM has become more of an accepted identity, the MSM community continues to evolve a gay identity and become more socially visible [24]. While there is a real risk for backlash, the self-identification of these men and community development may allow for better dissemination of education and prevention measures.

This study served as an assessment of human rights contexts for MSM in these countries. The results are a powerful reminder of the level of stigma, discrimination and human rights abuses that these men face in their everyday lives, including being denied housing and healthcare, being afraid to walk down the streets of one’s community, or being afraid to seek health care services. Though each of these rights abrogation likely limit access to HIV preventive services, none were significantly associated with HIV at the individual level. This could have been because abrogations were so common that ceiling effects made attribution difficult, as well as the fact that country sample sizes were small. However, having disclosed sexual orientation to family members was significantly associated with blackmail, and, having disclosed sexual orientation to a health care provider was significantly associated with having been denied health care. In the short term, these two factors will continue to limit disclosure of sexual orientation. In addition, those who reported blackmail were also less likely to have been tested for HIV in last 6 months. These structural barriers to available health care services will limit the efficacy of any interventions targeting individual level determinants of HIV transmission among MSM and must arguably, be mitigated to effectively decrease HIV incidence [25].

There are several limitations to this cross-sectional study. Resources and the constraints of working with small CBOs in these rights constrained environments limited the scale and scope of these probe studies. Due to the nature of the study we were unable to establish directions of causality. There are known biases in questionnaire-based estimates of sexual violence [26]. Specifically, using narrowly defined terms of sexual violence such as rape in a study instrument, as was done in this study, may underestimate its prevalence. The study samples are convenience samples generated by use of chain-referral techniques rather than population-based samples, which is a key limitation with this study methodology and limit the generalizability of the results to the wider population of MSM in respective countries. This problem, referred to as homophily, will likely be best addressed by larger respondent-driven sampling (RDS) studies, and by venue-time sampling approaches, where feasible[27]. Even with RDS or venue-based sampling, there will be biases in the sample recruited and calculated estimates, though likely of lesser magnitude than when using convenience samples. Non-random sampling may also have overestimated the level of HIV-related knowledge seen in the results. Finally, MSM tend to congregate in urban areas, which is why recruitment took place in urban centers; again, this may limit generalizability.

One conclusion of this research perhaps bears stating openly: MSM exist in Malawi, Namibia, and Botswana, and are at high risk for HIV infection and human rights abuses. Piot et al. recently published a call to action for HIV prevention indicating that each country should appropriate HIV prevention expenditures in an evidence-based manner [28]. To date, there have been no dedicated government expenditures funding evidence-based and targeted HIV prevention programs for MSM in these three countries. To comprehensively address the HIV epidemic, African national AIDS strategies should allocate funds based on evidence such as presented here, ensuring that the right to health care is respected for all. Community partners willing and able to do this challenging work also exist, and supporting these partners and including them in HIV/AIDS fora in country and internationally is likely critical to the success of prevention, treatment, and care programs in these countries.

We would like to acknowledge all of the community groups who continue to provide front-line human rights advocacy and health services for MSM in Africa, often with very limited funding and significant personal risk. The authors would like to acknowledge all of the study staff belonging to the following organization: Lesbians and Gays and Bisexuals of Botswana (LeGaBiBo), Botswana Network on Ethics, Law, and HIV/AIDS (BONELA), The Center for Development of People (CEDEP) in Malawi, and The Rainbow Project (TRP) in Namibia. We would also like to thank the team at IGLHRC-Africa for providing ongoing support to the community members. Benaifer Badha and Christina Alexander of the Sexual Health and Rights Project (SHARP) at OSI were responsible for duplicate data entry. Thoko Budaza, Sisonke Msimang, and Vicci Tallis of the Open Society Initiative for Southern Africa provided significant administrative support to each of the community partners as well as input into study design and the questionnaire. Joseph Amon of Human Rights Watch and Sam Avrett of amfAR also provided significant input into the study questionnaire. Finally, the authors would like to thank Sue Simon and Heather Doyle, founding and active director of SHARP, respectively, for being a driving force in initiating this work and providing ongoing support for this work and our partners.
Author Contributions

