A person’s behaviour and motivations are informed by the fulfilment of their three psychological needs: autonomy, competence, and relatedness. Factors such as socioeconomic status, structural inequities, political stances, and social norms impact the fulfilment of these needs and the brevity with which they are addressed by society. HIV is disproportionately prevalent in sub-Saharan Africa, with 3.1 million children (4.9% prevalence) having reported HIV-positive by 2010 in comparison to a 0.6% prevalence in North America, that is, without the consideration of the countless undocumented cases (HIV/AIDS in Children and Youth, 2014).
Within queer populations, the absence of one or more psychological needs concerning their health and well-being, directly shape these statistics. These needs are manifested by considering a person’s freedom of choice in sexual relationships, their knowledge and understanding of safe sex measures and HIV/AIDS transmission, testing, and treatments, as well as social support from friends and family can help one understand this relationship. As a result of shifts in political leadership, a prominent issue is the social and cultural environment surrounding HIV/AIDS, sexual relations, and same-sex relations.
1. Colonisation: A Shift in Law and Culture
Tanzania did not have blatantly queerphobic rhetoric in its judicial system until its colonisation by the British government. Same-sex relations were criminalised once the British government colonised the land. Law became a culturally accepted belief, which led to an abundance of stigma surrounding same-sex partners and their relation to HIV/AIDS, contributing to its vilification.
In October 2018, the Regional commissioner of Dar es Salaam indicated the administration of a task force that identified and arrested those who were suspected of homosexual conduct and encouraged citizens to help in the search. Since the British colonisation, same-sex conduct penalization has endured countless modifications, to now, punishing men with up to 30 years in prison for such misconduct. Through the enforcement of these laws, people explore the autonomy of participating in same-sex relations with shame, guilt, and fear, and experience ostracization from society.
2. “Queerphobic Immunopolitics”: What is it?
An increase in queerphobic political stances and discussions causes a retroactive effect on HIV diagnosis and treatment (Danil, 2021). With an authoritative shift, and thus, its subsequent cultural shift in attitude to antagonise same-sex relations, there appears a veil of fear in those with HIV. For instance, in Tanzania, where a clinic open for HIV testing in LGBTQ+ populations once observed 30+ patients routinely, now scarcely receives any visits (Fallon, 2017).
A hostile culture in comparison to a dismissive or avoidant one, can, in many ways, have a similarly damaging effect on queer people hoping to get HIV-tested, those who have already contracted the disease and are in search of a treatment, or are in an ongoing treatment cycle. A transgender sex worker named Princess Shadya articulates the shift in cultural climate, its effects on her trust in healthcare workers and the medical system, and her accessibility to treatment.
"Once she worried that she didn't have tap water in her home so it was hard to down her pills. Now she's afraid to go to the hospital to pick up her medications because police officers are patients there, she says, and she worries she could be arrested.” Fallon, 2017
Despite there being no physical constraint to her capability, she harbours a psychological constraint caused by changes in the social climate. This strays her away from fulfilling her psychological needs. She does not feel in complete control of her medical choices, lacks social support, and is now distancing herself from a medical institution that can further nourish her knowledge of the condition and treatment.
3. What has been recommended moving forward?
Tanzania has made leaps and bounds of progress in its battle against HIV/AIDS, showing a 22% drop in infection rate from 2010-2016 (United Republic of Tanzania, 2023). However, a discriminatory approach to addressing HIV suggests the impossibility of eradicating the disease from the population because the queer population will continue to contract it if they are left unaddressed.
Since Tanzania has complied with public health guidelines, such as increased accessibility to HIV testing and treatments, and successfully diminished infection rates by 22% by 2016, more strict adherence to these policies is recommended, with particular attention to “services and programmes implemented are non-stigmatizing, non-discriminatory, accessible, acceptable, affordable and equitable for all” (Birgin et al., 2016).
For those with existing HIV treatments, adherence is the greatest challenge. Whereas, for those in need of testing or treatments, the accessibility that is fabricated by a non-discriminatory system is the key to progress. The structural and social changes in Tanzania for queer individuals partaking in same-sex relations impact HIV testing, treatment, and long-term care. These factors also influence the fulfillment of their psychological needs, which directly impact HIV prevalence. Moving forward, a comprehensive outlook on healthcare that recognizes and advocates for underrepresented demographics should be considered.
References
Birgin, Ruth, et al. Edited by Jeff Hoover, Practical Guide for Service Providers on Gender-Responsive HIV Services, United Nations Office on Drugs and Crime, 2016, www.unodc.org/documents/hiv-aids/2016/Addressing_the_specific_needs_of_women_who_inject_drugs_Practical_guide_for_service_providers_on_gender-responsive_HIV_services.pdf
Danil, L.R. Queerphobic Immunopolitics in the Case of HIV/AIDS: Political Economy, the Dark Legacy of British Colonialism, and Queerphobia in Sub-Saharan Africa. Sexuality & Culture 25, 377–395 (2021). https://doi.org/10.1007/s12119-020-09774-w
Fallon, Amy. “People with HIV Are Panicking Due to Tanzania’s Crackdown on Gays.” NPR, NPR, 15 Mar. 2017, www.npr.org/sections/goatsandsoda/2017/03/15/518155924/people-with-hiv-are-panicking-due-to-tanzanias-crackdown-on-gays
“HIV/AIDS in Children and Youth.” Edited by Michael Clark and Heather Onyett, Caring for Kids New to Canada, Jan. 2014, kidsnewtocanada.ca/conditions/hiv
“United Republic of Tanzania.” UNAIDS, UNAIDS, 1 Feb. 2023, www.unaids.org/en/regionscountries/countries/unitedrepublicoftanzania
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