African Affairs, 111/443, 223–243 doi: 10.

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Advance Access Publication 7 March 2012

SEXUAL MINORITIES, HUMAN RIGHTS

AND PUBLIC HEALTH STRATEGIES
IN AFRICA
MARC EPPRECHT*

ABSTRACT
Remarkable progress has been made towards the recognition of sexual
minority rights in Africa. At the same time, a marked increase in attacks,
rhetorical abuse, and restrictive legislation against sexual minorities or
‘homosexuality’ makes activism for sexual rights a risky endeavour in
many African countries. Campaigns for sexual rights and ‘coming out’
are frequently perceived as a form of Western cultural imperialism,
leading to an exportation of Western gay identities and provoking a patri-
otic defensiveness. Cultures of quiet acceptance of same-sex relationships
or secretive bisexuality are meanwhile also problematic given the high
rate of HIV prevalence on much of the continent. This article examines
specific initiatives that are using subtle, somewhat covert means to nego-
tiate a path between rights activism and secretive bisexuality. It argues
that strategies primarily focused on health concerns that simultaneously
yet discreetly promote sexual rights are having some success in challen-
ging prevalent homophobic or ‘silencing’ cultures and discourses.

SMALL ASSOCIATIONS TO PROMOTE SEXUAL RIGHTS, sense of commu-

nity, and self-esteem among gays and lesbians began to be formed in
South Africa and Zimbabwe in the 1980s.1 These early associations
tended to be in the spirit of gay liberation and pride as pioneered in the
West. As such, they presented some quite profound principled challenges

*Marc Epprecht ([email protected]) is a Professor in the Department of Global

Development Studies, Queen’s University, Kingston, Canada. Research for this article was
made possible through the generous support of the Social Science and Humanities Research
Council. Thank you to Kåre Moen and the University of Oslo for inviting me to participate
in the Muhimbili workshop, and to the Heinrich Böll Foundation for the Cape Town con-
ference. I received very helpful insights from the anonymous reviewers and the assistance of
Samantha Lowe, Sara Dorman and Rita Abrahamsen for final revisions.
1 Terminology is contested, so I follow consensus language (as in UNAIDS and the major
NGO documents) or as used by activists at the time referred to (hence, ‘gays and lesbians’
in the 1980s). My one somewhat idiosyncratic exception – but see also the Preface in Mikki
van Zyl and Melissa Steyn (eds), Performing Queer, Shaping Sexuality – Ten years of democracy
in South Africa (Kwela, Cape Town, 2005) – is to use the lower case for lgbti (lesbian, gay,
bisexual, trans and intersex) and msm (men who have sex with men, or, more properly,
males who have sex with males), a nod to my unease at the essentialism or stability which
the upper-case suggests.

223
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to traditional African cultures, to the mainstreams of Christian and
Muslim faith, and to African nationalist politics. A state-led backlash
against them began in Zimbabwe in 1995, in part because of this per-
ceived cultural imperialism from the West against putatively African
values. As new associations were formed elsewhere on the continent in
the late 1990s and early 2000s, and as growing numbers of Africans
began coming out to publicly confront myths and silences around
so-called African sexuality, that backlash spread to country after country.2
It continues in sometimes extreme articulations, as seen most recently in
proposed draconian laws and constitutional amendments to preclude
sexual minority rights in Uganda, Nigeria, Malawi, and Burundi,
amongst others. This homophobic turn has mobilized activists in the
West and piqued the interest of Western media, which, in turn, appears
to have stiffened the resolve of some major aid donors to speak out
against human rights violations. The UK and USA have threatened to cut
off aid to the most egregious violators.3
These controversies have inspired some African lgbti to strengthen their
solidarity networks on the continent and with friends in the West, and to
engage in even bolder activism. A BBC-produced television debate in
Johannesburg featuring a long kiss by two of the lesbian debaters comes
to mind as a dramatic example, and others are discussed below.4 Yet the
controversies have also encouraged many same-sex-practising people to
remain in, return to, or adapt traditional forms of discretion that allow

2 The ‘coming out’ story is widely attested: see, for example, Simon Nkoli, ‘Wardrobes:
coming out as a black gay activist in South Africa’ in Mark Gevisser and Edwin Cameron
(eds), Defiant Desire: Gay and lesbian lives in South Africa (Ravan, Johannesburg, 1994),
pp. 249–57; and Neville Hoad, Karen Martin, and Graeme Reid (eds), Sex and Politics in
South Africa (Double Story, Cape Town, 2005).
3 See Scott Long, More Than a Name: State-sponsored homophobia and its consequences in
Southern Africa (Human Rights Watch and International Gay and Lesbian Human Rights
Commission, New York, NY, 2003); Neville Hoad, African Intimacies: Race, homosexuality
and globalization (University of Minnesota Press, Minneapolis, MN, 2005); Sibongile
Ndatshe, ‘The battle for the recognition of LGBTI human rights’, Perspectives: Political ana-
lysis and commentary from Africa 4, 10 (2010), pp. 4–9; and Ryan Thoreson and Sam Cook
(eds), Nowhere to Hide: Blackmail and extortion of LGBT people in sub-Saharan Africa
(IGLHRC, New York, NY, 2011). See also the websites African Activist, <http://www.
africanactivist.org> and Behind the Mask, <www.mask.org.za> for country by country
reporting, plus links to key documents and local associations. Kenya Human Rights
Commission, The Outlawed Amongst Us: A study of the LGBTI community’s search for equality
and non-discrimination in Kenya (KRHC, Nairobi, 2011) provides a pioneering rights argu-
ment from outside South Africa, while the summary report of the vibrant conference in
Cape Town (November 2010) on ‘The Struggle for Equality: Sexual Orientation, Gender
Identity and Human Rights in Africa’ can be found at <http://www.boell.de/democracy/
promotion/promotion-of-democracy-conference-report-struggle-equality-sexual-orientation-
gender-identity-human-rights-africa-11680.html> (4 January 2012).
4 The debate ‘Is homosexuality un-African?’ featured Ugandan MP David Bahati and
former President of Botswana, Festus Mogae, staged before a live audience in March 2011,
<http://www.bbc.co.uk/programmes/p00fjqpz> (14 March 2011).
 SEXUAL MINORITIES AND PUBLIC HEALTH STRATEGIES 225

them to avoid attention, including secretive, de facto bisexuality.5 In the

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context of high rates of HIV/AIDS, however, that strategy is also decided-
ly risky. A number of lgbti activists and their allies have consequently
adopted a more subtle strategy to promote sexual rights and sexual health
that steers between confrontation and closet. This ‘interim’ approach
urges the careful use of euphemism or implicit language and embedding
the rights and self-esteem agenda for sexual minorities within sexual
health campaigns that are ostensibly aimed at the heterosexual majority.
Can a public health approach to promoting sexual rights and, hence,
enabling or abetting the development of politically self-confident gay
identities, work in Africa? Does such an approach necessarily fuel ‘gay
identity migration’ from the West, as Matthew Roberts posits, or does it,
as Vinh-Kim Nguyen suggests, link new ‘forms of life’ around sexuality to
Western confessional technologies (and dollars) deployed to fight
AIDS-stigma?6 In this article, I examine specific initiatives that are using
somewhat covert means to challenge prevalent homophobic or silencing
cultures. In the process, I reflect on some of the tensions and dilemmas
of the public health approach in pursuit of what one recent manifesto
called ‘erotic justice’ for sexual minorities, meaning not just an end to dis-
criminatory laws and other serious problems, but also the promotion of
the idea ‘that sexuality, pleasure and the erotic are part of our common
humanity’.7 The argument draws primarily on a close reading of the per-
tinent texts, participatory observation of a number of regional and
pan-African workshops and conferences, and reflections on the pro bono
work I have been doing for refugee asylum claimants. As to the ethical
question of broaching such ‘secrets’ in a public forum, my view is that the

