Anti-LGBTI Discrimination Harms Efforts to Fight HIV/AIDS

AIDS worlds AIDS Day


I went to Mwananyamala Hospital (a government facility) for
HIV testing. During the pre-counseling, I came out as gay to
the health staff (counselor) and immediately he condemned
me saying that it was my fault to catch the virus because of
my behavior of practicing anal sex. The counselor used abusive
words and told me that I have to suffer both punishments
being HIV positive and also going to hell because of my sins.
That made me leave the Centre without testing. I developed a
negative attitude and decided not to go for HIV anymore until
my friend from a LGBT advocacy organization helped me go to
user friendly Centre [private] and was tested positive. I am now
on treatment.”
― 27-year old gay man interviewed in
Dar es Salaam, Tanzania

Through The Advocates for Human Rights’ work promoting LGBTI rights around the world, we routinely hear stories like this of the struggle to access health care and health information.  On World Aids Day (December 1), it is particularly important that we draw attention to the fact that anti-LGBTI discrimination harms efforts to combat HIV/AIDS worldwide.

Tanzania, where The Advocates has partnered recently with LGBTI human rights organizations, provides a good example of the problem. Due to widespread discrimination based on sexual orientation and gender identity, LGBT individuals in Tanzania fear disclosing their sexual orientation to health care providers.  Further, health care providers often refuse needed services to LGBT individuals. In its Third National Multi-Sectoral Strategic Framework for HIV and AIDS (NMSF III), the Government of Tanzania recognized the barrier that anti-LGBT discrimination can pose to health care access: “Stigma and discrimination against MSM [men who have sex with men] remains high, posing a significant challenge to outreach and delivery of friendly health services.”[1] Indeed, some non-governmental organizations estimate that over 2 million LGBT Tanzanians lack access to quality health services.

Anti-LGBT discrimination in the health sector includes denial of services, verbal harassment and abuse, and violations of confidentiality.[2] In particular, health care providers deny treatment to openly LGBT individuals seeking treatment for sexually transmitted infections (STIs) and HIV/AIDS.[3] Hostility from health care providers drives gay men outside of the health care system, depriving them of both services and information.[4]

In response to this discrimination, many LGBT Tanzanians choose to hide their sexual orientation or gender identity from their health care providers.[5] . Such nondisclosure, however, may prevent health care providers from addressing needs specific to LGBT patients. For example, a recent study assessing HIV and STIs among gay men in Tanzania found that they often do not disclose their sexual orientation to health care providers, hindering detection of rectal STIs.[6]

Tanzania’s legal system imposes some of the harshest penalties on homosexual conduct in all of Africa. Homosexual conduct has been illegal on mainland Tanzania since the implementation of the Tanzanian Penal Code in 1945.[7] Homosexual conduct has been illegal under the Zanzibar Penal Code since 1934.[8]

As a result, LGBT individuals decline to seek health care due to fear of revealing criminal conduct to health care providers.[9] Similarly, health care providers cite the criminalization of same-sex sexual conduct as a basis for denying services to LGBT people.[10] Moreover, criminalization perpetuates stigma, and stigmatization prevents lawmakers from addressing LGBT-specific health needs.[11]

In addition to obstructing health care access generally, anti-LGBT discrimination undermines efforts to fight HIV/AIDS. NMSF III recognizes men who have sex with men (MSM) as a population “at high risk for exposure to HIV or for transmitting HIV.”[12]  In fact, multiple sources recognize that the rate of HIV/AIDS among MSM is higher than that of the general population of Tanzania.[13]

Criminalization of same-sex conduct in Tanzania hurts all Tanzanians, because it hinders efforts to fight the harm that HIV/AIDS inflicts on all populations. Criminalization encumbers HIV/AIDS-related public health campaigns and research.[14] The International Lesbian Gay Bisexual Trans and Intersex Association recognizes that anti-LGBT discrimination drives LGBT people “underground,” impeding implementation of effective HIV/AIDS-related education program.[15] Criminalization also harms outreach efforts by NGOs that do not wish to violate Tanzanian laws.[16] Around the world, countries that criminalize same-sex conduct demonstrate higher rates of HIV among gay men than those that do not criminalize such conduct.[17]

