Guest blog by Chris Beyrer MD, MPH, Director of the Center for Public Health and Human Rights, Professor of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore USA.
Uganda has long been viewed as an exemplar of HIV/AIDS responses in Africa. While some aspects of Uganda’s national HIV/AIDS program, like its embrace of the ABC (abstinence, being faithful, condoms) approach for HIV prevention, have been controversial for prevention advocates, the national mobilization around HIV has been impressive. Donors, notably the U.S. PEPFAR (President’s Emergency Plan for AIDS Relief) program and the Global Fund, have been generous. But HIV prevention in Uganda has had its limits—and sexual minorities, including men who have sex with men (MSM), have been consistently excluded.
Uganda hosted the 2008 HIV/AIDS Implementers Meeting, the annual PEPFAR providers gathering. At that meeting, a small group of Ugandan LGBT (lesbian, gay, bisexual, transgender) activists staged a peaceful demonstration calling for the inclusion of sexual minorities in Uganda’s HIV/AIDS response. They were driven from the conference, arrested and charged, and the one man in the group was detained by the police for 24 hours and savagely beaten. So much for inclusion.
It has been argued that since Sub-Saharan Africa’s HIV/AIDS epidemics, including Uganda’s, have largely been driven by heterosexual sex, inclusion of MSM is not a public health priority. This argument is now clearly dated. In 2007 in PLoS Medicine we published a systematic review of HIV infection among MSM in low and middle income countries which included the limited data available on African MSM. Since then, data have emerged, including our collaborative work from Malawi, Namibia, and Botswana, which demonstrate a consistent reality: MSM are found in Africa wherever careful work has been done, and they have disproportionately higher burdens of HIV infection. Inclusion of MSM in African HIV/AIDS programs is called for on public health grounds alone.
The exclusion of sexual minorities in Uganda has taken a dangerously aggressive turn. Uganda is now debating legislation which would markedly increase the penalties for homosexuality from 14 years to life in prison, and, for so-called “aggravated homosexuality,” the death penalty. Ominously, the law also includes provisions for punishment of promoting homosexuality, which HIV advocates fear will be used against groups working on HIV prevention for sexual minorities.
There is no question that prejudice against LGBT citizens is widespread in much of Africa. Worryingly, however, Americans from the “Christian” right now seem to be actively engaged in Uganda’s movement against her LGBT citizens. In March of this year, the International Lesbian Gay Human Rights Commission, ILGHRC, and Sexual Minorities Uganda, its Uganda partner organization, reported on a three-day seminar held in Uganda and featuring speakers such as Scott Lively and Don Schmierer, a board member of Exodus International, a prominent “ex gay” group. ILGHRC’s Director Cary Alan Johnson predicted that the seminar would increase “…violence and other human rights abuses against LGBT people, women and anyone who doesn’t conform to gender norms.” Sadly, he was correct.
Uganda’s proposed law is an outright violation of human rights. It is an attempt to enshrine prejudice in legal garb and to imprison persons for life based on sexual orientation. That U.S. citizens have been engaged in promoting this kind of legislative hate is more than offensive. It is a further blow to African LGBT groups who continue to emerge and to press for their fundamental human rights with tiny resource bases and little public support. The public health, human rights, and HIV/AIDS communities, and above all LGBT communities in the developed world, must now take a stand on inclusion and support these African groups. There are gay people in Africa, and their fight for rights and dignity needs support, resources and engagement. The opponents of LGBT rights are already all too engaged.