5 I have referred to this elsewhere as ‘traditional closets’ or ‘cultures of discretion’, aware

that the term closet inadequately captures the complexity and variety of non-disclosure situa-
tions but that it is nonetheless commonly used and widely understood. See Marc Epprecht,
Hungochani: The history of a dissident sexuality in Southern Africa (McGill-Queen’s University
Press, Montreal, 2006).
6 Matthew Roberts, ‘Emergence of gay identity and gay social movements in developing
countries. The AIDS crisis as a catalyst’, Alternatives 20 (1995), pp. 243–64; Vinh-Kim
Nguyen, ‘Uses and pleasures: sexual modernity, HIV/AIDS and confessional technologies
in a West African metropolis’ in Vincanne Adams and Stacy Leigh Pigg (eds), Sex
in Development: Science, sexuality and morality in global perspective (Duke University Press,
Durham, NC, 2005), pp. 245–67; and Vinh-Kim Nguyen, The Republic of Therapy: Triage
and sovereignty in West Africa’s time of AIDS (Duke University Press, Durham, NC, 2010).
Another important iteration of this idea, using Roberts’s exact word (‘catalyst’) in relation to
the Treatment Action Campaign and the emergence of a ‘universal’ dyke lesbian identity in
small-town South Africa, is Jonny Steinberg, Sizwe’s Test: A young man’s journey through
Africa’s AIDS epidemic (Simon and Schuster, New York, NY, 2008), p. 200. For the global
context, see, notably, Dennis Altman, Global Sex ( University of Chicago Press, Chicago, IL,
2001), and the website of the International Gay and Lesbian Human Rights Commission for
updates on the progress of sexual rights and sexual health struggles globally: <http://www.
iglhrc.org> (3 January 2012).
7 ‘African LGBTI declaration’ from Nairobi in April 2010, reproduced in Sylvia Tamale
(ed.), African Sexualities: A reader (Pambazuka Press, Nairobi, 2011), pp. 47–8.
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health interventions discussed below are already public documents that
actively solicit informed public engagement with the issues. The excep-
tion is the leaked US embassy cables, which I have used with caution
because they tend to make African leaders and US officials look more
ethical (and reasonable) than their public statements often imply. My
approach to all of these sources is guided by the rich tradition of feminist
scholarship and activism in Africa that Ugandan legal scholar Sylvia
Tamale eloquently builds upon in her work.8

Safer spaces
To begin the discussion, it is important to contest one of the more
common tropes in the Western media. It is not self-evident that homo-
phobia is a uniformly continental issue, that African cultures are inherent-
ly homophobic, or that Africa is the worst place in the world to be gay.
On the contrary, many countries in Africa appear to have a de facto
culture of tolerance (or indifference) to same-sex sexuality that amounts
to freedom from discrimination, notwithstanding sometimes harsh laws
and elite homophobic rhetoric. In addition to enjoying same-sex relations
while still fulfilling social obligations of heterosexual marriage and the
appearance of virility/fertility (de facto secretive bisexuality), traditional
‘covers’ for sexual and gender nonconformity include spirit possession,
woman–woman marriage, and distinct occupational or other social niches
such as the ‘yan daudu of northern Nigeria or the gor djigen of Senegal.
The key proviso is that non-normative sexuality not be named as such,
but take place under the umbrella of heteropatriarchal constructions of
family, faith, and African identity – don’t ask, don’t tell, in other words.9
A corollary to this point is that some of the most extreme expressions of
homophobia in Africa today are directly linked to outside interventions.
I want to be careful not to romanticize traditional cultures or overstate
African passivity in the face of foreigners’ homophobic proselytization.
However, the role of US Christian fundamentalist or ‘ex-gay’ missionaries

8 Sylvia Tamale, ‘Researching and theorising sexualities in Africa’ in Tamale, African

Sexualities, pp. 11–36. See also Emidio Gune and Sandra Manuel, ‘Doing research on sexu-
ality in Africa: ethical dilemmas and the positioning of the researcher’, same volume,
pp. 37–46.
9 A significant body of scholarship makes these points, including Epprecht, Hungochani;
Rudolf C. Gaudio, Allah Made Us: Sexual outlaws in an Islamic African city (Wiley-Blackwell,
Hoboken, NJ, 2009); Ruth Morgan and Saskia Wieringa (eds), Tommy Boys, Lesbian Men
and Ancestral Wives: Female same-sex practices in Africa (Jacana, Johannesburg, 2005); Nkunzi
Zandile Nkabinde, Black Bull, Ancestors and Me: My life as a lesbian sangoma (Fanele,
Johannesburg, 2008); Mpumi Njinje and Paolo Alberton (directors), Everything Must Come
to Light (Out of Africa Films, Johannesburg, 2002); and Stephen O. Murray and Will
Roscoe (eds), Boy Wives and Female Husbands: Studies in African homosexualities (St Martin’s
Press, New York, NY, 1998).
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is the subject of some compelling investigative journalism that draws
attention to this pernicious external influence.10
It is also important to recognize recent successes in the struggle to
extend human rights to sexual minorities in Africa, again notwithstanding
strong appearances to the contrary. As most people know, South
Africa was the first country on the continent to enshrine the principle of
non-discrimination on the basis of sexual orientation in its constitution.
Since doing so in 1996, it has moved steadily to develop laws and national
HIV/AIDS prevention and education policies that meet (and in some
cases surpass) global best practices. In November 2007, for example, it
became only the fifth country in the world to legalize same-sex marriage.
But South Africa is not alone in this trajectory. Cape Verde in 2004
became the second nation on the continent to decriminalize homosexual
acts over the age of consent (16 years, equal to the heterosexual age).
A handful of other countries, including Gabon, Mauritius, Central
African Republic, Rwanda, and Sierra Leone, have since signed or sig-
nalled their intention to support the UN General Assembly’s resolution
to include sexual orientation within the Universal Declaration of Human
Rights. In Uganda in 2010, the High Court upheld the right of lgbti to
privacy; in Kenya, an openly gay man (David Kuria) ran for election to
the Senate; in Botswana, at the time of writing, the High Court has begun
hearings on the decriminalization of sodomy. Prominent African leaders
and intellectuals have added their voices to the struggle to defeat homo-
phobia on a pan-African scale.11
Progress towards the attainment of human rights for sexual minorities
may often seem painfully inadequate when seen against headlines of
homophobic hate speech and violence. A fair assessment, however, must
acknowledge, first, that significant successes have occurred in Africa in
the last few years, with good potential to continue to do so in the light of
the profound structural changes that have favoured human rights aspira-
tions almost everywhere else in the world (urbanization, international