A gay man from Mwanza stated:

I was very sick and some of my friends advised me to have an HIV test. I went to the nearest Centre where almost everyone knew me. A queue of people were pushing me away because they never wanted me near them. An officer came out and told me to find another place to go, because I was not welcome in that hospital because of my behavior. I had no choice but to leave the Centre ashamed and I planned to commit suicide. My friend learned about my plan before I poisoned myself and called [name withheld] who helped me go through that moment, he also referred me to a user friendly facility.[18]

Even the Tanzanian Government acknowledges that criminalization of same-sex conduct complicates Tanzania’s response to HIV/AIDS: “Given the criminalization of consensual adult homosexual intercourse, the multi-sectoral national response requires significant cooperation from all key stakeholders to ensure that MSM are reached with HIV and AIDS services.”[19]

Unfortunately, the Tanzanian Government has yet to take concrete action to amend the National Multi-Sectoral Strategic Framework for HIV and AIDS to establish that reducing the transmission of HIV among gay men is a central part of the national AIDS strategy and develop an implementation strategy to meet this objective.

On World AIDS Day, The Advocates for Human Rights calls upon all governments to ensure access to health care and health information for all LGBT individuals by:

  • Requiring all public health care workers to receive comprehensive diversity training, including training on sexual orientation, gender identity, and the rights of LGBT people.
  • Establishing and identifying LGBT-friendly health care facilities where LGBT people will feel free and comfortable to access services.
  • Advancing national Standards of Practice for providing health care to LGBT individuals. These standards should:
    • Prohibit discrimination in the delivery of services to LGBT clients and their families.
    • Require visible posting of non-discrimination policies and inclusion of policies in organizational brochures and informational and promotional materials.
    • Establish comprehensive and easily accessible procedures for clients to file and resolve complaints alleging violations of these policies.
    • Designate of one or more persons within each health care provider to ensure compliance with the Standard of Care.
    • Require all reception, intake, and assessment staff to be familiar with providers within the health care organization with expertise in and sensitivity to LGBT issues, and appropriately convey this information to patients.
    • Provide comprehensive ongoing training for direct care staff to identify and address basic health issues within their field of expertise that may particularly affect LGBT clients.
    • Develop a comprehensive resource list for appropriate referrals for special gay, lesbian, bisexual, and transgender health concerns.
    • Develop written confidentiality policies which explicitly include sexual orientation and gender identity, indicating that such information is to be considered highly sensitive and treated accordingly.[20]
  • Developing a public outreach and education campaign directed toward the LGBT community that educates LGBT Tanzanians on proper HIV/AIDS prevention and identifies LGBT-friendly health care resources.[21]

Jennifer Prestholdt is the Deputy Director and International Justice Program Director at The Advocates for Human Rights.

[1] United Republic of Tanzania, Prime Minister’s Office, Tanzania Third National Multi-Sectoral Strategic Framework for HIV and AIDS (2013/14-2017/18) (November 2013).

[2] Human Rights Watch, “Treat Us Like Human Beings”: Discrimination against Sex Workers, Sexual and Gender Minorities, and People Who Use Drugs In Tanzania (2013).

[3] Canada: Immigration and Refugee Board of Canada, Tanzania: Treatment of sexual minorities by society and government authorities; recourse and protection available to those who have been subject to ill treatment (2007-July 2014), 8 August 2014, TZA104923.E; Human Rights Watch, “Treat Us Like Human Beings”: Discrimination against Sex Workers, Sexual and Gender Minorities, and People Who Use Drugs In Tanzania (2013).

[4] George Ayala et al., Social Discrimination Against Men Who Have Sex With Men (MSM): Implications for HIV Policy and Programs (May 2010).

