Uganda’s new anti-gay law has laid the groundwork for crackdowns by police and government officials that have begun to curtail scientific research on HIV/AIDS in Uganda and in other parts of East Africa.
AIDS fighters end up working in the dark if they lack research analyzing and exploring ways to improve anti-AIDS programs for gay men, men who have sex with men (MSM) and trans individuals. As a result, HIV prevention programs are less effective among those populations and, from them, further HIV infection can spread to the wider population.
Scientists wonder who of them will be targeted next. Since police raided the research program at Uganda’s Makerere University in April, “We’re all sort of wondering who is on a list,” said Lisa Butler, a researcher at Boston Children’s Hospital who has been involved for more than 10 years with research on HIV prevention and treatment in an article in Nature Medicine, published online on May 7.
According to that article, by Miriam Schuman, several planned projects have already been abandoned because of Uganda’s anti-homosexuality law. One was a survey that was to be run jointly by the U.S. Centers for Disease Control with Makerere University. It was to estimate the populations of high-risk groups in rural areas, including gays and MSM. The other research project was to be sponsored by the U.S. National Institutes of Health to measure MSM’s and gays’ access to HIV prevention and health care services. Without this research, Ugandans and likely other Africans, can expect questionable quality of service delivered to gay men, MSM and trans individuals.
In March, several HIV clinics serving gays and MSM in Kenya were closed out of fear, but they were re-opened within a week.
On April 12, the MSM health advocacy organization ISHTAR reported via Twitter that Kenyan police raided the amfAR-funded office of the Men Against AIDS Youth Group in Kisumu, a city in western Kenya, allegedly for promoting homosexuality. The group was conducting research at their offices, a needs assessment co-funded with the AIDS Fonds of the Netherlands that brought together gay men, MSM and trans individuals.
Meanwhile, in Tanzania, a health and social justice group has reportedly been closed for allegedly promoting homosexuality. Tanzania’s Sisi Kwa Sisi Foundation apparently lost its registration effective April 4, according to a report stating that the Ministry of Community Development issued a public notice that the group must suspend all activity.
Involved in outreach work for the Tanzania AIDS Prevention Program and funded by the Centers for Disease Control, the Sisi Kwa Sisi Foundation described itself on its now-inactive Facebook page as a volunteer non-profit youth group, founded in 2008. It advocated for access to HIV/AIDS education and prevention services free from discrimination on the basis of sexual orientation.
The report in Nature Medicine cites several potential problems for future for AIDS research because of anti-gay attitudes in general and Uganda’s Anti-Homosexuality Act in particular:
Given the anti-homosexual climate, David Balikowa, a Kampala-based communications consultant who works with several nongovernmental organizations (NGOs), worries that clinical researchers may find it harder to recruit trial participants. “People are going to be very suspicious about NGOs,” Balikowa says, because the perception left by the police raid “is that the NGOs are being used as covers for promoting homosexuality.”
Concerns about participant confidentiality could also prevent international funding bodies and ethics review boards from approving African studies in high-risk groups. Some researchers worry that confidentiality may be breached during police raids, for example.
Others worry about trainee issues. Helen Verdeli, a clinical psychologist at Columbia University in New York, is collaborating with colleagues at Makerere on a study that involves training health workers in Uganda to deliver a specific form of psychotherapy. When she discussed the importance of confidentiality at a recent training session, one Ugandan trainee said that health workers do not have to report individuals who said they were homosexuals, but that person thought they should encourage such persons to turn themselves in to the police to comply with the law. Verdeli says she explained to the trainee that patient confidentiality means “not that you don’t have to report, it’s that you have to not report the person.”
That same sense of needing to comply with the law may also drive suspicions on research teams. “People who are our work colleagues may feel bound to report people with the [research] group, for both homosexual activity and the so-called promotion of it,” says Butler.