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amfAR's GMT Initiative supports grassroots organizations that respond to the devastating impact of HIV/AIDS among gay men, other men who have sex with men, and transgender individuals (collectively, GMT).

The Impact of the Nigerian and Ugandan Anti-Gay Laws on Public Health

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Posted by John Power on March 18, 2014

Protestors in front of the of the Nigerian Consulate in New York during the March 7 Global Day of Action against the Nigerian anti-gay law. 
Protestors in front of the of the Nigerian Consulate in New York during the March 7 Global Day of Action against the Nigerian anti-gay law.

Studies have clearly shown that criminalizing same-sex sexual behavior poses an immense structural barrier to HIV prevention. It “drives men away from services, reduces the likelihood of disclosure of risks to providers and partners, and makes men vulnerable to blackmail,” Dr. Chris Beyrer, the current president-elect of the International AIDS Society, wrote in 2010. Indeed, Nigeria and Uganda’s new anti-gay laws are already proving that they will be extremely destructive to efforts to combat HIV. In both countries, same-sex behavior was already illegal, but the new laws increase the severity of the prison sentences faced by LGBT and criminalize organizations that serve them.

Reports indicate numerous LGBT Nigerians have been assaulted and arrested since its “Same-Sex Marriage Prohibition” law was signed in January. On February 25, days after a similar bill was signed into law, a major Ugandan tabloid published a list of “Uganda’s 200 Top Homos,” prompting fears of attacks and arrests among Ugandan LGBT. As a result, healthcare centers serving GMT have closed their doors in both countries amidst fears of mob attacks, leaving GMT without HIV treatment and prevention services. Furthermore, many GMT have gone into hiding and are afraid that they will be targeted at health centers.

Since these laws also criminalize LGBT organizations, activists and healthcare providers are uncertain how they will affect the organizations that continue to provide GMT with HIV services. Will the ten-year prison sentence for Nigerians who “make public show of same sex amorous relationships” apply to patients who disclose their identity as GMT to their doctor? Will Ugandan healthcare workers report HIV-positive GMT to the police, leading to life sentences? Will Ugandans who distribute condoms to GMT or the healthcare workers who treat them be punished with a seven-year prison term for “aiding or abetting of homosexuality”?

Although HIV is diminishing in other parts of the world, the epidemic is a growing problem in these two countries. The latest data show that Nigerian MSM have an HIV prevalence of 17.2%, compared to the nationwide prevalence of 4.1%. An estimated 13.7% of Ugandan MSM are HIV positive, compared to a 7% prevalence nationwide. Without reform, the new laws will only cause these rates to rise. This is especially devastating in light of the recent progress that both countries had made in addressing HIV among GMT. Nigeria, for example, had one of the few African governments that had developed robust MSM-specific HIV goals. These included reducing HIV prevalence among MSM from 17.2% to 8.5%, increasing MSM condom use from 52.8% to 80%, and increasing the percentage of MSM who have been tested for HIV in the past year from 31.5% to 50%. Unlike most other African governments, the Nigerian government even designed a package of HIV services for MSM, which it aimed to deliver to 80% of them by 2015.

However, new reports indicate that the Nigerian government will no longer monitor HIV among GMT, a sign that its GMT programs will also be brought to a halt. We should not allow ourselves to be fooled by Nigerian and Ugandan government officials who proclaim that anti-gay laws won’t set back the HIV response or cause GMT to be discriminated against in the healthcare setting. The new wave of discrimination has already begun.

Developments over the past three weeks have also shown that the laws’ effect extends beyond national borders. For example, activists in Kenya have been threatened by mob justice, and Kenya, the Democratic Republic of the Congo, Malawi, and other countries have all seen a reinvigorated flurry of movement toward similar anti-gay legislation. Since these are countries where GMT are also disproportionately affected by HIV, this type of legislation will only impose further barriers to the HIV response.

If governments across Africa don’t reverse their course and commit to delivering equitable healthcare to GMT, the consequences could be disastrous. The gravity of the moment requires immediate steps to protect the rights of GMT, a sharp push to monitor GMT health, and a concerted effort to repeal the anti-gay laws or overturn them in the courts.


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