Stuck in the closet: gays left out of HIV/AIDS strategy

In a dimly lit karaoke bar in a suburb of Kampala, the capital, Crystal Namanya belts out Madonna's "Get into the Groove", following the words as they run across a television screen. Her rendition is a crowd pleaser, attracting applause and shouts of "you go, girl!" from her fellow revellers. This is no ordinary karaoke evening. Nearly everyone in the bar is gay, something most Ugandans consider un-African and un-Christian. The police have raided this secluded bar several times in the past year but, for the time being, it is one of just a handful of places where the city's gays and lesbians feel safe. Homosexuality carries a huge stigma in conservative Uganda, and a conviction for sodomy - deemed "an act against the order of nature" - carries a life sentence in jail. Most Ugandans prefer to pretend sexual minorities do not exist at all, a belief that permeates all levels of society, regardless of class or level of education. "We are made to feel like we shouldn't be alive," Crystal said. "The day you discover you're gay you lose everything - people look at you like you're sick, others say you are bewitched." A deadly consequence of denying that homosexuality exists in Uganda is that the national HIV/AIDS programme makes no provision for sexual minorities, despite scientific evidence that gay men are more susceptible to HIV transmission than any other group. A 2000 global UNAIDS report, 'AIDS and men who have sex with men', found that the risk of HIV transmission by unprotected anal sex was "several times higher than the next most high risk category". THE POLITICS OF PRETENCE Nobody knows how prevalent the HI virus is among gay Ugandan men - there are no statistics, as sexual minorities have never had a place in the government's fight against HIV AIDS. During the 1980s and 90s, the international community heaped praise on Ugandan President Yoweri Museveni for his administration's aggressive stance against HIV/AIDS, at a time when it was still one of Africa's most taboo subjects. The country's pioneering 'Abstain, Be Faithful, use a Condom (ABC)' strategy became a continent-wide model and has been credited with bringing prevalence rates in Uganda down from over 20 percent to the current level of about six percent. "There's no mention of gays and lesbians in the national strategic framework, because the practice of homosexuality is illegal," said James Kigozi, spokesman for the Uganda AIDS Commission. "These two groups [gays and lesbians] are marginal; their numbers are negligible." The Minister of State for Health, Jim Muhwezi, recently insisted that Uganda's ABC approach adequately catered for all groups in Uganda, including homosexuals. "They don't deserve a special message. They shouldn't exist, and we hope they are not there. If they do exist they are covered under the three-pronged approach of ABC and should be content with that." A Ugandan physician who has worked closely with sexual minorities for the last three years and spoke to PlusNews on the condition of anonymity, rejected the notion that the national average of six percent held true among homosexuals. "In Uganda, when someone is discovered to be HIV positive we do not ask about their sexual behaviour, so we get a statistic that is assumed to relate to heterosexuals," he said, commenting that although there were no statistics, he was certain the prevalence of HIV among homosexuals was several times the national average. Many gay men in Uganda remain unaware of the risk of contracting sexually transmitted infections through unprotected sex. The physician maintained that this ignorance was due to a deliberate "policy of pretence" regarding the existence of homosexuals, and to incorporate them into Uganda's HIV/AIDS framework would be tantamount to admitting their existence in society. "There are gay men - the fact is they are a more vulnerable grouping than anyone else, so they need to be targeted, they need to be educated," he stressed. Joel, 20, a gay Kampala resident, said, "Some boys believe that to sleep with a man is safe because all the billboards around town show heterosexual couples, with messages ... nothing is said about homosexual couples using a condom, so they think it is safer to sleep with each other than a girl." In a 'gay-friendly' pizza house in the centre of the city, Joel recounted the confusion of discovering his sexuality at the age of 14. Since then, he has been encouraged to go for a monthly blood test by his father, whose attitude to homosexuality became more liberal when he lived in the UK. Joel said he was fortunate to have both the moral and financial support of his family, which minimised his risk of becoming HIV positive - many of his gay contemporaries were not so lucky. Ostracised by their families and shunned by society, they were forced to sell their bodies, lured into a false sense of security by anti-AIDS campaign posters that warned only of the dangers of sex between heterosexual couples. Reluctant to report symptoms of sexually transmitted infections for fear of eliciting questions about their sexual orientation, many gays and lesbians say they have neither the choice nor the opportunity to be honest about their sexuality. FEW ALTERNATIVES FOR HIV/AIDS ACTIVISTS The UNAIDS report called on governments to eliminate pre-existing prejudices and encouraged a non-discriminatory approach to sexual minorities, but Beatrice Were, an HIV/AIDS research and policy analyst at ActionAid Uganda, said no such approach had been adopted in Uganda. "Our hands are tied behind our backs because we are bound by the law," she said. Indeed, in 2005, the Ugandan parliament endorsed an amendment to the constitution outlawing homosexual marriage. She conceded that prejudice in the NGO community meant they, too, were failing sexual minorities. "Many of us don't walk the talk. We have not yet dealt with our own fears and stigmas and therefore we are biased in our preventions," she said. The result was that gays and lesbians were denied access to HIV education, treatment and counselling. "We now have to be honest with ourselves and talk about sexual minorities," she said. "Otherwise, by the time you accept it [HIV among sexual minorities] the scale will be too big to deal with."