Benchmarks and beyond: assessing and addressing structural barriers to rights-based HIV programming for LGBTI key populations in six African countries

BACKGROUND: There has been significant progress in reducing new HIV infections and related morbidity and mortality in the general population in Africa, but much less among key populations. According to UNAIDS, by 2019, approximately 50% of new infections in Sub-Saharan Africa were among key populations and their sexual partners. There is considerable evidence that stigma, discrimination, criminalization and social exclusion make key populations more vulnerable to HIV infection and less likely to access and use relevant services. The UNDP's Inclusive Governance Initiative commissioned baseline research in six African countries to benchmark progress and barriers to the rights and inclusion of LGBTI people in national laws, policies, strategies and programmes, in the health sector and beyond.
METHODS: One of the aims of this research is to contribute to strengthening the structural conditions for effective and accessible HIV programming for diverse LGBTI populations in Africa. Country baseline studies were undertaken in Namibia, Zimbabwe, Angola, Côte d'Ivoire, Kenya and the Democratic Republic of Congo. Data was gathered through desktop research, targeted policy analysis, and stakeholder interviews in each country including with state decision-makers (in the judiciary, parliament, the executive, national human rights institutions and government departments) and leaders from development agencies and civil society.
RESULTS: Given the links between regulatory environments and HIV outcomes for key populations, structural interventions are necessary to tackle human rights barriers to HIV related services. Extrapolations from the country-level studies identified key policy and legislative developments where significant progress has been achieved, along with critical entry points for the further reduction of structural impediments to effective HIV programming for key populations. Structural factors that perpetuate the vulnerabilities of LGBTI people are also identified, along with potential strategies to address those.
CONCLUSIONS: The findings, which highlight contextual dynamics and explore their implications for structural reform efforts, are highly relevant to understanding LGBTI rights and inclusion as a critical step to reducing structural obstacles facing key populations. This provides contextually relevant knowledge to inform advocacy, law reform, and country and multi-country programming, aimed at challenging the structural dynamics that undermine right-based HIV prevention, care and support for marginalised groups in Africa.

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