New Ugandan HIV and AIDS law jeopardizes health of women, men, and children

By Anne Stangl

*This blog originally appeared on ICRW and Thomas Reuters Foundation 

Last week, Ugandan President Yoweri Museveni signed into law a bill that will likely harm the health of Uganda’s men, women, and children for years to come and could set the country back decades in progress in reducing the transmission of HIV.

The new law, the HIV and AIDS Prevention and Control Act of 2014, criminalizes the transmission of HIV, makes it legal for doctors to disclose their patients’ HIV status to partners and families without consent, and, last but not least, calls for mandatory testing for pregnant women and their partners. To be blunt, it is nothing short of a major step backward for a country that, for 30 years, has been a leader in tackling HIV head on.

A doctor draws blood from a man to check for HIV/AIDS at a mobile testing unit in Ndeeba,
a suburb in Uganda's capital Kampala, May 2014. REUTERS/Edward Echwalu

While Ugandan legislators insist that the goal of the new law is to protect the public’s health, the new law, in effect, will do little more than stigmatize and discriminate against men and women living with HIV and will likely result in fewer women and girls – and men and boys – seeking and adhering to treatment that could literally save their lives. This will lead to a huge step back in any progress made in tackling the epidemic, which affects over 1.5 million Ugandans.

This law is simply unnecessary. The law mandates that pregnant women and their partners get tested, yet research shows that women are already getting tested and previous research has found that mandatory testing has actually been shown to lead some women to avoiding getting antenatal care all together.  This new law will serve as yet another repressive measure targeted at women, but ultimately affecting the health of men and entire families, including their children.

Researching HIV stigma in Uganda for my dissertation in 2005, I got to see up close the barriers and challenges that face people living with HIV on a daily basis. Yet, I also witnessed an amazing transformation in communities where, for the first time, people living with HIV were able to access life-saving antiretroviral treatment. As men and women who were on death’s door became healthy, they were able to begin working and could contribute to their families and communities again. No longer were they viewed as a burden. No longer were they feared. No longer were their opinions disregarded because they ‘would soon die.’ Neighbors, who had previously shunned them, began stopping by to ask: how had they become healthy again? Could their relative or friend also get access to these medicines? Communities wounded by years of losing so many to AIDS, struggling with stigma and discrimination, began to mend.

Following the roll-out of antiretroviral therapy in Uganda, increases in HIV testing and care-seeking were tremendous. Home-based testing campaigns achieved over 95% acceptance in most communities. Given the gains achieved from a supportive government response to the epidemic, which was lauded globally for its high involvement of people living with HIV, I find myself wondering why the Ugandan government would go backwards. Why risk these tremendous gains, and the very lives of their citizens, by passing such a discriminatory law? 

While researchers are working every day to discover new strategies and technologies to bring an end to HIV and AIDS, we already know what will not work: stigmatizing and discriminating against those living with HIV. We know that when individuals, communities, and, as is the case here, governments stigmatize and discriminate against those who are living with HIV, others decide not to seek out treatment or stop adhering to their medication, which contributes to the further spread of HIV. When laws mandate testing and criminalize HIV transmission, expectant mothers are likely to avoid seeking health care, putting their health – and their babies’ health – at risk.

To be sure, the signing of this bill marks a sad occasion. But this new law must not be the end of the story, especially when Ugandans lives hang in the balance.

Advocates, policy makers and researchers alike must work together to urge the Government of Uganda to weigh the risk of backsliding on hard-won gains against HIV, which could result from criminalization and mandatory testing under this law. We must urge the Government of Uganda to use all appropriate means to reconsider the law, including during the development of regulations for its implementation by the Minister of Health. And lastly, we must encourage the Government of Uganda to once again be a leader in the global response to HIV by championing evidence-based, inclusive and supportive HIV policies instead of policies driven by fear and stigma.

We’ve come too far in the fight against HIV to let discriminatory laws, such as this one recently signed by President Museveni, derail decades of progress and jeopardize the health of millions of women, men, and children.