10 Kapya Kaoma, Globalizing the Culture Wars: US conservatives, African churches, and
homophobia (Political Research Associates, Somerville, MA, 2009); and Jeff Sharlet, ‘Straight
man’s burden: the American roots of Uganda’s anti-gay persecution’, Harper’s Magazine
(September 2010), pp. 36–48.
11 ‘Submission by NGOs to the African Commission on Human and Peoples’ Rights’,
Yogyakarta Principles in Action (November 2009), <http://www.ypinaction.org/files/01/55/
Thematic_Resolution_ African_Commisstion_2009.pdf> (20 May 2011); ‘Sexual orientation
under the African Charter on Human and Peoples’ Rights’, Pambazuka News 506 (2011)
<http://pambazuka.org/en/category/features/68953> (20 May 2011); Writers and Academics
Against Homophobia, ‘On the murder of David Kato, the Ugandan gay rights campaigner’,
Nigerians Talk (6 February 2011), <http://nigerianstalk.org/2011/02/06/on-the-murder-
of-david-kato-the-ugandan-gay-rights-campaigner/> (22 May 2011); plus numerous authors
in Elaine Salo and Pumla Dineo Gqola (eds), Feminist Africa 6: Subaltern sexualities
(September 2006) and Tamale (ed.), African Sexualities.
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migration, connectivity to social media, and so on). Second, a disjuncture
exists between the loud expressions of homophobia, on the one hand, and
popular cultures that prefer to turn a blind eye to private matters around
sexuality on the other. That disjuncture suggests a greater openness to
education and reasoned dialogue than is often assumed in anti-
homophobia interventions and in sensationalized media accounts.
In making these points, I do not want to minimize the dangers and in-
dignities that African lgbti and their friends and families often encounter.
It remains true that on most of the continent strong social stigma attaches
to open expressions of same-sex sexuality, and that this opens the door to
all kinds of abuse and self-harm. Same-sex sexuality is also criminalized
to various degrees in most African countries. Mostly this is achieved
through laws inherited from the colonial era that focus on specific, albeit
ill-defined, sexual acts – sodomy, above all, but also variations of ‘unnat-
ural acts’, ‘debauchery’, and even ‘buggery’, a term that passed out of
common usage in the source country (England) many decades ago. Such
laws are directly oppressive and have resulted in several high-profile cases
of imprisonment. But they are also indirectly oppressive by inviting
entrapment, extortion, blackmail, vigilantism, and cultivated ignorance
about unsafe sexual practices. Numerous reports suggest that this situ-
ation is worsening with a surge of violent homophobic rhetoric and acts
in recent years. Even in South Africa cases of homophobic hate crime are
reportedly on the rise, while the government has until very recently been
noticeably hesitant to incorporate this aspect of human rights in its
foreign policy.12
Complicating the situation is the widespread perception that human
rights discourse is a not-so-subtle form of Western neo-imperialism. In
the context of Western-backed structural adjustment policies that have
had a devastating impact upon African economies and societies, for many
Africans this is an intervention too far. Mistrust of the West has been
inflamed in recent years by African politicians and religious leaders with
demagogic language that links opposition to gay rights with patriotism.
Western pressures on Uganda to refrain from adopting its proposed
Anti-Homosexuality Bill, for example, were denounced by one prominent
Christian leader as ‘undemocratic threats’ and ‘homocracy’.13 Solidarity

12 Paul Canning, ‘SA leads fightback against LGBT rights at UN’, LGBT Asylum News,
<http://madikazemi.blogspot.com/2011/03/south-africa-leads-fightback-against.html> (28 May
2011); ‘Corrective rapes on increase – South Africa’, <http://www.mask.org.za/corrective-
rapes-on-the-increase-%E2%80%93-south-africa/#more-4681> (28 May 2011).
13 Josh Kron, ‘Pulling out all the stops to push an antigay bill’ (2011), <http://www.
nytimes.com/2011/04/14/world/africa/14uganda.html> (17 May 2011). This same man has
asked rhetorically if US President Obama wanted the people of Uganda to ‘eat da poo poo’
as he put it in a much-ridiculed YouTube clip – <http://www.youtube.com/watch?v
=euXQbZDwV0w> (20 May 2011).
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groups and NGOs in the West have also been tarred with the brush of co-
lonialism and racism – the ‘gay international’ according to one academic
rebuke, or ‘homonationalism’ to another. The latter refers to activists in
the West taking chauvinistic pride in their hard-won gay rights and in that
way, often unintentionally, adding to the ideological arsenal that bashes
Muslims and other supposedly retrograde folks.14
The result of all of this is that sexual rights activists in Africa commonly
risk their jobs, family, reputations, and possibly even their lives to speak
publicly and explicitly in favour of such rights. It is bad enough to be
denounced as a pédé (‘faggot’). But it hurts to be labelled as a zombie or
whore to the West as well. That small numbers of individuals, associa-
tions, and networks are speaking out is thus all the more remarkable.
They are conducting or supporting research that challenges the prejudices
of the anti-rights position, and forming alliances both domestically and
internationally to press their case to public opinion. From their own testi-
mony, this work can have a powerful, even revolutionary, impact upon
their personal sense of identity and citizenship, especially as it engages
broader issues of social transformation.15 The LGBTI Declaration of
2010, for example, lists economic justice, democracy, and land redistribu-
tion among its goals.16
Such sentiments have undoubtedly contributed to the successes noted
above. For most African lgbti, however, a bold rights or full disclosure
strategy in confrontation with the state or powerful religious groups is
simply too risky, unlikely to be successful, and unattractive. The fact
is that many governments in Africa are run by or beholden to populist
demagogues, are corrupt, and/or are frankly uninterested in human rights
of any kind beyond a cynical performance to secure aid from often
equally or more cynical Western donors. Moreover, even where willing,

14 J. Massad, Desiring Arabs (University of Chicago Press, Chicago, IL, 2007); Jasbir
K. Paur, ‘Homonationalism and biopower’ in Adi Kuntsman and Esperanza Miyake (eds),
Out of Place: Interrogating silences in queerness/raciality (Raw Nerve Books, London, 2008),
pp. 13–70. Strong critiques of ‘pink colonialism’ and racism within the European lgbti com-
munity around these issues can be found through the blog Black Looks, including a press
release from Ugandan activists denouncing sensationalist coverage in the US media, <http://
www.blacklooks.org/2010/07/beheaded-ugandan-not-an-lgbt-activist/> (31 May 2011).
15 See, for example, Karin Willemse and Ruth Morgan with John Meletse, ‘Deaf, gay,
HIV positive and proud: narrating an alternative identity in post-apartheid South Africa’,
Canadian Journal of African Studies 43, 1 (2009), pp. 84–105. See also the efflorescence of
lgbti fiction, art, and film analysed in, among others, Maureen Ngozi Eke, ‘Woubi Chéri:
negotiating subjectivity, gender, and power’ in Ada Uzoamaka Azodo and Maureen Ngozi
Eke (eds), Gender and Sexuality in African Literature and Film (Africa World Press, Trenton,
NJ and Asmara, 2007) and Marc Epprecht, ‘Recent trends in the treatment of homosexuali-
ties in literature and film by African artists’ in L. Ouzgane (ed.), African Men in Film and
Fiction (MacMillan/Palgrave, London, 2011), pp. 153–63.
16 Tamale, African Sexualities, p. 182. The origins of this manifesto are obscure.
Nevertheless, the sentiments expressed there were widely shared by delegates at the Cape
Town ‘Struggle for Equality” conference.
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African states typically lack the capacity or bureaucratic heft to put human
rights principles into practice on many issues, not just the lgbti file.
African lgbti are meanwhile so heterogeneous (by class, ethnicity, race,
language, gender identity, sexual orientation, religion, age, and so on)
that it is daunting almost to the point of impossible to forge a common
political front. Same-sex desire also, it should be emphasized, does not
negate patriotism and national or family loyalty. A human rights strategy
that involves mocking African leaders and cultures in generalized terms
can be directly alienating to African lgbti, as well as provoking a wider
nationalist reaction against lgbti people and greater policing of homosocial
or de facto gay friendly spaces.
The majority of same-sex-practising people in Africa thus still prefer to
keep a low profile, eschewing identity politics and adhering to family
expectations and social norms even as they quietly find same-sex partners
or surf the net for private connections. Even activists who are unambigu-
ously, courageously ‘out’ as regards their sexual orientation have
expressed frustration with pressure from the West to be more confronta-
tional, and more ‘out’ in the approved Western ways. The Rev. Rowland
Jide Macaulay of Nigeria offers one sober expression of that view.
Welcoming solidarity from groups and donors in the West, Macaulay
nevertheless strongly urges:
The international gay and lesbian movement is not a model for Africa. The way we
approach things is very, very different. Our culture is different. One of the things we keep
telling our European friends is bear with us, travel the slow pace with us. Recognize our
issues. Consult us before you act on our behalf.17

