Navigating Healthcare Amidst Legal Measures of the Anti-Homosexuality Act

Michael works as a health worker overseeing Sexual and Reproductive Health (SRHR) Services for Key and Priority Populations (KPPs) at a health facility in one of the cities in this country. These populations include female and male sex workers, men who have sex with men (MSMs), people who inject drugs, individuals in prisons and other closed settings, and transgender individuals.

Among the SRHR services provided to these populations are PrEP (which reduces the risk of HIV transmission), HIV Testing Services, Mental Health facilitation, Counseling, ART Care, Family Planning Services, PEP, STI Screening, Cervical Cancer Care, Post Abortion Care, Proctology, and management of NCDs, among others.

Michael’s life took a drastic turn when Parliament passed the Anti-Homosexuality Bill, subsequently signed into law by the President. His name, along with other health workers, was exposed on social media, linking them to homosexuality due to their work with LGBTQI+ individuals.

On May 26^th 2023, President Yoweri Museveni signed the Anti-Homosexuality Bill 2023 into law. The bill was introduced as Private Members Bill by Bugiri Municipality Member of Parliament, Hon. Asuman Basalirwa. The law criminalizes the act of homosexuality, explained in the law as a person performing a sexual act or allowing a person of the sex to perform a sexual act on him or her. A person who commits the offence of homosexuality is liable, on conviction, to imprisonment for life.

Following the signing, a Drop in Centre (DIC) affiliated with Michael’s health facility was surrounded by security officers from the police and UPDF. All individuals present, including health workers and peers were arrested and faced charges that were unrelated to their activities at the facility.

Materials such as condoms and lubricants, crucial for the health of KPPs, were seized during the raid. Despite being accused of promoting homosexual acts, the charges brought forth during court proceedings, such as theft and assault, were unrelated to their work.

In the aftermath, Michael’s colleague from the health center was also arrested, and his home was raided, resulting in the confiscation of similar materials. He is still in prison.The police demanded access to their workplace, where Michael and his team were detained and questioned regarding the use of lubricants found in the clinic.

Lubricants, commonly associated with men who have sex with men, are also utilized by female sex workers to prevent friction with their clients. However, misconceptions persist, leading security operatives to wrongfully arrest health workers under allegations of promoting homosexuality.

His name and the health facility were exposed on social media by individuals opposed to homosexuality. This exposure led to public scrutiny, loss of customers, eviction from his residence, and closure of his businesses.

However, Michael’s experience is not unique, as many health workers have faced harassment and various challenges since the enactment of the Anti-Homosexuality Act. These challenges include eviction from offices and homes, lack of trust from clients, closure of facilities, misinformation, lack of resources, forced rebranding, public exposure, and intimidation by law enforcement agencies.

Some health workers have also faced stigma from their family and friends who still do not want to associate with them because they think that providing SRHR services to KPPs aligns a health worker with the LGBTQ+ community. Additionally, some peers working at health facilities discriminate against KPPs through language and by refusing to serve them. They refer to them as “Those people,” “so-and-so’s people,” “the gays,” and “men-women” for transgender women, among other humiliating names. This has pushed many away to remain in communities for fear of being exposed by peers who are often too loud.

“It is nearly impossible for a patient to trust a health worker whose identity has been exposed on the internet and whose work has been jeopardized. Out of 25 KPPs I used to serve every week before the AHA was signed, less than 5 show up since it was passed. Some of these are even new and all my previous clients fear showing up at the facility. They even changed their phone numbers for fear of being tracked and I have no means of reaching out to them,” says one of the health workers.

Adding that “there is still a lack of trust, which keeps KPPs away from health facilities since they do not feel protected. With the law also came the challenge of outreaches. Many KPPs used to receive Sexual and Reproductive Health (SRHR) services in outreaches because we were coming closer to them, and they did not have to endure the burden of transport and being shamed. But with the current law, it is impossible for us to do this work due to lack of funding and trust from the KPPs.”

According to Agnes, a health worker in Kampala, she attempted to carry out an outreach with the hope of finding her clients in one of the Kampala suburbs. Unfortunately, a few minutes into the outreach, someone called the area leaders who surrounded her and scared off all the KPPs. They also threatened to take her to the police if she did not bribe them with a certain amount of money, which she did not disclose.

Unbeknownst to them, she was only volunteering and she did not have any money. Agnes was forced to call up a few friends who came to her rescue. She had in her possession boxes full of lubricants, condoms, HIV self-test kits, PrEP, and PEP, among other items needed by KPPs. When she tried to get in touch with the KPPs again, they reminded her how she had put their lives in danger and that they could not trust her again.

This has discouraged many other health workers who say community leaders attack, threaten and chase them away whenever they bring Sexual and Reproductive Health services to their areas, claiming that they are targeting to recruit children into acts of Homosexuality, despite KPPs including many other categories of people benefiting from SRHR services. The offence of promotion of Homosexuality according to the Anti-Homosexuality law, carries a punishment of imprisonment for a period not exceeding twenty years upon conviction. This discourages many health workers from carrying out outreaches in areas where some KPPs are suspected to belong to the LGBTQ+ community.

Outreaches are also a very expensive venture. However, with the signing of the law, many NGOs and other organizations that used to sponsor such activities have pulled back the funding, making it impossible for the health workers to afford such activities. According to one of their health workers, they have laid off more than 100 peers who used to do out reaches because there is no work for them anymore. This has caused unemployment, which is dangerous in our current times as a country. They called for more organizations to reconsider the decision to withhold funding as this is turning out to hurt many members of the community.

For some other health workers, they pretend to be security guards at their facilities for fear of being arrested whenever security operatives come for the security sweeps. There is hope that with sensitization from responsible organizations and the health ministry, local leaders can join forces with health workers to help KPPs get well-deserved SRHR services. Local leaders can help in educating communities that Sexual and Reproductive Health services are not only for members of the LGBTQ+ Communities but for every other individual. This will also help end stigma against health workers and peers who offer these services in communities and hospitals at large.

These challenges pose a significant threat to HIV prevention efforts, especially among key and priority populations. Criminalization of same-sex relationships, stigma, discrimination, and violence hinder access to HIV prevention, testing, and treatment, exacerbating health disparities among LGBTQI+ individuals.

Global median HIV prevalence among gay men and other men who have sex with men stands at 7.7%, ranging from 0% to 41.2% across 87 reporting countries, significantly surpassing the estimated global prevalence of 0.7% in the adult population aged 15–49 years.

The global median prevalence among gay men and other men who have sex with men aged under 25 years is 4.9%, while it’s 10.5% among those aged 25 years and over, based on data from 50 reporting countries. Antiretroviral therapy coverage remains low within this demographic, with a global median of 78.3%, ranging from 1.3% to 97.9% across 44 reporting countries.

Gay men and other men who have sex with men are consistently excluded from or undercounted in national population estimates, effectively erasing their existence. Among 138 countries that have reported population size estimates for this demographic, only 26 have referenced national estimates derived through probabilistic methods within the past five years.

These troubling statistics disproportionately impact countries like Uganda, where LGBTQI+ individuals are in hiding and unable to access health facilities due to fear of arrest and prosecution under the laws.

However, the recent relaxation of certain provisions of the Anti-Homosexuality Act by the Supreme Court offers some relief, particularly in healthcare access for LGBT individuals. However, challenges persist, particularly for transgender women who face public exposure when seeking healthcare, due to their feminine clothing.

Lawyers advise health workers to prioritize their duty of providing healthcare services while avoiding actions that could be misconstrued as promoting homosexuality, as outlined in relevant legal provisions.