[5] Canada: Immigration and Refugee Board of Canada, Tanzania: Treatment of sexual minorities by society and government authorities; recourse and protection available to those who have been subject to ill treatment (2007-July 2014), 8 August 2014, TZA104923.E.

[6] Ross MW, Nyoni J, Ahaneku HO, et al., High HIV seroprevalence, rectal STIs and risky sexual behaviour in men who have sex with men in Dar es Salaam and Tanga, Tanzania, BMJ Open 2014;4:e006175.doi:10.1136/bmjopen-2014-006175.

[7] Tanzania Penal Code of 1945 (as amended by the Sexual Offences Special Provisions Act, 1998), Sections 138A, 154-155. The Sexual Offenses Special Provisions Act of 1998 updated certain sections of the penal code, but kept the prohibitions on homosexual conduct.

[8] Tanzania’s heavy reliance upon its British based penal code stands in stark contrast to its neighbors—most of which have penal codes that impose significantly lower penalties on homosexual conduct or no penalties at all. Kenya, Zambia, and Malawi each have penalties of up to 14 years in prison for homosexual conduct, and Uganda’s criminal code mandates life imprisonment. Though homosexual conduct is illegal in Burundi, penalties only range from 3 months to 2 years. Homosexual conduct is legal in Mozambique, Rwanda, and the Democratic Republic of the Congo.

[9] United Nations Human Rights Office of the High Commissioner, Born Free and Equal: Sexual Orientation and Gender Identity in International Human Rights Law, HR/PUB/12/06 (2012).

[10] Id.

[11] Id.

[12] United Republic of Tanzania, Prime Minister’s Office, Tanzania Third National Multi-Sectoral Strategic Framework for HIV and AIDS (2013/14-2017/18) (November 2013).

[13] Human Rights Watch has indicated that HIV prevalence among MSM in Dar es Salaam is as high as 40 percent. Human Rights Watch, “Treat Us Like Human Beings”: Discrimination against Sex Workers, Sexual and Gender Minorities, and People Who Use Drugs In Tanzania (2013). Tanzania’s NMSF III cites a study in which 41 percent of 271 Tanzanian MSM tested seropositive for HIV. United Republic of Tanzania, Prime Minister’s Office, Tanzania Third National Multi-Sectoral Strategic Framework for HIV and AIDS (2013/14-2017/18) (November 2013). Further, a 2014 study found that MSM in Dar es Salaam had an HIV rate 2.5 times that of the general population. Ross MW, Nyoni J, Ahaneku HO, et al. High HIV seroprevalence, rectal STIs and risky sexual behaviour in men who have sex with men in Dar es Salaam and Tanga, Tanzania. BMJ Open 2014;4:e006175.doi:10.1136/bmjopen-2014-006175.

[14] Human Rights Watch, “Treat Us Like Human Beings”: Discrimination against Sex Workers, Sexual and Gender Minorities, and People Who Use Drugs In Tanzania (2013).

[15] Itaborahy, LP & Zhu, J, State-Sponsored Homophobia: A world survey of laws: Criminalisation, protection and recognition of same-sex love (8th ed. 2013); see also UN Office of the High Commissioner for Human Rights, Born Free and Equal: Sexual Orientation and Gender Identity in International Human Rights Law, HR/PUB/12/06 (2012).

[16] Human Rights Watch, “Treat Us Like Human Beings”: Discrimination against Sex Workers, Sexual and Gender Minorities, and People Who Use Drugs In Tanzania (2013).

[17] George Ayala et al., Social Discrimination Against Men Who Have Sex With Men (MSM): Implications for HIV Policy and Programs (May 2010).

[18] Personal interview with LGBT advocacy organization. The victim’s identity is being withheld for security reasons.

[19] United Republic of Tanzania, Prime Minister’s Office, Tanzania Third National Multi-Sectoral Strategic Framework for HIV and AIDS (2013/14-2017/18) (November 2013).

