UNAIDS: Anti-LGBTQ laws in Africa could prompt spike in HIV cases

LGBTQ and intersex activists protested in front of the Ugandan Embassy in D.C. on April 25, 2023. (Washington Blade photos by Michael K. Lavers)

The U.N body on the HIV pandemic has raised concerns over a spike in the disease among gay and transgender people in eastern and southern Africa due to harsh anti-homosexuality laws.

UNAIDS in its 2023 Global AIDS Update report released last month notes laws criminalizing consensual same-sex relations have remained a major obstacle in preventing and treating HIV among the LGBTQ community. These statutes have been enacted in the region the disease has impacted the most and in a part of Africa that has seen significant progress in reducing the number of new HIV infections.

New HIV infections have dropped by 57% and AIDS-related deaths have decreased by 58% among heterosexual people since 2010.

“HIV incidence has reduced substantially by 73% since 2010 among adult men aged 15–49 years, but it is not declining among gay men and other men who have sex with men,” reads the 196-page UNAIDS report.

HIV prevalence in 2022 around the world was 11 times higher among gay men aged 15-49 years, compared to heterosexual men within the same age bracket and 14 times higher among trans people.

The report reveals the HIV prevalence among gay men stands at 12.9% and 42.8% for trans persons in 21 of 24 surveyed countries in eastern and southern Africa where a total of 20.8 million people in live with the virus.

The disease remains rife among gay men and trans people and efforts to combat it among the aforementioned population continues to lag because of stigma and discrimination in accessing equitable HIV care from anti-homosexuality laws in Uganda, Kenya, Tanzania and in other countries.

A total of 67 countries in the world criminalize homosexuality, with nearly half of them being in Africa. Twenty countries criminalize trans people.

A recent survey in 10 sub-Saharan African countries showed HIV prevalence among gay men was five times higher in countries that criminalize consensual same-sex relationships compared Rwanda and South Africa and other nations that don’t.

The survey also notes HIV prevalence was 12 times higher in countries that use anti-homosexuality laws to prosecute gay men, compared to nations without such prosecutions. It also notes HIV prevalence was more than nine times higher in countries that curtail the operations of pro-LGBTQ civil society organizations, compared to nations that do not obstruct them.

UNAIDS Executive Director Winnie Byanyima noted HIV/AIDS killed one person every minute last year. She also called for stronger collaboration and equality to end the disease by 2030.

“HIV responses succeed when they are anchored in strong political leadership to follow the evidence, tackle the inequalities holding back progress, enable communities and civil society organizations in their vital roles in the response and ensure sufficient and sustainable funding,” she said.

The UNAIDS report points out gay men and trans people are left out of HIV treatment programs in eastern and southern Africa, where coverage among adult women stands at 86% and men at 78%.

The neglect that punitive laws and police harassment exacerbates has, in turn, led to HIV prevention gaps that increase the risk of transmission and limit access to services and sabotages efforts to decrease the impact of the virus among the group.

Uganda this year enacted the Anti-Homosexuality Act with a death penalty provision for “aggravated homosexuality” and severe punishment for organizations the government claims promote homosexuality. A similar punitive bill is set to be introduced in Kenya’s Parliament.

Ugandan President Yoweri Museveni’s decision to sign the Anti-Homosexuality Act in May saw a U.S.-funded HIV treatment clinic in Kampala that normally sees dozens of patients a day almost deserted because clients, many of them gay, feared arrest.

“Removal or reform of these laws in line with public health evidence would boost the HIV response and the human rights of people from marginalized populations, particularly, key populations who continue to have much higher HIV prevalence than the general population,” the UNAIDS report states.

In 2022, a total of $9.8 billion meant for universal HIV financing in eastern and southern Africa was spent. Thirty-nine percent of this money was domestic funding, while the rest came from the Global Fund, UNAIDS, the U.S. Agency for International Development and other international donor organizations. Botswana, Kenya and South Africa contributed the largest share of donor funding.

UNAIDS asks countries to use disaggregated data to effectively identify populations to ensure the LGBTQ community and other key groups are not left out of HIV care since many countries lack programs and size estimates. UNAIDS also requests stronger action against stigma and discrimination at healthcare facilities in order to increase access and use of HIV testing and treatment services by all people, regardless of their sexual orientation.

“Failure to protect people from key populations against HIV will prolong the pandemic indefinitely at great cost to the affected communities and societies,” warns UNAIDS.

UNAIDS notes Singapore and other countries last year repealed laws that criminalize consensual same-sex sexual relations and trans people and introduced statutes that protect gender identity. UNAIDS, nevertheless, in its report raised concerns over an increase in homophobia and transphobia in countries that prompt the introduction of anti-homosexuality laws.

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