Homophobia and HIV

In my previous "Is Gay OKAY?" blog post, I addressed the Anti-Homosexuality Bill crisis in Uganda. The bill called for the lifetime imprisonment of homosexuals. My blog post left off with the burning question of whether Ugandan President Yoweri Museveni would sign the Anti-Homosexuality bill. I am saddened to say that Museveni signed the Anti-Homosexuality Bill on February 24^th, 2014. The imprisonment ranges from 7 years to life.

The implications of this law are vast and complicated. On one hand, signing this bill is a tragic violation of fundamental human rights. Human rights advocatesare both disgusted and devastated with the decision. For example, U.N. High Commissioner for Human Rights Navi Pillay said, “disapproval of homosexuality by some can never justify violating the fundamental human
rights of others". 

I agree with this sentiment, as I don’t think human beings should be punished for who they are or what they believe in. Our very unique nature doesn’t lend itself to fitting in a specific mold of how a human being “should be”. Our world thrives on diversity, and there is no perfect mold. Even if a perfect mold existed, none of us would fill it. Furthermore, we cannot abuse, discriminate, or criminalize others for being different. Criminalizing homosexuals deprives them of a life of freedom and protection from stigma and violence.

In addition, criminalizing homosexuals perpetuates prejudice and shame that often excludes them from receiving the healthcare that they need. This inequality is unacceptable because it furthers the suffering of an already marginalized group and senselessly
claims a countless number of lives. Sexuality should not dictate who has a right to live, for every person should have a right to health. Thus, this blog post will focus on the health implications of homophobia .

 Because homosexuals are part of a high-risk group for HIV contraction and transmission, I want to explore the relationship
between homophobia and HIV. Does Uganda’s Anti- Homosexuality Law solidify and perpetuate preexisting homophobic sentiments in a way that increases HIV
prevalence?

In order to elucidate a proper understanding of this relationship, I will first establish a historical context of HIV in Uganda.  In the 1990’s, Uganda’s HIV prevalence was an alarming 18%. In response to this climbing HIV rate, Uganda initiated an aggressive “ABC” prevention campaign. The campaign was called “ABC” because it stood for “Abstinence, Being Faithful, and Condoms”. Ugandans were expected to follow the A-B-C approach in order, as the campaign largely focused on encouraging monogamous sexual relationships. Although condoms were an option, the campaign encouraged condom use as a last resort.  Overall, the ABC campaign was conservative because it emphasized monogamy and fidelity. Because the sight of friends and family members dying of AIDS traumatized many Ugandans, they took the HIV campaign very seriously. As a result, the campaign caused a large-scale behavioral change in reducing the number of sexual partners. This led to a HIV reduction from 18% in 1990 to 6% in 2000.  

However, HIV efforts saw failures in the new millennium. In 2003, President Museveni advocated for amore conservative approach.  The ABC campaign quickly changed to a fidelity and monogamy campaign with viral videos and advertisements like this telling people to “Get off the Sexual Network”:

Ugandans were expected to either abstain from sex or be faithful to their partners. Because extra-marital affairs are condemned as wrong, Museveni did not advocate for condoms that would be used in such affairs. Condoms were stamped as facilitators of infidelity.  This prompted President Museveni to neglect condom campaigns and spend a lot of time and money advocating for abstinence instead. Obviously, this is a moral ideal rather than a practical reality.

            As this conservative idealism progressed, social expectations of morality complicated health initiatives to reduce HIV. The neglect of condom campaigns was only the beginning of this mess. The need to maintain a morally upright society turned HIV prevention efforts on its head, as more emphasis was placed on eliminating marginalized communities such as the homosexuals. Thus, the people who were at highest risk for HIV infection were ignored.

          In 2009, homophobia climaxed with the proposal of an Anti-Homosexuality Bill that criminalized same sex relations and imposed a death penalty on homosexuals.  Despite the fact that this bill wasn’t passed till February 2014 (potential life imprisonment instead of death penalty), it is clear that homophobic sentiments have historically dominated Ugandan society. These sentiments bar homosexuals with HIV from receiving HIV care.

Statements like this highlight the issue further:

Presidential Advisor on Science Dr Richard Tushemereirwe told Museveni that "homosexuality has serious public health consequences and should therefore not be tolerated".

This statement truly troubles me because it seems incredibly backwards. The fact that serious public health consequences like HIV exist in the homosexual community is the REASON THEY SHOULD tolerate homosexuality. Toleration is not promotion. Ugandan health professionals might not be willing to promote homosexuality, but that doesn’t negate the fact that these are human beings in need of health care.

 Furthermore, providing healthcare is not synonymous with promoting homosexuality in the same way that providing condoms is not synonymous with promoting infidelity. What is “right” should not be equated to what is “safe”. These terms are not mutually exclusive. Criminalizing homosexuals will only worsen access to healthcare and thus increase HIV rates.

Here are some examples of barriers to HIV care that homosexuals with HIV face:

• Choose to hide their sexuality. Condemned to a life of secrecy
• Widespread intolerance prevents them from accessing HIV services
• Homosexuals are excluded from HIV studies. This means public health interventions are never created to address their needs
• Information about gay men not widely available: causes lack of health knowledge about how to practice safe anal sex and how to access HIV care
• Gay men face discrimination for being both gay and HIV + causes social ostracism from services
• Violence, threats, stigma

        The Anti-Homosexuality Law simply confirms that neglect and abuse of homosexuals is okay. It solidifies the injustices they already suffer in a stigmatizing society, building a bigger wall between HIV infected homosexuals and the treatment they need. 

Since 2003, when Museveni shifted HIV efforts in a more conservative direction, HIV has increased from 6 to 7.4%. I believe that Uganda’s morality conflict accounts for this increase, and the Anti-Homosexuality bill was just the icing on the cake. The Anti-Homosexuality Law highlights a larger societal issue that needs to be addressed. Without a serious break in the entanglement between morality and public health, I fear that Uganda is headed down a road with devastating health consequences.