Conceived and designed the experiments: SB GT FM EU SI FD CB. Performed the experiments: GT FM EU SI FD. Analyzed the data: SB EU SI. Wrote the paper: SB CB. Acted as the Study Coordinator: FD

7 – Members of a banned gay organisation in Botswana are suing the government

April 30, 2009 –

Gabarone – Members of a banned gay organisation in Botswana are suing the government in a landmark case aiming to legalise same-sex relationships in the southern African country, a lawyer said Thursday. Prisca Mogapi and Caine Youngman, both members of the outlawed Lesbians, Gays and Bisexuals of Botswana (Legabibo), filed the suit to challenge the sodomy law criminalising same-sex relations, attorney Uyapo Ndadi said.

"Due to the discriminatory nature of Botswana’s laws, gays and lesbians are viewed as criminals," she said. "The law that criminalises homosexuality violates the right to privacy and freedom of association." Ndadi is the legal officer for a local advocacy group, the Botswana Network of Ethics, Law and HIV and Aids, which is supporting the lawsuit.

A legal challenge to the sodomy law was tossed out in 2003, when a Botswana appeals court ruled that the country was not ready to accept homosexuality. The government in 2007 rejected Legabibo’s application to register as an officially recognised organisation, meaning the group is effectively banned from operating in the country.

8 – Government To Meet Botswana Homosexuals In Court

May 21, 2009 – Behind The Mask

by Nthateng Mhlambiso (BTM Managing Editor)
Gaborone – As the country prepares for its presidential elections in October, government has agreed to meet two members of Lesbian, Gays and Bisexuals of Botswana (LEGABIBO) in court on their demand to have section 164 of the Penal Code, which criminalises homosexual conduct, declared unconstitutional. Prisca Mogapi, a transman and Caine Youngman who is gay, through their representative Uyapo Ndadi, served the Registry of Society department with a statutory notice last month. This started when the department refused to register LEGABIBO as an organisation in 2007 on the grounds that it may be used for unlawful purposes, an answer that could have been informed by the controversial section 164 of the Penal Code.

Mogapi said they are only acting now, because the department took its time to respond to their registration request and that because of the nature of the case, it took long to prepare for it. He pointed out that refusal by government to register LEGABIBO became a strong evidence to challenge government about the country’s laws. “This is the first case of this kind and we want to know before the elections that if the constitution does not recognise us, are our votes valid?” he asked.

Mogapi said LEGABIBO is aware of the 2003 Court of Appeal’s decision stating that then Botswana was not ready to recognise homosexuality but said now is the time to show that Batswana’s attitude towards homosexuality has changed. “At first, culturally, homosexuality was not talked about but now people are talking about sexuality and gender. I have heard a lot of talk shows discussing homosexuality where members of society participated.” He added that LEGABIBO has also been disseminating information educating people about sexuality and sexual orientation.

“We have also done a needs assessment of lesbian, gay and bisexual people with regard to service provision and the MSM HIV Prevalence study in partnership with the Prevention and Research Initiative for Sexual Minorities, which helped us to interact more with the community.” Meanwhile Botswana Democratic Party (BDP) secretary general Jacob Nkate told Mmegi Newspaper that his party supported the government despite the fact that it has never critically looked at the issue, in light of changes in other parts of the world where other previously conservative countries have swiftly moved to legitimise homosexuality and same sex marriages.

Commenting on the issue, Botswana Congress Party (BCP)’s Publicity Secretary Dumelang Saleshando also told Mmegi that although his party did not have a firm position on homosexuality, it welcomes the case launched by LEGABIBO members. “We believe they should be allowed to take their issue to court to assert their rights,” Saleshando said, adding that it is important to celebrate people’s differences as opposed to being judgmental and condemning same sex relationships. A University of Botswana lecturer in the law department, Kehilwe Lekoba who acknowledged to Mmegi that section 164 of the Penal Code was discriminatory because it recognised only one form of sexuality also pointed out that the laws of Botswana were outdated and out of touch with reality.

9 – Rights Not Rescue

July 2009 – Open Society Institute

Female, Male, and Trans Sex Workers’ Human Rights in Botswana, Namibia, and South Africa
Date: June 2009
Source: OSI
Author: Jayne Arnott and Anna-Louise Crago

Sex workers are subjected to widespread human rights abuses, including police violence and unequal access to health care, in Botswana, Namibia, and South Africa. Despite enormous challenges, sex workers are organizing to protect their rights and demand an end to violence and discrimination.

