Toward the end of the millennium, there emerged widespread recognition that a variety of processes often taking the short hand of Globalization reconstituted and intensified both the risks of ill health and opportunities for addressing them. This recognition was accompanied by concern that existing institutional arrangements were not only increasingly constrained from addressing risks, but also from taking advantage of emerging opportunities. New Organizations and networks thus were formed to address global health issues and new ways of delivering health services and strengthening health systems. This dynamic environment constitutes what is called global health governance.
For many, the proliferation of new global health actors and shifts in the relative importance and roles of existing actors is to be welcomed. For others, this multitude of diverse actors and net works indicates continuing and growing fragmentation and chaos at global and national levels.
The proliferation of the new global health actors means there are many different bodies involved in quite similar activities both at global and national levels and many a times this being used as a platform to siphon resources from funders especially in less developed countries. It has been observed that this can result in duplication and even conflict in terms of the approaches they advocate or the activities that they are willing to fund or support. One such highly contested domain is on the health intervention treatment and prevention campaigns developed towards fighting HIV/AIDS such as the Safe Male Circumcision Project, Sexual and Reproductive health amongst the many others and now a shift in the global health financing architecture from infectious diseases to non infectious diseases.. For instance donors such as the USA refuse resources to any organizations offering abortion a highly contested subject area. There has also been mushrooming of International Non Governmental Organizations in many less developed countries doing same projects thus competing for funds and research participants in some instances.
The Botswana AIDS Impact Survey III (2008), observed that only 11% of the male population in the country had circumcised and as thus the country developed a national strategic framework to scale up safe male circumcision services to reach the intended national target of 480 000 (80%) of HIV negative men by 2016. The race to get many Batswana men circumcised has been ongoing and one wonders as to whether the set target is realistic or whether it is all about trying to push the numbers in order to keep the project on going thus keeping some people employable and satisfying the funders/donors. Often at times issues of corrupt practices emerge due to funds misuse for instance previously former President Festus G Mogae and Michael Leavitt were engaged by the Global Fund office of the Inspector General (OIG) to examine the fund’s financial systems, grant frauds and misuse. This came after reported cases of funds misuse, fraudulent invoices and payments among other investigations in Zambia, Mali, Mauritania and Djibouti. There is often a rot with respect to the recruitment of the human resources of agencies responsible for executing health intervention programs where some of them turned into cash cows and recruitment done on a buddy buddy basis. Others use the projects as retirement homes turning some into instant millionaires, earning extremely exorbitant remuneration packages and with lucrative benefits often covering extended family members.
The Global Commission on HIV/AIDS and Law has in the past years started conversations that are often perceived as a taboo and highly sensitive in African culture and custom. They called for explicit decriminalization of sodomy and have shown sympathy to Men who have sex with other Men and voluntary sex workers. Spearheading the initiative in Africa is the “Champions of HIV/AIDS, with former president Festus G Mogae responsible for the Botswana chapter. In 2011 Festus Mogae shocked the nation when he first presented the views of the Global Commission on HIV/AIDS and Law at NAC meeting. Many people were left in a state of shock because culturally issues of sodomy and commercial sex work are looked at with great disgust and shameful. Unfortunately even he Mogae was not quite convincing especially with regard to the reasons he advanced by calling for decriminalization of sodomy and voluntary sex work. Mogae stated he was now comfortable to advocate for decriminalization of sex work and gays, something he could not risk doing during his tenure in office, he could not afford to lose elections “just for gays”. Mogae’s presentation at NAC in 2011 is in line with the many agencies that have been set up to serve as the voice of the voiceless and this is related to the Right to health and the human rights approach to health.
