Break Another Silence: Understanding Sexual Minorities and Taking Action for Sexual Rights in Africa

understanding sexual minorities in Africa

Sexual Minorities and rights in AfricaBreak Another Silence: Understanding Sexual Minorities and Taking Action for Sexual Rights in Africa

This booklet is about marginalised sexualities and human rights and is also available in French.

In a context of widespread homophobia and misinformation, it aims to give Oxfam’s and other NGOs’ staff both facts and food for thought about alternative sexualities.  It’s written for people working in civil society and government organisations, with a focus on Africa, particularly the Horn, East, and Central Africa.



The idea for this booklet came from an HIV and AIDS forum, held in the Horn, East & Central Africa region, for Civil Society Organisation (CSO) staff working on HIV. The forum focussed on learning about linkages between gender, HIV & AIDS, and sexual rights. Two East African activists from a sexual minorities network spoke about how badly sexual minorities are treated, the violence and discrimination they experience, and the difficulties they face in accessing HIV and AIDS prevention, treatment & care services. Their testimonials stirred the participants’ interest. Some felt that they needed to know more. Many were surprised; they were working on HIV, and yet had not given much thought to sexual minorities. Some, perhaps, felt negative towards the two activists, a common reaction in African cultural settings. Others wondered how they and their organisations might support sexual minorities to claim their rights.

This booklet is to encourage staff in civil society and government organisations to: understand sexual rights as human rights; to become aware of the ongoing abuses of sexual minorities’ human rights including lack of access to essential services; and to take action to protect rights for all, including minority groups.

Chapter 1 focuses on basic information and key debates. Chapter 2 looks at reactions to sexual minorities and their sexual rights. The linkage between sexual minorities, human rights and HIV programming is explored in Chapter 3, while Chapter 4 deals with why most NGOs have been silent on the issue. The concluding chapter suggests ways to break that silence.

Briser un Autre Silence: Comprendre les minorités sexuelles et mener des actions en défense de leurs droits sexuels en Afrique

Sexualité, homosexualité

Sexualité, homosexualité Briser un Autre Silence: Comprendre les minorités sexuelles et mener des actions en défense de leurs droits sexuels en Afrique

Cette brochure traite des sexualités marginalisées et des droits de l’homme et a été écrite en anglais.

Dans le contexte de l’homophobie généralisée et de la désinformation, il vise à donner au personnel d’Oxfam et d’autres ONG à la fois des faits et des éléments de réflexion sur les sexualités alternatives. Il est écrit pour les personnes travaillant dans la société civile et les organisations gouvernementales, en mettant l’accent sur l’Afrique, en particulier la Corne, l’Afrique de l’Est et l’Afrique centrale.

(The French translation of Break Another Silence)



L’idée à l’origine de ce livret est venue d’un forum sur le VIH et le SIDA tenu dans la région de la Corne, l’Est et le Centre de l’Afrique à l’intention du personnel des Organisations de la Société Civile (OSC) travaillant sur le VIH. Le forum portait sur l’apprentissage au sujet des liens existant entre : Genre, VIH, SIDA et droits sexuels. Deux activistes est-africains provenant d’un réseau de minorités sexuelles se sont exprimés au sujet de la manière dont les minorités sexuelles sont maltraitées. Ils ont parlé de la violence et de la discrimination que ces minorités subissent et des difficultés auxquelles elles font face pour accéder aux services de prévention du VIH et du SIDA, de traitement et de prise en charge. Leurs témoignages ont suscité l’intérêt des participants. Certains ont eu le sentiment qu’ils avaient besoin d’apprendre davantage. Certains d’entre eux étaient étonnés ; ils travaillaient sur le SIDA mais, hélas, ils n’avaient pas beaucoup pensé aux minorités sexuelles. Certains, peut-être, ont eu le sentiment de désapprouver les deux activistes; une réaction considérée comme ordinaire dans un contexte culturel africain. D’autres se demandaient comment eux-mêmes et leurs organisations pourraient aider les minorités sexuelles à revendiquer leurs droits.

Ce livret est destiné à encourager le personnel des organisations gouvernementales et de la société civile à : Comprendre les droits sexuels comme des droits humains ; Prendre conscience de l’abus des droits humains dont sont victimes au quotidien les minorités sexuelles, dont le manque d’accès aux services essentiels ; et entreprendre une action pour protéger les droits de tous, y compris pour les groupes minoritaires.