[20] These recommendations are based on standards developed by the GLBT Health Access Project. More information on these standards are available at:

[21] See, e.g., Republic of Kenya, Ministry of Education, Science and Technology, Education Sector Policy on HIV and AIDS (2d ed. 2013),

Pamela Wandzel: “Right here at home”

Pamela J. Wandzel
Pamela J. Wandzel

People outside of my job often ask me what exactly it is I do for a living. When I respond with “I manage and develop pro bono opportunities for lawyers,” it often draws a blank stare. However, when I add “I herd cats and connect dots,” many people get this and start asking relevant questions.

Basically, I work with extremely busy lawyers and help them find ways to give free legal services to people and organizations that would not otherwise be able to afford their services. Some of my colleagues at the firm wonder at my ability to keep my sanity and humor when there are times I feel I’m the lone member of a team pushing a boulder up a hill.

The answer is easy: After many years, I still love my job. I love helping lawyers find projects they care about and can fit into the demands of a big law practice. It doesn’t matter if they are in their first year or fortieth year of practice. My goal is simple: Help them discover their passion. And when I can match a lawyer with a project for an organization I respect as much as I do The Advocates for Human Rights, life is good.

One of my favorite quotes of all time comes from Eleanor Roosevelt:

“Where, after all, do universal human rights begin? In small places,
close to home – so close and so small that they cannot be seen on any
maps of the world. Yet they are the world of the individual person; the neighborhood he lives in; the school or college he attends; the factory,
farm, or office where he works. Such are the places where every man,
woman, and child seeks equal justice, equal opportunity, equal dignity
without discrimination. Unless these rights have meaning there,
they have little meaning anywhere. Without concerted citizen action
to uphold them close to home, we shall look in vain for progress in
the larger world.”

Lawyers who want to work on human rights issues need look no further than The Advocates for Human Rights to satisfy their desire to impact lives here and abroad, and to help drive positive changes throughout a troubled world.

For me, and for my job, The Advocates offers something for just about everyone who takes Ms. Roosevelt’s quote to heart. From small, discrete research projects summarizing laws or reports to full-representation of asylum seekers, to drafting shadow reports to the United Nations Commission on Human Rights, our lawyers have the interest and make the time to help. Their response and comments relating to the work continues to inspire me in my own job. I could not be more proud of the multiple responses I receive to meet requests for assistance for this outstanding organization and its clients.

I began writing this post before the attacks in Beirut, Paris, and Mali. But as I write today and think about what is going on in the world and within our own borders, I find Ms. Roosevelt’s words as relevant today as they were in 1958. The backlash we have seen toward Syrian refugees, and now Muslims in general, is more than disturbing. But it reminds me of the importance of tolerance and understanding, and the need to support organizations like The Advocates for Human Rights. Right here at home.

By: Pamela J. Wandzel, Director, Pro Bono & Community Service, Fredrikson & Byron, P.A.

Slamming the door on refugees won’t make us more secure

Syrian Refugees Enes Reyhan via Flickr

The following opinion editorial written by The Advocates for Human Rights’ executive director Robin Phillips was published in the November 20 Star Tribune. Ms. Phillips’s o-ed responded to the Star Tribune’s editorial, “Carefully extend help for Syrian refugees,” November 18.

While the Star Tribune Editorial Board’s recent support for a pause in U.S. refugee processing may appear to be reasonable (“Carefully extend help for Syrian refugees,” Nov. 18) — especially when compared to the hateful rhetoric permeating the current political conversation — the position is based on faulty assumptions. The U.S. refugee system is well-equipped to ensure our safety without compromising our most deeply held American values.

First, the Editorial Board’s position assumes that the European citizens who masterminded recent acts of terror were somehow connected to the flow of refugees. In the search for a promise of security following this tragedy, some have made the leap that the threat lies in the refugees who are trying to escape the same violence that unfolded on the streets of Paris and Beirut. More than 50 percent of Syria’s entire population has been displaced from their homes by bombardment and civil war. Seventy-six percent of these refugees are women and children. Imagine 2 million children who have lost everything.

