By Amy C. Willis
With the introduction of the Anti-Homosexuality Bill (AHB) in Uganda in 2009, an environment of fear, stigma and shame now envelopes the country’s lesbian, gay, bisexual and trans (LGBT) community. Uganda’s LGBT population is under constant fear of social and legal punishment, with threats of persecution, public outings, and violence constantly bubbling under the surface. To make matters worse, the AHB includes a clause specific to HIV-positive LGBT-identified people under its aggravated homosexuality charge, with the death penalty as the punishment that accompanies a conviction of aggravated homosexuality. The impact of this proposed legislation on the LGBT community and HIV education and prevention is vast and can have a potentially negative impact on the LGBT and men who have sex with men (MSM) communities and beyond.
GAY=DEATH: Uganda’s Anti-Homosexuality Bill and what it means for HIV
In 2009, Ugandan parliamentarian David Bahati introduced the Anti-Homosexuality Bill (AHB), new legislation that aimed to further criminalize the LGBT population and their “homosexual” behaviours. The purpose of the bill was to uphold, preserve and maintain the traditional, socio-cultural construct of marriage between a man and a woman while simultaneously protecting children – the future of Uganda – from the clutches of the homosexual lifestyle and, most importantly, prohibiting the acknowledgement and promotion of anything other than heternormativity. Though the Bill was initially proposed in 2009, it lay mostly dormant until the Ugandan government aggressively resurrected the legislation in November 2012, in a concerted effort to pass it swiftly. That being said, the government has received a considerable amount of negative attention from other governments and activists globally around this proposed legislation, which has been tabled month after month and is currently sitting in a state of limbo.
Uganda is a heavily religious nation with more than 80% of its citizens identifying as Christian.1 Many believe that the introduction of the Bill was fuelled by evangelical beliefs and that Ugandan religious leaders and politicians receive considerable support from their American Evangelist counterparts.2 The AHB roughly defines “the offence of homosexuality” as any intentional touching, penetrating, or stimulation of sexual organs between two people of the same sex; if found guilty of this “offence”, a person can be imprisoned for life. “Aggravated homosexuality”, a significantly more severe charge, is used as an umbrella term under which numerous activities/offences fall, including sex with a minor (a person below the age of 18), sexual abuse of a person with a disability, and being HIV-positive, among others. Upon conviction, those who commit “aggravated homosexuality” can be sentenced to death. In addition to the LGBT population, LGBT empathizers and supporters also face legal threats for failing to report people known or suspected to identify as LGBT; the Ugandan government has effectively created a state-sanctioned witch hunt, whereby all citizens are expected to report suspected or known LGBT persons to the authorities within a 24-hour period or face jail time and monetary fines.3 There are many significant and extremely problematic aspects of Uganda’s proposed anti-legislation, including but not limited to the considerable human rights violations it poses. This paper will focus primarily on the potential havoc this proposed legislation may wreak on the country’s HIV epidemic.
The inclusion of the HIV-positive clause in the AHB serves to reinforce the historical, troublesome and erroneous relationship that exists between gay men and HIV/AIDS. Highlighting HIV within this bill serves to suggest that HIV is “the gay disease” even though in many African countries, Uganda included, the epidemic is more generalized and thus, is also prevalent in heterosexual populations. This unfounded association may therefore inadvertently give the heterosexual population permission to distance themselves from HIV education, awareness and prevention and to disassociate from better sexual health practices because they do not feel HIV is as relevant to them. Further, with the increased state-sanctioned discrimination against the LGBT population in Uganda, HIV and sexual health education targeting this demographic would likely be scaled down if it has not already happened. Effectively, the AHB has the potential to negatively impact HIV education and prevention for both the LGBT and heterosexual populations alike.