Le premier chapitre porte sur une information de base et sur les grands sujets de débats. Le chapitre 2 analyse les réactions courantes face aux minorités sexuelles et à leurs droits sexuels. Le lien entre minorités sexuelles, droits humains et programmation sur le VIH est explorée dans le chapitre 3, pendant que le chapitre 4 traite de la manière dont la plupart des ONG sont restées silencieuses sur la question. Le chapitre de conclusion suggère des voies de sortie pour briser ce silence.

Failing Women, Withholding Protection

HIV prevention with female condom

female condom to prevent HIV15 lost years in making the female condom accessible.

Oxfam Novib has been one of few organisations in the world investing in allowing the female condom to serve its purpose. I was fortunate to have the job of researching and writing this briefing paper for them.

They and the World Population Fund used it in their advocacy push at the 2008 International AIDS Conference. Find out more about their Universal Access to Female Condoms campaign here.



2008 marks 15 years since the female condom was invented, and, disgracefully, 15 years of failing to make them accessible to the women who need them. Despite the absence of any other female-initated form of protection, and unprecedented rises in funding for the response to HIV, female condoms remain inaccessible, and their contribution remains untapped.

The urgent need for access to female condoms is evident in the feminisation of the HIV pandemic, the large unmet need for contraception, and the pitiful progress towards meeting Millennium Development Goals 5 and 6 on maternal health and halting and reversing the spread of HIV.

Why provide female condoms, when male condoms are readily available, much cheaper, and provide a comparable level of protection?

  • Female condoms are a tool to assist women’s empowerment. Women who use female condoms report an increased sense of power for negotiation of safer sex, and a greater sense of control and safety during sex. It will be many years until women have any alternative femaleinitiated means of protecting themselves.
  • Providing both female and male condoms leads to more instances of protected sex and reductions in the incidence of sexually transmitted infections (STIs). Their additive effect, providing protection in instances which would not be protected by male condoms, makes them a costeffective form of HIV prevention.

Studies have repeatedly shown high levels of acceptability for female condoms. Some users prefer them over male condoms, as they offer more flexibility regarding the timing of putting them on and taking them off, and have a more natural feel. However, many donors and policy-makers remain sceptical that sufficient demand for them exists. Yet examination of femalecondom projects reveals significant demand, even though it is often deliberately suppressed and unintentionally undermined by stigmatisation and running out of stock. What is perceived as an issue of demand is actually one of supply. Expanding access to female condoms is held up not at the users’ end, but at the start of the chain: how much money donors and governments are willing to invest in buying female condoms, supporting female-condom programmes, and developing low-cost female condoms.

What is behind the failure to act comprehensively to create access to female condoms? Responses from donors and policy-makers to the female condom mirror the common reasons for not using a male condom: responses formed by ignorance, culture, denial, ‘poverty’, and conservatism. Added to this are overarching errors of a lack of leadership, a huge funding bias against existing forms of primary HIV prevention, failure to scale up programming, and failure to invest in strategies to lower the cost of female condoms.

Of course, some efforts have been been made in the past 15 years, which have accelerated since the launch of the United Nations Population Fund’s (UNFPA) global Female Condom Initiative in 2005. The rapid expansion of sales and free distribution in the few countries at the forefront of female condom programming demonstrates the massive unmet demand for female condoms. But there is so much more to be done. Worldwide, in 2007, roughly 423 male condoms were produced for just one female condom. Female condoms currently have a unit cost about 18 times higher than male condoms.

The levels of investment and programming needed to increase the choice of available female condoms, to lower prices and to expand production are highly feasible. Through collaborative action, donors, governments, civil society organisations and the private sector can begin the progress of achieving universal access to female condoms. Female condoms exist now, and concerted efforts to make them accessible must begin now.

Good Donorship in a Time of AIDS: Guidelines on Support to Partners to Manage HIV/AIDS in the Workplace

internal mainstreaming HIV

HIV in the workplace
Good Donorship in a Time of AIDS: Guidelines on Support to Partners to Manage HIV/AIDS in the Workplace

These guildlines were the outcome of an interesting process of research and negotiation with five Dutch donors.

