Kikonyogo Kivumbi is Behind the Mask’s Arcus Correspondent in Kampala and a Human Rights Defender.
Uganda is stuck at 6.4per cent HIV/Aids prevalence, with new figures released this week showing an increment in infections.
The new Uganda Aids Indicator Survey conducted by the Ministry of Health (MoH) reveals not only has the HIV prevalence rate stagnated over the last 10 years, the number of people infected with HIV has risen from 1.8 million people to 2.3 million today.
Dr Alex Opio, assistant commissioner, National Disease Control at the MoH, said this is not statistically different from the HIV prevalence of 6.4 per cent five years ago. But Dr Benon Biryahwaho from the Uganda Virus Research Institute says 6.7 per cent is a large burden of disease for a poor country, and Uganda needs to rethink its Abstinence, Be Faithful and Condom-use (ABC) strategy.
It is true that infections have risen slightly among married heterosexual people. And while it is also true that Uganda had previous successes in scaling down the pandemic from over 30 per cent in the 1980s, new frontiers to address the scourge are being frustrated through policies and laws.
The Proposed Anti Homosexuality Bill will make such efforts worse.
Many of my friends are married to women. But they also have sex with their fellow men. Such men do not consider themselves gay. They refer to their activities as a “boy’s night out” thing.
While these men insist on using condoms as a protection measure when cheating with another woman, they refuse to wear condoms when they are with other men.
The logic is simple here: Ugandans have been made to believe that one can only contract HIV from having sex with an infected member of the opposite sex. This is totally misleading. Unfortunately, this is the reality with Ugandan HIV policies. All the prevention, voluntary counselling and testing (VCT) messages target heterosexuals, leaving out the Men Who Have Sex with Men (MSM).
The key question becomes whether Lesbians, Gays, Bisexuals, Transgender and Intersex persons should be left to bear the brunt of an HIV prevalence rate that is twice the national average, or whether positive legislative and policy steps can and should be taken, based on evidence and research, to address their health needs.
Policy makers often feel compelled by moral concerns to pretend that the gay community or MSM do not exist. But consider the following statistics that have emerged from the Crane Survey Report, a research collaboration between MoH, Centres for Disease Control and Makerere University.
Of the population of Men who have Sex with Men (MSM) that was studied in the survey period:
- 31per cent of them had ever been married and 20per cent of them were currently married;
- 78 per cent of them had ever had sex with a woman;
- 44 per cent had ever lived with a female sex partner;
- 16 per cent were currently living with a female sex partner, and
- 29 per cent had fathered children
It should be noted that law and policy have a direct impact on the spread of HIV.
The Ugandan MP David Bahati’s bill, if passed, will be a bad law with regards to advancing health in this country. Good laws can reduce the spread of HIV, and bad laws can serve as a significant driver of the virus.
In Uganda, apart from the progressive policy on HIV/Aids that existed for a long time regarding the general population, the laws and policies regarding same sex practices have been, as shown above, historically retrogressive and have served to condemn LGBTI persons to death as effectively as if they had been hanged in execution of a court order.
The deliberate exclusion of homosexuals from the health services and supplies access radar is seeing an increment in the prevalence rates among gays.
It should be stressed that this higher prevalence is not because MSMs engage in behaviour which is riskier than that of the general population, but rather that the sexual activity they engage in has been arbitrarily declared illegal. This has rendered them criminals and has excluded them from the range of public health initiatives available to the general population.
The criminalization of same sex activity makes LGBTI persons a target population, unable to effectively access medical services that are relevant to our needs and vulnerable to stigma and discrimination as well as blackmail and extortion. This makes us an effectively invisible population in terms of access to the range of social services and justice necessary to address the issue of HIV and AIDS in our population.
These factors, based squarely on the repressive and outdated criminal law on same sex practice, are what are driving the epidemic among gays.
The MoH and the Uganda Aids Commission (UAC) have acknowledged this reality and have established the Most at Risk Populations Initiative (MARPI) which aims at meeting the HIV Prevention, Treatment and Care needs of vulnerable groups, including LGBTI persons. Nevertheless, this and other such initiatives cannot be fully effective in a hypocritical legal regime, including the proposed Bahati bill.
Uganda has lost its soul in designing country specific interventions. Placing such an important entity like UAC under the President’s Office with direct interference from Christian born-again friendly forces close to the President, is detrimental.
I attended a high policy makers meeting at Golf Course Hotel In Kampala last year at which a senior presidential advisor on HIV/Aids openly said he swore to himself never to include Pre-Exposure Prophylaxis (PrEP) in the National HIV response in Uganda because in his opinion “it benefits homosexuals more.”
He claimed he was “under specific instructions” from his employers to ensure homosexuals are not mentioned in UAC policy documents.
In so doing he seemed to have forgotten that PrEP also helps discordant heterosexual couples.