Putting the Money Where the Men Are: Homonormativity and HIV in Malawi

Increasingly, activists use public health arguments to advocate for human rights for queer people in African countries where same-sex activity is criminalised. These arguments, coupled with an increase in health-related donor-funding and development aid, have led to the inclusion of men who have sex with men (MSM), and, at times, transgender people, into a number of national HIV health policy documents. While these have been celebrated as significant achievements towards challenging heteronormative health policy, and realizing the right to health for sexual minorities, it also raises questions about who is included in these conceptualisations, and under which conditions. Drawing on in-depth interviews with healthcare providers and representatives of advocacy organisations in Malawi, participant observation, and critical discourse analysis of published research on sexual minority health, we argue that the dominance of aid-incentivized ‘MSM’ and HIV/AIDS discourse has led to a homonormative understanding of sexual diversity. As a result, sexual and gender diversity is equated with ‘MSM’, which invisibilises sexual minority women and transgender people, and results in a comparative and absolute absence of health programming tailored to them. By focusing solely on sexual health, this homonormative discourse ignores the wide range of health, including mental health, concerns, which affect queer people everywhere, and which may be more pronounced in a conservative context like Malawi, where consensual same-sex activity is criminalised. Male-centred homonormative discourses also raise important questions about the recognition of women’s (sexual) agency, and about queer women’s inclusion in queer activism and organising. Finally, we argue that by solely relying on aid-incentivized public health arguments focusing on HIV and MSM, the break in heteronormative healthcare practice and policy affirms an existing tendency to reduce the lives and health needs of queer people to sexual behaviour, closely associated with the spread of disease, and creates new homonormative identities.