Launched in November 1987, the Cameroon National Association for Family Welfare (CAMNAFAW) is one of IPPF-Africa Region’s four Learning Centres. Together with the Planned Parenthood Association of Ghana (PPAG) and Reproductive Health Uganda (RHU), it is implementing the idea of learning centres mooted by IPPF-Africa Region’s aimed at building the capacities of sister member associations and those of many other organisations, as well as playing the role of a South-South cooperation model.
The idea is innovative and akin to the driving forces that seem to have been propelling this association to new heights since its creation. In this Central African country plagued by the economic crisis, as is the case elsewhere on the continent, solutions to social problems do not always come to mind in the treatment prescribed. In this context, talking about access to family planning services, access or the right to pleasure or desire could be considered, with hindsight, as false optimism, which is the indispensable ingredient that moulds the vision and works of pioneers. From its relentless fight for people’s rights to family planning to the implementation of activities focusing on the provision of sexual and reproductive health services to the marginalised and vulnerable group composed of Lesbians, Gays, Bisexuals, Transgender and Intersexuals (LGBTIs) in Yaounde, through the establishment of youth centres in 1991, CAMNAFAW’s work seems to have been inspired by the quest for innovation.
The history of this organisation that has earned the recognition of Government authorities seems to be characterised by successful and daring initiatives which have enhanced its popularity and credibility at the national level, and even outside the country’s borders. In 1991, it opened the first Youth Centre for Information and Education in sexual and reproductive health in Yaounde, the capital city, followed by Douala, the second capital three years later. This is the first experience of its kind in Cameroon which has had a snowball effect. CAMNAFAW’s Youth Centres offer information to young people on responsible sexuality and go beyond information-education-communication activities to provide clinical services within a direct care structure.
Always in the Vanguard
CAMNAFAW truly gained recognition following the 1994 International Conference on Population and Development (ICPD) when Cameroon aligned itself to the ICPD conclusions by amending its texts. CAMNAFAW made a paradigm shift from family planning to reproductive health in December 1999, on the occasion of the national meeting organised by the public authorities, when it distinguished itself by making a presentation on the need for further involvement of non-governmental organisations in reproductive health issues affecting young people.
Once again, it was at the helm in the process initiated by IPPF-Africa Region and the Africa Union that culminated in the adoption of the Maputo Plan of Action. In fact, it was the first Member Association of IPPF-Africa Region to host a series of consultations for civil society organisations and meetings for Ministers of Health which resulted in this key reference document on reproductive health adopted by the continent’s Heads of State. When it came to repositioning family planning in Cameroon , it did not fail to provide leadership at the national level, by reacquainting itself with its first love, FP. The thorny issue of abortion, a quasi-taboo topic in a very Christian society, has also been tackled. CAMNAFAW has just conducted a national study on the issue and is using the findings to support the implementation of an abortion project.
The biggest innovation, however, remains its audacity to implement Meeting SRH Diversity Needs (MESDINE) Project, given its controversial nature in the country. The project is taking root in a Cameroonian context where the phenomenon of homosexuality has taken the centre stage in the media against a backdrop of social controversies and disputes. Instead of taking partisan positions, CAMNAFAW opted to conduct a study on the phenomenon. The conclusions are indisputable: homosexuality is a reality in Cameroon and the LGBTI community is faced with major sexual and reproductive health challenges: denial of rights to health, homophobia, all manner of discrimination and stigma, etc., and as a result, greater vulnerability of this category of people which also includes bisexuals, therefore, leading to a greater risk of spread along the STIs/HIV/AIDS transmission chain.
Consultation, the Buzz-Word
Through funding obtained from the IPPF Innovation Fund, CAMNAFAW was able to develop a project, with the participation of beneficiaries, aimed at improving access to reproductive health services in Yaounde’s LGBTI community. Strategies identified to carry the project to a successful conclusion include mobilisation and co-opting of members of the beneficiaries’ community (LGBTIs), institutional capacity building, improved service provision and monitoring-evaluation.
The very idea to develop and implement such a project has been the source of many discussions, as well as opposition. A meeting was organised for senior officials in the Ministry of Health to convince them of the importance of taking into account all potential circles and links in the STI/HIV transmission chain in order to effectively combat HIV/AIDS.
Confidence-building actions targeting the LGBTI community were also conducted. «In a hostile environment, the slightest indication of holding an assembly with our own may be perceived as a ploy to get arrested by the police, so we can never be too careful» a peer counsellor speaks his mind as he justifies the initial reluctance to the project.
During the first CAMNAFAW meeting, we had to be shrewd to ensure that it was not a trap. «Personally, on that day, I passed in front of the building I was shown several times paying particular attention to movements and the presence of people within, because I wanted to ensure that the police were not hiding there to catch us by surprise; I only entered the building when I was certain that nothing was amiss», says Ange Judicaël, who subsequently became a peer counsellor.