In them I set out the sponsoring donors’ commitments to support their partners’ efforts to manage HIV in their workplaces in pilot projects in Uganda and India. I also presented the rationale and basic steps for organisations to do this.



Why have we developed these guidelines?

Breaking the silence: in many partnerships between Northern and Southern NGOs, HIV/AIDS is not discussed, or is discussed only in terms of the effects at community level. We want HIV/AIDS to be part of our dialogue with partners, and hope that these guidelines will lead to it being on the agenda, for both donors and partners. The guidelines may also help stimulate discussion within partner organizations.

Acting in solidarity: we are now in the late stages of developing and implementing workplace programs for our own staff, but are funding local partners which lack such programs. We believe we should actively open up dialogue and provide support to our partners, rather than be ‘concerned bystanders’, watching the impacts of HIV/AIDS on our partners but doing little to assist.

Getting our ‘heads out of the sand’: a recent CARE survey3 of 42 NGOs in Southern Africa found that, despite a HIV prevalence rate of around 25%, two thirds of the respondents said they did not think they had any HIV-positive employees! This vividly illustrates how managers may act like ostriches by ignoring difficult realities, a costly habit in the case of HIV/AIDS. These guidelines are about raising our heads, stating our commitments, communicating them to our partners, and helping them also to raise their heads.

Responding to demands from local NGOs: some donors expect better results from NGOs in high prevalence settings, or lower costs, as if HIV/AIDS does not exist. Research with local NGOs shows that instead of that lack of understanding, they want more openness, more support, and more clarity from their donors with regard to managing HIV/AIDS4 . These guidelines should go some way to meeting those demands.

Responding to demands from Program Officers: our Program Officers sometimes get requests from partners to fund their workplace policies. Some of them feel ill-equipped to deal with this new topic, and have asked for guidance. These guidelines should help them make decisions, and should ensure that partners’ requests are dealt with consistently within each of the Dutch donor NGOs.

Influencing others: other NGOs who work through partnership with organizations in the South are facing the same issues, but none have ‘grasped the nettle’ and developed guidelines on good donorship in a time of AIDS. We can share these guidelines with those development agencies, and so use them to stimulate their response. We expect that partners may also use these guidelines to influence their other donors towards ‘good donorship’ with regard to HIV/ AIDS.

Greater accountability: where local NGOs do not have budgets to cover employees’ health care costs, managers may cover the costs with money from other parts of their budgets. They are unlikely to tell their donors about this. These guidelines should increase communication and so accountability between us by providing clarity on what costs we are willing to fund, and by initiating dialogue between donors and partners, so that we can agree budgets to cover the financial costs of HIV/AIDS and other chronic diseases.

Mainstreaming HIV/AIDS in Development and Humanitarian Programmes

mainstreaming hiv aids in development programmes

Mainstreaming HIV /ADIS in Development and Humanitarian Programmes

Aids on the Agenda – lite

AIDS on the Agenda is quite a long book, so in 2004 Oxfam produced this cut down version of it.

You can download it for free or buy a hard copy from Oxfam publications.


AIDS depends for its success on the failures of development. If the world was a fairer place, if opportunities for men and women were equal, if everyone was well nourished, good public services were the norm, and conflict was a rarity, then HIV (Human Immunodeficiency Virus) would not have spread to its current extent, nor would the impacts of AIDS (Acquired Immune Deficiency Syndrome) be as great. We now know that the spread of HIV and the effects of AIDS are closely linked to development problems such as poverty and gender inequality. Development and humanitarian agencies should be doing more to respond to the challenges posed by HIV/AIDS. This book suggests a way in which they can do so through their existing work without necessarily establishing special programmes of HIV prevention or AIDS care.

This book is a shorter, simplified version of AIDS on the Agenda (Holden 2003), a book which can be ordered from Oxfam GB, or downloaded for free from here. The ideas in the two books are the same; but this version, we hope, is accessible to a wider range of readers: those who actually do development and humanitarian work, in addition to those who manage it and fund it. Unlike AIDS on the Agenda, this book does not feature quotations and case studies; instead it presents general lessons learned – mainly from the experiences of non-government and community-based organisations (NGOs and CBOs) working in the parts of Africa that are worst affected by HIV/AIDS. AIDS has changed the world. This book is about the changes that we need to make in order to do effective development and humanitarian work in a world of AIDS.

