04.04.14

HIV services derailed in wake of Nigeria, Uganda laws panelists say

When Nigeria passed its “Same Sex Marriage (Prohibition) Law,” banning gay people from gathering, and criminalizing “gay clubs, societies, organizations,” and their “sustenance,” the work of reaching men who have sex with men life-saving HIV prevention, treatment and other health services in the country with the world’s second largest HIV epidemic, had only begun to make headway. With same sex relationships already criminalized, information on risks and needs had been nonexistent when researchers began to gather data in 2006, a spokesperson from the Population Council who is familiar with the situation in Nigeria said Thursday. Using word of mouth and then focus groups, researchers began to gather data. The need, they determined over time, was urgent. The more than 15 percent HIV prevalence among men who have sex with men was four times the prevalence among the general population.

The information, the spokeswoman said, led to the formation of the Men’s Health Network Nigeria, a project of local partners and the Population Council to provide comprehensive HIV services for men. The network reached the clients of sex workers and men who inject drugs as well, making services accessible to some of the least served and hardest hit by Nigeria’s HIV epidemic, and the numbers of men reached grew quickly.

“We thought everything was fine,” the spokeswoman added, “until January 7, 2014.”

She spoke of the day  the Nigerian Same Sex Marriage (Prohibition) Act became law at a Capitol Hill briefing, joined by Rep. Barbara Lee (D-CA), Population Council Vice President Naomi Rutenberg, Ugandan HIV treatment and gay rights advocate and physician Paul Semugoma, and amfAR Vice President Chris Collins, discussing: “The Public Health Impact of Emerging Laws in Africa: What does this mean for an AIDS-Free Generation?”

The new laws in Uganda as well as Nigeria furthering penalties for same sex relationships and criminalizing support for gay people came at a time when science and more than a decade of treatment roll out countries with the highest rates of HIV and AIDS had made envisioning an AIDS-free generation possible, Rutenberg noted in her introduction to the briefing.

In the wake of the Nigeria law, gains vanished overnight, said the spokeswoman (whose name the Population Council requested not be used for her protection). From reaching 1,700 men in three months, she said, programs saw numbers of new clients halve, and drop to zero, she said, as threats of extortion, arrests and mob violence drove patients into hiding. “Among health care providers there was a lot of panic, there was a lot of frustration, and a lot of fear,” she added.

As reaching people in groups became impossible, she said, programs had to change their strategies to reach individuals. The government, in turn had to release a statement saying it was okay to seek health services.

That the laws’ impacts on services go beyond the legislated prohibitions was highlighted by reports from Uganda raised by audience members at the briefing about the closing Thursday of the Makerere University Walter Reed Project, a non-profit partnership between Makerere University and the United States Military HIV Research Program that provides health services, including HIV treatment, for men who have sex with men, among other populations. Information on events leading to the closing remained incomplete, both at the briefing, where Semugoma and Collins said they were waiting to learn more, and today, when a note on the Project site announced a “Temporary Suspension of Activities,” following an incident Thursday morning when a Ugandan staffer at the project’s Kampala office was “taken into custody by police at the project’s offices . . .” The notice on the project’s web site says that the staffer was released, that efforts to clarify the event continue, and that in the meantime “the operations of the program are temporarily suspended to ensure the safety of staff and the integrity of the program.” (A local report from the Ugandan New Vision newspaper, quotes a Ugandan police spokesperson asserting that the person making the arrest was not a policeman, and speculating that the incident was an “attempted extortion.” A spokeswoman for the MHRP said today that no further information is yet available on the incident).

Rep. Barbara Lee at the briefing Thursday

Whatever form enforcement of the laws take, treatment interruptions will be inevitable when patients live in fear that seeking treatment could lead to exposure, said Semugoma, who left Uganda and moved to South Africa after coming out as gay at the 2012 International AIDS Conference. And yes, he replied, to an audience member’s question, treatment interruptions will further set back efforts to combat HIV, as well as harm individuals’ health, by leading to drug resistance in an environment where access to additional lines of treatment are challenged.

“There’s greater clarity about how to address the HIV epidemic than there ever was. The challenge is to scale it up,” Collins said. “The laws,” he added, “are really bringing home the inextricable connection between health and human rights.”

Lee, whose office co-sponsored the discussion, has followed the development of Uganda’s law since 2009 when it was introduced. The representative who led fellow house members to ask the White House for concrete responses to the laws, also pointed to laws criminalizing transmission of HIV and emphasized, “In our own country we have some of the most egregious policies.”

“It’s very important to keep in mind,” Lee said, “it’s not only an African issue.”

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