Dangerous turns
It may be asked then, as some African leaders pointedly have, why not
just leave things be – that is, don’t ask, don’t tell, and let the homophobic
steam blow over? This was the gist of Zimbabwe’s Prime Minister
Morgan Tsvangirai’s characterization of gay rights as ‘elitist’, and is a
common refrain in the confidential discussions between the US State

17 Rowland Jide Macaulay, ‘We are not asking for sanctions’, D + C: International Journal
38, 2 (2011), pp. 84–5. Numerous lgbti activists have urged Western donors not to provoke
a further backlash against them. See ‘African activists oppose cuts to Ugandan aid’,
Washington Blade (18 May 18, 2011), <http://www.washingtonblade.com/2011/05/18/
african-activists-oppose-cuts-to-ugandan-aid/> (23 May, 2011). On the tensions between
African lgbti and Western expectations of gay identity, see P. Awondo, ‘Identifications
homosexuelles, construction identitaire, et tensions postcoloniales entre le Cameroun et la
France’, espace et société, 13, 1 (2011), <http://espacepolitique.revues.org/index1818.html>,
(14 October, 2011); and Graeme Reid, ‘How to become a “real gay”: identity and termin-
ology in Ermelo, Mpumulanga’, Agenda 67, 20 (2006), pp.137–145.
 SEXUAL MINORITIES AND PUBLIC HEALTH STRATEGIES 231

Department and African leaders as revealed in the Wikileaks cables.18

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Unfortunately, as much as we can respect some of the merits of the ‘low
profile’ position, its sustainability in a globalizing world and in the
context of high rates of HIV/AIDS is vanishingly small. Indeed, beginning
in the late 1990s, tentative studies began to reveal that men’s practice of
hiding homosexual relationships behind the façade of a wife or girlfriend
was a much more serious factor in the spread of HIV in Africa than previ-
ously assumed. One study from Abuja, for example, found over a third of
msm had HIV – up to seven times the rate found amongst the population
as a whole. Another study from Kenya found over two-thirds of msm had
had unprotected intercourse with a woman in the previous year, while in
Senegal, one in five msm reported practising heterosexual anal intercourse
as well as their male–male practices. In Uganda, fully 90 percent of msm
informants in the first such study there had female wives. Relatively high
levels of sex work, of non-consensual sex, of substance abuse, and of mul-
tiple concurrent partners, plus low levels of condom and water-based
lubricant use in the context of low confidence in the healthcare system,
combine to create a perfect storm of conditions for the spread of HIV.
The government of Kenya estimates no less than 15 percent of all new
HIV infections in the country occurred as a result of male–male sex. Such
a toll adds to the recipe for the intensification of stigma against lgbti
people.19
Of course this is a huge tragedy. How many tens of thousands of
people died as a result of this two-decade blindspot in HIV/AIDS stra-
tegic plans, and how many more may be endangered by new forms of

18 See ‘MPs tackle Tsvangirai over gays’, <www.newzimbabwe.com/news-6362-Tsvangirai

%20tackled%20by%20MPs%20over%20gays/news.aspx> (26 October 2011). The US
Ambassador’s interview with Gambian President Yahya Jammeh in February 2010 is espe-
cially revealing on this point. Jammeh publicly blamed foreigners for corrupting Gambian
morals and threatened to cut off the heads of homosexuals, yet is quoted as privately saying,
‘There are gays here in The Gambia, I know that. But they live in secret and that is fine with
me, as long as long as they go about their business in private we don’t mind.’ <http://www.
cablegatesearch.net/cable.php?id=10BANJUL65&q=homosexuals> (3 January, 2012).
19 Kenya National AIDS and STI Control Programme (NASCOP), ‘Most at Risk
Populations – MARPs,’ (Kenyatta Hospital Grounds, Kenya, 2011), <http://nascop.or.ke/
marps/>, (27 May 2011). Other statistics are taken from Cheikh Ibrahim Niang, Moustapha
Diagne, Youssoupha Niang, Amadou Mody Moreau et al., Meeting the Sexual Health Needs
of Men Who Have Sex with Men in Senegal, (USAID, Washington, 2002); Dan Allman,
Sylvia Adebajo, Ted Myers, Oludare Odumuye, and Sade Ogunsola, ‘Challenges for the
sexual health and social acceptance of men who have sex with men in Nigeria’, Culture,
Health and Sexuality 9, 2 (2007), pp. 153–68; A. S. Wade et al. ‘HIV infection and sexually
transmitted infections among men who have sex with men in Senegal’, AIDS 19, 18 (2005),
pp. 2133–40; P. Kajubi et al., ‘Gay and bisexual men in Kampala, Uganda’, AIDS and
Behavior 12, 3 (2008), pp. 492-–504; National AIDS Control Council (NACC) of Kenya
and Population Council, ‘The overlooked epidemic: addressing HIV prevention and treat-
ment among men who have sex with men in sub-Saharan Africa, report of a consultation,
Nairobi, Kenya, 14–15 May 2008’, (Population Council, Nairobi, 2009), <http://
www.popcouncil.org/pdfs/HIV_KenyaMSMMeeting Report.pdf> (2 January 2012).
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stigmatization? On the other hand, many see an opportunity coming out
of this research. Public health, they argue, could push the rights agenda
ahead more effectively than either the gay rights or go-slow/‘low profile’
approaches. A third strategy has consequently emerged that expresses
alarm and frustration with the silences around same-sex sexuality while at
the same time recognizing the risks and limitations of using the kinds of
rights-based arguments and explicit language associated with gay liber-
ation in the West. In this view, the long-term objectives remain the attain-
ment of full human rights for sexual minorities and the gradual
attenuation of aspects of culture that require secrecy, public conformity to
heterosexual norms, and hypocrisy. This may or may not lead some indi-
viduals to adopt some elements of Western gay identities. Even where it
does not, however, and where African lgbti continue to express their
respect for African faith, family, and other values, it still poses the risk of
open confrontation with the state and community, against which there are
very few protections. The short run therefore requires more subtlety than
overt sexual rights activism. This strategy involves the use of euphemisms
to obscure or dilute the homosexual aspects of the argument. As one lgbti
activist in Kenya emphatically put it, ‘There are no gay rights!’20 This
strategy also requires the submersion of normative rights and justice
objectives within science-based public health arguments directed at either
the whole population or at ‘worthy’ heterosexual minorities whose work
or other circumstances make them especially vulnerable to HIV.
Can an interim, covert ‘health strategy’ have success in protecting
people and opening the door to societal acceptance of out lgbti, however
that outness is articulated? Matthew Roberts was certainly optimistic in
believing so.21 Writing long before the advent of anti-retrovirals and elec-
tronic social media in Africa, and at the very onset of political homopho-
bia in Zimbabwe, Roberts saw AIDS as a ‘catalyst’ for ‘gay identity
migration’. Along with tragedy, AIDS would motivate activism on sexual
rights that would result in their widespread attainment in Africa and the
Global South more generally by ‘Stonewall 50’ (that is, by 2019, fifty
years after the celebrated start of gay liberation in the West). Such a polit-
ical and social transformation would be led by male middle-class activists
supported by Western solidarity groups and donors.
This is a controversial argument on several levels. Is it possible to com-
promise or hide human rights principles without effectively surrendering
to the opposition? Who wants to trust the middle class or Western

