In Uganda, a new law that targets the LGBTQ+ community is causing concern among healthcare workers and endangering efforts to combat HIV. The law, passed in May, includes severe penalties for homosexuality, making it a capital offense in some cases. This legislation has created an atmosphere of fear and mistrust, affecting healthcare services and HIV prevention programs in the country.
At a local clinic that primarily serves HIV patients, staff members find themselves constantly monitoring CCTV footage for potential informants. This heightened sense of surveillance reflects the fear and anxiety that has taken hold of Ugandan health workers following the implementation of the controversial anti-gay law.
Brian, the founder of the clinic, expressed his concerns about the situation. He emphasized that trust between patients and healthcare providers is crucial, but the current circumstances have eroded that trust, leaving everyone apprehensive about each other’s intentions.
Impact on HIV Services
During a three-hour period observed by AFP inside the clinic, not a single patient walked in, signaling a worrying impact of the law on HIV efforts in Uganda. Brian, who chose not to disclose his last name for safety reasons, pointed out that the legislation, enacted in May, includes provisions that criminalize “aggravated homosexuality” and impose life imprisonment for consensual same-sex relations.
Additionally, the law has raised concerns that patients or healthcare providers could be reported to the police. Anyone found guilty of “knowingly promoting homosexuality” could face up to 20 years in jail, while organizations encouraging same-sex activities could be banned for a decade.
Brian recounted that when the parliament began debating the legislation in March, they received numerous requests from people to delete their information from the clinic’s records due to fears of being identified as LGBTQ+. As a result, attendance at the clinic has been steadily declining.
Approximately 35 percent of individuals seeking HIV prevention services have stopped visiting the clinic, and 10 percent of those in need of antiretroviral medication have also ceased contact. Furthermore, three health workers resigned because they felt unsafe working in such an environment, reducing staff capacity by over 25 percent.
As patients discontinue antiretroviral medication, their viral loads increase, elevating the risk of HIV transmission to others.
The Fear and Paranoia
Despite the Ugandan health ministry’s advisory to healthcare providers, which states that no one should be discriminated against or denied medical services, those working on the ground remain uneasy. Richard Lusimbo, director general of Uganda Key Populations Consortium, an organization focused on healthcare advocacy, noted that people have been arrested for possessing lubricants or condoms, and the law has created a pervasive atmosphere of fear and paranoia.
Even during the law’s debate, police arrested six men in Jinja in March, charging them with various offenses related to homosexuality. Lusimbo emphasized that the lack of clarity on discussing HIV prevention without being seen as promoting LGBTQ+ issues is a significant concern.
International organizations, including UNAIDS, the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and the US President’s Emergency Plan for AIDS Relief (PEPFAR), have warned that Uganda’s progress in combating HIV is in serious jeopardy due to the anti-gay law.
However, Uganda’s director general of health services, Henry Mwebesa, disagreed, stating that the country remains on track to eliminate AIDS as a public health challenge by 2030. He insisted that services are provided without discrimination, dismissing concerns that the law would reverse Uganda’s achievements in HIV prevention.
In the face of these challenges, healthcare providers like Brian and his staff are searching for ways to reach patients without compromising their safety. Telemedicine consultations and discreet delivery services have proven helpful in maintaining contact with their clients, but the underlying anxiety remains.
Brian acknowledged that even if the law is eventually overturned, the damage is profound. Many individuals have been radicalized, and the legislation has intensified homophobia. Rebuilding trust and reengaging those who have turned away from healthcare services will be a time-consuming and challenging process.