Second, the board’s position assumes that Europe’s abject failure to process refugees and its reliance on Turkey, Jordan, and Lebanon to indefinitely house millions of people with dwindling international support can in any way be equated to the U.S. refugee processing system. Syrian refugees numbering more than 5 million have crowded into countries neighboring their homeland. Faced with a desperate future in limbo, thousands of refugees risk their lives in a perilous journey by boat in search of a stable future in Europe. Already this year, more than 2,500 refugees have drowned in the Mediterranean.

By contrast, the U.S. handpicks those allowed to resettle through the refugee resettlement system. Less than one half of one percent of the global refugee population — no more than 85,000 people out of nearly 20 million refugees — was allowed to resettle in fiscal year 2016.

Third, the board’s view rests on an unsupported notion that the current refugee system somehow is inadequate. Refugees entering the U.S. undergo the most rigorous security screening process of anyone who comes to the this country. They go through multiple layers of security checks involving the Department of Homeland Security, the FBI, the Department of Defense, intelligence agencies and individual interviews. Refugees cannot enter the U.S. until they are cleared through this daunting process, which typically takes two years.

We understand the fear in the U.S. and in other countries. It is a harrowing time. But our impulse to slam the door in response to this violence will do nothing to make us more secure. Our only hope is in focused actions that address the reasons millions have fled their homelands.

The security of our country and its residents is paramount. Indeed, the U.S. has a duty to ensure the safety and security of those within its borders. But a knee-jerk abandonment of our commitment to refugee protection is not in line with our country’s history and values. No one should exploit horrific events that cause pain and fear to advance political agendas.

We do not want to close our nation off from the very groups of people who are best positioned to help identify those who mean to do us harm. Programs that profile based on ethnicity represent false solutions to real problems.

The U.S. has built a strong, multilayered process to ensure the security of its citizens and we should continue to invest in it, while acting on our responsibility to help address the refugee crisis. Accepting Syrian refugees is not an either/or situation. In the U.S., we can continue to welcome refugees while ensuring our own security. We must do both. Standing with the victims of the attacks in Paris, Beirut and elsewhere, and standing with the refugees, means standing for fundamental human rights.

By: Robin Phillips, Executive Director, The Advocates for Human Rights
Credit for Syrian refugee photo: Enes Reyhan via Flickr)

Minneapolis Must Do Better

black hands holding US flag RGB

The United States committed itself – and all of us – to the elimination of racial discrimination and to taking effective measures to review national and local policies and amend, rescind or nullify any laws which have the effect of creating or perpetuating racial discrimination. We made this commitment not simply to end discrimination but to prevent and combat racist doctrines and practices.

The United States ratified the International Covenant on the Elimination of All Forms of Racial Discrimination in 1994. Since then, the need to end discrimination and to combat racism wherever it exists and however violently or passively it manifests has continued.

Minneapolis now has the chance to live up to this commitment. It has the opportunity to make good on the promise we made more than 20 years ago to end all forms of racial discrimination with its response to the racist attacks against Black Lives Matter demonstrators outside the Minneapolis Police 4th Precinct late Monday night and to the police shooting of Jamar Clark which led to the demonstration.

Here’s what to understand about refugee law & policy

Syrian Refugees Enes Reyhan via Flickr.jpg

I’ve been working as an attorney, primarily in immigration for 12 years. The overwhelming majority of the cases I handled have been asylum cases. I’ve taught a law school clinical practicum for eight years. I’ve spoken and trained attorneys and non-attorneys about asylum law and immigration, nationally and locally. I know the law and I know the process well.

Asylum, for those who aren’t familiar, is based on the same legal definition as “refugee.” The difference is just in where someone is located when they apply for protection from harm.

Here’s what you should understand about refugee law and policy. It will help you better evaluate the statements being made by many others, and it will hopefully help you form a more informed opinion.