20 Mona Kareithi, ‘There are no gay rights’, <http://www.gaykenya.com/index.php?

option=com_content&view=article&id=126:there-are-no-gay-rights&catid=47:mona-kareithi
&Itemid=114>, (3 January 2012).
21 Roberts, ‘Emergence of gay identity’.
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donors? How will women who have sex with women be included in an
approach that necessarily emphasizes the high-risk nature of many current
msm practices? How can a stigmatized population avoid further stigma-
tization if publicity focuses on the health dangers they pose to the general
population? How are the goals of self-esteem and political confidence nur-
tured among young lgbti when the main associations representing them
prioritize disease and practice deception? If stealth is, in fact, necessary
for success, how ethical is it for allies to reveal and analyse the ostensible
secrets? And since secrecy so often evokes an element of eroticism, could
banal medical language generate unexpected ludic or ‘recruitment’ poten-
tial that might complicate the public health agenda or give rise to its own
set of scandals? It may be naïve, in other words, to assume that teachers
and public health workers will remain entirely immune to the effects of
talking about lubricants, pre-ejaculate, the correct application of a
condom to an erect penis, and other such topics in explicit language, and
that they will not be susceptible to homophobic accusations of recruit-
ment. Indeed, according to the first-hand account of a medical profes-
sional in Abidjan, precisely that has happened, along with the emergence
of other modern, liberal or ‘self-fashioned’ sexual identities, as bold con-
fessions of HIV status, sexual practices and gender performance have
been rolled out in the struggle to combat HIV/AIDS and stigma.22
Confidence in Roberts’s schema is also compromised by a close exam-
ination of the one clear success he identifies in Africa, Gays and Lesbians
of Zimbabwe (GALZ). Memoirs by founding members of GALZ do not,
in fact, support his claim that AIDS or other health issues were a catalyst
in its formation. Some of the principal gay men involved strongly accredit
the pioneering role of lesbians in the process.23 From my own observa-
tions of the troubled transition from predominantly white to predomin-
antly black leadership in the mid-1990s, middle-class members were not
necessarily reliable in that process. Recalling the context of extreme vul-
nerability for those who held formal employment, it is not surprising that
a ticket to London or New York was often preferable to assuming a lead-
ership role for a publicly despised association.

22 Nguyen, ‘Uses and pleasures’, focuses on changes in the homosexual milieu, while the
same author’s Republic of Therapy takes a broader view of the impact of Western biomedical
discourses on the refashioning of heterosexual identities and roles in francophone West
Africa.
23 Gays and Lesbians of Zimbabwe, Sahwira, (GALZ, Harare, 2002); Keith Goddard, ‘A
fair representation: the history of GALZ and the gay movement in Zimbabwe’, Journal of
Gay & and Lesbian Social Services 16, 1 (2004), pp. 75-–98; Charles Gueboguo,
‘Mobilisations transnationales des communautés homosexuelles en Afrique: une affaire à
suivre’, Anthropologie et Sociétés 32 (2008), pp. 85-–93 on Cameroon, where the gay rights as-
sociation predated the creation of a rival NGO for msm health.
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Nevertheless, it is possible to discern a discreet sexual rights movement
and identity formation unfolding at least somewhat as Roberts predicated,
with HIV/AIDS as a motivating factor particularly in countries that lack a
strong civil society. The remainder of this article considers specific mani-
festations of this strategy/movement, and their prospects for success.

The HIV gambit

A number of global actors have been crucial to funding new research, en-
abling the construction of networks, and mobilizing opinion on msm. The
International Gay and Lesbian Human Rights Commission (IGLHRC),
for example, made an important early intervention with its report on the
failures of virtually all African countries to help African msm protect them-
selves against HIV.24 Even more significant was the first-ever workshop on
the topic of msm and HIV/AIDS in Africa, primarily sponsored by the
US-based Population Council. Held in Nairobi in May 2008, that meeting
brought together dozens of activists and public health officials from ten
African nations. Its report urged African governments to recognize the ex-
istence of msm and to promote their right to health for pragmatic reasons,
with all that that implies for prevention, treatment, care, and the necessity
for ‘an overall high quality of life’. But the report also endorsed avoiding
the term msm in protocols and ethics applications, emphasized the need to
‘manage’ the media so as to avoid negative publicity as programmes
unfolded, and advocated designing studies to include injecting drug users
and the disabled, even if the principal subjects of the studies (msm) would
be likely to object to these inclusions.25
It may be an exaggeration to describe this as a ‘covert’ strategy:
‘discreet’ or ‘two-stage’ are probably more appropriate adjectives – that is,
the use of implicit, euphemistic, or vague language and acronyms to get
the foot in the door, then extend the discussions when circumstances are
favourable. That strategy, it should be emphasized, is by no means new in
the history of homosexualities in Africa. On the contrary, men and
women have always invented words and argots to disguise activities
and liaisons which popular culture disapproved. In northern Nigeria, a
highly sophisticated blend of languages and double entendres has enabled a
sub-culture of effeminate men who sometimes have sex with men to exist
more or less openly in an otherwise quite conservative Muslim society.
Recent neologisms such as kuchu (East Africa), nkouandengué
(Cameroon) and saso (Ghana) take some of the sting out of traditional

24 Cary Alan Johnson, Off the Map: How HIV/AIDS programming is failing same-sex prac-
ticing people in Africa (IGLHRC, New York, NY, 2005).
25 NACC, ‘The overlooked epidemic’.
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terms that imply an occult meaning, or more modern pejoratives. As
such, they may be facilitating a modicum of public acceptance for other-
wise censured behaviours. Perhaps the best-known example of this in
Southern Africa is nkotshana (hungochani, bukhontxana), invented by
migrant mine workers in the late-nineteenth century to describe a short-
term male–male ‘marriage’ but by the 1990s co-opted to mean sexual
orientation and identity in the modern sense, deserving of respect.
Gay rights activism in Africa also recorded its origins in unobtrusive
language. The very first attempt to organize people politically against state
harassment of gay men (in South Africa in 1966) was called the Law
Reform Fund. This had limited success, and in the late 1970s activists
turned to more militant and explicit language. Yet after a run of gay and
lesbian-named associations in the 1980s (GASA, GLOW, OLGA) some-
thing of a shift back to more neutral and inclusive language took place in
the 1990s. The intention was quite deliberate – to embed the struggle for
rights for sexual minorities within wider struggles for civil rights, and
women’s emancipation from patriarchal laws and customs in particular.
Hence Sister Namibia, the Triangle Project, the Rainbow Project, Forum
for the Empowerment of Women, and the Joint Working Group. There
has also been an emergence of safer social spaces for lgbti who do not
necessarily want to participate in political activism, notably through
lesbian soccer clubs and gay-friendly faith groups (Hope and Unity
Metropolitan Community Church in South Africa, Other Sheep East
Africa in Nairobi, and the Rainbow Church in Nigeria, for example).
Outside of Southern Africa, demurring to name the main intended direct
beneficiaries of sexual minority rights has been a strong feature of the move-
ment as it developed since the late 1990s. For those without insider knowl-
edge, it is hard to tell what issues and audiences Alliance Rights Nigeria,
Freedom and Roam Uganda, the Centre for the Development of People
(Malawi), Matrix (Lesotho), Andiligueey (Senegal, meaning ‘men working
together to help other men’ in Wolof), Horizon Community Association
(Rwanda), or Ishtar MSM (Kenya) are addressing. Even beyond the am-
biguous names, it often requires a close look at their websites to discern
their priorities. CEDEP in Malawi, for example, introduces itself as
working for the health of the country’s ‘most neglected minority groups’, of
which msm appears down the list from prisoners and (implicitly female) sex
workers. Yet further along on the website its programmes, including men’s
sexual health, peer education, voluntary counselling and testing, advocacy,
and research, indicate an overwhelming focus on msm.26

