Kampala — Uganda's president recently signed the HIV and AIDS Prevention and Control Act into law. The bill criminalizes the transmission of HIV and also enforces mandatory testing. Such provisions have upset activists who want to de-stigmatize Uganda's HIV-positive community.
The country's parliament passed the act in May. President Yoweri Museveni signed it act into law July 31.
Health advocates say they are alarmed by a number of passages in the bill that sanction forced disclosure, criminalize transmission and mandate testing for certain groups.
Asia Russell, the Director of International Policy with Global Access Project, explains why these passages are so troubling.
"This act, contrary to best practice, to human rights, to evidence of what works in contexts like Uganda, would actually criminalize HIV," she said. "And what we've seen is that in contexts where knowing your HIV status can be used as a criminal liability against you, it actually makes people hesitate. And the last thing we need is one more reason for people at greatest risk of infection to hesitate before seeking a test."
Uganda was originally a leader in working to reduce AIDS rates. After the disease arrived in the country in the 1980s, officials opened up the first voluntary HIV counseling and testing clinic in sub-Saharan Africa.
Media campaigns and the nationwide "ABC" program -- promoting abstinence, being faithful and condom usage -- helped bring down the HIV infection rate from 18 percent in 1991 to just under 6 percent in 2002.
More recently, though, the country has seen about 140,000 new HIV infections per year, pushing the infection rate back up to 7.2 percent. Russell says that a lack of applying established practices known to work is to blame.
"... What's needed is an accelerated, intensified effort by government, by donors, by civil society to reach everyone living with HIV with testing, with access to treatment and with counseling ... A country like Uganda can actually reach an end to the AIDS epidemic," she said. "That's what science shows us -- it's an incredibly exciting time. Thus the cruel irony that in defiance of that evidence, Uganda has pursued this highly flawed law."
Russell says criminalizing transmissions will discourage sex workers and Uganda's LGBT community from seeking treatment. She says for this reason, even some Ugandan health officials are against the new law.
"And that's why even the AIDS Control Program at the Ministry of Health and the Uganda AIDS Commission have acknowledged that this law will take this country a step backwards, she said. "So it's not only civil society it's also members of the government who are speaking out, not loudly enough, but speaking out against this law. We only hope it's not too late."
Activists say the HIV and AIDS Prevention and Control Act does have some positive aspects. They say it sets up provisions for a nationwide fund for HIV care, and outlaws discrimination against HIV-positive individuals in workplace and schools.
Supporters of the law argue the government has a responsibility to protect against purposeful transmission of HIV.
A local marketing consultant, Godfrey Mugisha, prefers those government protections.
"I am totally for the notion that people who knowingly infect other people need to be prosecuted," he said. "People who have had a chance to get tested have been availed with information on how to have safe sex and to prevent themselves from infecting other people. So anyone who goes ahead and knowingly infects another person ... . That is criminal. ... So basically I feel like the government is doing its job."
Many countries throughout the world, as well as some parts of the United States, have also criminalized attempted transmissions of HIV. While such laws haven't been shown to curb the virus, many feel safer because they view people who withhold or lie about their status as a public health threat.
Although advocates contend that the HIV Prevention and Control Act will do the opposite of what it intends, both sides can agree that they'd like to see the government focus on testing, counseling, anti-retroviral therapy, and de-stigmatization of HIV patients in the coming years.