“The drop-in center is the only place where I feel understood,” said Maiga, a 20-year-old transgender man living in Nampula, Mozambique.

Maiga is one of hundreds of people who have received health services at the drop-in center (DIC) in Nampula. Supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC), ICAP at Columbia University and the Mozambican LGBTQ+ association Lambda implemented the DIC in December 2023. Known colloquially as the “community center,” the DIC offers HIV prevention, care, and treatment services, and sexual and reproductive health services – including family planning, cervical cancer screening and treatment, and antenatal care – integrated with life skills education, legal support, and recreational activities to key populations.

Due to stigma and other factors, access to health services can be limited for key populations, including men who have sex with men, lesbian and bisexual women, and transgender people, in Mozambique. To bring these communities together and improve linkage to lifesaving HIV services, ICAP in Mozambique supports the DIC in close collaboration with Lambda, a group that promotes the rights of the LGBTQ+ community, as well as local authorities, such as the provincial health directorate.

When Maiga first visited the DIC, he felt welcomed by the chance to have open conversations with other young people and received HIV testing and counseling for the very first time. In just six short months since its launch, the DIC has tested 419 individuals for HIV. Of those tested, 18 individuals tested positive, all of whom initiated antiretroviral treatment (ART). Out of the 401 clients who tested negative for HIV, including Maiga, 343 started pre-exposure prophylaxis (PrEP).

Maiga receives PrEP for the first time.

“The care the community and I received from the ICAP-supported health workers was great,” said Maiga. “The counseling sessions I had before starting PrEP were very comforting. I did not know that other HIV prevention methods existed besides condoms and today my girlfriend and I are PrEP beneficiaries.”

Previously, in school, Maiga said that many classmates ridiculed the way he dressed. He has also faced challenges getting regular work. The DIC helped him find a path forward.

“Before joining Lambda, I didn’t know how to deal with the stigma and discrimination that I face every day because of my sexuality,” he said. “The fact that I am a transgender man, society does not accept me, even my family.”

In addition to HIV services, the DIC offers professional skills packages, such as learning English, cooking skills, or informatics skills. Lambda also organizes several recreational activities, including karaoke sessions, movies, and workshops, to bring the LGBTQ+ community together, create demand for the DIC’s services, and promote health and HIV literacy. Maiga, in fact, attended lectures on HIV and other health topics and participated in film screenings and social gatherings at the DIC. He even applied for and started the English course offered at the DIC to increase his chances in the job market.

This support, integrated with HIV health services, gives people like Maiga hope for the future.

“The health talks given by the health workers and the movie sessions have changed the way I see things,” added Maiga. “At the end of 2023, I came out at a family gathering and told my family that I am a trans man and am attracted to women. This revelation came as a shock to some family members; others already suspected that, but I needed to tell them my truth.”

Cisney Cobrey, Lambda provincial representative

Importantly, the DIC aims to ensure its space brings convenience to the lives of its clients. Unlike many local health centers that limit hours to 3:30 pm, the DIC remains open until 6:00 pm every weekday. The center also provides its members free access to the Internet, giving them opportunities to, for example, look for job opportunities or connect with the outside world. Cisney Cobrey, a Lambda provincial representative, said that even older adults, as well as LGBTQ+ young people who attend nearby schools, will stop into the center seeking available services.

“In addition to educational programs and vocational courses, the center plays a crucial role in empowering marginalized voices and improving the lives of its visitors,” said Cobrey. “It is a place where individuals can come together, learn, and advocate for themselves. In addition, it plays a crucial role in mobilizing the community for support and care.”

Luisa António Abdala, a clinical provider supported by ICAP, counsels recipients of care at the DIC.

“When I interact with clients, they often share more about their personal lives than just the health issue that brought them to the community center,” said Luisa António Abdala, a clinical provider at Lambda Community Center. “It seems like they really want someone to listen to them and seek advice on how to handle various challenges they face in their daily lives, whether it’s at home, school, or within the community. The community center provides a warm, safe, and understanding environment.”

Maiga said that Lambda and the DIC inspired him to want to pursue a career as a psychologist one day.

“I want to help people who are going through internal struggles and have nowhere to turn,” he said.

About ICAP

A major global health organization that has been improving public health in countries around the world for two decades, ICAP works to transform the health of populations through innovation, science, and global collaboration. Based at Columbia Mailman School of Public Health, ICAP has projects in more than 40 countries, working side-by-side with ministries of health and local governmental, non-governmental, academic, and community partners to confront some of the world’s greatest health challenges. Through evidence-informed programs, meaningful research, tailored technical assistance, effective training and education programs, and rigorous surveillance to measure and evaluate the impact of public health interventions, ICAP aims to realize a global vision of healthy people, empowered communities, and thriving societies. Online at icap.columbia.edu