Honduras: Why inclusive care matters

In Honduras, many people from LGBTQI+ communities are shut out of the healthcare system due to stigma, discrimination and health services that are not adapted to their needs. In response, MSF has been running a clinic in San Pedro Sula, the country's second largest city.

Here, patients are treated with dignity and respect, and can access care that isn't provided elsewhere. A few of them share what the clinic means to them...

David

I'm a guy who's passionate about business. If someone asks me what my hobby is, I always say business. I know it's kind of not that fun, maybe, to sound that way. But I love it. I have a small business that's about personal items and personal care.

I really like nature. In fact, when I think of my place, I imagine myself lying in the woods or next to a river.

I've been coming to the clinic since July of last year, and I receive psychology and psychiatry services. Very rarely, I've also received medical services. My partner brought me to get vaccinated, and that's when I saw the ads for community psychology. So, I decided to contact them.

I was afraid that there would be a problem with my therapy or maybe talking about my issues in such an open way. When I realised there was this place that was specifically for the community, I felt safer. And that's why I decided to come.

MSF has been very helpful in my process. When I arrived here, I was in a very bad place. The support I've had, both in my therapy and my medication, came about because I made the decision to become independent.

I've been attacked at certain times in public spaces. It makes me afraid. Sometimes going out on the street or being in a group surrounded by people makes me feel uncomfortable. And the mental health support has allowed me to feel more comfortable with the fear.

Melissa

MSF is very important for the LGBTQI+ community because it has included us in places where we feel safe to come for a general check-up, pre-exposure prophylaxis (PrEP) treatment, or HIV tests. And when we feel unwell, we can also see a general practitioner.

Before, for us in the trans community, it was really complicated because most of the time, when we needed to get a general check-up for sexually transmitted infections, we had to deal with the fact that most people were sex workers, and sometimes we had to stay up all night to get an appointment at the health centre. And now, we can come at any time, even 1 or 2 in the afternoon. Here I am.

The clinic is important to the LGBTIQ+ community because it is inclusive. We come here and feel confident getting tested. We feel at home. We have psychological problems, sometimes health problems, and some people don't know where to seek help, and MSF has both, with psychological and health care.

Jefry

I'm a gay man and in my country, there are no places where we can access health services without discrimination and stigma. The MSF clinic is the only place I could access these services here in Honduras.

Our country's public health system is a collapsed system in a very bad situation. Ordinary people don't receive adequate care, let alone people who are in vulnerable situations. So when we go to a public hospital or a health centre, we're always faced with the judgmental looks of doctors who don't have any training in diversity or inclusion. And that makes us not want to go.

Before coming to MSF’s clinic, I didn't know where or who to turn to. I didn't get tested, I didn't have access to medication, and I wasn't aware of how important it was to access those services at that time.

I believe MSF respects my identity. It's a place where I know I can go without stigma and where I can receive medical care without any prejudice. I've never dared to go to a health centre or a hospital to receive care before.

I'd never had access to psychological care. The first time I did was at MSF, and I think it marked a turning point in my life.

I was going through a pretty difficult time in my life after my father died in 2020 from COVID-19. My mood plummeted, and I didn't feel well. I didn't feel well at work, I didn't feel well at university, I didn't feel well with my family. And I needed support because I felt like I was sinking. I felt like I couldn't do it anymore. At that moment, I felt like I was carrying a lot of weight.

I looked for a way to go to MSF, and little by little, with psychological help, I was able to get out. I overcame it. Sometimes you feel like you relapse. But now, with the tools I learned, I feel like I'm capable of better managing my emotions and everything that's happening in my life.

Thanks to that psychological support, I now consider myself a stronger, more emotionally intelligent person.

MSF is more than a doctor's office or a clinic, it's a safe space where we can go without fear of being rejected or disrespected, and where we can receive quality medical or psychological care, with an inclusive diversity approach, and free of charge—above all, free of charge. In this country, where access to health care is very restricted, the health care system is designed for privileged people.

I think Honduras needs to develop public policies that benefit our community, but that's a long way off, and very difficult. 

Osman

When MSF arrived, it provided differentiated, high-quality, and more humane care for LGBTQI+ people, differentiated treatment for trans women, differentiated treatment for gay men, and differentiated treatment for sex workers. That's what makes it so important, because with the arrival of MSF, we've also seen how the services offered at clinics have changed or been modified.

In Honduras there was only one clinic providing specialised care for LGBTQI+ people, but they always focus on treating sexually transmitted infections or HIV.

Before we could access the full health care system, we had to get HIV tests, which was practically mandatory for us to go through the mobile health system before we could see a general practitioner.

There was this stigma that gay or trans people always had to go through HIV testing. If they had a headache, it was assumed to be HIV, if they had a stomachache, it was attributed to a bump or a sexually transmitted infection.

All those challenges we've been fighting for years have been broken down through many advocacy efforts and processes within the health care system when MSF came in to provide this kind of care. It's much more humane.

It's no longer mandatory to get an HIV test, it's no longer mandatory to have a physical exam or a rectal exam to access the health care system if you only need pills for a headache. MSF addresses all those challenges in the public health care system and makes access much easier for us.

We need to overcome the stigma surrounding the barriers we face within the national health care system and give international mechanisms and organisations that provide humanitarian assistance a chance, allowing us to access these services.

Secondly, we also need to remove the stigma; we are not just defined by sexually transmitted infections and HIV, but we also have other illnesses, conditions, and diseases that can be treated within a comprehensive and accessible healthcare system. 

Daniel

The clinic staff greet you with a big smile on their face. And they ask you, ‘Do you want a glass of water? Here is the bathroom if you need it.’

The other thing I like very much is the psychology service. The opportunity I have — to cry if I need to cry, to talk if I have to talk with someone. And they check on you. If it is necessary, they send you a message, asking you, ‘how are you feeling?’ That's something I love. I feel more comfortable here than in other places.

When I first started coming here, it was because it’s LGBTQ+ inclusive. They told us it is for us. But after, I discovered it's not only for us, it's for all the people. So I started bringing my friends, my family, to come here. They started to love this place, because it is accessible.

The first time I was tested for HIV, something I don't like is that other providers want to talk to your family and don't want to touch anyone.

And I didn't feel comfortable, because we are people. It doesn't matter if we have or don't have HIV. So I discovered that here at the MSF clinic, it doesn't matter if you have big, big illnesses. They are going to touch you. But other doctors don't like it. And that's why I refer a lot of my friends to come here.

Something I can say to everyone: Come here. You will never face discrimination. They will always [greet you] with a great face. The staff will help you, they will offer you care.

If you cannot come, they are going to send you a message asking you, what is happening? If it is necessary, they are going to call you. If you don't have a job, they have social service here.

Here, you feel like a family. Here, the most important thing for you — for them — is you.