Activists and health workers say Uganda's anti-homosexuality law, passed in February, will lead to an increase in AIDS-related deaths among an already marginalised population. As well as making lesbian, gay, bisexual and transgender (LGBT) people afraid to access health services, the draconian law deliberately targets HIV awareness organisations and health professionals working with this community.
A doctor at Mulago Hospital, who asked not to be named, said: "I am not worried about working with the LGBT community but my worry is about my security and that of my family. If the government discovers I am working with LGBT persons, they can arrest me."
The doctor's fears are well-founded. Section 3:7 of the law makes it a crime to fail to report homosexuals, with a penalty of up to seven years imprisonment. This clause has made health workers afraid to provide HIV and AIDS health services to LGBT people. As a result, many are resorting to private hospitals - but these services come with a high cost attached. The ministry of health plans to issue guidelines to health service providers to report all LGBT clients whom they treat.
Afraid to access healthcare
The anti-homosexuality law, together with intense homophobia in the community and the pressure on health workers, means LGBT persons living with HIV are afraid to seek treatment in case they are reported to the police, arrested and jailed. Others fear ridicule from the community and health service providers, and a number of them are afraid of being reported to their parents and relatives. As a result, people have died because they were too scared to go to health centres for treatment.
"Many sexual minorities in Uganda fear to go to healthcare centres in case their identities become known and they risk imprisonment," said David (not his real name), a gay Ugandan living with HIV.
"My colleague, who raised awareness of the plight of sexual minorities in Uganda, died in hospital because he could not access healthcare services in time. This was due to homophobia at the health centres he visited. With the current law I expect the worst: more and more of our colleagues will end up dying because of this. They fear to access services and I don't blame them, because I personally do."
Organisations fall prey
Non-governmental organisations working with the LGBT community, including those which provide HIV testing, prevention and treatment, are also under threat. After the law was passed, the police started a witch-hunt of all LGBT-friendly organisations.
Section 13:2 of the law states: "A corporate body or business or association or non-governmental organisation that indulges in activities that support homosexuals will be convicted, its certificate of registration cancelled, and the director, proprietor or promoter of the organisation shall be liable to imprisonment for seven years and pay a heavy penalty."
This resulted in the closure of the Walter Reed Project, a US-backed HIV/AIDS research centre, following a raid by the police and the detention of one worker. The organisation provided treatment, care and support to LGBT people living with HIV/AIDS. In a public statement, Ugandan police said this violated the country's anti-homosexuality law.
Following the case of Walter Reed, several LGBT-friendly HIV organisations have withdrawn health support from the community for fear of the punitive measures of the law. This means many LGBT people living with HIV have lost access to drugs and have gone back into the closet. Although they are being referred to other service providers, the need is still vast and growing as more centres risk being closed by the government.
According to David, these events will result in more suffering and deaths. He said: "Our plea goes out to the international community, as before: nations and individuals should stand against the anti-homosexuality law in Uganda."