From four groups of beneficiaries in various areas of Yaounde, the number grew to eight, and then gradually to twelve. Bernard Sing, a trader and former CAMNAFAW peer counsellor played in a key role in operationalising the project and scaling it up in Yaounde. She is the one who when contacted by CAMNAFAW volunteered to identify beneficiaries with whom she created the first group for which she was a peer counsellor. Three years after the launch of the project, it is coming to an end! Bernard is still available when she is requested to assist in the MESDINE Project. «This project has given me moral satisfaction, she proclaims; I have discovered new people through it, and it has helped to liberate many people who today have claimed their sexual orientation, and are capable of openly saying : «I am a homosexual, HIV positive and in ARVs’. She confesses, «to achieve this, we really have had to be moles».
Peer counsellors are an essential mechanism in the implementation of the project. Trained in counselling by CAMNAFAW, they literally play the role of coaches for other members of their group, and remain the interface between the latter and CAMNAFAW’s project management. The onus is on them, for example, to get RH commodities supplies and avail them to their respective members. They also report any difficulties in the project’s cycle to CAMNAFAW so that it takes corrective measures.
Implementation has had its share of challenges in a context of great hostility sanctioned by the country’s legal texts and reprobation by Cameroon’s Catholic church. Cameroonian law severely punishes the practise of homosexuality. In fact, the laws of the land provide for «6 months to 5 years imprisonment and a fine of 20,000 CFA (USD40) to 200,000 CFA (USD 400), for anyone that engages in sexual relationships with a person of the same sex».
It was important to get the buy-in of CAMNAFAW’s lead partner, the Ministry of Health. Emmanuel Ngappé, its Executive Director: «we had to bring together the senior officials in the Ministry of Health to hold discussions on the need to consider sexual diversity if all households are to be taken into account and the fight against HIV and sexually transmitted diseases is to be successful».
Organising a Values’ Clarification Workshop
A values’ clarification workshop was organised within CAMNAFAW itself to ensure that all staff took ownership of the idea of implementing such a project. As a result, implementation of this project has not been characterised by many difficulties, and as a staff member underscores: «the initial mistrust of homosexuals gave way to great trust among us».
That is all it took for IPPF’s Member Association in Cameroon to be stigmatised, and accused of encouraging and promoting homosexuality in the country.
A few months ago, the Minister for Foreign Affairs ordered the European Union to immediately stop giving financial support to ADEFHO, an association that defends homosexuals chaired by Ms. Alice Nkom, an advocate at the Yaounde bar. Following the public press release by the Minister for Foreign Affairs, civil society organisations, politicians and journalists, boldly denounced «the obvious bending of the law and violation of national sovereignty».
In response to its critics, CAMNAFAW’s Executive Director says: «we are not gay activists. We provide services to all, and care for everyone’s health. We cannot continue ignoring homosexuals in Cameroon especially since the HIV prevalence rate is 40% among those with whom we work» and concludes on this note: «the laws on homosexuality are not our concern; our problem is how to provide health to all».
Despite misconceptions and even open hostility to the MESDINE Project, CAMNAFAW’s management recognises that it has put its finger on a problem, ensured that the organisation has gained visibility, and opened the Government’s doors against all odds. The National AIDS Strategic Plan now has a component on Men who have Sex with Men, and by extension, covers all lesbians, gays, bisexuals, transgender and intersexuals. This recognition has been concretised by the fact that today the Association is one of Cameroon’s two principal recipients of the Global Fund to Fight AIDS, Tuberculosis and Malaria.
«We came out of the woods to claim our sexual identity»
In Cameroon, due to social barriers, homosexuality is perceived as a stifling burden. During a project, beneficiaries accepted to give their testimony; tongues were loosened and speech was unbridled: it was stark and revealing.
Like many young people of his age, Ange Judicaël was forced to seek employment very early to meet most of his family’s needs. He landed his first job in a restaurant in Yaounde, and with his modest salary was able to pay rent for the house where he lived with his father, a retired labourer, his mother and nephew.
For years, he faced up to his responsibilities until one day in 2008 when his boss paid him his salary and summarily dismissed him. Reason: he had just discovered his homosexuality. From that moment, his life was turned upside down. He became the subject of gibes and intimidation. Ange Judicaël, completely ostracised by the community and neighbours, had to learn how to cope with hostile looks when he passed by, blatant acts of stigma, not to mention verbal and physical violence.
«Because of my homosexuality, he says, I was stabbed and hospitalised; I filed a complaint, but the police did not follow it up. In Cameroon, when people hear that you are gay, they come out to abuse you».
It is in this hostile environment that, at the age of 27 years, he had to find a way to «bring home the bacon». Does this mean that he practised homosexuality to earn a living? «No», he quickly corrects himself, adding: «my last sexual encounter was 8 months ago».
He explains that paradoxically he discovered his homosexuality after he was raped, an experience which he affirms enabled him to discover his sexual orientation. He is one of the first contacts through which CAMNAFAW gained entry into the LGBTI community in Yaounde city. As a peer counsellor trained by CAMNAFAW, he facilitates a group of fifteen people over which he holds a certain charisma. During meetings which he regularly organises, he makes it a point to ensure that his group members accept to have protected sex, teaches them how to protect themselves against STIs/HIV and take precautions in cases of risky sex, etc.
