LGBTQI Movement And The Trade-Off: Public Health vs Rights

Person shouting and raising fist as a sign of protest. The person has rainbow glasses on portraying LGBTQI movement.
Illustration by Kokila B on Fine Acts (Modification made: Added translucent background)

In recent years, the LGBTQI movement in Zambia has used the public health angle to highlight and address the social and economic justice issues faced by LGBTQI persons as a result of the country’s hostile social, legal and economic context towards LGBTQI persons. It is true that this approach has moved the LGBTQI rights advocacy a notch higher, and the movement has made significant strides, with an increase in visibility and mainstreaming of issues and organizations in the country being quite notable. However, there looms a dilemma of whether to adopt a less politicized public-health approach or a more nimble, grass-roots-oriented, and social-justice approach to their advocacy. As a Queer feminist organizing around marginalized women’s sexual reproductive justice, some of my key observations of the trade-off on this approach are outlined below:

  • Exclusionary nature of the public health approach, particularly for LBTQI persons as a direct result of the focus on sexual behaviour and how public health advocates assume the assumed sexual behaviour impacts HIV transmissions among members of a social group. In the public health approach within the LGBTQI spectrum, priority for resources and service provision has been placed on gay men, men who have sex with other men, and transgender women. We have seen Lesbian, bisexual women and transgender men being excluded in the discourse with services and messaging not tailored to their health needs. The fact that quantitative data usually drive the projects adds pressure on organisations to ensure more of the priority groups are reached, leaving very minimal efforts delegated to the groups not considered a priority.

The reality of social and economic justice indicates that advocating for access to HIV health services does very little to change the lived realities of LGBTQI persons in Zambia

  • Grass-root organizations exist in a capitalist world and often search for resources to support their interventions, and ultimately, their existence. With more than 4billion USD investments by PEPFAR in the HIV pandemic and the focus on MSM, gay men and transgender women, most organizations have found themselves in a situation where they seek resources from the public health response mechanisms to sustain organization core costs. However, access to these resources means more efforts being dedicated to vertical HIV interventions and not a holistic approach to social and economic justice. However, the reality of social and economic justice indicates that advocating for access to HIV health services does very little to change the lived realities of LGBTQI persons in Zambia who face multiple layers of socio-economic vulnerabilities, such as unemployment, criminalization, and limited/no access to social and economic opportunities. More so, the limited focus on advocacy cements the marginalized context as a reality for most, particularly LBQI womxn in the country.
  • With the focus on public health as an entry point, the LGBTQI movement slowly sees a much more disintegrated movement as the resources drive the agenda emphasizing one group over the other through financial priority allocation. This has seen organizations being forced to either focus on MSM, bisexual and transgender issues or LBTQI issues as opposed to a holistic approach that takes on the needs of all persons and identities within the LGBTQI spectrum.

Public health cannot replace human rights, and that is the underlying issue in this discourse.

  • Public health cannot replace human rights, and that is the underlying issue in this discourse. However, the donors continue to drive an agenda that focuses more on the issue’s fruits(access to services) and not the roots (structural barriers to access to services). Organizations continue to engage in this approach at the expense of transformational change as the resources drive where work happens. Advocacy that focuses on human rights and decriminalization of LGBTQI persons have taken a reduced priority. With the reduction in regional spaces that focus on LGBTQI rights advocacy in a more holistic manner due to the Covid pandemic, there is a looming risk that will need to be addressed by the activists as the needs driven by the donors may not necessarily reflect the needs of LGBTQI persons in Zambia.

The public health approach in Zambia badly needs an intersectional feminism approach if the interventions are to translate into any real change in the lived realities of LGBTQI persons in the communities they live in.

BY Sibusiso Malunga