LGBTQ Health Connect

13.7% of LGBTQ Ugandans live with HIV compared to 5.7% of the general population according to the national HIV statistic from the Uganda AIDS Commission. In a survey we carried out with 111 respondents when starting our clinic, 78% of LGBTQ persons said they mainly access health info from google and self-medicate thereafter.

In 2019 a lesbian woman was assaulted by a doctor for accessing services at his clinic, and so many other related cases have led to refusal and delay in seeking health services for LGBTQ persons that have resulted in high HIV prevalence rates and poor outcomes for people in our community.

During the COVID19 pandemic, more than 500 LGBTQ persons and community peers, were arrested either at their shelters, Drop-in Centers where they access medical and basic social services or arrested during delivery of life-saving medications for their communities during lockdown – because they were not categorized as essential workers.

In Uganda, there is a general lack of friendly, LGBTQ competent and culturally appropriate healthcare workers. In many cases, people end up with the wrong diagnoses, inappropriate counselling leading to low retention levels and indefinite disappearance from the healthcare system. In 2021, while conducting a mapping exercise for friendly health workers, out of the 87 endocrinologists we interviewed, only one had supported transgender persons in his career and his experience came while he was working in Australia.

There are real and perceived fears for persons accessing health services in regards to data safety and confidentiality because of the rampant raids on LGBTQ safe spaces and organizations. Documents and often confiscated and this affects the trust of the community towards organizations that are meant to improve their lives and livelihood outcomes.

There is no LGBTQ-tailored health information, and there is limited comprehension of health information only available in English – this undermines the absorption of medical and behavioural change efforts.

All these problems are attributed to the criminalization, Stigma and discrimination that affects access to health services, endorse violence towards our communities, lead to systematic exclusion and self-withdrawal from government programs including vaccination, and limit research and data for LGBTQ health needs.

LGBTQ Health Connect helps LGBTQ persons connect to our network of health workers from within the LGBTQ community and other friendly services providers across 8 districts to access timely, competent, and appropriate healthcare wherever they are.

The LGBTQ Health Connect Project does the following;

1. Bypasses barriers like Stigma and Discrimination and Improves access to health workers through telemedicine.
2. Improves the quality of services provided by linking LGBTQ persons to friendly, culturally appropriate, and competent health workers and therefore improves uptake, utilization, and retention into care.
3. Covers knowledge gaps by providing access to health and wellness information in multiple languages to address the poor comprehension of medical information for persons with minimal education, or language barriers.

Currently what LGBTQ Health Connect does is;

Use digital platforms to improve access to friendly and competent health workers and bypass barriers mentioned in our problem statement. Use the support of our existing network of LGBTQ health workers and other friendly health workers in different parts of Uganda where clients are supported by their local health workers and extreme cases are reported in real-time to senior health workers at our facility who can recommend tests, diagnose and recommend treatment for clients.

We work with peer educators attached to several LGBTQ organizations, shelters, and safe spaces to link our communities to these health workers. We also use social media platforms where LGBTQ persons scattered around the country can reach us.

What we want to transform into is;

Build a call center, attended to by our health workers, connected to community health workers through digital devices like mobile phones to provide real time support to our communities.

We want to build a data system for our clients that schedules automated reminders to test, and pick their refills for ART and PrEP, provide live and real-time medical consultations and support to individuals with or without internet.  We want to scale up the service to provide support directly to individuals who might be far from local health units, or closeted individuals that are a blind spot in our healthcare system.

Our call center will consist of a multi-language toll free helpline and where a USSD code, with prerecorded audio health info, and a website where LGBTQ persons can access links to video and literature in 4 major languages spoken in Uganda.

Local health workers in villages will be supported with training to use digital tools like smart phones, uploading pictures and videos where needed, recording client data safely. They will also be availed with resources to handle other emergencies like GBV, and linkage to legal aid clinics since our community faces a high burden of violence from communities and state steered homophobia.

Clients will be provided with smart cards to that store their medical info and history, these cards will be updated each time a client visits a facility. This will also bypass the fears of misuse of LGBTQ data, improve safety for clients medical data and  safety to use while with the health workers and all their medical history can be accessed through that card by the health worker.

LGBTQ persons in Uganda are a stigmatized and discriminated against population, victims of abuse and many forms of violence subjected to them. Unlike other groups, LGBTQ persons are scattered individually or in tiny groups around Uganda and this makes it hard for them to mobilize or target for support services because they are hiding from public programs due to the poor lived experiences.

Most LGBTQ persons tend to leave home at an early stage compared to heterosexual persons because of the pressure to meet social responsibilities like marriage and parenthood. They mostly adopt a lonely life and others find and adopt new families with their friends.

They seek solace in alcohol and other drugs, are likely to live poor lives because of fewer education opportunities, no employment opportunities and lack of social support structures like families.

The are not included in national programming, are dismissed because there is no data availed to advocate for policy changes for them, they are harassed in public places including hospitals and schools.

