For decades, Uganda's HIV response has been exemplary, reducing the country's mortality rate by nearly 90 percent from 1990 to 2019. Now, a sweeping anti-gay law enacted last year that excludes LGBTQ people threatens to cause a resurgence of the disease. Too afraid to seek the medical care you need.
The law criminalizes consensual sex between adults of the same sex. It also requires all citizens to report anyone suspected of such behavior, a duty that does not allow for exceptions for health care providers who treat patients.
Under the law, even having a same-sex relationship while living with HIV could be a charge of “aggravated sodomy” and punishable by death.
Anyone who “deliberately promotes homosexuality” by employing or housing an LGBTQ person or failing to report them to the police faces up to 20 years in prison. Scores of Ugandans have been forced from their homes and fired from their jobs, according to interviews with lawyers and activists.
Entrapment and intimidation, sometimes by police, is rampant in person, on social media and on dating apps, according to interviews with dozens of people.
LGBTQ people, their advocates and the health care workers who support them have been exposed to intimidation and violence.
The law brought global condemnation and dealt a severe blow to Uganda's economy. However, it is widely popular among the people. Many Ugandans believe that homosexuality is a Western influence and that the law is meant to correct it. The country's Constitutional Court is expected to rule on the legality of the law as early as next week.
In response to pressure from global health organizations, Uganda's Ministry of Health in June guaranteed universal access to health care, regardless of orientation or identity. He did not promise that patients would be spared prosecution.
The country's Ministry of Health did not respond to multiple requests for comment on the law's impact on public health.
However, Health Minister Dr. Jane Achieng said on social media site X that the government remains committed to ensuring access to HIV prevention programs and “eradicating AIDS as a public health challenge.”
Some see a disaster brewing. Although the law targets LGBTQ people, the resulting stigma and discrimination could deter all Ugandans from seeking medical care, said William W. Popp, the U.S. ambassador to Uganda.
“The U.S. government's position is that the entire law should be repealed,” he said in an interview. “This is a violation of fundamental human rights and puts all Ugandans at risk.”
Dozens of LGBTQ people, advocates and health care providers in Uganda said in interviews that they fear the law is having a devastating impact on public health. Although hard data is hard to find, clinics and hospitals estimate that the number of people coming in for HIV testing, prevention and treatment has fallen by at least half.
Some shelters for people living with HIV have closed, and some centers that once provided HIV services on a walk-in basis are now closed to minimize the possibility of raids. sees patients during limited hours, often by appointment.
Dozens of medical workers and patients were arrested.
“The government has tried hard to create the impression that anti-gay laws are not actually enforced and that they pose no real threat to LGBT people, but that is not true,” the rights group said. Director Justin Baruya said. An awareness forum representing many of those arrested.
Uganda has been at the forefront of HIV research and public health policy. The new law requires scientists to reveal the identities of research participants.
“It's difficult from a research and academic perspective, and it's difficult from a scientific perspective to actually develop the medicines and tools that we need to combat future disease epidemics,” Ambassador Popp said.
Around the world, the protection of gay rights is intricately linked to the management of HIV.
A recent United Nations report found that gay and bisexual men living in countries with laws criminalizing homosexuality are more likely to be infected with HIV than men living elsewhere. It is said to be 12 times more expensive.
“We are suffering so much and our lives are in danger,” said Nathanian Issa Rwaguma, 34, a gay man and activist.
Western advocates have provided few resources needed to protect LGBTQ people, especially those who are outspoken, several said. “Do you expect human rights defenders to die or do you expect them to live?” Hajjati Abdul Jamal, a 29-year-old transgender woman, asked about aid organizations.
Many of the arrested Ugandans are not prosecuted under this law, but are instead charged with “common nuisance” with “sexual knowledge contrary to the law of nature,” or sex trafficking (so-called human trafficking). even if it means moving from the living room). Baruya said to the bedroom of the same house.
Almost all of those arrested will be released after about a week, but several may remain imprisoned for years awaiting trial, it added.
In March, three gay men and three transgender women who were working as HIV educators were arrested in the eastern Ugandan city of Jinja.
They spent four months in prison, enduring sexual harassment, beatings and two forced anal examinations, according to the doctor and lawyer who ran the clinic where they worked. One educator was whipped so severely with his cane that he was unable to sit or lie down for two weeks.
In November, Mulindwa Benda, a 24-year-old transgender man and educator, was in Busia, on the Uganda-Kenya border, to lead a workshop on sexual and reproductive health. He was charged with promoting homosexuality.
