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Uganda anti-LGBTQ+ law threatens HIV gains as patients fear arrest

A medical clinic officer holds a package of medicine at his working station that supports HIV/AIDS programmes in Kampala, Uganda June 1, 2023. REUTERS/Abubaker Lubowa

A medical clinic officer holds a package of medicine at his working station that supports HIV/AIDS programmes in Kampala, Uganda June 1, 2023. REUTERS/Abubaker Lubowa

What’s the context?

Anti-Homosexuality Act means fewer LGBTQ+ Ugandans access healthcare, despite a top court saying they had a right to treatment

  • Fewer LGBTQ+ Ugandans accessing healthcare
  • Health workers fear arrest and violence
  • Fears for reversal of Uganda's HIV/AIDS progress

NAIROBI - Hoping to avoid the police, Alexy set off one night to get his monthly antiretroviral treatment (ART) from a clinic just east of the Ugandan capital that he knew treated gay men like himself.

But shortly after a nurse began administering the life-saving HIV/AIDS treatment to the 28-year-old, police arrived at the door.

Both were arrested and accused of promoting homosexuality in violation of the Anti-Homosexuality Act (AHA) passed a year ago that also imposes the death penalty for "serial offenders", or anyone who transmits a terminal illness, such as HIV/AIDS, through gay sex.

"They kept us in police holding cells for three days without trial," said Alexy, who is gay and asked that only his first name be used.

"Two days later the clinic was attacked and everything destroyed," Alexy said from Kenya where he has since fled.

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Uganda's Constitutional Court ruled in April that the AHA was legal, but struck down a number of clauses, including the section that said citizens had a "duty to report acts of homosexuality". It said that clause had been "adjudged to infringe the right to health, privacy and freedom of religion".

It said law enforcement needs were "over-ridden by the need to preserve medical ethics as a vital component of the right to health", and also for "positive national health outcomes".

The court ruling should have given healthcare workers the legal cover they needed to treat LGBTQ+ Ugandans without fear of arrest, but rights groups and doctors said little had changed.

Health service providers still fear prosecution for promoting homosexuality and LGBTQ+ Ugandans do not feel safe accessing HIV/AIDS care, said Richard Lusimbo, executive director of the Kampala-based Uganda Key Populations Consortium, which advocates for those most affected by HIV, including LGBTQ+ people.

"The most affected are those on ART treatment because the majority of private health facilities they were relying on for services are yet to get a guarantee that authorities will not harass them for doing their work," said Lusimbo.

'Healthcare workers targeted'

On top of fear of falling foul of the law, some healthcare workers said they had been attacked due to what they said was a rise in intolerance towards LGBTQ+ people fostered by the AHA.

"Organisations supporting and providing HIV treatment and prevention services are also operating in fear, especially when serving the LGBTQ+ community," said Lusimbo.

Ark Wellness Hub, a private clinic providing ART to underserved populations such as gay men and sex workers in Kampala, halted services for a week in August after three of its staff were attacked. Since then, the clinic has offered early morning and late evening appointments, as well as home visits.

"Most of our clients now prefer home visits which come at an extra cost," said the clinic's executive director Brian Aliganyira.

But Uganda's Health Ministry said access to HIV/AIDS services had not been affected by the AHA, no one had been stopped from seeking ART and no one was asked about their sexuality before treatment.

"If we have people not seeking ART services, it is out of their own unfounded fears, but not because government has denied them services," Dr. Diana Kanzira Atwine, permanent secretary of the ministry, told Context in a statement.

Uganda has 1.4 million people living with HIV/AIDS in a population of 49 million and 85% of those are accessing treatment, according to 2022 UNAIDS data.

UNAIDS data showed Uganda had been making good progress towards reducing HIV/AIDS infections before the AHA. But even then, LGBTQ+ Ugandans already lagged behind in receiving HIV/AIDS care, the data showed, with only 13% of trans Ugandans and 66% of infected men who have sex with men accessing ART.

Health workers fear those numbers could now decline further.

Stalled progress

The heads of the Global Fund to Fight AIDS, Tuberculosis and Malaria, UNAIDS and the U.S.-funded President's Emergency Plan for AIDS Relief (PEPFAR) warned last year the AHA put Uganda's HIV/AIDS progress in "grave jeopardy".

Uganda's health sector is highly reliant on international funding. Health Minister Jane Ruth Aceng told parliament in March that 85% of healthcare funding came from foreign donors. PEPFAR alone invests around $400 million a year in Uganda's HIV/AIDS response.

At Mulago Hospital, Kampala's largest public health facility, the number of LGBTQ+ people seeking services remained low, said Anthony Arthur Afunye, the head of the hospital's sexually transmitted infections clinic.

"From the more than 100 LGBTQI+ patients we would see in a day, we currently attend to less than half of that," said Afunye.

Irene, a 24-year-old trans woman who asked for her last name not to be used, used to make monthly visits to Mulago Hospital for ART. But in November, she said scaled down services had made access unreliable, prompting her and four friends to turn to private clinics. While Mulago Hospital provided free treatment, the university student now pays $40 for each visit.

But in Irene's experience, even private providers "are still operating in fear and are reluctant to continue offering service to the queer community."

For Lusimbo, this points to how little impact April's Constitutional Court decision has had.

"What the court did has very minimal effect on the current violations of LGBTQ+ basic rights," said Lusimbo. "The only thing that could save us from agony is a total (repeal) of the law."  

This story is part of a series supported by Hivos's Free To Be Me programme.

(Reporting by Jackson Okata in Nairobi; Editing by Sadiya Ansari and Jon Hemming.) 

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