July 24, 2014
Written by by Scott Kellerman, MD, MPH
This post originally appeared on the MSH @ AIDS 2014 conference blog.
Since HIV was first identified in sub-Saharan Africa, Uganda has distinguished itself as a leader in developing and implementing an effective HIV response. In recent years, however, HIV incidence has been increasing in the country, and a series of restrictive, punitive measures have replaced the common sense, public-health approach that had set this beautiful country apart.
This year, Uganda joined Nigeria and a handful of other sub-Saharan African countries that have passed, or are considering, repressive, egregious laws criminalizing HIV transmission and homosexuality–laws that are regressive and disastrous from a public health point of view.
Among other things, the anti-homosexuality law in Uganda requires Ugandans to report anyone who may be homosexual to the authorities. Anyone. This means mothers turning in sons, fathers turning in daughters. Anyone.
Meanwhile, the Ugandan “HIV Prevention and Control Act” criminalizes “attempted” or “intentional” transmission of HIV, with fines of up to ten years in prison, and mandates testing for HIV of pregnant women, their partners, and for all accused of rape, not convicted, accused. It further allows for court ordered disclosure of HIV status—in some circumstances without the individual’s consent. While Ugandan President Yoweri Museveni has not yet made it official, it is likely he will sign the HIV bill any day.
MSH has worked in Uganda for over 15 years, measurably improving the health of Ugandan women, men and children, and helping to save the lives of people needing HIV & AIDS prevention and treatment. The new law’s restrictions on “abetting” homosexual relations will impair efforts by healthcare providers and development organizations like MSH to provide comprehensive prevention, counseling, testing, and clinical care and treatment services for vulnerable people living with HIV or those at risk of HIV infection.
Some say that far-right US interests have fueled the fear and fomented discrimination of gay people in Uganda and elsewhere. Regardless of the source, sadly some anecdotal reports suggest that many Ugandans do not see a problem with the new laws.
The LGBT communities in Africa, Asia and elsewhere are unfortunately no strangers to these insults; and I have been trying to formulate a response to these unfortunate turn of events. My conclusion, in light of such intolerance against a select group of people for petty political gains, is simply to stand up and be counted. So in solidarity with those who suffer from these crude attempts at discrimination, I state proudly what my family, friends and colleagues have long known and supported: I’m a gay man. And, as a gay man, I will only be able to participate in the rebuilding of Uganda’s HIV response from afar. So, while MSH has multiple projects working in Uganda, serving hundreds of thousands of Ugandans, if I were to go and help my MSH colleagues on the ground, they would be compelled to turn me into the authorities or face prosecution themselves. I cannot put my colleagues at risk.
How many others face this quandary? And what of our gay and lesbian friends and colleagues working and living in Uganda, shrouded in secrecy? What will become of them?
What about the Ugandans who must hide who they are—even if it means not getting tested for HIV, or not adhering to antiretroviral treatment for fear of this specific sort of stigma and discrimination that the Ugandan laws have created?
More people will go underground. More will hide their HIV status. Fewer people will get tested. More HIV transmission will occur.
I stand with those whose courage is head and shoulders above mine:
Uganda’s own Frank Mugisha, executive director for Sexual Minorities of Uganda (SMUG), Uganda’s umbrella LGBT rights organization, who was out of the country when President Museveni signed the anti-homosexuality law but then chose to return knowing full well that he might be targeted for persecution, prosecution or worse.
I stand with Dr. Paul Semugoma, winner of this year’s International AIDS Conference Elizabeth Taylor Human Rights Award. Dr. Semugoma remains in exile from Uganda, his home country, because him being gay and having the temerity to state it, unashamed, publicly, put him in grave danger in his country of birth.
I stand with Binyavanga Wainaina, the wonderful Kenyan author who decided to tell the world he was gay in response to Uganda’s and Nigeria’s laws. His book , “Someday I will write about this place,” is as universal a coming of age memoir as any I’ve ever read. Following their example, willing to proclaim simply who they are, raising my hand and adding to their voice seems a paltry response. But it’s the most potent tool I can think of.
I stand with the anonymous men and women—gay and presumed gay—who are languishing in fear or in prison and those who are ill who don’t feel they have the option of seeking care for fear of the response from those in their communities, the clinics, or the authorities.
I stand with the many others who have the courage to stand up and say, this is who I am. Do not criminalize me.
In speaking up, gay and straight, we say: all people deserve the opportunity for a healthy life – living with HIV, at high risk of infection, in any country or region—no matter how far from a health center you may have been born: you are worth seeing, testing, and treating. You have as much right to life and health as President Museveni of Uganda, President Jonathan of Nigeria, those who make the laws, and every one.
We will continue to work with global and local partners to support Uganda’s and Nigeria’s efforts to strengthen their health systems. But, these laws will make reducing HIV transmission, and preventing maternal and child deaths much harder.
Health includes dignity.
We hope that as more people—gay and straight, living with HIV, and allies–stand and work together, more people in Uganda and around the world will believe: All people deserve the opportunity for a healthy life. One thing is clear: we do not improve health and humanity by stigmatizing and criminalizing sexuality or living with HIV.
Scott Kellerman, MD, MPH, is the Global Technical Lead for HIV & AIDS at Management Sciences for Health (MSH).