Poli­cies – a silent en­emy in the bat­tle against HIV amongst sex­ual mi­nori­ties

By: Winnie Watera

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.