Anti-Gay Laws Imperil Their Countries' Health, Too

Four years ago it was proven that if you give people HIV drugs and they take them, their chance of infecting someone else falls by at least 96%. It's stupid to drive into hiding the people you may need to treat to continue your fight against AIDS.

The anti-gay laws enacted in Uganda and Nigeria recently aren't just cruel: they also pretty much guarantee a renewed upsurge of HIV in the population. That's why here at Aidsmap we and the European AIDS Treatment Group have created a statement of basic principles to be observed when treating people with HIV. It's launched today, Thursday 27 February.


In the last year I've become inured to violence against gays and lesbians, pleas to get them out of jail and petitions to stop anti-gay laws. Last Wednesday, though, it got personal; the Facebook post was about a friend, a Ugandan gay activist. "Stop Paul Semugoma being deported from South Africa", it read.

Eventually, after a 24-hour flurry of letter-writing and rainbow-hued street demos, the South African Home Office released Paul back into the embrace of his partner, Brian Kanyemba.

I'd met Paul six years ago in Mexico City before an International AIDS Conference. At the previous conference in 2006 no African gay activists addressed the meeting. Two years later there were all these young gay guys around, not just southern Africans but Maghrebis and Indians and Tajiks too, daring the world to Stop them Now. The globe had discovered Gay Lib.

Paul was a diffident young doctor in steel-framed glasses, feeling his way, I sensed, not only into being a campaigner but, as an African gay man, into an identity with few role models.

"Aren't you scared they'll get you?" I asked, in the wake of the murder of activist David Kato. "They won't touch me, I'm too well known," he said defiantly. Things are darker now: last Wednesday Paul was fighting for, at the very least, his freedom, and probably for his life.

What the criminalisation of good men like Dr Paul Semugoma tells us is that the anti-gay laws and witch-hunts being enacted in countries like Uganda, Nigeria and Russia are not only unjust and cruel. They are also, as bullies often are, stupid.

Any sane Ugandan would prize Paul as one of its brightest and best sons. Addressing 15,000 people at the Washington International AIDS Conference two years later, he talked about his work running his own small medical practice in Kampala; how gay men who came to him for lifesaving HIV treatment they could access nowhere else for fear of persecution.

Here's someone - someone who could have joined the brain drain and secured a comfortable living in the west - treating fellow Ugandans for the disease that has scarred their country for 35 years. In the process he's also advising them on safer sex and how to stop spreading HIV further - and also, simply by treating them, reducing the chances of their passing on HIV.

Four years ago it was proven that if you give people HIV drugs and they take them, their chance of infecting someone else falls by at least 96%. It's stupid to drive into hiding the people you may need to treat to continue your fight against AIDS.

A couple of months ago, I was passed an email from a kindly doctor in Cameroon (where the director of another organisation founded by a gay doctor was also arrested for being gay last week).

"I recently came across a 20 year old boy who had been denied antiretrovirals by a clinician because he was a man who had sex with men [MSM]. Another MSM was chased away but I was able to intervene when I found him crying along the corridors in our clinic. If we continue this way, our MSM clients will default on medication and we shall be fuelling an epidemic."

Yet it's usually a mistake to assume politicians are really stupid;they're generally smart opportunists, and many are well aware that if you just refuse to treat a bunch of people, your reward is a resurgent HIV epidemic. So, if you are a homophobic President, what do you do to make sure gays are duly punished while containing the public health menace you think they pose?

Simple: you blanket-test everyone for HIV, and make avoiding a test illegal. Last year, while some African countries were tightening anti-gay laws, others were making HIV testing compulsory. Botswana passed a law last April that enabled doctors, surgeons and dentists to force patients to have HIV tests without their consent or even their knowledge. Robert Mugabe thinks this is a jolly good idea and has recommended every southern African country follows suit: Ugandan MPs like it too.

Now imagine being a gay man in a country where being open about your sexuality is illegal, but refusing to test for HIV is also illegal. They've got you coming and going. Take your HIV test, it outs you as gay, go to jail. Avoid your HIV test, you're Typhoid Mary, still go to jail.

The idea of universal testing started with the best intentions when people realised that if everyone with HIV took treatment, the epidemic might stop in its tracks. I was pretty excited about this idea myself. Many publications not normally noted for espousing draconian measures against HIV - such as the New York Times - praised 'mandatory testing' as a sensible measure in high-prevalence countries. We didn't think hard enough about why people might fear testing, believing it was only ignorance that stopped them.

Contfronted with such measures against both gay people and others with HIV, we can write e-petitions and threaten trade campaigns: but that may only stiffen resistance in the countries concerned. But there is another weapon: science.

While gay activism is similar to other civil rights movements, HIV activism, historically, has been a bit of a breed apart. Born, as the Oscar-nominated documentary How to Survive a Plague shows, in the need to know as much about the science of AIDS as the scientists, we've always aimed to oppose those who know what's best for us not just with civil disobedience, but with references...

So NAM and EATG drafted a 'Community Consensus Statement', a set of basic principles to be observed in treating every person with HIV. It's launched today. So far it's taken a year to develop, going through 22 drafts, a public consultation and a community meeting. Its influence, the degree to which it's a real consensus, will depend on how many sign it.

Its message to leaders is simple: whether you deny people HIV therapy or try to make them take it, you're doomed to failure: force and banishment will not clear HIV from your country: only partnership with an informed, empowered, respected HIV positive population will do that. Here's how you do it and, oh, you just did the opposite. Well done.

It was important that the statement was clearly based in the science of prevention. Because of this, there are three versions: the 24-article sign-on communiqué crafted last year, a shorter list of Key Points for editors and teachers, and a densely-referenced 11-page paper giving in-depth information about the science - including what we don't yet know.

We don't stop here. This is not a petition; it's intended for long-term use. We'd love the Statement to be taught, discussed, adapted to suit local conditions, used as the basis for HIV treatment and prevention programmes; to be as pivotal as other declarations by HIV activists have been all the way since the Denver Principles of 1983, which first enshrined the idea of people with HIV being key to decisions about their own lives.

A precious human rights approach to HIV and people vulnerable to it is in danger: we want to do what we can to keep it alive.

See, and sign if you agree. Every name counts.


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