26 CEDEP: The Centre for the Development of People, <http://www.cedepmalawi.org/>

(20 May, 2011). To be fair, CEDEP also collaborated in an important “outing“ with the
publication of Patricia Watson, Queer Malawi: Untold stories, (Gay and Lesbian Archives,
236 AFRICAN AFFAIRS

The strategic embrace of health discourses is one ‘cloaking’ mechanism

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to slip sexual minority rights onto the local agenda. Nigeria’s INCRESE
(the International Centre for Reproductive Health and Sexual Rights), for
example, lists diversity among its four core values, with msm as just one
of its target populations. Yet it has emerged as one of the key actors facili-
tating research and lobbying against proposed homophobic laws and prac-
tices in Nigeria.27 The Uganda Health and Science Press Association
(UHSPA) is another recent creation whose name does little to alert the
opposition to its interest in sexual rights. In an important public interven-
tion, the UHSPA is upfront that it is in fact a registered LGBTIQ organ-
ization and calls for the compete decriminalization of same-sex sexuality
between consenting adults. The bulk of the memorandum, however,
methodically presents a harm reduction argument against the govern-
ment’s proposed punitive approach to HIV infection. It stresses the public
health benefits cited in the 2009 ruling by the Delhi High Court when it
struck down the Indian law against ‘carnal knowledge … against the order
of nature’ (the exact same law had been imported by the British to
Uganda), namely that the law ‘contributes to pushing the infliction [sic]
underground’, and makes ‘risky sexual practices go unnoticed and unad-
dressed’. The UHSPA concludes with an appeal to ‘self-preservation’
of the heterosexual majority by emphasizing the extent – and threat – of
hidden bisexuality in Ugandan society.28
None of this is to suggest disingenuousness. On the contrary, health
clearly played a key, sincere role in motivating same-sex-practising people
into political activism across the continent. As PEMA (Persons
Marginalized and Aggrieved, a Mombasa-based lgbti association) puts it,
the group owes its existence to the lonely death of a member of the com-
munity who was ostracized by his family. In the soul-searching that fol-
lowed, friends determined to do something to address the issues that
contributed to the tragedy. By its own account, PEMA quickly trans-
formed from a male-only association to one that includes lesbians and
transgender women.29 Elsewhere, msm respondent-driven sampling to

Johannesburg, 2010). The extent to which the book will be available in Malawi is unclear,
but CEDEP is acquiring a profile in the mainstream Malawian media as an advocate of gay
rights.
27 International Center for Reproductive Health and Sexual Rights, ‘Welcome to
INCRESE’, <http://www.increse- increse.org/> (31 May, 2011).
28 ‘Ugandan LGBTI Community petition Parliament over the Right to Health and HIV/
AIDS Control Bill 2010’ (Uganda Health and Science Press Association, 2011), <http://
uhspauganda.blogspot.com/2011/04/ugandan-lgbti-community-petition.html> (22 May,
2011).
29 Gay and Lesbian Coalition of Kenya, ‘Persons Marginalized and Aggrieved (PEMA
Kenya)’, < http://galck.org/index.php?option=com_content&view=article&id=76:persons-
marginalized-and-aggrieved-pema-kenya&catid=3:galck-members&Itemid=3> (25 May,
2011).
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investigate high death rates in the studies noted above helped to conscien-
tize the subjects with scientific knowledge, and provide confidence to
speak out publicly.
A significant amount of gay rights activism has also simply melded into
mainstream HIV/AIDS lobby groups. The strikingly successful Treatment
Action Campaign is the most famous of these. TAC was founded in 1998
by Zackie Achmat and several other activists behind the sexual orientation
clause in South Africa’s constitution. The immediate motivation to form
TAC, according to Achmat, had been the death of pioneering black gay
activist, Simon Nkoli, who had not been able to access the anti-retroviral
drugs that were saving the lives of better-insured, and usually
lighter-skinned citizens. TAC today makes virtually no reference to these
origins and only minimally to homophobia as a stigma that has an impact
on HIV/AIDS.30 Other mainstream HIV/AIDS NGOs have meanwhile
begun to incorporate msm in their vocabulary, learning in the process to
be discreet. As one such worker reported from Mali, an initial lack of dis-
cretion had sparked protests against a planned workshop on HIV/AIDS
and homosexuality.

They made such a fuss about this, accusing the organizers of trying to lure teenagers into
homosexuality, as a result we had to cancel the workshop. Today we try to run our activ-
ities more discreetly, we are flying under the radar. Recently we were invited to join
Africa Gay, a network of LGBTI organizations that fight against HIV and AIDS, but we
had to decline this opportunity for fear of protests by people.31

The network referred to above may be the African Men for Sexual Health
and Rights (AMSHeR), a Johannesburg-based NGO established in 2009
with a mandate ‘to address the vulnerability of gay and bisexual men,
male-to-female transgender women and other MSM, to HIV’.32
AMSHeR was the brainchild of both HIV and human rights advocates,
and indeed, its first executive director was a former employee of
IGLHRC who holds a graduate degree in International Human Rights
Law (Joel Gustave Nana). AMSHeR clearly indicates that it uses ‘a
rights-based approach which recognizes the need to protect our members

30 Samantha Power, ‘Letter from South Africa, The AIDS Rebel’, The New Yorker, 19
May 19 2003, pp. 54-–67. See also Steven Friedman and Shauna Mottiar, ‘Seeking the high
ground: The Treatment Action Campaign and the politics of morality’ in Richard Ballard,
Adam Habib, and Imraan Valodia (eds), Voices of Protest: Social movements in post-apartheid
South Africa (University of KwaZulu-Natal Press, Scottsville, 2006), pp. 23-–44.
31 Jerina Chendze Messie, ‘Homophobia drives Malian MSM underground’ (2011)
<http://www.mask.org.za/homophobia-drives-malian-msm-underground/#more-4313> (22
May, 2011).
32 African Men for Sexual Health and Rights, ‘Contact AMSHeR’, <http://amsher.net/
AboutAMSHeR/tabid/56/Default.aspx> (28 May, 2011). AMSHer is primarily funded by
the Dutch through AIDS Fonds and HIVOS, the UNDP, and other international non-
government organizations.
238 AFRICAN AFFAIRS

