Out of the Shadows

Published: June 4, 2013

During the XIX International AIDS Conference (AIDS 2012) in Washington, DC, last year, Paul Semugoma, MD, gave a passionate speech on behalf of both LGBT and HIV-positive people. Coming out as gay during the speech made it even more memorable.
As a private physician in Kampala, he specialized in researching HIV/AIDS among vulnerable communities in Uganda, including LGBTs. He shares why he came out, the aftermath of his speech and his hope for change.

What is the state of the epidemic in Uganda?
 The picture is very mixed. We have a mature generalized epidemic. There are about 33 million people in the country. About 7.3 percent of adults in Uganda have HIV, up from about 6.4 percent in 2010. There was a time when at least 18 percent of adults were HIV positive. The percentage of adults with the virus has flatlined for more than 10 years, while prevention efforts have become stagnant. Of those who are positive, about 40 percent know they have the virus.

The figures show that HIV is still not under control. We are not yet optimally covering those who are infected. Using the less than 350 CD4 cells criteria, a third of Ugandans with HIV are eligible for antiretroviral (ARV) treatment and about half of those are on ARVs. Our health care system is generally in shambles, which tends to mean that prevention is the most important path for most of our people.
How are men who have sex with men (MSM) affected?
 There has been a systematic denial of the very existence of MSM, which has made LGBT people invisible in all aspects of prevention and care. Data from a 2008 study released in 2009 showed an HIV prevalence among MSM in Kampala of 13.4 percent, compared to 4 percent among all adult men in the city. A follow-up study is reportedly under way.

Those were the very first figures in the country on HIV among MSM. For a country famous for the success of its prevention efforts, it’s remarkable there had been no knowledge of this key population before.

There is no culturally competent care for MSM, with most unable to come out to their health care providers. Officially, health ministry officials believe they do not discriminate because they don’t ask about the sexuality of their clients.

The anti-homosexuality bill would make HIV prevention efforts for MSM much harder. It was proposed by David Bahati, a member of the Ugandan Parliament. Its aim is to make sure that homosexual relations don’t happen in Uganda. Punishments for violating it include death for serial offenders who are HIV positive.
The bill was first introduced in 2009. It has not been passed, but it is still on the agenda for Parliament.

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