If no adjustments are made, the Anti-Homosexuality Act 2023 will obstruct health education and the outreach that can help end AIDS as a public health threat.
This Spring the Parliament of Uganda instituted one of the most severe anti-LGBTQIA+ laws in the world. The bill builds on existing anti-LGBTIA+ laws under the Uganda Penal Code Act.
The Uganda Penal Code Act includes provisions for “unnatural offenses,” in so that any person who “has carnal knowledge of any person against the order of nature” or “permits a male person to have carnal knowledge of him or her against the order of nature,” has “committed an offence and is liable to imprisonment for life.” The Penal Code provides a clear example of the ways in which same-sex activities are currently criminalized in Uganda.
The Anti-Homosexuality Act (AHA) further escalates penalties in the Penal Code. The new act includes ten-year sentences for attempts at same-sex conduct and, under specific circumstances, the death penalty. Several provisions of the AHA are broader and more punitive than the existing penal code act (section 145) by making same-sex practices a capital offense. For instance, the bill criminalizes the “promotion of homosexuality,” which creates a hostile environment for individuals, activists, and organizations who advocate for LGBTQIA+ rights. The clauses to “impose a burden on the community to report homosexuals” and “aiding and abetting homosexuality” can affect the provider-client relationship whereby health providers may be forced to disclose the identity of a MSM or a transgender person. In health care settings, confidentiality must be maintained at all costs unless there is an imminent risk to self or others posed by non-disclosure. The perception that health providers can disclose MSM or transgender persons’ identity to authorities would severely affect access to services and diminish the clients’ ability to disclose their sexuality and receive appropriate care or services. In addition, health providers may be unwilling to provide services to MSM and transgender people for fear of being at odds with the law or because of stigma and discrimination.
The institutionalization of discrimination and stigma will further push vulnerable communities away from life-saving health services. Research in sub-Saharan Africa show that HIV prevalence in countries that criminalize same-sex activities is five times higher among men who have sex with men than it is in countries without such laws. If no adjustments are made, the Anti-Homosexuality Act 2023 will obstruct health education and the outreach that can help end AIDS as a public health threat.
This bill may also obstruct research efforts in Uganda. At-risk populations such as MSM and transgender persons may be unwilling to participate in research for fear of being identified. Furthermore, the researchers may fear engaging with LGBTQIA+ communities because of contravention of the laws. Regulatory agencies may be unwilling to grant ethical approval for research studies targeting MSM and transgender people. It may also be difficult to find venues or safe spaces in the community to conduct studies as landlords may be unwilling to be associated with LGBTQIA+ groups.
A 2022 paper also identified high HIV and sexually transmitted infection (STI) risk among younger and older male sex workers (MSW) in Kenya, many of whom reported engagements in same-sex activity, stressing a need for targeted risk reduction and service access campaigns. The Council’s previous HIV work in East Africa has focused on these key and vulnerable population groups. For example, our six-year Project SOAR (Supporting Operational AIDS Research) spanned 21 countries (including Uganda and Kenya) and examined strategies to increase HIV testing, and link people living with HIV to receive care and treatment. This anti-LGBTQIA+ bill, and similar legislative patterns emerging across East Africa, fosters a hostile environment that discourages much needed future research. The AHA makes it increasingly difficult to target MSM and other hidden and at-risk groups with health services and research which is the basis for evidence-based programming.