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Uganda AIDS policy: from exemplary to ineffective

Published in: The Observer (Uganda)

In mid-July AIDS experts from around the world will gather for the 18th international AIDS conference. The focus will be on where AIDS is being defeated and where it is re-emerging. Unfortunately, Uganda will be discussed in the second category.

At the start of the AIDS epidemic, countries around the world turned to Uganda and saw a nation that forcefully addressed AIDS, using straight talk, evidence-based approaches, and the engagement of people living with HIV. Ugandan government and civil society leaders became famous on the world stage.

So much has changed. Intolerance and bias have replaced effective approaches. Widespread corruption, including the theft of millions of dollars targeted for HIV services, has damaged Uganda's anti-AIDS efforts, as well as its reputation.  Discriminatory, punitive laws and policies are proposed instead of common-sense approaches. There is no longer the sense that "AIDS affects us all".

The HIV and AIDS Prevention and Control Bill tabled in parliament recently is a case in point.  If passed in its current form, the bill would criminalize a broad range of conduct, including intentional and attempted HIV transmission and "misleading statements or information regarding curing, preventing, or controlling HIV."  

Criminalizing HIV transmission is a discredited idea, out of step with the recommendations of global health and AIDS organizations. Countries with such legislation have found that it is applied rarely, often arbitrarily, and has no impact on preventing HIV infection. Prosecuting "misleading statements" on HIV prevention will depend on who gets to decide what is misleading. Such provisions could unjustly snare scientists and religious figures, as well as politicians and teachers.

The bill also includes mandatory testing for HIV, and permits broad disclosure of HIV status to "any other person with whom an HIV infected person is in close or continuous contact including but not limited to a sexual partner, if the nature of contact, in the opinion of the medical practitioner, poses a clear and present danger of HIV transmission to that person." 

What do these provisions have in common? Well, for one, they won't reduce HIV transmission. Second, they will encourage ugly attitudes toward people living with HIV and drive people away from information and help.

Last month when I spoke with Parliamentarians in Kampala about this pending bill, they often defended it as protecting women. But if enacted, it is women who will be victimized. Laws criminalizing HIV transmission and permitting the broad disclosure of a person's HIV status hit women hardest, exposing them to violence, discrimination, and further stigma.  Women account for 60 percent of HIV cases in Uganda; and as a result of pregnancy-related medical care, they form the majority of those who know their HIV status.

Many women are not in a position to refuse sex or insist on condom use, and risk being beaten, evicted, or losing their children and property if they disclose that they are HIV positive to their husbands or boyfriends.  The proposed law would put them in a dangerous double-bind:   risking violence and other serious abuses by trying to protect their intimate partners, or risking prosecution by failing to do so.  They may face punishment under the law even if they never transmit the virus, and drop out of the public health system altogether as a result. Maternal and child mortality could increase.

There may well be cases in which criminal prosecution is appropriate -- cases of willful, intentional transmission of HIV -- and an HIV/AIDS bill that prohibits discrimination and ensures access to health care is important. But existing provisions in the Ugandan penal code are sufficient to address intentional transmission, and the proposed law falls short of guaranteeing access to health care for all.

The United Nations secretary-general, Ban Ki-moon, wrote on June 15 about Uganda's AIDS crisis and the need for greater global financing of HIV treatment worldwide. The commentary was entitled "Snatching Defeat from Victory in AIDS Crisis." With its good intentions and flawed provisions, it's a good title for a discussion of Uganda's HIV/AIDS bill as well. Reforming the bill and ensuring the law supports effective HIV policies and protects the rights of people living with HIV will help Uganda to again be a leader, and a success, in the fight against AIDS.


Joe Amon is director of the Health and Human Rights Division at Human Rights Watch.

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