Part 1: The case for mainstreaming HIV/AIDS

Chapter 2 considers the two-way relationship between under-development and the causes and consequences of HIV/AIDS. It shows how the disease can make gender inequality worse, and claims that HIV/AIDS is a long-term development problem with no obvious solution.

Chapter 3 explores what mainstreaming means, by setting out the four main terms used in this book: • AIDS work • integrated AIDS work • external (programmatic) mainstreaming of AIDS • and internal (organisational) mainstreaming of AIDS. It identifies similarities and differences between them, and gives practical examples of what the terms mean for development and humanitarian organisations.

Chapter 4 addresses the question ‘Why mainstream HIV/AIDS?’. It considers some of the problems that may arise if development and humanitarian organisations fail to take AIDS into account in their ordinary work. It also responds to some objections to the idea of mainstreaming HIV/AIDS, and describes two problems which development organisations may meet when they do AIDS work.

Chapter 5 draws together all the elements of Part 1. It presents a ‘web’, showing four levels of influence on HIV transmission, and different kinds of response, both direct and indirect.

Part 2: Ideas for mainstreaming HIV/AIDS

Chapter 6 provides some general strategies for initiating and sustaining mainstreaming, and proposes some guiding principles. Chapter 7 offers ideas for mainstreaming HIV/AIDS within the internal operations of development and humanitarian agencies, and Chapters 8 and 9 offer suggestions for external mainstreaming in development and humanitarian programmes respectively. Chapter 10 presents an overview of the issues and challenges involved in promoting and adopting the strategy of mainstreaming, and the book concludes with Chapter 11.

AIDS on the Agenda: Adapting Development and Humanitarian Programmes to Meet the Challenge of HIV/AIDS

Managing and mainstreaming HIV

managing and mainstreaming HIVAIDS on the Agenda: Adapting Development and Humanitarian Programmes to Meet the Challenge of HIV/AIDS

My book on HIV mainstreaming written for policy-makers, managers, and programme staff in development and humanitarian agencies. AIDS on the Agenda was one of the first publications on this subject. Many of the definitions which I developed back then are now widely used.

You can download the entire book for free or buy it from Oxfam.

See also Mainstreaming HIV/AIDS in development and humanitarian programmes for a cut down version of this book.


This book is concerned with AIDS (Acquired Immune Deficiency Syndrome), but not with specific responses to it. If you are looking for advice about work that is focused exclusively on the problem of AIDS – home-based care, medical treatment, voluntary counselling and testing, condom promotion, or AIDS education – then you need a different book. But if you are concerned about the devastation that AIDS is causing, and you believe that more needs to be done, and by more people, than can be achieved by AIDS-specific work alone, then read on. You will find ideas based on experiences of adapting mainstream development and humanitarian work to address the problem of AIDS indirectly, along with ways in which organisations can respond from within to protect their employees and their business. AIDS has changed the world; this book is about the changes needed for effective development and humanitarian work in a world of AIDS.

This book considers the dual challenge for development and humanitarian organisations of ‘mainstreaming’ HIV and AIDS, which consists (i) of making changes to the internal management of their organisations, with a view to limiting the impacts of AIDS on their employees and their work, and (2) adapting their external work in order to take account of the causes and consequences of AIDS. In arguing that mainstreaming HIV and AIDS is a task for all organisations involved in development and humanitarian work, this book aims to stimulate thinking and debate about ways in which organisations can respond to AIDS without necessarily also doing work specifically focused on AIDS.

It is organised in three parts:

Part I: Mainstreaming HIV/AIDS in development and humanitarian programmes: background and rationale

Chapters 1 to 6 offer a general introduction to the global threat of AIDS and the international community’s response to it, and present the arguments for mainstreaming as an additional strategy.

Part II: Experiences of mainstreaming AIDS

Chapters 7 to 9 address the reality of work on the ground, and the lessons that emerge from the case studies.

Part III: Ideas for mainstreaming AIDS

Chapters 11 to 15 present practical ideas for agencies seeking to mainstream HIV/AIDS into their work.


The Resources section at the back of the book provides further practical ideas for mainstreaming AIDS, in the form of a series of ten user-friendly Units, designed to stimulate readers to think how they might introduce mainstreaming into their own organisations.