The university does, however, fund HIV/AIDS research and prevention efforts involving LGBT populations in countries such as South Africa and Peru, where homosexuality is legal.

Of the countries where UCLA conducts HIV/AIDS work, Malawi is one of the harshest toward gay men and women – men face up to 14 years in prison with hard labor if convicted of homosexual acts, and women face up to five years.

A current moratorium on enforcing the laws exists, but social stigma and the rare possibility of arrest still serve as barriers to medical care.

Although it is nationally and internationally acknowledged that MSM are a high-risk population, nonprofits and universities in the country have to be careful of addressing the issue for fear of alienation from the government and people they work with. Organizations say they could lose the support of the government and their local infrastructure if it seems like they are pushing other countries’ ideals in opposition to Malawi’s laws.

Malawi, though it has a secular government, is a mostly Christian nation in which anti-gay sentiment is high and people often refer to the Bible to reinforce their point that homosexuality is wrong.

Blaine Ohigashi / Daily Bruin Senior Staff Partners in Hope Medical Centre is located in Lilongwe, the country's capital. The Christian center was founded by Dr. Perry Jansen, who was trained at UCLA, and provides private care as well as a free HIV/AIDS clinic. The UCLA Program in Global Health partners with Partners in Hope for HIV/AIDS research and programs throughout the country, and the center is also a part of a rotation program for UCLA medical residents.

Along the M1, the highway that spans the length of Malawi and serves as its main trade artery, a sign reading “Partners in Hope” greets drivers on their way into the country’s capital of Lilongwe. It leads to an expansive three-part medical center, founded by Dr. Perry Jansen, who was trained at UCLA.

UCLA works with the Christian medical center to provide private care, a free HIV/AIDS clinic, and training and research throughout the country.

The free HIV/AIDS wing is called the “Moyo Clinic” – Moyo means “life” in Chichewa, the most commonly spoken language in Malawi.

Partners in Hope and UCLA denied us access to the medical center, health care providers and patients for this series.

Before the trip, UCLA Vice Chancellor for Legal Affairs Kevin Reed wrote in a letter that “you will both make this trip at great personal risk to yourselves, and there is great concern within the UCLA administration that your project … will create undue risk for other persons as well as to UCLA programs operating in Malawi.”

John Hamilton, the clinic director for Partners in Hope and the head of the UCLA Program in Global Health in Malawi, refused to answer any questions when we went to Partners in Hope, because he needed approval to speak with us, and asked us to email questions instead. He then referred those questions to Jansen, the Partners in Hope founder and director, and Thomas Coates, the director of the UCLA Program in Global Health.

Jansen answered some questions via email. He wrote that the clinic welcomes all patients.

“(Partners in Hope’s) ethos is to consider all of our … patients worthy of our best,” Jansen wrote.

UCLA does conduct HIV/AIDS research in Malawi, as well as a clinical rotation program for UCLA medical residents. The university’s research and prevention efforts have focused largely on preventing mother-to-child transmission of HIV, and UCLA receives funding through the U.S. President’s Emergency Plan for AIDS Relief on a project called “EQUIP-Malawi” to train and provide aid to local healthcare providers for better HIV/AIDS care.

But in other places, UCLA does tackle LGBT issues from a medical standpoint. In South Africa, where the LGBT community has full legal rights, the UCLA Program in Global Health partners with the MAC AIDS Foundation to provide local HIV prevention fellowships.

A number of the recipients focus on the LGBT community. One program near Capetown provides protection and legal aid for lesbian women who have been through “corrective rape,” the practice of raping lesbians in order to try to make them straight, while another in Johannesburg addresses the prevention needs of refugee male sex workers.

Meanwhile, the U.S. National Institute of Health is funding multiple UCLA Program in Global Health studies focusing on HIV prevention for MSM in Peru.

The difference between these countries and Malawi is the spectrum of legal rights. South Africa is, on paper, one of the world’s most LGBT-friendly countries, with legal rights built into the constitution. Human rights violations and hate crimes still happen in those countries, but a legal framework exists to protect the community.