Published by the Open Society Institute, Rights Not Rescue is based on a series of interviews and focus groups with sex workers and advocates throughout the three countries.

December 11, 2009 – The Sunday Standard

AG orders NACA to disregard BONELA’s findings on HIV among gays

by Gowenius Toka
The spread of HIV-Aids in Botswana continues unabated due to government’s refusal to accept the fact that same sex relationships contribute to the high rate of infection. It has emerged that the attorney general’s chambers instructed the National Aids Coordinating Agency to disregard the findings and recommendations of a research conducted by the Botswana Network on Ethics Law and HIV-Aids (BONELA) regarding appropriate interventions for people involved in same sex relationships.

NACA Coordinator, Batho Molomo, denies that they were instructed, preferring to say that they were advised not to allow discussions of BONELA’s findings and recommendations at the National Aids Council (NAC).

“The Attorney General simply pointed out that discussion of BONELA’s findings had the risk of prejudicing a case in which an organization associated with lesbians, gays and other sexual minorities, LEGABIBO, has arraigned Government before the courts for refusing to register it with the registrar of societies,” said Molomo.

While he maintains that NACA was not obliged to accept the AG’s advice, he agrees that they eventually heeded the advice “as we felt that there was no harm in doing that”.

Molomo’s statement was immediately rebutted by BONELA Director, Uyapo Ndadi, who pointed out that there is no case involving LEGADIMO and government before the courts of law, which he said immediately invalidates NACA’s argument that the matter is sub judice.

Read Article HERE

December 2009 – CDC

Status of the Botswana TDF2 Study of Pre-Exposure Prophylaxis for HIV Prevention

About the TDF2 Study
TDF2 is one of several clinical trials around the world working to identify a new strategy to reduce the impact of HIV in Botswana and globally. The study was designed to determine the safety and efficacy of a daily tenofovir-emtricitabine pill (brand name Truvada®) in reducing HIV infection among heterosexual men and women in Botswana – a strategy called pre-exposure prophylaxis, or PrEP. Approximately 1,200 people are enrolled in the trial. The study is being conducted by BOTUSA, a partnership between the Botswana Ministry of Health and the U.S. Centers for Disease Control and Prevention.

Planned Changes to the Study
The TDF2 study will be adapted due to unanticipated challenges that make it very unlikely that the trial will be able to determine if tenofovir-emtricitabine is effective in reducing the risk of HIV infection. The trial protocol and timeline will be revised to focus instead on the other remaining study questions – primarily behavioral and clinical safety and adherence. The study’s independent data safety and monitoring board has conducted ongoing evaluations of safety data and has identified no safety concerns to date. While the trial met its original enrollment goals, this study will not be able to determine efficacy given much lower than anticipated HIV incidence in the study population (likely due to declining HIV rates in Botswana generally, and to extensive HIV prevention services provided to all participants), and challenges in retaining participants in this highly mobile population of young adults.

While trial expansion was considered as a potential solution, after a thorough analysis, CDC determined that even with a doubling of participants to 2,400, it would be unlikely that a valid efficacy result could be obtained due to the lack of required retention to date. Low retention rates have been due to many factors, including: participants moving out of area; pregnancies; and time requirements that some participants felt were too great. BOTUSA has taken extensive steps to overcome these challenges, including adding weekend clinic hours, increasing participant reimbursements, and strengthening participant education and retention procedures. While these efforts have resulted in significant improvements in retention, a valid efficacy result could still not be assured.

The trial, however, will provide critical information on safety and adherence to help guide potential implementation planning should PrEP prove effective in other trials.

February 2010 – PlosOne

HIV Prevalence, Risks for HIV Infection, and Human Rights among Men Who Have Sex with Men (MSM) in Malawi, Namibia, and Botswana

In the generalized epidemics of HIV in southern Sub-Saharan Africa, men who have sex with men have been largely excluded from HIV surveillance and research. Epidemiologic data for MSM in southern Africa are among the sparsest globally, and HIV risk among these men has yet to be characterized in the majority of countries.

