John (not his real name) is 24 years old and, for the last three years, he has been at the forefront of the HIV response for men who have sex with men (MSM) in Uganda. He was in the UK last week to take part in an Alliance-run advocacy training course for youth leadersI.
John is an outreach worker at Uganda's first clinic for lesbian, gay, bisexual, transgender and intersex (LGBTI) people in the capital, Kampala, where it provides testing, counselling and treatment for HIV and other sexually transmitted infections.
“Over the last three years, the community has become more determined; they have found a new confidence about accessing services. When our clinic opened two years ago, there was initially a low turnout. Men were in the closet, frightened, in fear of being outed and disowned by their family. But we did lots of outreach. People came on board.”
Accurate data on MSM in Uganda is difficult to find. However, one study from 2008-2009 (published 2012), found that HIV prevalence is 13.9% - almost double the national average of 7.2%.
Until last week, the clinic where John works was seeing 20 to 25 young men each day – in addition to fielding telephone calls for advice. Many of the peer workers at the clinic are also ‘treatment buddies’ for young men living with HIV. This is someone who takes on a special role of helping a client to stick to their anti-retroviral treatment regimen. John is a buddy to 15 clients at the clinic.
“They feel confident with me,” he says. “I act as their advocate.”
John developed his drive to help other young people when he was at school.
“I saw what they were going through. I said ‘let me fight for them’.” John also lost a cousin to AIDS. “I watched the challenges he was going through – the sickness and the stigma. I said to myself ‘What if I was the one? This is wrong’.”
In his two years at the clinic, John has watched five ‘comrades’ die from AIDS related illness. He says that many MSM live in denial, experiencing the ‘double stigma’ of being both gay and living with HIV, tells the story of his first client. John persuaded him to have an HIV test, and he discovered that he was not only HIV positive but had a CD4 count of just 40.
“He got on the treatment too late. He died at the clinic. I was there.”
A step back for the AIDS response in Uganda
During the week that John spent in the UK, the President of Uganda, Yoweri Museveni, signed into law the Anti-Homosexuality Act. The Act, first introduced in 2009, threatens LGBTI Ugandans with life imprisonment for having sex, getting married or even touching another person with ‘intent’.
“This law will take the movement a step backwards.” John says. “All that work over the last three years, it may be for nothing.”
At the clinic they are already seeing its effect. John explains, “the doctors came as usual this week, but the youth did not. Only a few showed up. They are scared.”
Being away from home last week was tough. Two of John’s friends were ‘outed’ in a national Ugandan newspaper, Red Pepper, which shockingly printed a list of ‘200 top homos’. However, John was happy to have been part of the advocacy training course and says the support of the Alliance and its partners is important. “If you have someone behind you pushing and supporting, you can never give up.”
Despite the dangers, John was determined to return to Uganda at the end of the training.
Global commitments to tackle HIV by 2015 and to halve the number of countries with “punitive laws and practices” are at risk. With over 80 countries globally listing homosexuality as a crime, we are going backwards not forwards.
Criminalising homosexuality does untold damage to HIV treatment and prevention efforts. On top of this, the Ugandan law also criminalises anyone who ‘aids or abets homosexuality’. Enrique Restoy, the Alliance’s senior adviser on human rights explains the impact of this.
“Criminalisation increases the reluctance of HIV providers to engage with this population…we have seen this among some health providers in Uganda, Nigeria, and Senegal who are increasingly afraid to offer services.”
In addition to losing services, Restoy says “our partner organisations have documented a number of cases of discrimination in public health-care settings and refusals to provide treatment for the LGBTI community”. If there aren't enough resources to treat everyone, “those who are branded as ‘criminals’ are the first to be denied treatment or discriminated against”, he says.
Support for John and his colleagues
- The Alliance is coordinating it’s response to the emergency in Uganda, working with partners on the ground and with others around the world to challenge the Bill and provide emergency support to those most affected. Follow us on Twitter for regular updates.
- On Friday 7 March, activists have organised a global day of action against Nigeria’s same-sex law. Find out how you can support the movement here.
- The Global Forum on MSM & HIV are coordinating a sign on campaign to bring lesbian, gay, bisexual, and transgender (LGBT) issues to the forefront of the next WHO Executive Board Meeting in May 2014. Sign up here.
I The training was part of Link Up, a Dutch funded programme which aims to improve the sexual and reproductive health and rights (SRHR) of more than one million young people living with and affected by HIV in five countries.
- Link Up: download this Project Overview which describes the programme (2013-2015).
- Discrimination against LGBT people triggers health concerns: read this report in The Lancet.
- African civil society speaks out: read this statement from the The AIDS and Rights Alliance for Southern Africa (ARASA) condemning the signing of the Bill, and this statement by Alliance Linking Organisation, BONELA, which calls on the Botswana government to condemn the Ugandan Law.
The law will take the movement a step backwards. All that work, it may be for nothing.