Stories from the LGBTI Community in Swaziland

Published 11/02/2022 in Scholar Travel Stipend
Written by Joyce Ou | 11/02/2022

One of the first things my professor taught me about global health was that behind every statistic is a story.

One of the first things my professor taught me about global health was that behind every statistic is a story. He takes this to heart in his work. Though an epidemiologist by job title, he really leaves his mark on public health through filmmaking. This is how he ended up considering Swaziland to be his second home—he followed Musa, the only surviving multi-drug tuberculosis (MDR-TB) patient co-infected with HIV in his study, all the way back to his Swaziland home. He was curious about why this one man beat the odds, and he ended up spending several months living with Musa. As his relationship with Musa and his family grew, so did his desire to tell the man’s story via a documentary.

In the course of my summer studying global health and filmmaking, my professor challenged us to approach global health, and any endeavors in general, in the same way. He lectured about global health for an hour and fifteen minutes on weekdays, but most of my time was dedicated to making a documentary with my film group, seeking a story behind an issue of our choice that we were passionate in.

My group chose LGBTI issues, motivated largely by one member of my group who wants to devote his life to LGBTI advocacy. A quick Google search told us that acts of homosexuality are criminalized in Swaziland, and any LGBTI movement (if any) was largely underground.

Yet, a visit to a Swaziland LGBTI NGO told us that Google did not tell us everything. The Swaziland LGBTI advocacy movement is in fact thriving, though of course stymied by many problems. Over the course of a conversation that took over an hour, the director of the NGO told stories about the many LGBTI people who come to her every week. Some come with only a bag of clothes because their family had just kicked them out of the house. Stories of police brutality and corrective rape are never shocking to the director (nor to anyone else whom our group spoke to). After hearing of the very real danger that comes with being openly homosexual, my group was tentative in asking her to be in our documentary, expressing our concerns over her doing so. I will never forget the brave response of the director: “Oh, we want to get into trouble.” This steely courage was universal in all the advocates we spoke to, and not once did it fail to amaze and inspire me to do better.

Our meeting with the LGBTI NGO also revealed an interesting intersection between public health and the LGBTI movement. Swaziland has a high HIV prevalence, and homosexuals are a “key population” infected with HIV. As such, in a traditional society that largely refuses to acknowledge the existence of homosexuality, public health has become the launching platform through which LGBTI advocates began to sensitize the public on homosexuality.

 Health care acceptability for gay men has thus improved, but the LGBTI advocates I met were still less than excited to discuss health care—it was not the cause they were impassioned for, but the cause public health officials cared about. It was supposed to be a means to an end, not their one and only fight. And yet, health care is the only place where the LGBTI movement has made inroads.

 To public health officials, homosexuals seem to amount to only a “key population,” an important statistic for their work. But as my professor said, behind every statistic is a story.

This conversation was a sobering reminder of the responsibilities that I will have if I choose to enter public health—responsibilities that I feel are too easily forgotten under the stacks of public health journals and the almost daunting public health mission of broad disease prevention. As population-level based as the field is, ultimately we are seeking to help individuals through broad measures. I forgot this in my initial excitement toward the intersection of LGBTI and public health issues, and failed to realize that while this intersection appeals to my passions, it may not be of central importance to LGBTI advocates. I had never considered that LGBTI advocates might feel used by top public health officials who at best seem sympathetic only to the HIV part of their many challenges and at worst seem to only engage with LGBTI issues to receive funding. I am sure (at least some) officials genuinely want to help, but in working to accomplish their mission, they forget to consider the needs and the agency of those who they want to help—they forget to engage with them as fully living humans, not as patients or generally people who need help.

Similar situations in Swaziland continued to remind me of the wisdom of my professor’s advice that behind every story is a statistic. To enforce this lesson, he had Musa gave a special lecture, right in Musa’s backyard (with many of his community members in attendance!). We learned about the strict pill regimen that comes with MDR-TB and HIV: multiple pills per day, all to be taken at specific hours of the day. We passed around Musa’s pill bottle for HIV, marveling at how large the pills, which combined several drugs into one, were (about the size of my thumb). He told us that the only thing he knew about HIV when he was diagnosed was that it will probably kill him, and how scared he was because of this. He revealed that he did not even know he had MDR-TB until late in the disease because the mine companies he worked for as a migrant worker will send their workers with TB “back to home to die” (a popular saying among health officials familiar with this phenomenon) but will not bother to tell the workers why they were being sent home—an injustice that was the driving force behind my professor’s first documentary “They Go to Die.” When considering all these personal challenges, which are often not captured in public health classes, I began to wonder how much of the TB’s high morality in Swaziland is caused by the lethality of the disease’s biology, and how much is caused by personal and societal factors that Musa faced. 

In my ponderings of the humanity of the problems I was tackling, I eventually began to question the meaning of the documentary my group was making. I could not help but feel like we were taking time away from these LGBTI advocates. I am making a documentary on a movement whose problems are ones that I don’t have to face, in a country that is literally a 33 hour journey away from home. The documentary features someone with a gripping story of trauma resulting from his friends’ homophobia, but I didn’t know if I, essentially a stranger, even had the right to questioning him about the most vulnerable experiences of his life. I question if I’m helping anyone at all with this documentary. Sure, our documentary will give a voice to their issues, and we’ll even try to distribute it to relevant advocacy groups, but who is really helping whom?

The uneasiness and shock I’ve felt through my various experiences in Swaziland are feelings I want to take with me as I continue to pursue global health. They remind me that even if these issues are important to me, they ultimately are not mine. They belong to a body of people whose stories I have yet to know and will never fully understand. My next moves in global health will be deliberate and carefully thought out, but they will likely not be perfect. But that’s okay—as long as I am cognizant of the stories and the people that make up global health. I will remember the warmth and kindness of those I have met, who guided me with an outreached hand into their worlds, whose stories have altered my perspective. I always considered myself someone who loves stories, but in Swaziland, I learned the importance of stories.

Meeting with local LGBTI Advocates2

Originally Written in 2016