Monday, May 20

With the harsh anti-LGBTQ law, Uganda risks a health crisis

For decades, Uganda’s campaign against HIV has been exemplary, reducing the country’s mortality rate by nearly 90% from 1990 to 2019. Now a sweeping law enacted last year, the Anti-Homosexuality Act, threatens to renew the epidemic as LGBTQ citizens are denied, or too afraid to seek, necessary medical care.

The law criminalizes consensual sex between same-sex adults. It also requires all citizens to report anyone suspected of such activity, a mandate that makes no exceptions for health care workers caring for patients.

Under the law, simply having same-sex relationships while living with HIV can lead to a charge of “aggravated homosexuality,” which is punishable by death.

Anyone who “knowingly promotes homosexuality” – by hiring or hosting an LGBTQ person, or by failing to report one to the police – faces up to 20 years in prison. Dozens of Ugandans have been evicted from homes and fired from jobs, according to interviews with lawyers and activists.

According to interviews with dozens of people, entrapment and blackmail – sometimes by police – are rampant in person, on social media and on dating apps.

LGBTQ people, as well as their supporters and the healthcare workers who help them, have been subjected to threats and violence.

The law brought global condemnation and dealt a severe blow to Uganda’s economy. But it is very popular among its citizens. Many Ugandans see homosexuality as a Western influence and the law as a corrective. The country’s Constitutional Court will rule on the legality of the law as early as next week.

Responding to pressure from global health organizations, Uganda’s Ministry of Health in June guaranteed healthcare to everyone, regardless of orientation or identity. It did not promise that patients would be safe from prosecution.

The country’s health ministry did not respond to multiple requests for comment on the law’s impact on public health.

But Dr Jane Aceng, the health minister, said on the social media site X that the government would ensure access to HIV prevention programs and “remains committed to ending AIDS as a public health challenge”.

Others see a disaster in the making. Even though the law targets LGBTQ people, the resulting stigma and discrimination could deter all Ugandans from seeking health care, said William W. Popp, U.S. ambassador to Uganda.

“Our position on the part of the United States government is that the entire law should be repealed,” he said in an interview. “It is a violation of basic human rights and puts all Ugandans at risk.”

In interviews, dozens of LGBTQ people, advocates and health workers in Uganda say they fear the legislation has had a devastating effect on public health. While hard data is difficult to find, clinics and hospitals estimate that the number of people coming in for HIV testing, prevention or treatment has fallen by at least half.

Some shelters for people living with HIV have closed, and some centers that once delivered home-based HIV services now see clients for limited hours, often by appointment only, to minimize the possibility of raids.

Dozens of health workers and patients were arrested.

“The government has done everything to create the impression that the anti-homosexuality law is not really enforced, that it does not pose a real threat to LGBT people, but that is not true,” said Justine Balya, director of Human Rights Awareness and promotion forum, which represents 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 study participants.

“It is worrisome from a research and academic perspective, and equally worrisome from a scientific perspective, to actually develop the drugs and tools that we need to address epidemics in the future,” Ambassador Popp said.

Around the world, the protection of gay rights is closely linked to the control of HIV

According to a recent United Nations report, gay and bisexual men living in countries with laws that criminalize homosexuality are 12 times more likely to be living with HIV than those in the rest of the world.

“We are suffering so much and our lives are in danger,” said Nathanian Issa Rwaguma, 34, a gay activist.

Many argue that Western advocates have offered few resources needed to protect LGBTQ people, particularly those who have expressed themselves openly. “Do you expect a human rights defender dead or alive?” asked Hajjati Abdul Jamal, a 29-year-old transgender woman, referring to the aid organizations.

Many arrested Ugandans have not been charged under the law, but rather of being a “common nuisance,” of having “carnal knowledge against the order of nature,” or of sex trafficking, even when the so-called trafficking means moving from the living room to the bedroom bedroom from the same house, Ms. Balya said.

Nearly all those arrested are released after about a week, but some could remain in prison for years awaiting trial, he added.

In March, three gay men and three transgender women working as HIV educators were arrested in Jinja, a city in eastern Uganda.

They spent four months in prison suffering sexual harassment, beatings and two rounds of forced anal exams, according to the doctor who runs the clinic where they worked and their lawyers. An educator was hit so hard with a stick that she was unable to sit or lie down for two weeks.

In November, Mulindwa Benda, 24, a transgender man and educator, was in Busia, on the Uganda-Kenya border, to lead a seminar on sexual and reproductive health. He was accused of promoting homosexuality.