In November 2006, for instance, Human Rights gurus held an experts meeting at Gadjah Mada University in Yogyakarta, Indonesia. It is at this meeting that the “Yogyakarta Principles were adopted with the primary objective being to address a broad range of human rights standards and their approach to issues of sexual orientation and gender identity. These principles stated that all human beings are born free and equal in dignity and rights. That all human rights are universal, interdependent, and indivisible and interrelated. The principles further recognize that sexual orientation and gender identity are integral to every person’s dignity and humanity and must not be the basis for discrimination or abuse. The principle provides that everyone is entitled to enjoy all human rights without discrimination on the basis of sexual orientation or gender identity and that everyone has the right to recognition everywhere as a person of diverse sexual orientation and gender identity. The Yogyakarta principles can be argued to have opened up conversation (s) to issues that are considered as highly sensitive especially in Africa, where culture, customs and norms take centre stage whenever issues of this nature are discussed. They are considered as disgusting and highly immoral with some positing that discussions of this nature are ways to open flood gates of sodomising Africa and introducing Western disgusting cultures where women have sex with other women and vice versa with biblical connotations of Sodom and Gomorrah.
Many advances have been made toward ensuring that people of all sexual orientation and gender identities can live with equal dignity and respect to which all persons are entitled. Many governments now have laws and constitutions that guarantee the rights of equality and non discrimination without distinction on the basis of sexual orientation and gender identity. Nevertheless, human rights violations targeted towards persons because of their actual or perceived sexual orientation or gender identity constitute a global and entrench pattern of social concern.
In Zimbabwe President Robert Mugabe, once called David Cameron satanic for backing gays and said that homosexuals were worse than pigs and dogs. In Malawi a gay couple was jailed after getting engaged. Recently in Uganda, President Yoweri Museveni signed the controversial law against homosexuals comprising the entire LGBT community, justifying his choice as a necessary act to stop an unnatural preference. In Botswana, the government is reluctant to open up on the issue of LGBT. I must also confess that I used to be homophobic. I could not just stand and tolerate gays and lesbians especially with respect to their public display of affection. A friend of mine, we fondly call “Chips” can bear testimony to this.
However, that was then, I have since changed. I have come to accept that they too are human and should not be discriminated against on the basis of their sexual orientation. My University in the USA is one of the leading Universities that practices and preaches social justice and one day in one of my Health Policy classes, “Reproductive & Sexual Health and Development”, my Professor confessed about her sexual orientation and told us that she was married to someone of the same sex. Initially, I was in a state of shock but gradually I had a change of mindset. So recently when one of my students shared with us that he will be getting married to a same sex partner, I was not shocked. Interestingly his brother is a very prominent politician in the country and one wonders how he has taken it.
I am not gay. However, just like former President Festus Mogae stated, I do not understand homosexuality, I am a heterosexual, I look at women. I don’t look at other men. But I have come to accept that there are men who look at other men. I have come to accept that there are Men who have sex with other Men. I am aware that many people frown and regard it as a taboo and see the practice as shameful and disgusting. They behave as if sodomy is a new thing in our culture and custom, despite that we have Setswana words such as “Matanyola” and “Maotwana” (sodomy). Others however, have raised concerns about the explosive rate of gays and lesbians in the country attributing it to lifestyle and a fashion statement. That is a discussion for another day.
Many societies impose gender and sexual orientation norms on individuals through custom and law and to seek control how they experience personal relationships. The policing of sexuality remains a major force behind continuing gender inequality and sexual discrimination. The International system has seen great strides towards gender equality and protection against the voiceless poor. In addition, key human rights mechanisms of the United Nations have affirmed country’s obligation to ensure effective protection of all persons from discrimination based on sexual orientation or gender identity.
The question then arises, what is our position as a country on LGBT as vulnerable minority? Their silence and invisibility is not the result of shame as many conservatives may believe. It is rather the result of attempting to avoid societal prejudices and stigma, which are reinforced and perpetuated by the criminalization of homosexual and diverse orientation activity. And again the world is slowly, but painfully, moving towards the formal recognition of the existence of a third gender besides male and female, are we ready to embrace and recognize the third gender – transgender?
Time is now for the government to open up and state their position, we cannot just rely on the Champions of HIV/AIDS, there is need for new game changers, because clearly the perspective of trying to make sense of global health governance and the right to health and human rights seems remote.
Thabo Lucas Seleke is a Scholar & Researcher in Global Health Policy, Health Systems strengthening and HIV/AIDS.