Read Report HERE

February 26, 2010 – Behind The Mask

Sexual Minorities Demand Inclusive Health Care

by Simangele Mzizi (BTM Intern)
Botswana – In an effort to raise awareness about the plight of sexual minorities’ difficulty accessing proper health care in Botswana, a march will be held on Saturday (27 February) by Lesbians, Gays and Bisexuals of Botswana (LeGaBiBo) together with other stakeholders to urge government to address this issue.

Skipper Mogapi of LeGaBiBo said the march will commence at 10:30 in front of the National Stadium in Gaborone and proceed to Riverwalk where a panel discussion around sexual minorities and access to health will take place. Different groups consisting of lesbians, bisexuals, trangender, intersex , sex workers, people living with HIV, and unions, are expected to attend this march set to give government a wake up call about its healthcare responsibilities.

“It is high time that the government takes into consideration that there are people who are not heterosexuals who are also affected by HIV and we can not achieve universal access if we exclude other populations”, said Mogapi. He explained that the march was prompted by a 2008 study which found that there are no HIV interventions that cater for men who have sex with other men (MSM) and women who have sex with other women (WSW) in Botswana.

Findings from the HIV Prevalence, Risks for HIV Infection, and Human Rights study among Men Who Have Sex with Men (MSM) in Malawi, Namibia, and Botswana suggest that MSM are a high-risk group for HIV infection and human rights abuses and are afraid to seek health services because of their sexual orientation.

“We hope to create dialogue between LGBTI’s, MSM’s, WSW’s, sex workers and health care providers and we want the community to be sensitised about studies regarding these groups”, he said. “We have done a needs assessment of lesbian, gay and bisexual people with regard to service provision and the MSM HIV Prevalence study in partnership with the Prevention and Research Initiative for Sexual Minorities, has helped us to interact more with the community”, he said.

Around 300,000 people are living with HIV in Botswana and the government has committed to provide universal access to antiretroviral treatment and to achieve zero new infections by 2016. “If we are neglecting other populations that target will not be achieved”, said Mogapi. According to a report to the World Health Organisation (WHO) and UNAIDS by the government of Botswana in late 2007, and by December 2008 around 145,000 people had been enrolled on antiretroviral treatment through a network of 81 clinics.

However sexual minorities are still marginalised and homosexuality is outlawed despite findings that indicate a higher HIV prevalence among MSM compared to the general population. LeGaBiBo is a gay rights organization aiming to promote recognition, acceptance and equal protection of all human rights of the LGBTI community in Botswana.

3 March 2010 – All Africa News

Bonela to Present Findings of Access to Health By ‘Gays’

by Isaiah Morewagae
The Botswana Network on Ethics, Law and HIV/AIDS (BONELA) is expected to make a presentation at the National AIDS Council (NAC) on findings of an assessment of access to health services by the Lesbian, Gay, Bisexual and Trans-gendered community as well as a study on men who have sex with men (MSM) in May this year.
BONELA says this decision was made by former president Festus Mogae, at the NAC last week, following a query by BONELA as the presentation initially scheduled for May last year, was cancelled at the last minute, without consultation.

Commenting on this turn of events, the Director of BONELA, Uyapo Ndadi said; "As an organisation, we are excited that our leaders are now more progressive and open towards issues of sexual minorities which is reflective of sound democratic principles. The fact that we were the first country to provide antiretroviral therapy to those in need was a great leap forward, but evidence reveals that this alone will be overshadowed and undermined by leaving sexual minorities in the lurch."
Relevant Links

In addition, BONELA’s Prevention and Research Initiative for Sexual Minorities, Coordinator, Felistus Motimedi said that Botswana can not respond adequately to an epidemic based on hearsay, but needs to engage in a holistic intervention that is evidence-based and tailor-made to suit different groups. She added that the research findings by BONELA are unique as no such research has been conducted in Botswana before, ‘thus it will assist the country in putting in place policies and programmes inclusive of marginalized and most at risk populations’. BONELA added that they conducted a needs assessment on access to health services by sexual minorities as well as a study on MSM in 2008 to determine prevalence of HIV and knowledge of HIV transmission in this community.

