The Silent Health Crisis Facing Malawi’s LGBTQ+ Community

By Florence Mwale and Wezi Nyirongo

Access to quality health care remains a challenge for lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people in Malawi. Lives are at risk as they face discrimination at health facilities because of their sexual orientation or gender identity.

Abiti (pseudonym) aged 33 and based in the commercial city of Blantyre, fell ill in July but was turned away from a public health facility after nurses discovered that she identifies as a trans woman.

“It was a hellish experience. It seemed the person attending to me informed her colleagues about my gender, and no one was willing to help. I left without a diagnosis or treatment,” she said.

Several sources spoken to for this story say Malawi’s healthcare workers lack the training and knowledge needed to address gender and sexual minorities’ medical needs.

In a heart-to-heart conversation, Abiti pours out her frustration seeking medical care only to face the wrath of transphobic healthcare workers who fail to accommodate and treat people from the community.

“People just have stereotypes, misconceptions, and assumptions about us. When we go to the hospitals, they’re so judgmental. They’ll even call each other and say, ‘Look at this person,’ and not even treat you right or give you the treatment, citing their cultural or religious beliefs, like totally denying you access to health care facilities,” she said.

“There are other people that are on hormone replacement therapy, and you find that a lot of hospitals here do not have the required hormones,” she continued. “As a result, people are not getting the services that they need. We also do not have a legally bound policy that can ensure that we are assisted accordingly when we seek medical care.”

Malawi’s National Health Policy was developed in line with Section 13 of the Constitution, which stipulates that the State is obliged to provide adequate health care commensurate with the health needs of Malawian society and international standards of health care.

Section 20 of the Constitution also provides that “Discrimination of persons in any form is prohibited and all persons are, under any law, guaranteed equal and effective protection against discrimination on grounds of race, colour, sex, religion, political or other opinions, national or ethnic origin, property, birth or other status.”

In the course of our conversation, one of Abiti’s friends chips in to share the story of Michael (pseudonym), a gay man who suffered at the hands of health workers at a public health facility.

“So, Michael had an STI and went to the hospital for medical help. Instead of receiving care, he was met with judgmental questions like, ‘How did you get that?’ These invasive questions only intensified his self-stigma, making it hard for him to fully explain his condition. The staff called each other over, mocked him, and failed to provide the necessary treatment. In the end, it was clear that there was little interest in addressing STIs or reducing HIV infections in our communities,” the friend explained.

Several faith groups under the Religious Leaders Network for Choice have joined calls denouncing homophobia, social and religious exclusion, and injustice towards the LGBTQ+ community.

Reverend Michael Mtambo, a board member of the coalition, made a passionate call to Malawians and religious bodies to respect the dignity of all human beings, irrespective of their gender, sexuality, or other notable diversity.

“Religion is a beautiful concept that will only be appreciated when it is a place for the marginalized and ostracized in society. Let us all embrace diversity and ensure social inclusion of all people regardless of their sexual orientation,” said Reverend Mtambo.

Responding to a questionnaire about the challenges LGBTQ+ people face when accessing healthcare services, Principal Secretary in the Ministry of Health Samson Mndolo acknowledged allegations of negative attitudes among health workers in public health facilities and said steps are being taken to stop the malpractice, including training and access improvements.

The Ministry also drafted a standard operating procedure for healthcare workers to consult when addressing the needs of gender and sexual minorities. This document awaits validation and approval by a senior management team.

Mndolo advises people who face discrimination when seeking health care to inform the hospital’s ombudsman, who is empowered to investigate, mediate, and provide remedies to complaints lodged by service users, their representatives and other stakeholders about a hospital’s service.

“The Central Hospitals and District Hospitals have Ombudsmen to coordinate complaints from the public, including the LGBTQ+ community. So far we have not received substantial proof of allegations to follow-up,” Mndolo said.

Despite new measures, the experiences of individuals like Abiti and Michael reveal that significant work remains to ensure equitable healthcare access for Malawi’s LGBTQ+ community.

The commitment to change must translate into tangible improvements in the healthcare system, fostering an environment where all individuals can receive the care they need without fear of discrimination.