This story by Kahofi Jischvi Suy, which BBC News originally published in French on 6 November 2019, is part of a series produced with support from the Arcus Foundation and Heinrich Böll Stiftung Southern Africa. It emerged from an October 2019 journalism training workshop in Cape Town, South Africa.
Joël, whose name has been changed to protect his identity, walks towards the gate of a residential house in Biétry, a district of Côte d’Ivoire’s capital city Abidjan. Behind this unassuming gate is the NGO Espace de confiance’s Clinique de confiance, a specialized health center that works to reduce the spread of HIV and other sexually transmitted infections among key populations.
UNAIDS defines key populations as those most vulnerable to HIV and least able to access adequate health services. They include sex workers, intravenous drug users, transgender people, prisoners, and men like Joël who have sex with other men.
“I heard about the clinic through a ‘branché’ friend,” Joël said. “Branché,” which means “trendy” in French, is local LGBTQI+ slang for “gay”. “My friend encouraged me to go to the clinic for a check-up and HIV test. I prepared to accept the final result. If the test was negative, it would be okay, but if it were positive, I knew I would have to accept it too”.
Joël learned he is HIV-positive. He now comes to Clinique de confiance for free monthly check-ups, psychological support, and medication including antiretroviral treatment. In recent years the clinic has become a social space where LGBTQI+ people feel free and safe to discuss health issues with doctors, social workers, and one another.
Prejudices that persist
Same-sex sexual activity is legal in Côte d’Ivoire, but homosexuality is widely considered taboo, meaning that LGBTQI+ people struggle to receive adequate health care at most clinics and hospitals.
“Some health professionals are still reluctant to treat homosexuals,” said Dr. Aka Emmanuel, a general practitioner at Clinique de confiance. “This may be due to misinformation they have about men who have sex with men (MSM) and women who have sex with women (WSW), or perhaps because sexual orientation remains a taboo subject. In reality, homosexuals are patients like any other.”
The clinic has built trust between health staff and LGBTQI+ people by working with key populations and LGBTQI+ NGOs for more than 10 years. It is the first center in Côte d’Ivoire to offer MSM- and WSW-specific health care, using appropriate tools and training to deal with common health issues these key populations face.
Clinique de confiance was established in 1992 as a research project under the Center for Disease Control and Prevention’s Retrovirus Côte d’Ivoire (Retro-CI) program. In 2004, clinic staff created the social health organization Espace de confiance, which now manages Clinique de confiance with international support from UNAIDS, PEPFAR, and SIDACTION. Espace de confiance operates five other centers that offer prevention and awareness services to key populations around Côte d’Ivoire.
A 2018 UNAIDS report showed that 11 percent of sex workers, 13 percent of MSM and 9.2 percent of intravenous drug users in Côte d’Ivoire are HIV-positive. These rates far exceed the general public’s rate of is 2.9 percent, according to Colombia University’s latest population-based HIV impact assessment. Given these higher rates, Clinique de confiance works to reduce HIV transmission among the city’s LGBTQI+ community and pays special attention to HIV-positive people who struggle to accept their status.
“We help these people recognize that HIV is not a death sentence, to understand that it is like a chronic disease for which the treatment is free,” said Kotchi Rachelle, a doctor at Clinique de confiance.
Rachelle adds that most HIV-positive MSM and WSW eventually come to terms with their status, which helps their treatment and reduces the risk of transmission or acquiring other STIs.
In addition to its treatment services, Clinique de confiance is monitoring the research of a health program for MSM who use PrEP (pre-exposure prophylaxis) drugs in West Africa. PrEP is a preventive treatment for HIV-negative populations at high risk of contracting the virus. When used properly, PrEP can reduce the risk of contracting HIV by 99 percent.
“PrEP is a revolution in the treatment of the virus and a hope to put an end to contaminations, especially among MSM,” said Dr Anoma Camille, director of Clinique de confiance.
Beyond the clinic’s walls, peer educators conduct outreach activities in the field. Tom, whose name has been changed to protect his identity, is one such peer educator who goes to gay-friendly bars around Abidjan to raise HIV awareness among MSM and WSW community members.
In the heat of the night
Around midnight on a Saturday in Abidjan’s Marcory district the party is in full swing at trendy bar. Several members of the LGBTQI+ community arrive, dressed in glamorous clothes. Tom is well known here as a peer educator, promoting condom use, lubricating gels, and voluntary HIV tests; educating people about risky behaviours; and referring people to Clinique de confiance.
“In the past, LGBTQI+ people were harassed, abused, and assaulted. This made our awareness campaign very difficult. But today, mentalities have changed in several districts of Abidjan, even if the stigma remains,” Tom said.
Clinique de confiance also sensitizes health practitioners to the needs of MSM and WSW, helping to create more LGBTQI+-friendly health centers.
“This will be long-term work because the sexual orientation of gay people is not yet accepted,” said Joël, the man we met at Clinique de Confiance. “In my family, being gay is viewed negatively, and things haven’t really evolved positively.”
Heteronormativity, the belief or assumption that heterosexuality is a person’s default sexual orientation, and conservative religious beliefs are often at the root of stigma against LGBTQI+ people in Côte d’Ivoire. To fight such stigma, Dr. Camille said awareness must be raised at all levels, including among doctors and other health practitioners.
Dr. Emmanuel said the work of the clinic cannot continue to be an exception and that health care services must be available to LGBTQI+ people in every hospital, clinic and health center in Côte d’Ivoire.