1. Case Studies  Effective HIV interventions and human rights violations  Malawi  Senegal  Uganda  Tanzania  South Africa

2. Case Study - Malawi

3. Arrests in Malawi, 2010

4. Interrupting Structural Interventions, April, 2011

5. Malawi, May, 2011

6. Variable Fear of Seeking Health Care OR (95% CI) Denied Health Care Services OR (95% CI) Blackmailed OR (95% CI) Diagnosed with an STI2.4 (1.4-4.3) *6.9 (3.0-15.6) **1.5 (0.8-2.7) Treated for an STI2.8 (1.7-4.9) **7.3 (3.3-16.2) **1.5 (0.8-2.6) Received recommendation for an HIV test 1.9 (1.2-3.0) *2.2 (0.98-4.8)1.8 (1.1-2.8) * Ever tested for HIV1.1 (0.7-1.7)1.6 (0.7-3.7)1.0 (0.7-1.6) Self-Reported Diagnosis of HIV or AIDS 2.6 (1.1-6.5) *3.3 (0.9-12.1)2.7 (1.1-6.6) * Self-Reported Treatment for HIV 3.7 (1.6-8.6) *46.1 (17.3-122.8) **5.4 (2.2-13.2) ** HIV positive1.7 (0.9-3.2)1.2 (0.4-3.6)0.9 (0.5-1.6) Any interaction with health care2.6 (1.6-3.9) **6.4 (2.5-16.1) **2.1 (1.4-3.2) * Pooled Data from Three Countries * - p <0.05 ** - p <0.01 Source: Fay H, Baral S, Trapence G, Motimedi F, Umar E, et al. Stigma, Health Care Access, and HIV Knowledge Among Men Who Have Sex With Men in Malawi, Namibia, and Botswana. AIDS and Behavior, Dec 2010: 1-10. Associations between fear and experienced discrimination with sexual health and use of services among MSM in Malawi, Botswana, and Namibia.

7. Case Study - Senegal

8. Senegal, December 2008  2007-2011 Senegalese national AIDS strategy indentifies MSM as a key target population for prevention activities  ICASA held in Dakar in December 2008  MOH publicly pledge support to reduce HIV among MSM  Nine male HIV prevention workers arrested a few weeks later  Article 319.3 of Senegalese penal code: whoever commits an improper or unnatural act with a person of the same sex will be punished by imprisonment of 1 -5 years and a fine of 100,000 - 1,500,000 CFA.  January 2009 : the men receive 8 year sentence and 500,000 CFA fine  April 2009: the men are released on appeal

9. Senegal – After Arrests, 2008  Religious Leader: The government violated the law by releasing the homosexuals

10. MSM in Senegal, 2008-2009 Source: Poteat, …, and Baral, PLoS One, In press

11. Case Study - Uganda

12. Uganda, 2010

13. David Kato in Uganda (1969-2011)

14. Uganda, May, 2011 We also know of efforts by some MPs to turn it around and get rid of the bill in favour of the gays.” Pastor Martin Ssempa PEPFAR Sub-Grantee of PSI, 2004 http://www.pepfar.gov/partners/76136.htm

15. Case Study - Tanzania

16. Tanzania, 2008 Headline “Gay man undressed and raped” Inside: “the gay person who was raped enjoyed the incident”

17. South Africa

18. Human Rights Violations among MSM in Black and Coloured Townships Surrounding Cape Town, 2008 Characteristic Overall %(n/N) Black %(n/N) Coloured %(n/N) p-Value* Denied Housing5.0 (10/200)3.9 (4/102)6.8 (6/88)0.37 Denied Health Care5.0 (10/200)6.9 (7/102)3.4 (3/88)0.29 Blackmailed10.5 (21/200)12.8 (13/102)8.0 (7/88)0.28 Arrested4.0 (8/200)2.9 (3/102)4.6 (4/88)0.56 Beaten by the police or a government official8.0 (16/200)10.8 (11/102)5.7 (5/88)0.21 Yes to any of the above24.5 (49/200)27.5 (28/102)21.6 (19/88)0.35 Afraid to seek health care services21.0 (42/200)27.5 (28/102)14.8 (13/88)0.03 Afraid to walk in community9.1 (18/199)8.9 (9/101)8.0 (7/88)0.81 * p-values correspond to a Pearson Chi 2 test between the two townships