Policies – a silent enemy in the battle against HIV amongst sexual minorities
Trivialities of life seem so important until you realize your health is failing; who the next president of the country will be sounds so important until you start to see blood in your stool and your CD4 count is so low, the risk from serious infections has multiplied fivefold. Not common but this is what happens when you are infected with the HIV/AIDS virus.
Luckily, the parliamentary committees on HIV/AIDS and other related matters, health and presidential affairs have all been actively involved in HIV/AIDS related issues, with all playing key roles in the HIV/AIDS response in the country. Also, the Uganda AIDs Commission (UAC) was established by the Parliamentary Statute No. 2 of 1992, situating it under the Office of the President with a mandate to oversee, plan and coordinate AIDS prevention and control activities throughout Uganda. It’s through policy strategies like the HIV/AIDS National Strategic Plan (NSP) 2015/16-2019/2020 among others that the commission executes its mandate.
A number of Ugandans will appreciate the efforts of the government and its related agencies for key achievements in the fight against HIV/AIDS; seeing that we have come a long way in combating the disease compared to the situation in the 1980s. Whilst the government has not taken the fight lying, statistics and facts on ground spell out the need for more effort to be directed towards HIV/AIDS.
Despite the fact that the trend of new HIV infections has declined over the past 3 years, HIV prevalence shot up to 7.3% and was highest among females (8.3%) compared to the males (6.1%). Statistics show that women are more severely affected by malaria, Tuberculosis and HIV/AIDs than their male counterparts. A 2014 research by UNAID showed that there were 570 new HIV infections each week among females aged 14-24 years. Most at risk populations include commercial sex workers, fisher folk and people living along the borders and men who have sex with men (MSM). Concerted Government efforts should be geared towards the most vulnerable persons to the disease
Government has expressed its commitment by increasing budget allocation to the health sector from UGX 799 billion to UGX 1.12 trillion in 2013/2014 and 1.28 trillion in 2014/15. However allocation reduced by 4.7% in 2015/16 to only 1.2 trillion, despite the fact that the health allocation covers UAC’s Budget as well. It is also noted the sector allocations as a proportion to the total budget decreased from 8.9% to 7.9% way below and the Abuja declaration target of 15% and the Health Sector Strategic & Investment Plan (HSSIP) target of 10% are not likely to be met by 2015. The low funding is going to have a heavy toll on the HIV sector as it is projected that by 2020 people living with HIV will have increased to 76% from the current 45%. this is expected to be worsened by the fact that in the post 2015 period most external funding will be transferred to the prevention and treatment of non-communicable diseases (long term illnesses that progress slowly over a long period of time and kill rapidly for example cancers, cardiovascular diseases, diabetes among others) since it is projected that deaths caused by these diseases will surpass those caused by communicable diseases like HIV/AIDS. There is already an existing gap in the drug supply chain yet Uganda AIDS Commission budget continues to remain the same at UGX 6.950 billion. Revision of the budget allocation to UAC should be a top priority given the increasing prevalence rate of HIV and AIDS and the impeding donor threats to cut aid.
In relation to hostile laws and policies, The HIV Prevention and AIDS Control Act 2014 assented to despite the objections of key stakeholders in the HIV response in Uganda, such as the AIDS Control Programme of the Ministry of Health, the UAC, and gender experts, Health Service Providers, Civil Society Organizations and People living with HIV. Its argued that the HIV specific Act that provides for mandatory HIV testing and disclosure of the test results without consent to third parties coupled with criminalization of HIV will take Uganda’s AIDS response in the wrong direction.
The gender, human rights and public health analysis of the provisions of contention in the Uganda’ HIV Specific law clearly indicates that the HIV response will negatively be impacted by people shying away from prevention, treatment, care and support services which may end up escalating the HIV Prevalence. In addition, the most vulnerable particularly women and young girls will be made more vulnerable to HIV, Gender Based Violence, Domestic Violence and stigma and discrimination. it should most preferably be amended.
The Anti-Homosexuality Act 2014 was thrown out of the constitutional court on grounds of lack of quorum, even then the law was flawed on many fronts. It criminalized same-sex relations, the then maximum punishment was the death sentence then later ‘reduced’ to life imprisonment; and includes lesbians for the first time. Ever since the bill was tabled by Honorable David Bahati in 2009 Homophobia heightened in Uganda and this has consequently severely impacted knowledge about HIV amongst Men who have Sex with Men (MSM) and has hampered their access to HIV services. Data regarding MSM in Uganda is almost non-existent, HIV prevalence among same sex couples in Uganda is unknown and HIV services targeting them in Uganda equal almost none.
Due to the criminality of same-sex relations, MSM are often fearful of being tested in case they have to disclose their sexual orientation. This leads to HIV being transmitted more easily and rapidly amongst this at-risk population. They also face homophobic stigma and discrimination from all levels of society; the bill will be re tabled, however, one can’t help but wonder if the bill will incorporate such important issues aimed improving access to HIV services for this at-risk population and central to reducing HIV transmission in Uganda.
There are many other challenges faced by people living with HIV/AIDS in the country, challenges that can be discussed for days on end however that is a discussion for another day. To avert the risk of new HIV infections and also prevent the grave impact of the epidemic, first off parliament can provide social support and protection by challenging the current harmful legal and policy environment, get involved in HIV prevention campaigns, provide for care and treatment of persons living with HIV and last but not least ensure community and health systems strengthening by allocating more funding to UAC.