The police ridiculed him for “dressing as a man” and kept him for 72 hours in a tiny cell with eight women and an unflushed bathroom, Mr. Benda said in an interview.

Outreach workers in Lugazi, Mbarara and several other towns were arrested for distributing lubricants and condoms. Police officers often associate the products with same-sex intimacy.

“It is part of the overall climate of persecution and violence that instills fear in health workers, as well as gay and bisexual men and trans women who need HIV support and stigma-free services,” said Asia Russell, director executive of the health advocacy group. I split.

About 13% of Ugandan men who have sex with men are living with HIV. Many are now excluded from treatment.

Mulago Hospital’s STD clinic, among the largest in Kampala, treated more than 100 LGBTQ patients a day. Now, fewer than half come to the clinic, said Dr. Afunye Anthony Arthur.

“The others are hiding, so you have to look for them,” he said.

Dr Afunye said he had been approached by angry people at a restaurant and at his home, where he lives with his wife and three young children.

To make visits safer for clients, Ark Wellness Hub, a clinic in Kampala, now stays open late into the evening and offers private appointments.

Even though three of the clinic’s seven staff members have been evicted from their homes, “you have to find a way to move forward with your work,” said Brian Aliganyira, the executive director.

Some clinics have resorted to hiding lubricants out of sight or using euphemisms to refer to them. In many clinics, staff and volunteers continue to provide care, spending their own money to deliver medications.

However, hundreds of patients have stopped contact with Mulago and Ark Wellness. Some are sex workers who could transmit HIV to others as levels of the virus increase without treatment, Dr. Afunye said.

In an interview, a 32-year-old gay man said he had taught shoemaking but was forced to leave the job in July after being accused of promoting homosexuality at school. He was diagnosed with HIV in 2021 and took his last antiviral pill on December 6.

Two of his friends died in August from HIV-related complications after stopping treatment. But he was still too afraid to go to a clinic: Another friend was stoned to death in his village in Masaka district, he said, after an acquaintance recognized him on public transport.

Ivan Melisa Kakuru, 26, a transgender woman, still collects her HIV medications at the Mulago clinic. But she often doesn’t have enough money to eat, she said. Ms Kakuru said she fled her hometown when her father tried to kill her and had nowhere to live.

His friend Carlos Bahuriire, 36, a transgender man, said he had been evicted by his landlord and had been staying with an understanding friend.

President Yoweri Museveni called LGBTQ citizens “disgusting” and “abnormal” and said they have “a kind of disease.” He also blamed the West for bringing homosexuality to the country.

Ugandan police have falsely accused activists and educators – like those arrested in Jinja – of recruiting children into homosexuality and making pornographic videos. Some government officials have also confused homosexuality with pedophilia.

“If you start raping children and so on, we will kill you,” Museveni said last year about the law.

Dr. Aceng, Minister of Health, celebrated the passage of the law. “Our culture and dignity are upheld and Ugandan children are protected,” he wrote on X.

The criminalization of homosexuality is actually a remnant of colonialism and puts Uganda out of step with the rest of the world, said Matthew Kavanagh, director of the Global Health Policy and Politics Initiative at Georgetown University.

The President’s Emergency Plan for AIDS Relief provides Uganda with more than $400 million in HIV funding each year. Over 96% of this is implemented by organizations outside the Ugandan government.

Now the Biden administration has redirected $5 million of the remainder away from the government, Ambassador Popp said.

Effective January 1, the United States revoked Uganda’s access to the African Growth and Opportunity Act, which provides duty-free access to the U.S. market. Washington also sanctioned Johnson Byabashaija, commissioner general of the Uganda Prison Service, for torture and human rights abuses.

But Dr. Kavanagh and other experts said the Biden administration could do more to impose financial sanctions or pressure the Ugandan government to repeal the law.

Mr Byabashaija’s sanction was based partly on evidence from the March 2020 arrest of Henry Mukiibi, who runs an HIV clinic and shelter, along with 19 others.

The group was held for 52 days, during which they were tortured and beaten; some had their genitals burned with a piece of firewood, Mr. Mukiibi said in an interview.

“Every time I talk about this case, I have nightmares,” he said. “You traumatized me.”

Last July the organization was raided again and the clinic was closed. Undeterred, Mr Mukiibi moved to a new safe place.

Mr Mukiibi said he believes it is important to speak out. “Sometimes, when we hide things, or when the person speaking becomes anonymous, people don’t understand exactly the situation you’re going through,” he said.