– who often work in repressive environments’. Yet even here one can

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sense a gentle pulling of punches. The main stated goal is to fulfil the
right to health for men who have sex with men. The rights to freedom of
speech or association or privacy remain implicit. The ordering of institu-
tional objectives also suggests an element of caution, and a hierarchy of
priorities: strengthen capacity, increase the visibility of MSM issues,
greater resources, an evidence base and, lastly: ‘Advocate for the protec-
tion of gay men and other men who have sex with men from human
rights violations.’33
This is not a criticism of AMSHeR, which in fact remains quite bold in
its reference to gay men and LGBT. Even msm, invented precisely to get
around those identity politics by categorizing people according to activity
rather than sexual orientation, remains inflammatory in many contexts.
AMSHeR found itself the focus of hostile attention in that regard at the
2011 International Conference on AIDS and STIs in Africa in Addis
Ababa. A coalition of Christian churches threatened to close down its
proposed workshop on msm with a massive public protest. The crisis was
only averted through the direct intervention of the Ethiopian Minister of
Health.34
The NACC report on msm also noted that the term has been met with
‘obstructionism’ by health officials in Zambia and Kenya. For that reason,
it advocates deploying a new acronym as a preferred way to ease the
concept past suspicious eyes – MARP or Most At-Risk Population.
MARP refers primarily to msm, intravenous drug users, and female sex
workers, but also includes presumably heterosexual long-distance truck
drivers, street children, fishing and beach communities, widows, lesbians
who may be subject to so-called curative rape, and any other groups
whose life circumstances structurally undermine their ability to make or
to negotiate safer sex choices. The NACC report explicitly advises groups
seeking local research ethics approval to use the term MARP ‘in lieu of
“MSM”’ in their applications.35
A self-conscious need for discretion or self-censorship is not the only
or even the dominant motivation behind such naming practices and lists
of priorities. In at least one case a sexual rights association adopted its
present ambiguous name not out of its own sense of caution but at the

33 Ibid. I do not mean to invest too much into reading a simple list. But can it be coinci-
dence that the NACC report (‘The overlooked epidemic’) similarly states five future prior-
ities for prevention, care and treatment of msm, and that the only one of these with an
immediately recognizable ‘gay pride’ or anti-homophobia focus is again placed last?
34 ‘The homophobic disruption of AMSHeR’s Pre-ICASA meeting: what
really happened’, <http://www.mask.org.za/the-homphobic-disruption-of-amsher%E2%80%
99s-pre-icasa-meeting-%E2%80%93-what-really-happened-2/>, (5 January 2012).
35 NACC, ‘The overlooked epidemic’, p. 7.
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direct behest of government: The Burundian Groupe de réflexion des homo-
sexuelles du Burundi changed its name to Humure, meaning ‘do not be
afraid’, in order to get official accreditation as an NGO.36 At the same
time, there has been a flowering of explicitly lgbti associations in the past
few years which reject the need for ambiguity (Gay and Lesbian Coalition
of Kenya, the Gay and Lesbian Association of Ghana, ADEFHO
(Association pour la Défense de l’Homosexualité – Cameroon), and the
very outspoken Coalition of African Lesbians. The NACC report also un-
ambiguously acknowledges that public health and human rights argu-
ments cannot be separated, and that human rights should not be
neglected: ‘When you walk over hot coals, you need both of your
shoes’.37
Nonetheless, the language chosen by the NACC in its strategy recom-
mendations to get rights for sexual minorities on the national agenda is
instructive. Rather than demanding, challenging, speaking up, mobilizing,
and protesting, it suggests consulting, sharing, advocating, managing, in-
cluding, encouraging, non-confronting, peer approaching, engaging, inte-
grating, sharing, and sensitizing. Also interesting are the recurrent terms
‘circumvent’ and ‘avoid’. The latter is implicitly recommended for acti-
vists and mid-level bureaucrats, who rather than directly engage potential-
ly prickly national governments and political appointees are advised to
‘Advocate at the donor level of MSM in National Strategic Plans (NSPs),
as most NSPs are externally funded’.38 Similarly, NPS language can be
couched in generic terms so as to circumvent national laws that criminal-
ize same-sex practices, for example, using phrases such as ‘people-
centred’ rather than naming specific disapproved populations. The report
suggests avoiding appeals to controversial human rights documents in
favour of ‘epidemic modelling as a tool of persuasion’.39

Does the public health strategy work?

Science has a woeful history in Africa of being used to sugarcoat forced
population removals, racist social engineering, and other assaults by the
state on cherished aspects of African culture. Some Africans will un-
doubtedly perceive attempts to promote sexual minority rights under
cover of public health discourse in the light of that history, and so
respond negatively. Senegal’s Andiligueey was one of the first active msm
health support groups in West Africa, for example, with terrifying

36 United States Department of State, ‘Human Rights Reports for 2009: Global equality’,
p. 2.
37 NACC, ‘The overlooked epidemic’, p. 7.
38 Ibid., p. 17.
39 Ibid., p, 17.
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numbers to support its arguments (up to 29 percent seroprevalence
among msm versus 1 percent of adults in the general population), and a
modest, muted rights agenda. It did not survive the publicity it gar-
nered.40 Similarly, an msm drop-in centre in Malindi in Kenya was
closed down by public protest shortly after opening, while healthcare pro-
fessionals have been implicated in the ongoing abuse of msm in
Mombasa.41 The public health strategy also remains deeply controversial
within the lgbti movement. Do the risks of a mostly male-centred,
disease-focused, externally funded strategy outweigh the benefits of a
more radical approach à la the LGBTI Manifesto, the trans-activism of
groups like Gender DynamiX, or feminist-identified associations like the
Coalition of African Lesbians (which, in 2010, became the first lgbti asso-
ciation to apply for observer status with the African Commission on
Human and People’s Rights – unsuccessfully, so far)?42
Despite the setbacks and unresolved debates, evidence points to some
striking successes on the health track, even in countries where the political
rhetoric has been most discouraging. Several African countries have offi-
cially sanctioned such an approach in principle, including the country
that kickstarted the political homophobia in the mid-1990s
(Zimbabwe).43 While the political leadership is unlikely to trumpet this
move in public, and funding may not be forthcoming as required, it is
nonetheless a vindication of the argument that potentially public health
pragmatism can trump even the noisiest homophobic rhetoric. We can
infer as much from many of the leaked US embassy cables gathering
information on the issue in 2009–10. They suggest, for example, that
Rwanda’s dramatic change in policy at the United Nations and in facilitat-
ing sexual minority support groups domestically owes much to the role of
‘Minister of Health Sezibera, one of the more influential figures in gov-
ernment’.44 The differential response of the Cameroonian state to rival
sexual minority associations is also revealing. The msm health-oriented