31 March 2010 – LGBT Asylum News

Botswana stops MSM HIV/AIDS prevention

Source: African Activist

Botswana’s Ministry of Health has intervened to block US funding for HIV/AIDS prevention efforts targeted at men who have sex with men (MSM) and their partners because homosexuality is illegal in Botswana, the Sunday Standard reports.

The Botswana government has intervened to stop an initiative by the United States government to fund HIV-AIDS interventions targeted at same sex partners. Sunday Standard can reveal that the Ministry of Health stepped in at the eleventh hour to halt a call for proposals, issued by the US government under its Presidents’ Emergency fund for HIV and AIDS(PEFPAR), for HIV-AIDS intervention initiatives for same sex partners, on the grounds that the its target groups are classified as unlawful in Botswana.

African Activist recently posted about the work of Uyapo Ndadi, the Executive Director at Botswana Network on Ethics, Law and HIV/AIDs (BONELA). At the time of the posting, Ndadi had planned to present the findings of an HIV/AIDS study at the National AIDS Council (NAC). The Sunday Standard continues:

BONELA recently revealed the findings of their private investigations into the extent of HIV-AIDS prevalence on same sex partners. They had hoped that more funding from the US would help them intensify their research. “This is another opportunity gone down the drain. It is a case of serious denials on the part of government” [Ndadi] said…

The project would in the end increase access to high quality HIV prevention, care and treatment services for men who have sex with men (MSM) and their partners. It consisted of two components, implementing a needs assessment in six identified urban areas and designing and conducting a needs-based and targeted HIV prevention intervention aimed at reaching MSM, with prevention messages.

On February 19, reported on Ndadi’s plans to advocate for the decriminalization of homosexuality in Botswana. Uyapo Ndadi is set to fight it out with government in court over section 164 of the Penal Code, which criminalises same sex relationships. Homosexuality is regarded as abominable and sinful, it is perceived as a crime and homosexual sex is punishable with a possible jail sentence if convicted.

21 April 2010 – Sexually Transmitted Infections

Bisexual concurrency, bisexual partnerships, and HIV among Southern African men who have sex with men (MSM)

by Chris Beyrer, Gift Trapence, Felistus Motimedi, Eric Umar, Scholastika Iipinge, Friedel Dausab, Stefan Baral1, + Author Affiliations

Correspondence to:
Dr Stefan Baral, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, E7146, 615 N Wolfe Street, Baltimore, MD 21205, USA;
Contributors SB and CB designed the template protocol. CB led the writing of the manuscript, and SB led the data analysis. The in-country coordinators were FD in Namibia, GT in Malawi and FM in Botswana. EU and SI participated as coinvestigators providing in-country technical assistance and guidance on data analysis and the writing of the manuscript.

Accepted 9 February 2010
Published Online First 21 April 2010

Objectives The sexual behaviour of men who have sex with men (MSM) in southern Africa has been little studied. We present here the first data on bisexual partnerships and bisexual concurrency among MSM in Malawi, Namibia and Botswana.

Methods A cross-sectional probe of a convenience sample of 537 men who have ever reported anal sex with another man using a structured survey instrument and rapid-kit HIV screening.

Results 34.1% of MSM were married or had a stable female partner, and 53.7% reported both male and female sexual partners in the past 6 months. Bisexual concurrency was common, with 16.6% of MSM having concurrent relationships with both a man and a woman. In bivariate analyses, any bisexual partnerships were associated with lower education (OR 1.6, 95% CI 1.1 to 2.3), higher condom use (OR 6.6, 95% CI 3.2 to 13.9), less likelihood of having ever tested for HIV (OR 1.6, 95% CI 1.1 to 2.3), less likelihood of having disclosed sexual orientation to family (OR 0.47, 95% CI 0.32 to 0.67) and being more likely to have received money for casual sex (OR 1.9, 95% CI 1.3 to 2.7). Bisexual concurrency was associated with a higher self-reported condom use (OR 1.7, 95% CI 1.0 to 3.1), being employed (OR 1.8, 95% CI 1.2 to 2.9), lower likelihood of disclosure of sexual orientation to family (OR 0.37, 95% CI 0.22 to 0.65) and having paid for sex with men (OR 2.0, 95% CI 1.2 to 3.2).

