Uganda and HIV prevalence: Has Homophobia become a public health risk?

13 February 2015

As the Ugandan LGBT community braces itself for another anti – gay bill to be brought forward, the impact of such institutional and societal homophobia is having a damning impact on the fight against HIV/AIDS transmissions.

Although the controversial ‘kill the gays’ law, which garnered a lot of international condemnation, was ‘watered down’ to life imprisonment and then eventually struck down in 2014 by Uganda’s highest court, parliamentarians are again pushing for a new discriminatory bill to rapidly be made into law. Only this time lessons have been learnt. There is no explicit reference to homosexuality in the new bill, only a need to punish the deliberately vague “unnatural acts” and the “promotion” of them with a 7 year prison sentence. If passed, this will be the latest in a line of anti – gay laws, which include the HIV/AIDS Prevention and Control Act, the Anti Pornography Act and the Narcotics Law. By radically expanding what is considered the ‘promotion’ of homosexuality, this new bill will go after “anyone who funds work that promotes the wellbeing of the LGBT community”. For those in the fight against HIV/AIDS, the consequences will be severe.

From World Leader to International Pariah

Once hailed a world leader in combatting the spread of the virus, Uganda’s once rare success story in a continent that’s otherwise been blighted by AIDS has now seen a significant rollback. The rate of infection increased from 6.4% to 7.3% between 2006 and 2012. An estimated 1.4 million people currently live with the disease, with 150,000 new cases being diagnosed every year, meaning that Uganda is now in the minority of countries showing an increase in transmissions. Amongst each of the nations designated a “Focus Country” by the U.S. President’s Emergency Plan for AIDS Relief (Pepfar), only Uganda has reported a rise in new cases of HIV. Prominent Ugandan LGBT activists say this is symptomatic of the recent wave of persecution of the LGBT community and the upswing in homophobic attitudes and legislation.

Uganda is a country where being gay and being HIV positive are both regarded as interrelated and are severely stigmatised. As attitudes have hardened against the LGBT community, many sexual health clinics have had to close since 2006 for fears of being charged with “promoting” homosexuality. Police have been known to carry out raids on clinics that dare to offer services to gay men and women, such as last year when a Kampala AIDS clinic affiliated with the U.S. military was raided by officers and ordered to be shut down. Additionally, one Pew Attitudes Survey found that a staggering 96% of Ugandans surveyed have an “unfavourable” view of gay people, a pervasive homophobia that has been an unequivocal disaster for safe sex advocates. Condom and lubrication also bear the stigma of being associated with homosexuality, leading to their use in court as “evidence” against those accused of “sexual deviancy”. Consequently, use of both has declined sharply. Between 2005 and 2011, condom use fell from 53% to 38% amongst men while women also reported a drop in usage, from 47% to a mere 29%. Is it any wonder that HIV rates have crept back up?

Getting Off ‘The Sexual Network’, and Punishing Those Who Stay On it: The Embrace of Abstinence

The rise in homophobia has been spearheaded by fundamentalist Christian evangelical groups hailing mainly from the U.S, who on the cusp of defeat at home in the gay marriage culture wars, are taking their fight against LGBT rights abroad. In doing so they are negatively affecting HIV prevention and treatment efforts. A substantial shift in health policy has come about in Uganda as a result of the increased presence and influence of these groups that embrace a more conservative Christian – oriented to sexual health, one that doesn’t just frown upon homosexuality but generally all premarital sexuality and sexual activity. Many of these groups have received funding from the U.S. either through the aid dollars given to the Ugandan government or by teaming up directly with PEPFAR since 2003, when the Christian Right had control of all three branches of the U.S government. This emphasis on abstinence and fidelity has been reflected in new health legislation as politicians are keen to bow to the pressure from the evangelicals and their vote-wielding followers in the run up to the 2016 elections. The most prominent of which, the aforementioned HIV Prevention and Control Bill, makes it illegal to “willfully” transmit the virus, an offence that can land you up to ten years in prison. “It had become a habit for people who know they have HIV to prey on innocent partners,” says Sam Okuonzi, a physician and member of the parliament, “in order not to ‘die alone.’”

It’s feared that it is this ‘official hysteria’ that has deterred people from getting tested or receiving treatment in a desperate bid to avoid the label of criminal culpability. In doing so this has made it harder to control the disease’s spread, fatally so in a country where an estimated 65,000 people die each year from HIV/AIDs related illnesses. By criminalising HIV for its association with homosexuality and other ‘ungodly’ behaviours, the Ugandan government has made it a taboo subject. “This will send LGBT people underground and lead to riskier sexual behaviors,” says Dr. Frank Mugisha, executive director of Sexual Minorities Uganda. Ignorance of the disease is therefore dangerously widespread. Only 38% of men and 37% of women have a “comprehensive and accurate” knowledge of HIV, a recent survey found.

The Effects On Wider Society: Homophobia As A Public Health Risk

That so many Ugandans remain in the dark over HIV/AIDs is unfortunately just one of many ways in which the persecution of the LGBT community is affecting the wider population at large, increasing their risk of exposure to the disease. Women in general are particularly hard hit. In Africa, 60% of those living with HIV are women, and Uganda, where women have double the prevalence of men, is no exception. In a country where homophobia is so arguably so rampant, many gay men are forced to remain closeted and marry women as a cover. However, as with anything, criminalisation doesn’t equal eradication, it just gets driven underground. 1 in 3 men who reported having sex with another man have also married and fathered children. Fewer than half of these had used protection, leaving their wives vulnerable to contracting HIV, at least partially suggesting why one 2013 survey found that 43% of new HIV infections came from married couples. The puritanical approach to tackling the spread of the virus, and the homophobia which comes with this approach, has also made it harder to provide services to sex workers, both male and female. Having a 37 percent rate of HIV infection, many will likely avoid health services for fear of being prosecuted under the punitive HIV Prevention and Control Act for “wilful” transmission. The state – sanctioned culture of silence around HIV has also done little in the way of tackling mental health issues associated with living with the disease. 96% of HIV positive Ugandans will experience mental health problems in their lifetime and 56% have experienced chronic depression. Many will have to suffer in virtual isolation, too afraid to speak out and get help in such a hostile environment.

What is to be done?

It’s clear that by persecuting the LGBT community the Ugandan government is impeding the fight against HIV/AIDS. In doing so they are effectively worsening the health risks for the public at large. In combatting transmissions, any effective approach will have to be more than just about the biomedical and take into consideration the structural and societal factors that are perpetuating the homophobic and puritanical attitudes. There needs to be a move away from the abstinence – only initiatives and an inclusion, not criminalisation, of the HIV – positive and LGBT Community and other high risk groups. The costs of doing otherwise are just too high. Unfortunately, if lawmakers continue to press ahead with new anti – gay legislation, it won’t just be the LGBT community that suffers, but the Ugandan public at large.

Disclaimer: This blog is a space for discussion and personal reflection. Any opinions expressed within the blog are those of the author and are not necessarily held by HART. Individual authors are responsible for the accuracy of statements made within the blog.

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