First, what does it even mean to be a refugee? Under U.S. law (8 USC 1101(a)(42)), we use this definition (I’m going to paraphrase a little for ease of reading): Someone who is outside of their country of nationality, and who is unable or unwilling to return or get protection from their own government because of persecution on account of their race, religion, nationality, membership in a particular social group or political opinion.

A refugee must be outside his or her country of origin and outside the United States to seek “refugee” status. They go through an application process, which involves in-person interviews and extensive background checks. This includes full fingerprints, INTERPOL checks, name checks, and cross-referencing a lot of government databases. The United States must approve them before they can set foot in this country. The approval process, before someone can be admitted to the United States, routinely takes between 12-24 months, and sometimes longer.

There is no “right” to refugee status. Individuals can be denied for any reason. Common reasons for denial are not meeting the legal definition of refugee or having inconsistencies in the person’s story.

Refugees must meet eligibility guidelines to enter the United States. These include not being “inadmissible.” There are a lot of reasons you can be deemed inadmissible. For a little “light” reading, check out 8 U.S.C. 1182(a)(3). It explains all of the “Security and Related Grounds” of inadmissibility. Having spent years appearing in Immigration Court and working with and against the good people at Customs and Border Protection and Immigration and Customs Enforcement – trust me, they are not erring on the side of admitting people who might be a danger.

The “material support” provision excludes not just people who’ve associated with “known” terrorist groups. It excludes anyone who we have “reasonable ground to believe” is likely to engage in terrorism or terrorist-type activities. This section of law is incredibly broad and permissive in favor of the government to exclude potential refugees and immigrants. Terrorist groups can include any group of “two or more individuals.” The list of activities that can get you barred is long. Really, just go read the statute if you aren’t sure.

The number of refugee admissions statutorily allowed by congress is pretty small – for FY 2015 that number was capped at 70,000 as it has been for years. It’s only recently that we’ve even come close to filling that capacity. Often we’re below it.

We cannot predict the future. Someone may, after being admitted as a refugee, do something terrible. So might someone who is a U.S. citizen, as we have witnessed many times. Emily Good

By: Emily Good, an attorney  working as the Legal Projects Manager for Minnesota Legal Services State Support. She was formerly a staff attorney and director for The Advocates for Human Rights Refugee & Immigrant Program.

Credit for Syrian refugees’ photo:
Enes Reyhan via Flickr


If you have questions about how the legal immigration system works, post them below. We’ll do our best to answer or ask someone who might know.

Scott Pelley: “Life is asking, ‘What’s the meaning of you?'”

Scott Pelley, anchoring the CBS Evening News for a third-straight night in Paris following Friday’s deadly Islamic terror attacks, concluded Wednesday’s broadcast with an emotional commentary. We share it here with you:
“This week, parents looked at the questions on the faces of their children and did their best to make sense of the senseless. How to explain? What is the meaning of life if life is lost so easily to those who hate? In Paris, we recognized each and every face. We know them. We met in Oklahoma City, in New York and Washington after 9/11, and after the last mass shooting. Familiar in every time and every place, children serene because they don’t understand, parents in anguish because they can’t understand. Today a Parisian, Antoine Leiris, found his answer. His wife, who he called the love of his life, was killed Friday, leaving him to write a letter to the terrorists for himself and his 17-month-old son. “You will not have my hatred,” he told the killers. “This little boy will insult you by being happy and free.” The letter reminded us of Viktor Frankl, the psychiatrist who endured Auschwitz-Birkenau. The love of his life was lost in the death camps. “Everything can be taken from a man but one thing,” Frankl wrote, “the last of the human freedoms to choose one’s attitude,” or, as Antoine Leiris put it today, “we are two, my son and I, but we are stronger than all the armies of the world.” The search for an explanation leaves us with silence until we search inside. In these times, don’t ask the meaning of life. Life is asking, what’s the meaning of you?”