HIV awareness and prevention, particularly in relation to testing, is also under immediate threat for the LGBT community should the proposed legislation pass. According to a report produced by UNGASS in 2010, only 20% of Ugandan women and men between 25 and 49 years of age had been tested for HIV in the previous 12 months and knew the result of that test.4 What complicates this issue even further is that should the AHB pass, confidential relationships previously shared between healthcare providers and patients would no longer exist, as doctors would effectively be required by law to report any patients whom they suspect (or know) to identify as LGBT and/or are HIV-positive. Given the pending legislation and its call for the death penalty for those who are both LGBT and HIV-positive, it is easy to see why many Ugandans in the LGBT community may forego an HIV test to prevent themselves from becoming susceptible to the government’s draconian laws. While not knowing their status may protect them from a death sentence at the hands of the Ugandan government, the LGBT population may suffer in silence by their inability to access life-saving antiretroviral drugs (ARVs), inadvertently transmit the virus to others and subsequently die due to AIDS-related complications. For the LGBT population in Uganda, the proposed AHB is a deadly catch-22.
The negative and insidious impact that stigma and discrimination have on HIV awareness, education and prevention has been widely documented.5,6,7,8 When coupled with state-sanctioned homophobia, an environment of fear, shame, and hostility is created. This is evidenced in the Crane Survey,8 one of the only studies to date which examines HIV in relation to men who have sex with men (MSM) in Uganda. Not surprisingly, after the introduction of the AHB in 2009 and despite UNAIDS identifying MSM as one of the highest HIV at-risk groups, Uganda’s Ministry of Health (MoH) stopped collecting data on MSM in relation to HIV. Since then, the only data that has become available is what is offered through the Crane Survey. Based on the 2009 UNAIDS report, MSM accounted for 13.7% of Uganda’s HIV-positive population,9 though it is safe to assume that this number has increased, particularly in light of the AHB and the stigmatizing environment created by this legislation. The Crane Survey, (conducted in collaboration among the United States’ and Uganda’s Centers for Disease Control and Prevention’s (CDC) Division of Global HIV/AIDS, the Center for Global Health at the University of Amsterdam, Uganda’s MoH, and the School of Public Health at Makerere University in Uganda), involved respondent-driven sampling to recruit 300 MSM in Kampala; eligibility criteria included being ≥ 18 years old, being a resident of Kampala and having had anal sex with a man in the last three months.8 Many of the findings indicated high levels of LGBT-related stigma, pointing toward dangerous outcomes regarding HIV transmission within the MSM community and the sexual networks to which MSM are connected. For example, of the 300 participants, 31% had been married, 44% had lived with a female partner, and 16% were currently living with a female partner.8 What this potentially indicates is an environment of embedded stigma where MSM do not feel they can openly identify as gay or bisexual and subsequently live their lives in heterosexual relationships in public while engaging in underground or secretive sexual transactions with other men. Because the sexual relations between men are hidden and taboo, there likely is not much opportunity to discuss safer sexual practices and sexually transmitted infections (STIs), thereby increasing the risks associated with these sexual encounters. In addition, for MSM who are also currently in a sexual relationship with a female partner, unless safer sex is practiced consistently, the female partner is also at risk of contracting STIs. This risk is reflected in MSM’s self-reports regarding condom use by partner type: in the last 3 months, 40% of the sample reported condom use with their casual female partners, 39% of the sample said they used condoms with steady female partners, 43% said condoms were used with casual male partners and 50% stated condom use with steady male partners.8
Other key findings that came out of the Crane Survey included that the MSM within the study sample were found to have relatively low levels of knowledge on HIV risk in relation to anal sex. For example, when asked, “What kind of anal sex do you think is more dangerous to get HIV?”, 11% of the sample said that both insertive and receptive sex had no risk, 65% responded that the risk was equal, 13% thought that insertive sex was riskier and 11% reported that receptive anal sex was riskier. This is especially concerning given that the risk of contracting many STIs, including HIV, is considerably heightened for the receptive partner in both anal and vaginal sex.8 When asked, “Compared to vaginal sex how important is it to use condoms for anal sex?”, 10% reported that it is less important to use condoms for anal sex compared to vaginal sex, which is a troubling percentage given that in terms of the sexual health of MSM, condomless anal sex is generally riskier than condomless vaginal sex in terms of STI transmission.8 What these findings indicate is that there is a considerable gap in terms of the sexual health and safer sex education that is being provided and that MSM in particular are not receiving the sexual health education that is targeted at them. When asked about their last MSM sex act, only 49% of respondents reported using condoms, only 53% had engaged in sex with a steady partner, and only 4% perceived their partner’s serostatus to be positive. In relation to knowledge of one’s own status, 45% of the sample did not know their own HIV status, 44% stated they were negative and 12% stated they were positive.8
These data point to many troubling themes within the MSM community in Kampala. First, it is evident that there is a considerable lack of knowledge around sexual health, safer sex practices and risk-reduction strategies, thereby resulting in an increased risk of STI transmission – not only within the MSM population but also for their female partners and any other subsequent partners in their sexual networks. Second, many MSM are unaware of their HIV status yet are still engaging in sex without condoms, which may potentially heighten the level of risk for everyone involved. With the proposed legislation including the HIV-positive clause under the aggravated homosexuality charge, many MSM may actively avoid getting tested, since not knowing their status decreases their risk of legal consequence and possibly the death penalty. In addition, for any MSM who have had unpleasant experiences within STI clinic settings, this stigmatization presents further barriers to access testing and treatment for those who are positive. As of 2010, only 54% of HIV-positive Ugandans were receiving ARVs;9 for any LGBT HIV-positive Ugandans, there are concerns about possible barriers to accessing treatment, the potential impact of future treatment should they develop any drug resistance, and how discontinuation of ARVs might also impact rates of transmission.
