Uganda's new anti-LGBTQ law could make PEPFAR's work 'illegal'

Uganda has “gone back 100 steps backwards in the fight against HIV/AIDS,” activists there say after the country’s president approved a draconian anti-gay bill which has also led to warnings of sanctions and visa restrictions by donor countries. The law, signed by President Yoweri Museveni, includes the death penalty for "aggravated homosexuality," which it defines as same-sex acts involving people living with HIV or minors, among others. The bill approved by the leader on Friday and announced in a statement by the speaker of the country’s Parliament, Anita Among, on Monday, also prescribes up to 14 years in prison for “attempted aggravated homosexuality” and 20 years for the “recruitment, promotion and funding” of homosexuality. After a version of the bill was passed through Parliament in March, activists warned that the legislation would essentially criminalize inclusive HIV programs and undermine the country’s efforts to end AIDS by 2030. Some said that the bill would essentially make some U.S. President’s Emergency Plans for AIDS Relief-funded programs “completely illegal.” Shantal Mulungi, executive director of Coloured Voice Truth, stressed to Devex that the law prohibits queer people from assessing medical services in hospitals. “Automatically we have gone 100 steps backwards in the fight against HIV/ AIDS,” she said. She added that on the same day that the law was approved, her landlord had thrown her out “with immediate effect.” In a joint statement, the Global Fund, UNAIDS, and PEPFAR’s heads said that “Uganda’s progress on its HIV response is now in grave jeopardy.” They called for the law to be reconsidered. “The Anti-Homosexuality Act 2023 will obstruct health education and the outreach that can help end AIDS as a public health threat,” wrote Peter Sands, executive director of the Global Fund, Winnie Byanyima, executive director of UNAIDS, and Dr. John Nkengasong, U.S. global AIDS coordinator and special representative for global health diplomacy for the U.S. Department of State. “The stigma and discrimination associated with the passage of the Act has already led to reduced access to prevention as well as treatment services.” They noted that Uganda and Museveni had displayed leadership in the fight to end AIDS, “The strong health systems built to support the AIDS response serve the entire population of Uganda.” “This was evident as community health workers and health systems developed for the AIDS response played a key role in tackling COVID-19 and other disease threats.” The U.S. government is the single largest donor to Uganda’s health sector. It contributes 32% of total health spending in Uganda annually, accounting for 76% of all overseas contributions to the sector. Through the U.S. Agency for International Development, the U.S. has invested about $39 million over six years. U.S. President Joe Biden has called for the “immediate repeal” of the new law. “Innocent Ugandans now fear going to hospitals, clinics, or other establishments to receive life-saving medical care lest they be targeted by hateful reprisals,” he said in a statement. Biden said that he had asked the National Security Council to assess the law’s consequences on all aspects of the country’s engagement with Uganda, including its capacity to safely deliver services via PEPFAR assistance and investments. Steven Kabuye, co-executive director of Coloured Voice Truth, told Devex that the law could lead to individuals being afraid to seek medical care or disclose their sexual orientation to health care providers. Furthermore, the law also criminalizes the promotion of homosexuality, which could make it difficult for organizations working to provide HIV prevention and treatment services to the LGBTQ+ community to operate. This could result in the inaccessibility of services and have a significant impact on the health of individuals in the LGBTQ+ community, said Kabuye. But he said that activists in Uganda last month urged different countries not to cut aid to Uganda because it would widely affect the whole country “if the leading health sector donors back down.” A petition challenging the law was filed Monday evening in a Kampala court by 11 members of Parliament and organizations, including MP Fox Odoi-Oywelowo, the only legislator who voted against the latest version of the bill in Parliament. Odoi-Oywelowo told Devex the law will “reverse the gains made by Uganda in the fight against HIV/AIDS,” given the responsibility it places on medical practitioners and landlords to report same-sex relationships. “The LGBTQ+ community will be driven underground and may not easily access medical care.” In a response to Nkengasong on Twitter, Uganda’s health minister Dr. Jane Ruth Aceng Ocero said that the government will “ensure that prevention programs for HIV epidemic control remains accessible to those that need them in a non-discriminatory manner observing principles of confidentiality and equity.” Uganda’s information minister Chris Baryomunsi, the government’s spokesperson on the issue, told Devex that “it is ridiculous to hear from PEPFAR, Global Fund and other Partners claiming that the AHA will reverse the gains in the national HIV/AIDS response.” “Probably, what these partners are saying is that they will withhold their financial resources because of this law,” he said. “This kind of blackmail is not acceptable.”