Building a case

While UCLA’s approach to HIV/AIDS is similar to that of most international institutions operating in Malawi, other organizations do direct aid to the LGBT community.

Stefan Baral, a researcher at the Johns Hopkins Center for Public Health and Human Rights, has been working with the LGBT community in Malawi since about 2006. He works mostly with the Centre for the Development of People, known as CEDEP, Malawi’s primary gay rights organization.

Blaine Ohigashi / Daily Bruin Senior Staff Centre for the Development of People administrator Dunker Kamba and Johns Hopkins Center for Public Health and Human Rights researcher Andrea Wirtz check data from a study on men who have sex with men in Malawi.

But research in the country requires ethical approval from both the home institution and the host country.

Baral and CEDEP used a carrot-and-stick approach to get the Malawian Ministry of Health to support their research on HIV/AIDS prevention in MSM, Baral said.

He pointed out that more data on the MSM community in Malawi would increase the country’s eligibility for Global Fund money, which is increasingly becoming tied to human rights.

Baral also warned the ministry that to maintain their current funding levels, they needed to use data to demonstrate which populations are in need and develop specific plans.

The timing was convenient – the United Nations had recently asked countries to provide reports detailing their responses to AIDS in different categories. Some of those included prevalence, levels of condom use and HIV testing in MSM, and the government asked Baral to include those indicators in his surveys.

“It makes them look better, more responsive to the UN,” Baral said.

Malawian Minister of Health Catherine Hara did not respond to multiple email requests for comment about the country’s HIV/AIDS prevention and treatment strategy concerning MSM.

It was difficult to get the projects going, though. Baral had little luck approaching organizations and nonprofits who work with HIV/AIDS prevention in the country, because people said they did not want to jeopardize the rest of their work by touching such a contentious issue.

“People would meet with me because I’m from Johns Hopkins and I’m a physician,” Baral said. “But as soon as it got into a serious conversation about what we wanted to do and what we were there for, the conversation ended.”

Baral’s team and CEDEP leaders determined that in order to provide aid for the community, they must first prove there is an LGBT presence in Malawi, something many people still deny.

They started with a 60-person survey in 2006 to establish the existence of MSM in the country and ask about the community’s needs. Then they moved on to the 2008 population estimate in Blantyre, where about 21 percent of about 200 participants tested HIV positive. The 2008 study led to the first governmental acknowledgment of the LGBT community.

“The data ... was used to justify the inclusion of MSM in the national HIV strategic plan,” said Gift Trapence, CEDEP’s director.

But getting MSM in the national plan doesn’t mean that the government is actually allocating aid to that community.

So Baral and the center at Johns Hopkins are conducting a study with CEDEP to determine whether it would be possible to implement an intervention and prevention program for the MSM community in Malawi.

In 2010, the researchers took 100 HIV negative participants from the population estimate study and monitored them with HIV counseling and testing every three months, as well as contact with peer educators who provided communication, condoms and lubrication. They’re now in the analysis stage of that study.

Blaine Ohigashi / Daily Bruin Senior Staff This poster is in the office of the Centre for the Development of People, Malawi's primary lesbian, gay, bisexual and transgender rights organization.

CEDEP is also conducting a population estimate in the rest of the country, to provide a more complete view of the MSM community and HIV prevalence, which could also help improve aid. This should be done by the end of the year, Baral said.

With a tighter grasp on how to prevent HIV in general populations and increased concern about getting the greatest possible value for donor money, governments and agencies are expected to make a strong and specific case for funding, said Patrick Brenny, the former director for the Joint United Nations Programme on HIV/AIDS, or UNAIDS, in Malawi. Brenny was the director until August, when he moved to Tanzania.

“Malawians haven't had to make that case before," Brenny said.

A helping hand

Zulu, Chipo’s friend and the project coordinator for the Johns Hopkins University Research Project, has more personal reasons for helping the LGBT community.

Chipo and Zulu met in 2010, when she did a presentation to teach MSM about HIV transmission and safe sex.