A new national HIV/AIDS strategic plan for Uganda is due to be finalized before the year's end, and gay rights activists are urging its authors to break with tradition and, for the first time, provide for programming for men who have sex with men.
The current national strategic plan, which covers the period between 2007/2008 and 2011/2012, does not mention MSM, despite studies reporting that they are at higher risk of contracting HIV than other adult men.
The plan lays out a framework for responding to the epidemic, pinpointing priority areas for programming; the next one is expected to guide the country's HIV programmes until 2015.
"[The strategy] directs how resources from donors and governments are utilized," said Kikonyogo Kivumbi, executive director of the Health and Science Press Association (UHSPA-Uganda), which advocates for the rights of sexual minorities. "It means that whoever is going to access those resources in the delivery of public health services, if the policy directs them [to], they can introduce LGBTI [Lesbian Gay Bisexual Transgender and Intersex]-friendly services."
The Crane Survey, a 2008/2009 study of high-risk groups in Uganda, reported that the HIV prevalence among MSM respondents was 13.7 percent, more than twice the national prevalence of about 6.4 percent.
"These people are engaging in sex. Whether you want it or not, infections [and] HIV will occur," said Kivumbi.
According to Frank Mugisha, executive director of Sexual Minorities Uganda (SMUG), the absence of a national dialogue around safe sex education for sexual minorities means that many members of the MSM community do not know how to avoid HIV transmission.
A draft version of the new strategic plan distributed to civil society organizations mentioned the MSM community by name under an introductory section outlining groups that have prevalence rates above the national average, but the strategy concluded that MSM did not play "a big role" in the transmission of HIV in Uganda and did not warrant a high rank among prevention activities.
The draft strategy did recommend that more research be done within communities of MSM and injecting drug users to determine whether the groups were at risk of an upsurge in new infections.
Although it stops short of actually including MSM in HIV programming, for Kivumbi, the draft strategy was nevertheless a cause for celebration. "It's the first HIV programming to mention MSM by name... It's a big and overwhelming shift," he said.
He added that his organization would continue to advocate for explicit recommendations for the MSM community. Had MSM been ranked among most at-risk groups - such as sex workers and fishing communities - they could expect to access services including risk-reduction counselling, condom distribution and community outreach.
However, James Kigozi, spokesman for the Uganda AIDS Commission - which draws up the plan - told IRIN/PlusNews that because homosexual activity was illegal in Uganda, programming for MSM was unlikely to make it into the final version of the plan.
For SMUG's Mugisha, any mention in the strategy without specific intervention recommendations was just a "first step". He urged the UAC to come up with policies based on expert consultations and best practices in neighbouring countries rather than just calling for more research, which would be extraordinarily difficult to conduct in a country that criminalizes homosexual activity.
The authors of the Crane Survey reported that it was "severely interrupted" by the arrests of LGBTI advocates.
Apophia Agiresaasi, executive director of Action Group for Health, Human Rights and HIV/AIDS (AGHA-Uganda), said one of the lessons they learned while studying the ability of sexual minorities to access healthcare was that collecting data among the MSM community is difficult.
"They will say they belong to a category that's more acceptable, or if they're in sexual relationships with both men and women, they will identify [themselves] as heterosexuals," she said. "Any statistics may be less than what is on the ground."
There was more good news for gay rights activists, when the cabinet on 17 August turned against the Anti-Homosexuality Bill, which called for the execution of people repeatedly convicted of committing homosexual acts, among other offences, but there are still laws on the books criminalizing homosexual activity.
"The government's position is that the law is unnecessary - we have adequate laws to deal with it [homosexuality]," Adolf Mwesige, Minister for Local Government and the ruling party's lawyer, told IRIN/PlusNews. "We are trying to persuade parliament to drop it; if they insist on it, we will oppose it."
David Bahati, the architect of the controversial bill, insisted he would go ahead with it despite widespread opposition. He told IRIN/PlusNews many of the more controversial clauses had been removed.
"The [reworked] legislation will take care of all concerns raised by different stakeholders, including those concerns about HIV/AIDS prevention and treatment," he said.
But even if the national strategy were to call for treatment and prevention services for MSM, there are still significant hurdles to actually offering those interventions in a country where homophobia is rampant.
Need for health worker sensitization
In 2010, Mugisha was among the 100 alleged gays and lesbians whose photographs were published in a local magazine under the headline, "Hang Them".
For sexual minorities attempting to access health services, this stigma can be difficult to overcome. The 2010 AGHA-Uganda report found discrimination by doctors and healthcare workers against LGBTIs was the biggest barrier to healthcare access for that community.
"Some doctors are homophobic," Mugisha said. "You don't have anything legally binding to compel them to treat Uganda's LGBTI community... [current laws] justify the myth of their cultural and religious arguments against treating MSM and others.
"My desire would be to tell the doctor, 'Yes, I'm having sex with another man,'" so he could receive appropriate care, he added..
Mugisha said he knew people who had been misdiagnosed at health centres because doctors were unfamiliar with sexually transmitted infections that are more common among MSM and the people seeking treatment were too afraid to reveal their sexuality.
While a policy pronouncement might not immediately change doctors' attitudes, Mugisha said it would give LGBTI patients leverage to fight discrimination.
But a change in policy would need to be accompanied by sensitization training for healthcare providers and lessons in LGBTI-specific health needs, which is missing.
AGHA-Uganda's study did find some interest among health workers in learning more about care and treatment specifically for LGBTI.
But until a national directive becomes a reality, SMUG will continue to work with partner organizations to compile a list of LGBTI-friendly health workers and clinics where MSM and others can access some treatment.
"We want to work with the government," Mugisha said. "Government can begin with the policies... then we would have the backing of the law."
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions