Tanzania's Anti-LGBT Crackdown and the Right
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HUMAN “If We Don’t Get Services, RIGHTS We Will Die” WATCH Tanzania’s Anti-LGBT Crackdown and the Right to Health “If We Don’t Get Services, We Will Die” Tanzania’s Anti-LGBT Crackdown and the Right to Health Copyright © 2020 Human Rights Watch All rights reserved. Printed in the United States of America ISBN: 978-1-6231-37991 Cover design by Rafael Jimenez Human Rights Watch defends the rights of people worldwide. We scrupulously investigate abuses, expose the facts widely, and pressure those with power to respect rights and secure justice. Human Rights Watch is an independent, international organization that works as part of a vibrant movement to uphold human dignity and advance the cause of human rights for all. Human Rights Watch is an international organization with staff in more than 40 countries, and offices in Amsterdam, Beirut, Berlin, Brussels, Chicago, Geneva, Goma, Johannesburg, London, Los Angeles, Moscow, Nairobi, New York, Paris, San Francisco, Sydney, Tokyo, Toronto, Tunis, Washington DC, and Zurich. For more information, please visit our website: http://www.hrw.org FEBRUARY 2020 ISBN: 978-1-6231-37991 “If We Don’t Get Services, We Will Die” Tanzania’s Anti-LGBT Crackdown and the Right to Health Glossary ...........................................................................................................................i Summary ......................................................................................................................... 1 Recommendations ........................................................................................................... 4 Methodology ................................................................................................................. 10 Timeline: Tanzanian Government Attacks on LGBT Health and Rights, 2016-2019 ........... 13 I. Background ................................................................................................................ 23 Political Context ................................................................................................................... 23 Bulldozing Rights........................................................................................................... 24 Reversing Gains ............................................................................................................. 25 Legal Context ....................................................................................................................... 28 II. Attacks on the Right to Health .................................................................................... 30 The Lubricant Ban ................................................................................................................ 36 The Ban on Drop-in Centers and Community Outreach for HIV Prevention ............................... 41 Stigma and Discrimination at Government Health Facilities.................................................... 46 Limited Access to Anti-Retroviral Therapy (ART) ..................................................................... 50 Mental Health Impacts of the Lack of Access to LGBT-Inclusive Services ................................. 52 III. Attacks on LGBT Civil Society Organizing .................................................................. 54 Deregistration and Threats to Deregister Non-Governmental Organizations ............................ 54 Raids on Health and Rights Workshops and Meetings ............................................................ 56 IV. Arbitrary Arrests and Forced Anal Examinations ........................................................ 61 Arrests Accompanied by Forced Anal Examinations ............................................................... 62 Arrests Related to “Same-Sex Marriage” Fears ....................................................................... 65 “Walking While LGBT” .......................................................................................................... 67 V. Escalating Attacks and International Responses ........................................................ 70 The World Bank Intervention ................................................................................................. 73 PEPFAR’s Intervention .......................................................................................................... 75 VI. Obligations Under International and Regional Law .................................................... 78 The Right to the Highest Attainable Standard of Health .......................................................... 78 Regional and International Guidelines on Realizing the Right to Health ............................ 80 The Rights to Freedom of Association .................................................................................... 82 The Right to Privacy .............................................................................................................. 84 The Right to Non-Discrimination ........................................................................................... 84 The Right to Be Free from Ill-Treatment .................................................................................. 85 VII. Acknowledgments .................................................................................................. 88 Annex II: Human Rights Watch Letter to Health Minister Ummy Mwalimu ....................... 94 Annex III: Human Rights Watch Letter to Constitutional and Legal Affairs Minister ........ 101 Annex IV: Health Ministry Statement ............................................................................ 106 Annex V: World Bank Statement on Lifting the Suspension of Missions to Tanzania ...... 111 Glossary Bisexual: The sexual orientation of a person who is sexually and romantically attracted to both women and men. Cisgender: The gender identity of people whose sex assigned at birth conforms to their identified or lived gender. Closeted: Describes a person who does not acknowledge their sexual orientation to others. People may be “fully” in the closet (not admitting their sexual orientation to anyone), fully out, or somewhere in between. Drop-in Centers (DIC): In Tanzania, a center providing health services to key populations, with an emphasis on services related to related to HIV and sexual health, including HIV prevention information, testing, treatment, counseling, needle and syringe programs, and provision of safer sex commodities. Gay: A synonym for homosexual in many parts of the world; in this report, used specifically to refer to the sexual orientation of a man whose primary sexual and romantic attraction is towards other men. Gender: The social and cultural codes (as distinct from sex assigned at birth) used to distinguish between society’s conceptions of “femininity” and “masculinity.” Gender Expression: The external characteristics and behaviors that societies define as “feminine,” “androgynous,” or “masculine,” including such attributes as dress appearance, mannerisms, hair style, speech patterns, and social behavior and interactions. Gender Identity: A person’s internal, deeply felt sense of being female or male, both, or something other than female or male. Gender Non-Conforming: Not conforming to stereotypical appearances, behaviors or traits associated with sex assigned at birth. i Heterosexual: The sexual orientation of a person whose primary sexual and romantic attraction is toward people of another sex. Homophobia: Fear of, contempt of, or discrimination against homosexuals or homosexuality, usually based on negative stereotypes of homosexuality. Homosexual: The sexual orientation of a person whose primary sexual and romantic attractions are toward people of the same sex. Intersex: An umbrella term that refers to a range of traits and conditions that cause individuals to be born with chromosomes, gonads, and/or genitals that vary from what is considered typical for female or male bodies. Key Populations: Populations disproportionately impacted by HIV when compared with the general population, irrespective of the epidemic type or local context. The World Health Organization defines key populations as comprising men who have sex with men, sex workers, people who inject drugs, people in prisons and other closed settings, and transgender people. Key and Vulnerable Populations: Key populations and others who whose situations make them especially vulnerable, or who experience inequality, prejudice, marginalization and limits on their social, economic, cultural and other rights. In Tanzania, “vulnerable populations” is often used to refer to adolescent girls, orphans, street children, and mining and fishing communities. Lesbian: The sexual orientation of a woman whose primary sexual and romantic attraction is toward other women. LGBT: Lesbian, gay, bisexual, and transgender; an inclusive term for groups and identities sometimes also grouped as “sexual and gender minorities.” LGBTI/LGBTQ/LGBTIQ: Umbrella terms used to refer inclusively to those who are lesbian, gay, bisexual, and transgender along with those who are queer and/or intersex. ii Men Who Have Sex with Men: Men who engage in sexual behavior with other men, but who may or may not identify as “gay,” “homosexual” or “bisexual.” Sometimes abbreviated to “MSM.” Non-Binary: Gender identity of people who identify as neither female nor male. Queer: An inclusive umbrella term covering multiple identities, sometimes used interchangeably with “LGBTQ.” Also used to describe divergence from heterosexual and cisgender