Activists protest outside the Ugandan embassy over Uganda’s parliamentary Anti-Homosexuality Bill on April 25, 2023, in Washington, DC. | Anna Moneymaker/Getty Images
Outlawing homosexuality has forced health care underground.
In the six weeks since Uganda’s president signed the country’s Anti-Homosexuality Act (AHA) into law, the LGBTQ community and its supporters in Kampala, Uganda’s capital and largest city, have faced escalating harassment and security threats. The regulation has led to more than 300 human rights violations against people suspected of being gay in Uganda, according to reporting from CNN.
Experts are deeply concerned about the law’s impact on Uganda’s progress on health — in particular, its impact on HIV transmission. Although gay men and their sexual networks comprise less than a third of new HIV cases in the country, containing the infection’s spread among men, women, and children depends on steady access to HIV treatment and prevention.
A court challenge to the AHA is in progress, but so far, there is no indication that Uganda’s leaders intend to walk back the law. In the meantime, the AHA poses material threats to people who provide health care to LGBTQ people, raising the risk of treatment interruptions for many Ugandans with HIV.
In Kampala, amid intensifying hostility toward LGBTQ people and those who provide their health care, Brian Aliganyira is executive director of the Ark Wellness Hub, an LGBTQ health clinic. We talked to him in mid-June about the clinic’s work, the risks he and his staff face, and what action he thinks people outside Uganda should take in response to the AHA.
When we checked in with Aliganyira in early July, his clinic had just received a visit from employees of the national bureau that monitors nongovernmental organization work within Uganda. He was told the bureau had information on the group’s involvement in immoral acts and the recruitment of minors for homosexual behavior.
The Ugandan press is littered with stories that demonize LGBTQ people, Aliganyira said. And while “everyone believes these kinds of stories,” they’re worlds away from reality: “The number of people pushed out of their homes has skyrocketed,” he said, “and we are struggling to find people food and places to stay — it’s been a mess for our community.”
“These are stories I really want to tell, but the local press doesn’t want to hear them,” Aliganyira said.
He wasn’t sure if he would be okay — but “we aren’t going to close the clinic,” he said.
This conversation has been edited for length and clarity.
Tell me about the clinic. What kind of work do you do?
We started providing services in January 2020. Our target population is LGBTQ people but also includes other subpopulations that might benefit from our services, like drug users and male sex workers. We provide prevention, treatment, and care for HIV and sexually transmitted infections, mental health services, and we do vaccinations for hepatitis B and other diseases. We also engage in health education even for those who are far away, so we provide telemedicine services and education through phone calls.
Long before this law passed, our community faced a lot of stigma and discrimination, and a lack of competent counseling services and information. Our idea was to gather people from within [the LGBTQ] community who are skilled or professionals in different disciplines, and to have them provide services in one place.
HIV infections among our community is very high — prevalence is about 13.5 percent [among men who have sex with men in Kampala]. So we are open seven days a week until late evening, and we’ve been able to provide services to around 4,200 LGBTQ persons.
Just providing health education is a challenge. It’s very hard to provide information that includes sexual health for men who have sex with men or for LGBTQ persons, because now that is also termed as promotion of homosexuality. And now authorities are viewing just providing lubricants as promotion of homosexuality, so our supplies of those have gone down.
What are the threats currently facing LGBTQ people seeking health care, and the people who provide that care?
For us as health workers and service providers, we are at risk for being penalized under this law. But if we give up and don’t provide services to our community, we’d be assured they would not get them anywhere.
In early June, a transgender woman who had been beaten was taken to the hospital to access emergency services. While the doctors were tending to her wounds, they saw that she had male genitals and called the media. This person was in critical condition, and instead of giving them care, they just called the media and took pictures and exposed the person.
That’s supposed to be a place where life is protected — and not only is this person not taken care of, but also embarrassed and ashamed.
So it’s quite a painful situation to be in right now. And we know it’s going to get worse because communities have been radicalized. No one looks at an LGBTQ person as a human being. Everyone looks at you as an enemy of their country, their morals, their culture. It will take a lot of work for us to undo what has been done.
We’ve not had any attack on the clinic physically. But in the past few months, we’ve lost about four health workers who resigned because of the danger of this work.
There’s a false narrative that clinics like ours promote homosexuality and human trafficking. So occasionally, people — spies — show up dressed as students and pretending to be seeking sexual partners abroad. They use it as a trap to see if you fit the narrative. So we train our staff on what to do when people come in and try to trick them into doing something wrong.
How have security threats to LGBTQ people changed how your patients get care?
Recently, the police arrested six guys who were in Jinja [a city in eastern Uganda] and said they were caught having group sex. But according to some reports, when they were peer educators working for health care organizations. To avoid this kind of situation, we avoid having a number of people in one place at the same time.
So although we welcome walk-ins, we have shifted to doing a lot of our care outside the clinic. Like for people who are on HIV medication and need blood samples collected for testing, we now send someone to them to collect the samples. So we tell clients, unless you really have to walk up, please order whatever you want or maybe let’s do a phone call or video call. The most important thing is protection for everyone.
We have been able to maintain care for most of our clients through telemedicine, but not all. About 600 clients who don’t have phones or internet or who cannot read have fallen out of contact.
How have these threats changed the way your clinic operates?
We have always provided telemedicine services, but this period has made us focus more on telemedicine, which has made things more expensive for us. We’ve switched from providing most of our services at the clinic to having almost 3,000 people seek services online. It takes a toll on our communication and internet budget, and we also had to hire another staff person to support the receptionist in handling all the calls and messages and deliveries. And although we have a nurse and a medical officer at the clinic, we need someone to be able to collect samples in the community.
It’s been three months since those guys in Jinja were arrested, and they are still in prison. Every time they go to court, they are denied bail. I think about it every single day. Like, if one day something goes wrong, I will end up in prison — and for how long? The whole office staff is scared. Even the lawyers we work with are scared — the law also criminalizes them for supporting us.
It makes me so frustrated that our work is shifting from providing services to just basically always trying to stay safe, like in a war zone — instead of providing health services, the biggest share of our budget now is going into security. I feel so bad when my work is reduced to just survival.
We can do so much with improving health care for our communities, but also the general communities and society in general. But instead, we are in survival mode. Right now, donors are mostly giving money for security. If we didn’t have this punitive law, all this money would go to improving people’s lives and health.
I’ve heard some Ugandan activists suggest foreigners should be kind of quiet about their disagreement with this law to avoid playing into the idea that Uganda is caving to Western pressure if it adopts a more open stance toward homosexuality. What do you think?
I do understand the argument. But that narrative silences the Western community, and it’s going to leave local communities here without a voice. These laws take away our voices, and in the moments when we can’t talk, we need someone else to speak for us until we can also speak for ourselves. The law disempowers us so much, and we cannot also disempower ourselves by saying people should not speak out.