Gerson: Anti-gay laws make the AIDS crisis worse
The Washington Post 00:53
The proximate cause of these crackdowns is political. Both Jonathan
and Museveni, facing a variety of electoral and economic challenges,
are picking populist fights with Western colonialism. After signing
Uganda's most recent anti-gay law, Museveni said, "
There's now an attempt at social imperialism, to impose social values
. We're sorry to see that you [the West] live the way you live, but we
keep quiet about it." This
defiance plays well in African electorates (as dictators such as
Zimbabwe's Robert Mugabe have exploited for decades). And the West's
outraged reaction plays into the strategy, at least in the short term.
Anti-gay laws in Africa (and elsewhere) are often remnants of old
colonial statutes, but they also reflect a broad cultural consensus.
Homosexuality is
illegal in 38 of 54 African countries
. Religious leaders, both Muslim and Christian, have a history of
encouraging intolerance. Africa's growing evangelical churches --
rather than being distinguished by principled beliefs in human dignity
and moral persuasion -- have supported criminalization. And a few U.S.
religious figures have incited malicious prejudices rather than
confronting them.
This problem has many political, cultural and religious layers. One
matter of science, however, is clear: Anti-gay laws are bad for public
health.
The context here is HIV/AIDS. Over the past decade, serious
progress has been made in places such as Uganda
on promoting testing, reducing transmission and providing treatment
among most groups. But these advances have slowed or stalled as the
fight against AIDS has involved more marginalized, difficult-to-reach
populations, including men who have sex with men (MSM).
Because MSM are stigmatized, they often go unstudied. But the problem
in Africa, as elsewhere, is unprotected anal intercourse with a high
number of partners. African MSM are nearly four times more likely to
be HIV-positive than men who don't have sex with men. And typical
categories of "gay" or "bisexual" don't fully capture the diversity of
these sexual practices. Many MSM in Africa identify themselves as
heterosexual. In one Ugandan study, about 75 percent of MSM have sex
with women as well -- making their female partners more vulnerable to
disease.
What influence does criminalization and persecution have on this
group? Senegal provides a test case
. After nine male HIV-prevention workers, arrested in 2008, were
convicted of "acts against nature" in and sentenced to eight years in
prison, researchers studied the result. Heath providers reported a
sharp decline in medical visits by MSM. Some, fearing assault, left
the country or discontinued their medical treatment. A number of
service providers, concerned for their own safety, stopped doing
targeted outreach to MSM.
It is the job of public health officials to account for the reality of
human behavior in pursuit of the public good. Anti-gay laws complicate
that task in practical ways. MSM who are afraid of prosecution and
violence are less likely to attend meetings where they are given
education, condoms and lubricants. Less likely to be honest with their
physicians about their sexual histories. Less likely to be tested for
AIDS and receive treatment and care. And more likely to inadvertently
infect others.
When Western governments lecture African countries about their
retrograde views, it can feed a populist, anti-colonial backlash. When
donors threaten to cut off aid, it can cause lesbian, gay, bisexual
and transgender activists to cringe -- fearing they will be scapegoated
for the punishment of their whole country.
What might be more effective is a forceful health-related message.
This is an area in which civil rights -- starting out with a simple
zone of personal privacy -- is a requirement of public health. Nations
such as Nigeria and Uganda are committed to ambitious objectives in
fighting AIDS. Those goals are unachievable while any group is
targeted for discrimination and excluded from effective outreach.
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--
SIBOMANA Jean Bosco
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