Over the last couple of years HIV rose in Uganda, along with a reported rise in discrimination against sexual minorities.
Over the last couple of years HIV rose in Uganda, along with a reported rise in violence, stigma and discrimination against sexual minorities, with many losing their property and income.
Same-sex sexual relations have remained illegal in Uganda since the Penal Code Act in 1950, and if convicted of this ‘crime’ people can receive a life sentence. But in 2014, the passing of the Anti-Homosexuality Act worsened an already hostile environment for lesbian, gay, bisexual and transgender people (LGBT), making access to health information and services extremely difficult and dangerous. Although the Act was overturned by a constitutional challenge on a technical issue in August 2014, the government continues to criminalise LGBT people.
This criminalisation of sexual minorities and endemic homophobia severely impacts knowledge about HIV, particularly among men who have sex with men, one of the key population groups most at risk of the disease. It results in their access to HIV services being compromised and is reflected in the fact that while the national prevalence for HIV in Uganda is 7.4 per cent, among men who have sex with men it is 13.2 per cent (AVERT).
Reaching people at risk of HIV
For the government and organisations trying to reach groups of people most at risk of HIV the context in Uganda is incredibly challenging and requires creative ways of working.
Margina Joseph, programme officer at the sexually transmitted infections unit for the Most At Risk Populations Initiative (which is run by the Ministry of Health), said: “We provide quality, friendly health services, offering technical support through the peer outreach model. This helps us trace those who fear to come for treatment. For example, due to the criminalisation of same-sex relations, men who have sex with men are often fearful of being tested in case they have to disclose their sexual orientation.”
Criminalisation and discrimination from all levels of society against LGBT people leads to HIV being transmitted more easily and rapidly among this population group. Eliminating anti-gay legislation is vital if the government wants to reduce HIV transmission in Uganda, and if it is serious about meeting its commitment to the global goals for sustainable development, in particular to ensuring healthy lives for all.
Joseph said: “Providing health services to LGBT people is not easy. Many government officials thought we were promoting homosexuality but when we had meetings with Ministry of Health officials they began to understand the situation and necessity of providing treatment and care. But another challenge we have is sustainability of the programme since DANIDA [Denmark’s international aid department] has pulled out many are going to remain in the closet because of fear of coming to the main hospital.”
The Community Health Alliance Uganda (CHAU) provides technical support for the initiative, and Gracias Atwiine, CHAU’s project coordinator for sexual and reproductive health for key populations is also concerned about the situation. He said: “DANIDA has been helping with the supply of drugs and if they are not available, people from key populations will not come to access our services, and this will impact them in terms of behaviour. There will be more re-infections because funding has stopped.”
Institutionalised LGBT discrimination
The criminalisation of same sex sexual activity in Ugandan encourages a society which institutionalises discrimination against sexual minorities and incites violence, harassment and brutal actions against LGBT people.
Sam Oliech, 32, used to be a hotel manager in Kampala. “But my colleagues identified me as gay, and stopped associating with me, they abused me with all sorts of words,” he said. “My boss gave me a termination letter. After this I joined a support group for men who have sex with men.”
Oliech, who is now a peer educator for sexual minorities at the STI clinic in Mbarara Regional Referral Hospital, said: “A person refusing to report or to give information about someone suspected to be gay, or even trying to defend such a person, can be prosecuted. It aims to intimidate any political, personal solidarity, any liberal thought about sexual orientation this will increase HIV Prevalence due to fear.”
Fear to access health services
Richard Lusimbo, 28, lives in Kampala and works with Sexual Minorities Uganda (SMUG). He said: “My family knows I am gay. I never had a chance to tell them but they read it in the newspapers.” After being outed by Ugandan tabloid Red Pepper, Lusimbo sat down with his family and discussed his sexual orientation with them, which they accepted.
But accessing health services remains hard, Lusimbo says. “We are scared that the doctors might report us and we’ll be arrested. But the annulment of the Anti-Homosexuality Act gives gay rights advocates in Uganda legal leverage to fight a reported surge in discrimination, including evictions, jobs lost and denial of medical treatment,” he said. “And at the Most At Risk Populations Initiative there is space for people who are victims of social pressure, victims of violence to feel that they can take their complaints somewhere and hopefully obtain some access to justice.”
Read more about HIV and human rights