At the time of writing this article, the AHB has not been passed within Uganda’s parliament. Numerous newspaper articles have suggested that the Ugandan government has made some amendments to the bill, including the removal of the death penalty under the aggravated homosexuality charge. However, the amended draft of the legislation has not yet been made available to the public and, therefore, it is not possible to confirm the truth of these claims. Nonetheless, in many ways, the damage has already been done. The Ugandan government has set the stage for gross human rights violations against its LGBT population and, in doing so, has potentially encouraged considerable spread of HIV among the MSM community and beyond. To argue that there is a lot at stake should the proposed Anti-Homosexuality Bill pass is a vast understatement. The situation is dire and what is at risk is not only the lives, human rights and dignity of many LGBT-identified Ugandans, but also the potentially disastrous cascade effect that this legislation could have on HIV awareness, prevention, transmission, and treatment.
Editor’s Note: Under the recommendation of a Special Advisory Committee appointed by the government, the final version of the Ugandan Bill did not include a death penalty clause. The bill was signed into law on Feb 24, 2014 with further revisions.10
- Central Intelligence Agency. “CIA World Factbook.” Last modified February 5, 2013. https://www.cia.gov/library/publications/the-world-factbook/geos/ug.html.
- Jeffrey Gettleman, “Americans’ Role Seen in Uganda Anti-Gay Push,” New York Times, January 3, 2010, http://www.nytimes.com/2010/01/04/world/africa/04uganda.html?_r=2&.
- The Government of Uganda’s Anti-Homosexuality Bill. Accessed January 29, 2013 http://wthrockmorton.com/wp-content/uploads/2009/10/anti-homosexuality-bill-2009.pdf
- Uganda Country Report. UNGASS. Accessed February 9, 2013. http://www.unaids.org/en/regionscountries/countries/uganda/
- Epstein, Helen. 2007. The Invisible Cure: Why we are losing the fight against AIDS in Africa. New York: Picador,.
- Lane, Tim. 2009. From Social Silence to Social Science: HIV research among township Men who have Sex with Men in South Africa. In From Social Silence to Social Science: Same-sex sexuality, HIV & AIDS and Gender in South Africa, edited by Vasu Reddy, Theo Sandfort and Laetitia Rispel, 66-77. Cape Town: HSRC Press,.
- Steinberg, J. 2008. Three-letter plague: A Young Man’s Journey through a Great Epidemic. Johannesburg: Jonathan Ball Publishers,.
- Hladik, W., Barker J, Ssenkusu JM, Opio A, Tappero JW, Hakim A, and Serwass D. 2012. HIV Infection among Men who have Sex with Men in Kampala, Uganda – A respondent driven sampling survey. PLoS ONE 7: 1:9. Accessed February 9 10, 2013 http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0038143
- Uganda Country Report. UNAIDS. Accessed February 9, 2013. http://www.unaids.org/en/regionscountries/countries/uganda/
Ugandan President Yoweri Museveni signs anti-gay bill. Accessed on March 5, 2014. http://www.bbc.com/news/world-africa-26320102