Concerns have been mounting in Uganda’s hospitals and clinics since Western donors began leaving the country to protest a new law making homosexuality a crime punishable by years in prison. The World Bank put a US$90-million loan on hold, and several European countries suspended donations, but Ugandan President Yoweri Museveni has reacted defiantly. At a demonstration last month, he told thousands who marched through the streets of Kampala to celebrate the law’s passage that the cutbacks were "contemptuous."
Published: April 28, 2014
But at Kampala’s Mulago National Referral Hospital, doctors are apprehensive about what will happen to clinical programs and research projects involving people with HIV or AIDS, though some are reluctant to voice their concerns in public or discuss the issue with journalists.
Their worries were heightened Apr. 3 after police raided the Makerere University Walter Reed Project, which does HIV vaccine research and runs a mobile male circumcision clinic. An employee of the United States-funded project was arrested "allegedly for conducting ‘unethical research’ and ‘recruiting homosexuals,’" stated the US Department of State. Operations are now "temporarily suspended to ensure the safety of staff," according to the project website.
Uganda’s government spokesperson, Ofwono Opondo, tweeted the day after the raid: "Police burst Walter Reed Project in Makerere University#training youths in homosexuality." The claim that gay men are teaching schoolboys to become homosexuals has been made for several years in Uganda.
The raid has raised concerns among clinicians and researchers, not only for their programs, but also for patients and research subjects, given the possible seizure of confidential records at the time of the arrest. And there are also fears about which program could be targeted next.
The law has already had a chilling effect on physicians in leadership positions. Dr. Margaret Mungherera, president of the World Medical Association, says that before the law passed, she and other members of the Ugandan Medical Association (she is a former president) publicly criticized a clause that would have required doctors to report patients who said they were homosexuals. They also met with Uganda’s Minister of Heath about their concerns. The clause was removed, but Mungherera says the Ugandan Medical Association has decided to no longer speak about the law publicly.
Uganda’s medical programs have experienced these sorts of cutbacks before, and physicians have seen the effects on their most vulnerable patients. Dr. Adrian Kamulegeya, an oral surgeon at Mulago Hospital, remembers when revelations of government corruption led to restrictions on donor aid in 2009. "We ended up having funds cut off, and we actually saw most of those centres that were taking HIV/AIDS people no longer taking new patients, because they did not have the medication," he says.
At the time, Kamulegeya was researching whether ranulas in the mouths of HIV-positive individuals signaled progression of disease. After examining patients, he would send them to other clinics to have CD4 and CD8 counts done free of charge. "Then I would have the evidence to actually say, ‘This person might not have shown clinical AIDS, but we need to link them to treatment.’"
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