Conclusions The majority of MSM in this study report some bisexual partnerships in the previous 6 months. Concurrency with sexual partners of both genders is common. Encouragingly, men reporting any concurrent bisexual activity were more likely to report condom use with sexual partners, and these men were not more likely to have HIV infection than men reporting only male partners. HIV-prevention programmes focussing on decreasing concurrent sexual partners in the African context should also target bisexual concurrency among MSM. Decriminalisation of same-sex practices will potentiate evidence-based HIV-prevention programmes targeting MSM.

May 2010 – Behind The Mask

Bonela Scores For Gays And Lesbians

In an unprecedented move, the government will meet with representatives of gays, lesbians and sex workers next month, in a development that could signal official acceptance of the existence of these groups. In a coup for NACA and the advocacy group that has been campaigning for these groups to come out from the cold, the Botswana Network Of Ethics, Law and HIV/AIDS (BONELA) will lead the Lesbians, Gay and Bisexuals of Botswana (LEGABIBO) and the Research Triangle Institute (TRI) to a meeting of the National Aids Council on June 4 to discuss research findings on these groups.
TRI represents the interests of sex workers.

The aim is to chart a way forward for addressing issues of HIV/AIDS and related illnesses as well as intervention measures for these marginalised groups. The National Coordinator of NACA, Richard Matlhare, has confirmed this meeting, saying these groups cannot be ignored because the HIV/AIDS pandemic affects everyone. “We will take the research findings to the council to discuss intervention measures that will benefit these specific people,” Matlhare said. However, he could not provide any further details on the meeting.

The meeting is anticipated as a break with the past, when the government steadfastly refused to even acknowledge the existence of homosexuals. Last year, a lesbian working for BONELA, Prisca Mogapi, and a gay member of LEGABIBO, Caine Youngman, threatened to sue the government over Section 164 of the penal code which criminalises same sex relationships. The two wanted the ‘offending’ section to be declared unconstitutional.

The controversial section provides that “any person who has carnal knowledge of any person against the order of nature or has carnal knowledge of an animal or permits a male person to have carnal knowledge of him or her against the order of nature is guilty of an offence and is liable to imprisonment for a term not exceeding seven years”. Significantly, in 2007, the Registrar of Societies dismissed an application by BONELA to have LEGABIBO registered. LEGABIBO had stated that its objective was “to integrate a legal, ethical and human rights dimension into sexual, reproductive and health rights without discrimination”.

Registration of LEGABIBO was based on Section 164 of the penal code. To-date, LEGABIBO is not registered with the Registrar of Societies.
Article by Maranyane Ngwanaamotho, staff writer Mmegi Online

11 June 2010 – All Africa

Homosexuality a ‘Sickness Mostly of Our Own Making’

Bishop Valentine Tsamma Seane of Botswana has said that the clerical abuse scandals are a "reflection of a sick society" and that homosexuality is a "sickness mostly of our own making." In an interview published on June 10 by the Gaborone Sunday Standard, 43-year-old Bishop Seane, Botswana’s leading prelate said that clerical abuse is "a reflection that the clergy come from a sick society that produces serial killers, rapists, and abusers." Defending the discipline of clerical celibacy while acknowledging that the pope could hypothetically change it, Bishop Seane made clear that women cannot be ordained:

"Christ could have instituted women (into the priesthood), but he didn’t. At the Last Supper he sent out men, not women. We are following the tradition of the master who is the Founder of the Church. We are a very traditional Church. This is the Church of Christ himself, not so and so. (If you were to ask) who founded the Anglican Church, the answer is Henry VIII. Who founded the Lutheran Church? Martin Luther. You can put the name of a founder to every other church. Who founded this Church? It’s Christ," the prelate said.

Commenting on homosexuality, Bishop Seane said that "this sickness is mostly of our own making. You can’t justify it. It’s against the natural definition of what’s male and female and what they are there for. The Church will marry man and woman, not man and man; or woman and woman." But the Church will sympathize to see how people who find themselves with such inclinations can be helped. There are interventions that include surgery, hormonal (balancing), and psychological counselling, the bishop also said.