Redoubling efforts to fight stigma and discrimination key to ending AIDS

By Anne Stangl
**This blog post originally appeared on Devex.com

It’s been 30 years since HIV was identified as the cause of AIDS, and since then we’ve made significant progress in fighting the epidemic.

The massive rollout of antiretroviral drugs worldwide has dramatically reduced AIDS-related deaths and prolonged the lives of millions of people. Innovative biomedical interventions — such as microbicides, male circumcision, universal testing and ARV prophylaxis for preventing transmission from mother to child — have greatly expanded our collective prevention toolbox. Great strides have also been made in understanding how to deliver services and motivate uptake and adherence, from home-based HIV testing to education entertainment programs like Soul City. And perhaps most importantly, the tremendous advocacy efforts of people living with HIV in countries like South Africa and the United States have ensured widespread access to affordable, lifesaving treatment.

Although we have a lot to celebrate, we must remember that we’re not even close to ending this epidemic.

This week, the 20th International AIDS Conference is taking place in Melbourne, Australia, under the theme “Nobody left behind,” which underlines the need to use a human rights-based approach to ensure that everyone — especially those who are most at risk and affected by HIV and AIDS — receives treatment. We cannot accomplish this without overcoming one of the most devastating barriers to prevention and treatment: stigma and discrimination.

The problem

Stigma and discrimination prevent millions of people, especially vulnerable populations like women and youth, from accessing the prevention and treatment they need.  

According to the 2014 Gap Report recently published by UNAIDS, more than half of those living with HIV globally do not know they have the virus because they have yet to get tested. Equally troubling, UNAIDS also notes that while more than 28 million individuals around the world need treatment, only 34 percent of these individuals had access to treatment. How does this happen? In many countries, the culprit is pervasive social stigma and discrimination in clinics and at both the local and national levels.

For example, a whopping 60 percent of countries around the world have laws, regulations or policies that prevent populations most at risk of HIV infection — like pregnant women, men who have sex with men, and people who inject drugs — from accessing these services. HIV transmission or the failure to disclose one’s HIV status to a sexual partner is criminalized in more than 60 countries. Additionally, 40 countries impose some form of restriction on entry, stay and residence of people living with HIV; 18 deport individuals whose HIV positive status is made public; and five countries have a complete ban on the entry and stay of individuals living with HIV.

Efforts to stigmatize and discriminate against populations living with HIV do nothing to reduce the rates of transmission. Instead, they keep people from getting tested for HIV and prevent people living with HIV from disclosing their status to partners, accessing care and adhering to treatment.

Small wins make a huge difference

Despite these worrying developments, organizations working to reduce stigma and discrimination have made significant progress over the past couple of years. For example, the 2014 Global AIDS Response Progress Report, which details the landscape of the epidemic around the world, now includes a section on measuring how many people hold discriminatory attitudes toward those living with HIV. Additionally, the U.S. State Department just released instructions on how embassies can work to track levels of HIV-related stigma and discrimination in countries as part of the department’s annual Human Rights report.

While these may seem like small wins, they’ll make a huge difference in measuring where stigma and discriminatory attitudes exist so that countries can better target their efforts to reduce these harmful social norms.

For far too long, gaps in data have prevented countries from truly understanding how stigma and discrimination prevent vulnerable populations from using needed health care services, and these efforts will help fill those gaps. The International Center for Research on Women is helping in this effort, undertaking important research on how HIV stigma and discrimination among health workers and communities in South Africa and Zambia influence the success of biomedical approaches to HIV prevention. This research will help inform how best to scale up new biomedical prevention strategies to ensure that the general population is open to accepting and adhering to them.

As the world’s attention turns to HIV and AIDS this week, we must redouble our efforts to ensure that sufficient attention is focused on how to reduce and overcome the stigma and discrimination that are impeding efforts to end AIDS. When we work together to end stigma and discrimination, we will be able to ensure that all people — regardless of their sexual orientation, race, age, gender or class — have access to vital HIV prevention, care and treatment services.

For more information on sessions and events at AIDS 2014 focused on stigma and discrimination, check out the Stigma Action Network's "stigma road map." 

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