As Uganda seeks to reverse rising HIV infection rates, Ugandan LGBTI activists are seeking improved contacts with leaders of anti-AIDS programs and an end to stigma that excludes LGBTI people from HIV services.
By Kikonyogo Kivumbi
Ugandan LGBTI human rights activists want the U.S. President’s Emergency Plan for AIDS Relief (Pepfar) in the country to directly work with their community to scale down HIV/AIDS infections.
At a consultative meeting between Pepfar’s Uganda staff and civil society leaders on Feb. 3, in Kampala, human rights defenders said that current implementing partners (IPs) for Pepfar Uganda are not adequately consulting LGBTI and Key Populations during programme interventions, especially in rural areas. IPs are institutions that enter into contractual obligations to execute Pepfar programmes. No LGBTI-led group or institution is an IP in Uganda.
An earlier meeting that had been planned for Jan. 17 between Pepfar Uganda’s IPs and civil society organizations was called off at the last minute, furthering uneasiness among activists that Pepfar does not care about constructive criticism of its underperforming and homophobic IPs .
But Heather Smith, acting Pepfar coordinator in Kampala, said the meeting will be rescheduled and that “Pepfar takes feedback on its programmes seriously.”
Mark Meassick, Uganda mission director for USAID, encouraged activists to ask for more support from the Ugandan government’s health sector. Pepfar cannot do everything for the country, he said.
Political changes, in particular a “proliferation of new districts across the country,” have increased the costs of programme management, he said. In Uganda, the government has created many new districts for political reasons. As a result, many donors complain, the cost of public administration is soaring and the cost of programmes management is increasing. The country is now divided into more than 100 districts, up from about 33 that existed 30 years ago.
Meassick said activists should find ways of encouraging communities and the local government authorities to channel tax revenues to the health sector, and should advocate for increased budget allocations.
In the past, Uganda and the United States have had a difficult relationship in managing HIV among LGBTI and Key Populations groups. In 2014 in Kampala, a U.S.-funded LGBT-friendly clinic run by the Makerere University Walter Reed Project was raided by security agencies, which accused the clinic of promoting homosexuality. The clinic was then closed.
The clinic was later re-opened, and some Uganda government officials have consistently accused the U.S. of peddling “ gayism.” The United States withdrew some support from Ugandan recipients of U.S. federal funds to protest discrimination against Ugandan LGBTI people in accessing health service. The U.S. openly and publicly criticised Uganda for the Anti-Homosexuality Act, which was enacted in 2014 and overturned by the Constitutional Court later that year.
Many LGBTI-friendly institutions and civil society groups fear that new U.S. President Donald Trump may withdraw U.S. support to groups that provide LGBTI access to health services in Uganda, including Pepfar. One reason for that fear is the executive order Trump signed on Jan. 23, barring U.S. funding worldwide to any health-care organization that provides abortions or abortion-related family planning, even if U.S. dollars would not go to those abortion-related services.
Ugandan gay activists have urged the United States in the past to deny funding to anti-gay groups and groups fomenting anti-gay violence. Some gay-friendly institutions have backtracked on openly supporting LGBTI people’s right to health services, preferring a wait-and-see approach if the new U.S. administration will continue supporting LGBTI health programmes.
How Uganda is faring with Pepfar support
Uganda is one of a few African Pepfar-focused countries reporting rising rates of HIV infection. A new Ugandan government study (obtained and discussed Feb. 7 by the Erasing 76 Crimes blog) indicates that Uganda’s HIV burden has shot up from 1.4 million people infected in 2013 to 1.5 million in 2015.
That study, the Uganda HIV and AIDS Country Progress Report by the Uganda AIDS Commission, focused on the period from July 2015 to June 2016. It assessed the first year of implementation of Uganda’s National HIV/AIDS Strategic Plan (NSP).
LGBTI Ugandans bear the biggest burden of the HIV pandemic due to harsh, hostile laws and social stigma, which bar gay people from access to health services due to their actual or suspected sexual orientation or gender identity/expression. Reports indicate a 13 percent HIV prevalence among men who have sex with men (MSM) as compared to 7.3 percent in the general population.
If LGBTI and other Key Populations don’t have access to Pepfar Uganda’s IPs, “neither are we able to encourage our members to take up the services they offer,” said Yusuf Mawazo, an advocate for increased services to Uganda’s fishing communities.
People in Ugandan fishing communities are at high risk of contracting HIV, he noted. They need immediate support from the government, Pepfar and well-wishers, he said.
What’s needed, he said, is “to mobilize these communities for testing, ART [antiretroviral] intake and follow-up, like what the Global Fund does in some instances.”
The Feb. 3 meeting was held as part of the ongoing development of the Pepfar Uganda Country Operation Plan (COP) for 2017. [See the “Civil Society Rough Guide to the Pepfar 2017 Country Operation Plan (COP) Process.”] A total of US $379.1 million has been earmarked for COP 2017, according to a U.S. Department of State letter on Jan. 18, 2017, to Deborah R. Malac, the U.S. ambassador to Uganda. (Erasing 76 Crimes has obtained a copy of that letter.)
The meeting was organized by Pepfar Uganda to bring together a cross-section of key stakeholders in the national HIV response, including mainstream organizations. Civil society organizations (CSOs) had been widely consulting among themselves, discussing priorities for scaling down infections in the new COP. Malac said CSOs reach more inaccessible community members, whom even some government programmes cannot currently reach.
At the meeting, Geoffrey Mujisha, director of the Most at Risk Populations Network (MARPS Network), presented the priorities of LGBTI and Key Populations for COP 2017. He suggested that Pepfar Uganda needs to take a new approach, including:
- Targeting hot spots for HIV testing.
- Considering expansion of HIV self-testing.
- Partnering with bar managers and beach management committees.
- Working with trained focal persons in health facilities.
- Continuing to explore differentiated care delivery models both at the facility level and at the community level.
- Scaling up PrEP (pre-exposure prophylaxis) — medication for high-risk populations that can prevent people from contracting HIV infections.
- Expanding peer-to-peer programs along the entire continuum of care.
- Piloting drop-in-centres.
- Estimating the size of Key Populations.
- Sensitising at-risk communities.
Kikonyogo Kivumbi is the elected representative for Ugandans who are most at risk of HIV on the CCM health panel, which oversees programs supported by the Global Fund. He is also the executive director of the Uganda Health and Science Press Association.
In cooperation with Erasing 76 Crimes