For him, the MESDINE Project has been a life-saver: «CAMNAFAW has become our home; people there respect my sexuality and I can receive care like anybody else. I feel more of a citizen today that I did before because at the public hospital, homosexuals are not welcome». Filled with gratitude, he adds: «My friends and I are now aware of our sexual rights through MESDINE, which has boosted our confidence, and helped us organise ourselves» and concludes: «This project should continue because poor and marginalised members of the Cameroonian society like ourselves have found people who are sensitive to our problems to the extent that today we feel at home when we are at CAMNAFAW where we can receive treatment. Before, members of our community were dying like flies, as they were not accorded the least attention whatsoever».
Unfortunately, Ange Judicaël and his friends are far from receiving the same level of understanding from other segments of the Cameroonian society who are openly hostile to their sexual orientation. His heart sinks as he agrees to recount the unforgettable humiliating experience he underwent when he was introduced to a crowd in his residential area that booed him, «because I have a different sexual orientation», he says. It is also with a heavy heart that he explains how mass was celebrated in front of the house in which he lives with his parents, «to exorcise me because it was claimed that I was possessed and would infest the place I stay in where children would no longer be safe». He adds, «According to Muslims, I should be burnt alive because I am the devil, and therefore do not deserve to live».
Through CAMNAFAW and MESDINE, he continues «today, I am able to assume my sexual orientation because I have come out of the woods to claim my identity, and nothing will ever take it away from me».
He informs us that eventually within the confines of close family he has found solace, since «my father and mother have accepted me as I am; I respect them and they in turn respect me». Due to the respect that he has for his parents, Ange Judicaël, affirms that he has never spent the night away from home and has made it a rule never to appear with another man in their presence. To prove that he is a human being like any other, he speaks in an impassioned way: «I have responsibilities like any other adult, with monthly expenses of about 150,000 CFA F per month (USD 300) including rent of 35,000 CFA F (USD 70). If something were to happen to me today, my father, mother and nephews would suffer».
Unlike Ange Judicaël, Kevin is less talkative. Although he is a reserved person, he talks with admiration about his life in the MESDINE Project. Kevin, who is a history student at Université de Yaoundé, confesses that he knew nothing about reproductive health before engaging with MESDINE. Through his friends, he learnt about this project whose themes on sexual rights and health rights were of great interest. For him, MESDINE is a platform for training, education and communication. «Before MESDINE, there was conflict within me», he recounts, which explains why initially he wanted to become a priest. He discovered his first homosexual instincts in the choir where he sang that. «There was a boy for whom I felt carnal attraction every time he would start dancing during our rehearsals. With time, it developed into love, but I forbid myself from expressing it because it would be badly perceived; I feared bringing violence upon myself».
Under these circumstances, Kevin had to carry his cross alone, in silence that he describes as destructive. MESDINE therefore turned out to be an enlightening experience for him. He explains: «I am naturally shy and uptight, but as I participated in MESDINE activities, I have learnt to express myself, talk about my sorrows and difficulties. I have learnt to accept myself, to claim myself and take responsibility for my choices» and adds: «before MESDINE, I was ashamed, I felt guilty for being different» and concludes: «If this project were to stop, many people would not find themselves; the voice of the LGBTI community in Cameroon would once again be stifled».
«Accompanying Homosexuals living with HIV»
Dr. Michèle Bomia, the Director of the CAMNAFAW clinic has been carrying out an experiment, worthy of interest, as part of the MESDINE Project: the principle of a referral ticket. It seeks to enhance access of HIV positive homosexuals to care provided by the National Social Security Fund (CNPS) Hospital.
Discretion is the catchword to guarantee beneficiaries total confidentiality. It involves distributing cards to all peer counsellors who, during their group meetings in residential areas, give them to members that wish to go for consultation at the CAMNAFAW clinic.
The ticket, which bears a code assigned to each peer counsellor, is signed by the latter, and countersigned by CAMNAFAW. Depending on the colour, the service provider knows what the issue at hand is; the pink ticket means consultation for an HIV test, while the green ticket indicates that the holder requires other reproductive health services.
The ticket is kept by the service provider who gives it a client-code. The principle of free service provision applies to bearers of the ticket for consultations, whereas 50% of lab tests costs are borne by the project.
If the test turns out positive, the concerned party is sent to a community-based health agent who acts as a tutor. The latter is trained to care for people living with HIV (PLWHAs), and consequently, accompanies the person and provides psychosocial support. A second confirmation test is carried out at the Pasteur Centre. If the individual is confirmed to be HIV positive, the referral procedure to the CNPS is set in motion. After a therapeutic test, if the concerned party is eligible for treatment, he is put on antiretrovirals.
Treatment is provided on a monthly basis and the concerned party may decide to have his community health agent collect the medicine on his behalf and give it to him discreetly. On its part, CAMNAFAW conducts the community follow-up, once or twice a month, through its field agents.
Michèle Bomia, who is coordinating this operation, highlights one major constraint: «there is a high attrition rate. Many of our clients disappear into thin air once they discover that they are HIV positive» before mentioning the fact that: «40% are positive after the HIV test and we have noted that among gays no protection is used during sex».
In light of the foregoing, all the gains made in the MESDINE Project could be jeopardised.