40 ‘AIDS initiative shattered by state persecution’, AIDS Portal, <http://www.aidsportal.org/

web/guest/document?view=object&loc=/db/Domain/62756/Data/62776/Atom/UC-Contribute-
62776-10113-20100630-120837&id=0895d8ef-7916-4fc5-a91f-e26b29a501e4> (25 May,
2011).
41 Kenya Human Rights Commission, The Outlawed Amongst Us (Kenya Human Rights
Commission, Nairobi, 2011) (2011).
42 < http://www.genderdynamix.co.za/> and <http://www.cal.org.za/> (12 January 2012).
43 ‘Zimbabwe National HIV and AIDS Strategic Plan (ZNASP)’ (Harare, National AIDS
Council, 2010), <http://www.ilo.org/wcmsp5/groups/public/—ed_protect/—protrav/—ilo_
aids/documents/legaldocument/wcms_125613.pdf> (27 May, 2011).
44 ‘Ministry of Health lobbies against anti-homosexuality legislation’, <http://www.
cablegatesearch.net/cable.php?id=09KIGALI860&q=homosexuality> (12 January 2012). A
government spokesperson recently almost acknowledged as much by claiming that its Health
Development Initiative since 2009 is behind a more ‘positive attitude’ towards sexual
minorities – Dr Aflodis Kagaba, cited in <http://www.mask.org.za/positive-change-of-
attitude-towards-homosexuality-in-rwanda/> (12 January 2012).
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association Alternatives-Cameroon has long benefited from foreign
funding (US-based Foundation for AIDS Research, notably) without in-
curring the wrath of the state. Indeed, the state itself has accepted foreign
money – the Global Fund – with an explicit commitment to fund msm
projects. When the head of the rights-oriented association ADEFHO was
successful in her application for funding from the European Union,
however, she was immediately threatened with arrest and a fatwa by pro-
government youth groups.45
We do not yet have any close studies of institutional decision-making
processes and policy formulation on the health versus rights approaches
to sexual minorities, nor comprehensive fieldwork to assess the compara-
tive views of health, rights, and status quo advocates. In their absence, it
is impossible assess how effective the health strategy is in promoting
policy and attitudinal changes that open the door to the achievement of
sexual minority rights. For now, perhaps an anecdote serves to illustrate
how arguments that build from immediate public health needs to expan-
sive human rights provisions can be persuasive to reasonable people even
in highly conservative societies. I have witnessed this myself on several
occasions – for example, at the pilot short course on MARPs at
Muhimbili University of Health and Allied Sciences in Dar es Salaam in
2009. Let me finish this section with a brief account of that remarkable
event.
I had been invited to address a group of about forty healthcare profes-
sionals, bureaucrats, and activists from Tanzania, Ethiopia, Kenya,
Madagascar, Uganda, Kenya, and Zimbabwe on the issue of msm. Of
course I assumed the audience would be open-minded to the topic – why
else would the funders have invited me from halfway across the world and
openly advertised my credentials and lecture titles? I therefore launched
enthusiastically into a planned series of four lectures followed by small
group workshops. The first day seemed to go smoothly as I focused on
traditional practices and ways of not seeing. The second day, however,
took a turn for the worse as I discussed the emergence of msm subcul-
tures in prisons and industrial compounds and the rise of a gay rights
movement. I presented the latter as a more or less unambiguously positive
development, as it engaged with parallel struggles for women’s rights and
the general enrichment of civil society. The conference convener – a
fluent Swahili-speaker – picked up a growing unease as I spoke, verging
on rebellion. At our tea break he took me aside to request an emergency

45 The threats against ADEFHO and Alice Nkom continue, described in a joint press
release with the Spanish group Fondacion Triangulo, <http://www.fundaciontriangulo.org/
adefho/index-en.html> (12 January 2012). See also Paul Canning, ‘Cameroon protests EU’s
support for Cameroonian LGBT; France urged to defend,’ <http://www.
dayagainsthomophobia.org/Cameroon-protests-EU-s-support-for,373> (12 January 2012).
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change of programme, to which I reluctantly consented. He then took
over leadership and backtracked to what seemed a very simplistic level of
discussion of what to do about msm in Africa. It culminated in small
group discussions in which each and every group, after debating the
issues as they understood them, fundamentally rejected the premises of
my entire presentation of the first day and a half. They either denied the
existence of msm in their own countries or brainstormed ways to catch,
isolate, and/or ‘cure’ them.
It was a deeply dispiriting turn. Nonetheless, I hung in through the next
week of lectures and workshops. These focused on intravenous drug users,
sex workers, and other MARP issues, with me listening and learning a lot
but also intervening now and then to remind people that msm presented
similar challenges. An invited member of the Dar gay community made a
dramatic appearance. To my surprise, it slowly became apparent that the
group was beginning to accept that msm existed on a much bigger scale
than they had ever imagined. More importantly, they no longer seemed to
present as much of a danger to Africa’s cultural integrity as some of the
other people under discussion (extortionists, and heroin or human traffick-
ers, for example). From that point, the participants moved fairly steadily
from ‘How do we cure them?’ to a broad acceptance of a harm reduction
approach through education and the protection of human rights for msm.
I moved in tandem from feeling like a pariah to feeling like a VIP. Hugs,
warm handshakes and email addresses were exchanged and it seemed,
after two weeks, that a fundamental shift in thinking had taken place in a
small but potentially influential group of people.

Conclusion
Many factors are at play behind the proliferation of lgbti associations and
networks, and gay or gay-ish identities in Africa south of the Sahara.
Health concerns are one such factor. It is impossible, however, to demon-
strate a direct co-relation between these concerns and ‘gay identity migra-
tion’ from the West or South Africa to the rest of the region. Indeed, in
some countries, associations focused on rights and self-esteem came first,
and health-focused initiatives followed. In other countries the opposite
happened or, more commonly, the two types of association quickly
learned that health and rights need to be addressed at the same time.
African efforts to mobilize and theorize the lgbti movement meanwhile
fairly consistently stress the need not to simply replicate Western models
and language, and have at times been quite critical of Western pressures
to conform to those models and their associated pace of change.
I would therefore conclude, first, that Matthew Roberts was not only
overly optimistic with his ‘Stonewall 50’ prediction, but also that he
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overstated his case about the process of gay identity migration related to
HIV/AIDS. Similarly, many factors have contributed to the emergence of
the anti-homosexuality backlash in so many African countries. We might
better speak of homophobias in the plural rather than a singular wave of
reaction against rights for sexual minorities: traditional notions of family
and respect, fundamentalist Christian and Islam ideologies, political
demagoguery and anti-Western sentiment, anxieties about masculinity
stemming from the economic malaise, and so on. Some expressions of
these homophobias are deeply discouraging to anyone who believes that
evidence-based advocacy on human rights and sexual health is guaranteed
eventual success.
However, my second conclusion is that we should not let those homo-
phobias blind us to the very real progress that has occurred in the struggle
to broaden acceptance of the notion that sexual orientation and gender
identity are human rights. Those successes build on a recognition that the
enemies – homophobia, ignorance, disease – are complex, and that conse-
quently strategies and tactics need to vary according to the specific
context in which they are encountered. Discreet, non-confrontational and
‘stealthy’ approaches are not mutually exclusive to the kind of bold
language – including anti-sexism, anti-racism and anti-colonialism – that
contributed to the human rights revolution in South Africa. The other
emerging or nascent successes in the fight for sexual minority rights
suggest that it may be this very combination of approaches that accounts
for the progress to this point.
Ultimately, reasoned argument based on collaboration between
msm-focused initiatives and broader lgbti associations will need to be
supplemented by an element of shaming and coercion in order to effect
the necessary changes in the face of homophobic oppositions. Africa’s
tiny lgbti and msm groups, with their other often similarly vulnerable
allies in civil society and ministries of health, are never on their own going
to be able to move entrenched politicians or charismatic religious leaders.
Additional pressure will need to come from friends on the international
scene. Because of the high potential for backlash, donors will need to be
careful that such interventions do not increase the exposure of sexual
rights groups to further victimization. A strategic emphasis on public
health, with rights discreetly embedded in the discussion, appears to be a
promising way to do that.