Gay Men and Sex Workers Overlooked in Uganda's Fast-Track HIV Initiative

Ugandan President Yoweri Museveni launched an initiative to combat HIV by 2030, but activists are already criticizing it for failing to take into account gay men, sex workers and drug users, who bear a disproportionate share of HIV.

The Guardian reports that the five-point plan instead focuses on stopping new HIV infections among adolescent girls and young women, and eliminating mother-to-child HIV transmission.

"Uganda will not end Aids if these populations are left out and [continue] to be marginalized, stigmatized and discriminated against in our planning. They have high HIV prevalence and incidence," said Sylvia Nakasi, policy and advocacy officer, Uganda Network of Aids Service Organizations (Unaso).

They are also attempting to reach UNAIDS 90-90-90 target, which calls on countries to ensure that by 2020, 90 percent of people living with HIV are diagnosed, 90 percent of diagnosed people are on ARVs, and 90 percent of people on treatment have a fully suppressed viral load.

Moses Mulindwa, deputy executive director of Spectrum Uganda Initiatives, which works to empower gay men, said that if the president's initiative is to succeed, it must involve MSM and other at-risk groups.

But Health Minister Sarah Achieng Opendi openly revealed the anti-gay animus prevalent in Uganda, saying, "We don't want homosexuality and homosexuals in this country. People want to promote what is not in our culture. We can't accept it. Our hospitals are open. We don't ask people whether they are homosexual or not. Let them go and test. If they are positive, they start treatment. But we can't give them special attention."

Homosexuality, sex work and drug use are all outlawed in Uganda. And in 2014, they took a "step backward in the fight against AIDS" when they passed the punitive HIV Prevention and Control Act, which criminalizes deliberate transmission of HIV.

Existing laws, absence of data, community intolerance, discrimination and marginalization, along with low opportunities for funding, makes it more difficult for them to access care and treatment, according to Uganda's HIV and Aids country progress report 2015-2016.

Men are understandably reluctant to get tested, resulting in only 60 percent of Ugandan men tested and only 52 percent on ARVs. It will take much more, say activists, to reach this goal.

"We will only achieve the target to eliminate HIV by 2030 if we change the way we are doing business," said Unaso's Nakasi. "We need to set ambitious targets, increase our domestic financing of the response -- we need a National AIDS Trust Fund up and running -- more emphasis on prevention, prevention using proven options like VMMC [voluntary medical male circumcision], use of prophylactic medications (PrEP), targeting high risk populations, and above all address HIV stigma and discrimination."