"We do acknowledge that such orientation might result from physiological make-up or hormonal imbalance, but you can work on that. Sometimes socialization plays a role, especially in a family that perhaps had wanted to have a girl to such an extent that the parents insist on dressing a son in girl’s clothes," Bishop Seane said. "Look at it this way. Sometimes a baby is born with heart outside, or someone gives birth to siamese twins. These things happen, but we can make interventions. We can’t accept them as usual. The same applies to homosexuals," the bishop declared.

He said that "They are our brothers and sisters. We have to love them, sympathize with them, and help where we can. The Church does not reject them. We only reject attendant practices, like sodomy. "In Botswana, the Church is growing. The trend is evident throughout southern Africa generally. The reason for this is that people are facing a challenge in getting satisfaction from material things.

In the 1980s and 90s people picked material things. But now they realize that material things will not satisfy them. People are also sick, and they find refuge in the Lord," Bishop Seane added Botswana has a population of 1.9 million, 67 percent are Protestant and less than 5 percent are Catholic.

19 October 2010 – All Africa

Botswana Ex-President in Plea Over Homosexuals

Nairobi — Botswana’s former president Festus Mogae yesterday said African governments and leaders must not enact laws that criminalise homosexuality and sex work, warning that such legislation would inhibit the fight against HIV/Aids. Mr Mogae, who chairs a team dubbed ‘Champions of an HIV-Free Generation’ that comprise prominent African anti-Aids activists, told Zambian President Rupiah Banda at State House in Lusaka that homosexuals and sex workers were part of society and they should not be stigmatised or discriminated.

Mr Mogae said he had written to some African Presidents, without mentioning names, who wanted to pass laws to criminise homosexuality, advising them not to do so. The former President, who explained that he is heterosexual, said in Botswana homosexuality was illegal but he had been engaging the government to repeal the law that criminalises homosexuality. Due to his advocacy, Mr Mogae said "nobody has been prosecuted over the last three years" for being homosexual.

And President Banda, whose government is anti-gay rights, accused the foreign donors were making youths believe that "homosexuality is a human right and that if you appear to speak against it then you are a reactionary and you don’t understand the world". Without categorically backing Mr Mogae’s position, President Banda said to "hear it from the position of the Champions in the fight against Aids then you understand why we should not criminalise them [homosexuals], understand them and at the same time try and sensitize our young people" about homosexuality.

November 26, 2010 – The Voice

Glad To Be Gay

by Staff Reporter
First lesbian couple to publicly declare their love – A brave couple who met through the pages of their favourite newspaper, will today carve their names in the history of civil rights in this country. Onkemetse Pule, 26, from Mahalapye and Lawrence Kwataka, 24, of Serowe met through the popular ‘Lets Get Personal’ dating service in The Voice
They are soul mates, head over heels in love and courageous enough to have agreed to this interview and become the first lesbian couple in Botswana to publicly declare their love.

They have been in the relationship for ten months and as they both say: “Have never been happier.” Now they want the world to know that they are two women who have found the ideal partner in one another.

Happily in love
Lawrence has been aware of her sexuality for close to 10 years and first had a relationship with her literature teacher in high school. She said of her partner Onkemetse: “She is my world, and everything that I could ever want in a relationship. I have never felt so emotionally, physically and spiritually fulfilled in my life. I am so stress free, I feel like I am floating on air. It is such a beautiful and liberating experience that I wish every woman could share this depth of feeling and have such a wonderful love life.”

Soft spoken Onkemetse reiterated her lover’s sentiments. “I feel safe in this relationship. I am so content and fulfilled. It is incomparable with being in love with a man.” Despite the disapproval their open relationship might raise amongst the more conservative and traditional elements of society, the two say they are ready to face the world as long as they have each other. The couple, who are both loyal Voice readers, have the paper to thank for getting them in touch with each other.

“I placed an advert in the ‘Let’s Get Personal’ column last January, and I specified that I was looking for a lesbian mate, and that age did not matter as it was just a number,” said Lawrence. As fate would have it, Pule saw the advert and immediately got in touch. “I sent an SMS and my details to the given code and after a while got her cell number. We then spoke for two days before deciding to meet in Gaborone,” she said.

Taking up the story, Lawrence adds with a chuckle: “When we meet on the appointed day, it was love at first sight. There was an instant attraction, an unbelievably strong chemistry between us. We experienced a strength of feeling that neither of us could understand, but just knew that God had made us for each other.”

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