The HIV/AIDS treatment centre in Kampala, Uganda, is grappling with a significant decline in patients, as one of the world’s most oppressive anti-gay laws takes effect. The usual daily influx of approximately 50 patients has dwindled to near emptiness, leaving antiretroviral drugs unused and the fight against HIV compromised. Concerns are growing among medical staff at the US-funded clinic, as new waves of HIV infections emerge while vulnerable individuals shy away from treatment centers, fearing identification and arrest under the new legislation.
The anti-gay bill, recently signed into law by President Yoweri Museveni, imposes life imprisonment for engaging in same-sex relations, with “aggravated homosexuality” carrying the penalty of death, including in cases involving HIV transmission. The impact of this legislation on the Kampala clinic, once a symbol of success in combating HIV/AIDS, has been devastating. Uganda, with 1.4 million people living with the virus and an annual death toll of 17,000, as reported by the Uganda AIDS Commission, now faces the severe consequences of patients avoiding treatment, resulting in the presentation of more advanced HIV cases.
Andrew Tendo, resident medical officer at the clinic, warns of the distressing situation faced by the LGBT community in Uganda, stating, “They don’t have preventive services. They cannot access condoms…they cannot access ARTs (antiretrovirals).” While Uganda’s health minister denies the notion that the law will reverse the country’s progress in fighting HIV/AIDS, the trend of patients refraining from seeking treatment extends nationwide. Mary Borgman, country director for the US President’s Emergency Plan for AIDS Relief (PEPFAR), confirms the escalating fear factor deterring people from treatment since the introduction of the anti-gay bill in parliament.
The detrimental consequences of reduced American funding loom over Uganda’s healthcare system. Concerns are raised that the free services and essential support received by the LGBT community could be jeopardized, compounding the fear that has already confined many to their homes. President Joe Biden has directed his National Security Council to evaluate the implications of the law on US engagement with Uganda, including PEPFAR’s role. PEPFAR’s funding, totaling $418.4 million in the last fiscal year, constitutes over half of Uganda’s HIV/AIDS treatment budget, making any potential cuts a significant threat.
Efforts to combat the HIV/AIDS epidemic in Uganda have relied heavily on PEPFAR’s support, resulting in remarkable progress over the years. Scaling up antiretroviral treatments and prevention programs have averted nearly 600,000 HIV-related deaths between 2004 and 2022, as estimated by PEPFAR. However, the specter of reduced funding leaves vulnerable communities, including LGBTQ individuals, at great risk. The implications of the anti-gay law extend beyond medical access, as providers fear that offering healthcare services to LGBTQ patients may be construed as “promoting” homosexuality, punishable by up to 20 years in prison.
In the midst of this challenging landscape, the Kampala clinic’s medical officer, Andrew Tendo, empathizes with the struggles faced by LGBTQ people in Uganda, who have already endured rejection and arrests. Their reluctance to seek medical care stems from the fear of being raided or detained at any moment. As the nation grapples with the devastating consequences of these anti-gay laws, urgent measures are needed to ensure access to HIV/AIDS treatment, protect vulnerable communities, and combat the spread of the virus.