The Kingdom of Swaziland (eSwatini) continues to miss the boat by several rivers on issues relating to access to healthcare for the LGBTI. The country’s upper house in parliament, Senate, has recently failed to see the importance of a debate on the lived experiences of each and every individual in the LGBTI community, when going to a state hospital.
Health is a fundamental human right, and on the premise of human rights. Human rights are commonly understood as “inalienable fundamental rights to which a person is inherently entitled simply because they are a human being.” Human rights are thus conceived as universal (applicable everywhere) and egalitarian (the same for everyone). By virtue of health being a fundamental human right, it follows therefore that everyone should be able to access health care in the same manner as everyone.
Health is a commodity that all humans should be able to enjoy in the amounts in which they all wish to have it. By virtue that health is a commodity, it therefore means that there are factors that will determine how humans will demand the commodity. There are pecuniary issues or rather financial issues that determine how individuals will access health care. And there are also non-financial barriers to access to health care or determinants thereof, these include but not limited to the following;
Geographic location, service availability, affordability and acceptability. Let us zero in on acceptability. Acceptability has globally been defined to include the following;
- Characteristics of the health services – Management/staff efficiency
- User’s attitudes and expectations – Technology
- Household expectations
- Community and cultural preferences, attitudes and norms
In the design of health systems it is therefore imperative not only to focus on the business side of the entity. There are also social issues that need to be factored into the equation to ensure that every citizen receives the care that they deserve. Imagine walking into a shop and getting racial stares or being given attitudes by the shopkeeper, what would your first impulse be? Would you still stay and shop at that place or you would leave and go shop elsewhere?
In some situations a consumer of the commodity has the right to vote with their feet and source the commodity elsewhere, however, with health care it is a commodity that we consume because we are sick and one requires it to improve their health. If then one cannot access health care because of the attitudes of health care workers, then that is tantamount to telling that one person to go die. Or, is it that the government values one life less compared to another? A life is a life regardless.
Constitutional Protection for the LGBTI
The constitution of Swaziland does indeed make provision for the rights and freedoms of individuals, but when specifying protection across various axes of difference, sexual orientation (and gender identity) is blatantly excluded. One can argue that all individuals are protected, but without an explicit statement on the differences which qualify for protection; personal views, preferences and prejudices can be enforced as the constitution, making it very difficult to prove discrimination. This means that the provisions made by the constitution exist in theory, but without the will to apply it fairly, it might as well not exist.
When one is discriminated against, the constitution counts for very little in that moment because one can only take remedial action. When having to call on structures for protection from an act that has already been committed against one, the likelihood of encountering someone who shares the prejudiced views enforced to bring about the injustice is high. The official has power to enable or retard the retributive process and LGBTI people (and others) are often strangled by bureaucracy so they don’t bother to see the process through. The fact that practitioners are not sensitized around their duty to treat everyone fairly allows for personal prejudice to operate undetected, in a society where prejudice towards difference is normalized at various levels of society.
To say that the LGBTI is asking for special treatment at the expense of others is a misinterpretation of the motion. When they are not getting fair treatment and being discriminating against based on sexual orientation and gender identity, making special provisions in an unjust system is actually just equality.
The LGBTI in Swaziland is not considered with the same respect and fairness that other citizens are, and hence their experiences are trivialized. Under these conditions the ability to access healthcare and treatment without fear of being denied treatment and victimization, is severely impaired. Making provisions to curb this is simply ensuring that the end result is that everyone gets the same service.
The point is not the intention, by rather the consequence. At the moment, good intentions see LGBTI people excluded; hence more needs to be done to see them included as are all other citizens.
LGBT Specific Health Issues
LGBT individuals encompass all races and ethnicities, religions, and social classes. Research suggests that LGBT individuals face health disparities linked to societal stigma, discrimination, and denial of their civil and human rights. Discrimination against LGBT persons has been associated with high rates of psychiatric disorders, substance abuse, and suicide. And need I value the economic and social costs for the above illnesses, refusing to provide some sort of protection to LGBTI people in terms of access to health care, will cost the country even more in impact mitigation.
Experiences of violence and victimization are frequent for LGBT individuals, and have long-lasting effects on the individual and the community. Personal, family, and social acceptance of sexual orientation and gender identity affects the mental health and personal safety of LGBT individuals.
Why LGBTI Health is Important
Eliminating LGBT health disparities and enhancing efforts to improve LGBT health are necessary to ensure that LGBT individuals can lead long, healthy lives. The many benefits of addressing health concerns and reducing disparities include:
- Reductions in disease transmission and progression
- Increased mental and physical well-being
- Reduced health care costs
- Increased longevity
The Honourable Senator Ngwenya was right to state that this will cost the country more in the medium to long term. Furthermore, she was justified in her argument that if Swaziland is really to win the fight against HIV, Cancer and other non-communicable diseases there is need to ensure effective investments in all population sub groups. Owing to the branching processes of diseases, that is the process through which diseases get transmitted from one person to the next.
Let us make this hypothetical scenario, if a bisexual person has two partners, one gay and one straight, if straight partner has HIV for example, it gets transmitted through the bisexual person to a gay person for example. And if gay human being has another straight MSM partner imagine the spread of the virus. By rejecting this motion, effectively it means senators have left that conduit of transmission wide open and with no room for recourse.
The Research on LGBT Health and Trans Health
LGBT health requires specific attention from health care and public health professionals to address a number of disparities, including:
- LGBT youth are 2 to 3 times more likely to attempt suicide.
- LGBT youth are more likely to be homeless.
- Lesbians are less likely to get preventive services for cancer.
- Gay men are at higher risk of HIV and other STDs,
- Lesbians and bisexual females are more likely to be overweight or obese.
- Transgender individuals have a high prevalence of HIV/STDs, victimization, mental health issues, and suicide and are less likely to have health insurance than heterosexual or LGBTI individuals.
- Elderly LGBT individuals face additional barriers to health because of isolation and a lack of social services and culturally competent providers.
- LGBTI populations have the highest rates of tobacco, alcohol, and other drug use.
It is therefore, imperative that the health system be capacitated to deliver effective and efficient services to all population sub groups if we are to reach zero new HIV infections by 2022. If the country is to truly halt the spread of the cancer and other non-communicable diseases, it is imperative that we plan for all Swazi’s. Every life counts and it is imperative that we seek to ensure that we protect each and every life. No one has the right to play God, there is only one Judge and that Judge is God, ours as health care providers is to provide effective services to try and preserve each and every life.
Is the point about equality or equity? If a group of people have been denied access to certain services and had their rights disregarded, putting structures in place to correct that is not special treatment. Not affording that treatment to others is not discrimination because they already have it. This is equity.
There is a gap that exists, and in order to close that gap more needs to be done for those who have been disenfranchised to allow them to catch up to those who are fairly treated and properly protected. Only once equity has corrected the imbalance can equality be considered where everyone is at the same starting point.