Three months after it was signed by President Yoweri Museveni, the real implications of Uganda’s controversial anti-gay law are starting to be truly felt by the international aid community.
Donors have cut or redirected aid, some implementers and health workers have been subject to raids and harassment, and a growing number of members within the country’s LGBT community are finding it more difficult to get treatment against HIV and AIDS.
To make matters worse, now another bill threatens to criminalize intentional transmission of HIV. The legislative proposal had been sitting in parliament since 2010, but with HIV and AIDS infection rates rising and Uganda starting to lose the battle against the disease despite being touted as a model for its anti-HIV strategy just a few years ago, the government seems to think the new bill — or rather parts of it — can bring the numbers down.
“For me, it's a mixture between panicking and misunderstanding of how the HIV response happen, and finding a scapegoat for an epidemic that criminalize across the whole Uganda population,” said Enrique Restoy, senior adviser on human rights at the International HIV/AIDS Alliance.
Under the bill, those proven to have intentionally transmitted HIV to another individual and those who attempted to do so could serve up to 10 years and five years in prison, respectively.
But whether it gets signed into law or not, evidence from the report of the Global Commission on HIV and the Law, which found that more than 60 countries around the world have criminalized HIV transmission, exposure or nondisclosure, shows that criminal laws, while often passed with good intentions in mind, impede AIDS responses by fuelling stigma and discrimination, which discourages people from accessing HIV prevention services, Tenu Avafia, policy advisor for human rights, law and treatment access at the U.N. Development Program in New York, told Devex.
This means the bill Uganda wants to pass could potentially drive up — not down — HIV and AIDS cases in the country.
"The evidence is quite clear: the criminalization of transmission, nondisclosure or exposure to HIV hasn't reduced incidents of HIV transmission ... if anything there are clear linkages between punitive legislation and the increase of stigma and discrimination ... which in turn drives the AIDS epidemic underground, because few people are then getting tested," he said.
‘Double letdown’ for LGBTs
It’s a double letdown for members of the Uganda’s LGBT community, whom Restoy said are "coming less and less forward to receive anti-HIV services."
Implementers are already starting to think about what it will mean for them and how criminalizing HIV transmission can impact their work on the ground.
Fluvia Birungi, program officer at ACORD Uganda, told Devex that although it's too early to speculate about such a scenario, they are already seeing potential problems, like for instance reaching their beneficiaries — especially women — who may be turned down by health service providers if their husbands don't accompany them when they get tested for HIV. This is required under the current bill, but in Uganda’s male-dominated and ultra-conservative society, husbands aren't very keen about going with their wives for testing, or counseling.
This was supported by Restoy, who gave the following scenario: "You can imagine now, if you are a gay person in Uganda and you are HIV-positive, you can imagine how little encouragement there is for you to attend a public hospital with that issue, knowing that you have two pieces of legislation criminalizing you twice."
The Alliance and the AIDS & Rights Alliance for Southern Africa have recently come out with a Good Practice Guide in integrating human rights in HIV response in response to such punitive laws.
Several members of civil society and groups including the Global Commission on HIV and the Law have called for the president not to sign the bill. It’s better, Avafia highlighted, to do this now rather than just wait for the proposal to be debated and later approved by the president, as after which additional steps such as an amendment would be required.
"Prevention is better than cure. Rather than trying to reverse legislation, it makes sense if we can prevent the passing of legislation that can impede the anti-AIDS response," he said.
Uganda’s decision goes against the growing trend in some countries, such as Guinea, Senegal and Togo, where similar laws have been revised or new laws have been adopted to “limit the use of HIV transmission to exceptional cases of willful transmission,” according to a statement released on Thursday by members of the Commission.
Law reform often requires persistence. Even in developed countries like Denmark, for instance, it took several years of intervention by civil society and experts before the government was persuaded to suspend a 1994 law criminalizing HIV transmission.
But how about donors? How are their concerns — if any — being communicated on the ground?
So far, there hasn't been an uproar, but Birungi said that doesn't mean they shouldn't be talking about the bill, which if passed could have huge implications on their anti-HIV efforts in the country — as well as in the global response against the disease.
Maybe, some have even suggested, the silence could have something to do with the fact that a few donors have in effect laws similar to the one Uganda could pass.
"What many donors or international actors do nationally is not necessarily what they preach internationally,” Restoy said. “Intergovernmental agencies state very clearly how negative the impact of criminalization is, and that it is not the way to go, but there's a disconnect between HIV governance, what happens at the national level, and what happens for recipient countries."
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