Uganda Activists Press for Gay Inclusion in National HIV Plan

Activists in Uganda are fighting social and political bias in pressing for the inclusion of gays and other men who have sex with men (MSM) in a new national strategy to combat HIV, PlusNews reported on Aug. 30.

Activists and health experts have long warned that anti-gay nations that simply try to sweep gays under the rug (or round them up in mass arrests, as a minister in Ghana has recently said he would do) court disaster. The fear is that gays, bisexuals, and men who identify as heterosexual but still have sex with other men (MSM) will simply go underground and avoid testing and treatment.

Because HIV positive individuals who do not receive proper and timely treatment are at much higher risk of passing the virus along, persecution that promotes such health risks runs a grave risk of pushing AIDS rates higher.

Such was the case in South Africa during a period of time when government officials refused to take effective action and even promoted ineffectual preparations made with beet juice as a "cure" for HIV. As a result, the nation's HIV rates skyrocketed.

Uganda's political situation is so anti-gay that a bill stipulating the death penalty for gays has been in play for more than a year. The political climate has informed the social climate to such an extent that gays are now facing intense pressure and personal endangerment. One tabloid newspaper went so far as to publish the names, pictures, and home addresses of 100 men that the paper claimed were gay. The accompanying headline urged readers to "Hang Them!"

But mounting scientific evidence indicates that homosexuality is a natural and innate part of human sexuality for a minority of people. Gays cannot be punished or outlawed into being straight, even if they adopt protective heterosexual coloration like entering into marriages with opposite-sex partners.

Even so, Uganda's national plan for dealing with the AIDS epidemic does not factor gays and other MSM into the picture -- an oversight that activists are saying must be corrected.

The new plan will be completed this year, and "lays out a framework for responding to the epidemic, pinpointing priority areas for programming; the next one is expected to guide the country's HIV programs until 2015," the PlusNews article says. But in its current form, the plan barely acknowledges MSM and dismisses them as insignificant in the AIDS epidemic and efforts to combat it.

This assertion is flatly contradicted by the data. The article referenced a survey that showed HIV rates among MSM were more than double that for the general population. Even that survey was affected by the nation's anti-gay policies, though -- the article noted that assembling the data for the survey was "severely interrupted" when advocates for the gay community were placed under arrest.

Such persecution interferes in researchers' efforts to gain meaningful and accurate data because the people they are trying to talk to are less willing to talk to them, said Apophia Agiresaasi, who heads the Action Group for Health, Human Rights and HIV/AIDS.

"They will say they belong to a category that's more acceptable, or if they're in sexual relationships with both men and women, they will identify as heterosexuals," Agiresaasi said, adding that as a result the data from such surveys may underreport the number of gays and MSM.

The HIV plan "directs how resources from donors and governments are utilized," according to Kikonyogo Kivumbi, who heads up the Health and Science Press Association, an advocacy group.

"It means that whoever is going to access those resources in the delivery of public health services, if the policy directs them, they can introduce LGBTI -friendly services," added Kivumbi.

"These people are engaging in sex," Kivumbi said. "Whether you want it or not, infections of HIV will occur."

"According to Frank Mugisha, executive director of Sexual Minorities Uganda (SMUG), the absence of a national dialogue around safe sex education for sexual minorities means that many members of the MSM community do not know how to avoid HIV transmission," the article said.

The current version of the plan would do nothing to correct the situation. Though it identifies sex workers and other populations (such as those who live in fishing villages) as susceptible to the epidemic and in need of education, condoms, and other forms of outreach, the national plan neglects to provide similar resources for gays and MSMs.

The anti-gay lawmaker behind the "death to gays" bill, David Bahati, has rewritten his bill somewhat to attempt to mollify critics, but observers say that the most egregious parts of Bahati's legislation have appeared in other forms and charge that lawmakers are trying to slip the bill's punitive provisions into the nation's laws under the radar.

Bahati claims that his bill, in its rewritten form, "will take care of all concerns raised by different stakeholders, including those concerns about HIV/AIDS prevention and treatment."

"But even if the national strategy were to call for treatment and prevention services for MSM, there are still significant hurdles to actually offering those interventions in a country where homophobia is rampant," the PlusNews article said, citing the stigma attached to gays that cause the nation's health care workers to turn them away.

"Some doctors are homophobic," said Mugisha -- who was himself one target identified in the infamous "Hang Them" article.

"You don't have anything legally binding to compel them to treat Uganda's LGBTI community," added Mugisha, going on to say that the laws, in their current form, "justify the myth of their cultural and religious arguments against treating MSM and others."

What is needed is a pragmatic, fact-based approach, Mugisha suggested. "My desire would be to tell the doctor, 'Yes, I'm having sex with another man,' " Mugisha added. That way, a health worker can have complete and relevant information.

"Mugisha said he knew people who had been misdiagnosed at health centers because doctors were unfamiliar with sexually transmitted infections that are more common among MSM and the people seeking treatment were too afraid to reveal their sexuality," the article reported.

The same government that has increased the nation's anti-gay sentiment since entertaining the "death to gays" bill can calm the social disruption that has resulted, but only if it sets aside anti-gay animus.

"We want to work with the government," Mugisha told the press. "Government can begin with the policies," he added, "then we would have the backing of the law."

In a nation where Bahati's bill is still before lawmakers despite nearly two years of controversy and international outcry, however, that hope seems forlorn.