Benda said in an interview that police mocked him for “dressing up as a man” and held him in a cramped cell with eight women and a non-flushing toilet for 72 hours.
Outreach workers in Lugazi, Mbarara and several other towns were arrested for distributing lubricants and condoms. Police officers often associate the product with same-sex intimacy.
“This is an overall climate of persecution and violence that is scaring not just health care workers, but also gay and bisexual men and trans women who need supportive and non-stigmatizing HIV services. ,” said Asia Russell, executive director of the advocacy group Health. gap.
Approximately 13 percent of Ugandan men who have sex with men are living with HIV, and many are currently unable to access treatment.
Kampala's largest sexually transmitted disease clinic at Mulago Hospital once treated more than 100 LGBTQ patients a day. Dr Afunye Anthony Arthur says less than half of people now visit the clinic.
“Others are hidden and we have to look for them,” he said.
Dr Afniyeh said he was accosted by angry people at a restaurant and at his home where he lives with his wife and three young children.
To help customers feel safer, Ark Wellness Hub, a clinic in Kampala, is now open late into the night and offers private appointments.
Three of the clinic's seven staff members have been evicted from their homes, but “we have to find a way to move forward with our work,” said executive director Brian Arriganilla.
Some clinics hide lubricants out of sight or use euphemisms to refer to them. At many clinics, staff and volunteers continue to provide treatment, delivering medicine at their own expense.
Still, hundreds of patients lost contact with Mulago and Arc Wellness. Dr. Afniyeh said some sex workers, without receiving treatment, can develop elevated levels of the virus and potentially transmit HIV to others.
The 32-year-old gay man said in an interview that he taught shoemaking but was forced to resign in July after being accused of promoting homosexuality at the school. He was diagnosed with HIV in 2021 and took his last antiviral medication on December 6th.
Two of his friends died in August from HIV-related complications after stopping treatment. But he was still afraid to go to the clinic. Another friend was stoned to death in a village in Masaka district, he said after an acquaintance noticed him on public transport.
Ivan Melisa Kakul, a 26-year-old transgender woman, still receives her HIV medication at the Mulago clinic. But she often doesn't have enough money to eat, she said. Kakuru fled her hometown because her father almost killed her, she said, and she has no place to live.
Her friend Carlos Bafuriire, 36, a transgender man, said he was evicted by his landlord and was staying with a sympathetic friend.
President Yoweri Museveni has called LGBTQ people “disgusting” and “abnormal” and said they suffer from “a kind of disease”. He also accused Western countries of introducing homosexuality into the country.
Ugandan police falsely accused activists and educators, such as those arrested in Jinja, of recruiting children into homosexual relationships and producing pornographic videos. Some government officials confuse homosexuality with pedophilia.
Last year, Museveni said of the law, “If you start raping children, we will kill you.''
Health Minister Dr. Aceng congratulated the passage of the law. “Our culture and dignity are protected and Ugandan children are protected,” she wrote to X.
The criminalization of homosexuality is actually a vestige of colonialism, setting Uganda out of step with the rest of the world, says Matthew Kavanagh, director of the Global Health Policy and Politics Initiative at Georgetown University. he said.
The President's Emergency Plan for AIDS Relief provides more than $400 million in HIV funding to Uganda each year. Over 96% of it is carried out by organizations outside the Ugandan government.
Ambassador Pop said the Biden administration has redirected the remaining $5 million from the government.
Effective January 1, the US removed Uganda's access to the African Growth and Opportunity Act, which provides duty-free access to the US market. The US government also sanctioned Johnson Byabashaija, head of the Uganda Prisons Bureau, on charges of torture and human rights violations.
However, Dr Kavanagh and other experts said the Biden administration could impose financial sanctions or pressure the Ugandan government to repeal the law.
Byabashaija's sanctions were based in part on evidence from the March 2020 arrest of Henry Mukiibi, who runs an HIV clinic and shelter, and 19 others.
The group was held for 52 days, during which time they were tortured and assaulted. Some people had their genitals burned with firewood, Mukiibi said in an interview.
“Every time I talk about this incident, I have nightmares,” he says. “It traumatized me.”
Last July, the organization was raided again and the clinic was closed. Still, Mukiibi moved to a new, safer place.
Mukiibi said he felt it was important to speak out. “Sometimes when we hide things or the person we're talking to becomes anonymous, people don't understand the exact situation you're going through,” he said.