Our Solutions will;

• Improve their access to safe, friendly and timely healthcare to limit HIV incidences its effects, and the poor health outcomes of prolonged lack of access to health services.
• Provide Access to LGBTQ competent health workers who provide informed health and wellness information and transform their risky behaviors of our community for better behavioral outcomes.
• Improve the lives and livelihood of our community to live healthy, productive and sustainable lives.
• Improve the capacity of health workers and Drop-In Centers to support LGBTQ persons, sustain safe spaces and Mental Health services.
• Impact other stakeholders to acknowledge the existence of LGBTQ persons and their needs, research and invest in LGBTQ programs to benefit the wider Uganda.
• Our solution will feed data into research to improve programming and infrastructure for LGBTQ persons

The entire team at Ark Wellness Hub identifies as either Lesbian, Gay, Bisexual or Transgender, we are a part of the community that we are seeking a solution for.

Ark Wellness Hub was founded with a mission to provide services and link our community to friendly, nearer and competent health and wellness services. We have done this work since 2019 and have built a network of 80+ health workers who identify like us and are interested in supporting our community to access health and wellness services.

In 2019 and 2020, to support our PrEP Connect program, we trained more than 50 health workers in Kampala, Wakiso and Mukono districts on sexual orientation, gender identity, and LGBTQ health-related needs.

Our community is involved in designing these programs with our open policy on the inclusion of community ideas, we host LGBTQ persons every quarter to monitor and discuss interventions. We are members of the Sexual Minorities Uganda (SMUG) and Uganda Key Populations Consortium (UKPC) and are actively involved in the National Key Populations Community-Led Monitoring (CLM).

We currently reach 2000 LGBTQ persons scattered around mostly Central Uganda, provide PrEP services to more than 500 People.

We are applying to solve because we need financial and technical support to implement this solution. Scaling up the solution requires investment in infrastructure, human resource costs, training, and more.

We also require technical support to from individuals or groups that have implemented or implementing this kind of solution.

Our solution bypasses Stigma, discrimination, and many forms of marginalization that the LGBTQ community goes through. The solution further addresses the real and perceived fear relating to data safety and confidentiality by Introducing smart cards that store clients’ medical data that will only be stored in our servers.

The available LGBTQ data has been used to criminalize LGBTQ persons in Uganda and as seen recently in Ghana, this has led to fear of accessing services by our community. Our solution relies on technology to keep the data safe, only provide it to people in the community and contribute to national data without tracing who the people are.

The solution changes the market because AWH as an institution safeguards individual data not be shared with non-health actors. This fosters trust in the communities and leads to better uptake, utilization and retention in the healthcare system, leading to better health outcomes.

-To Link 3000 LGBTQ persons to friendly health workers in Kampala, Wakiso, Mukono, Mbarara, Mbale and Arua in 1 year.

- To link 10,000 LGBTQ persons to friendly health workers in 3 districts per region in the next 5 years.

• -Through monitoring the number of clients accessing services from different health workers.
• -Through Monitoring the number and frequency of calls requesting for support from the community.
• -Call Center data
• -Feedback from DIC (Drop In Centers) and health workers
• -Surveys targeting the LGBTQ community members and other stakeholders.

To improve access to health services for LGBTQ persons, we are going to orient peer educators, Drop-In Centers non the program deliverables, orient health workers on the program and carry out training for use of the platforms and gadgets availed. This will equip the health workers with knowledge and tools to deliver services.

We shall then equip our call center to start functioning and supporting the community to access the health workers. We will be using social media, SMS, peer educators, drop-In Centers, and organizations to link LGBTQ people to the call centers.

We will then direct the community to friendly service providers in their locations where they access safer, friendly, and LGBTQ competent services.

Our solution is people-centred, addresses a spectrum of marginalized persons because it’s powered by various technological mediums like USSD, SMS, and Helplines, and SmartCards that are interlinked to a communication universe which is our Help Center. We are leveraging on existing platforms, that are popularly used by people both in Urban Centers and Rural Areas and technology that doesn’t seclude a section of people based on language barriers, location, education level, comprehension of information or any form of disability.

This aims to decentralize and broaden the reach of our services through a platform that can be accessed in 4 major languages, that an audial impaired person can use through USSD, that visually impaired person can call in and still get supported.

The Smart Cards will be used to store information for each client separately, these cards can be kept by either the client of the facility depending on the client’s decision.

Ark Wellness Hub is an LGBTQ-led service organization, we have a 75% policy of staff coming from within the LGBTQ community where acronyms are fairly represented on the secretariat or the Advisory board.

Ark Wellness Hub builds the capacity of its staff to develop and plan a solution, mobilize resources, and lead the implementation of the program and activity, activities to grow as professionals but also assume responsibility for the organization and their community.

Our Human Resource and Code of Conduct Policy clearly outline our intolerance to bullying, any form of malice and disrespect.

Our target is LGBTQ persons scattered across the county who are criminalized, stigmatized, and are not able to access services in public health facilities. What we are offering is a way to access services remotely through a centralized communication but decentralized service delivery in safer places, with friendly and competent health workers.

Our business model gives us a competitive advantage in reaching our communities with health programs. Global Fund, PEPFAR, and EJAF for example support programs that are inclusive, and yet the policies and laws in Uganda discriminate against LGBTQ Ugandans. Ark Wellness Hub will gain through being an implementing partner for LGBTQ Organizations.

We have put together a sustainability plan for Ark Wellness Hub, whereas an organization running an LGBTQ clinic and a call center will;

• Increase the number of services offered and introduce Health insurance packages for LGBTQ organizations, individuals, Key Population-led businesses, and allies.
• Acquire the tender and business of supplying the National Key Population programs from both the government and Development partners with sexual health and wellness products, and drugs.
• Continue to compete for grants and acquire donations.