Access to HIV Care: Are Some Ugandans More Equal Than Others?

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This story was produced by The Community Agenda and first appeared here. It was written as part of a media skills development programme for Ugandan and Kenyan journalists run by the Thomson Reuters Foundation and led by Taboom Media’s founding director Brian Pellot in May 2019. 

KAMPALA — Sanyu (not her real name)  30, a lesbian sex worker, is one of the millions of Ugandans who witnessed  Uganda’s president Yoweri Museveni sign the Anti-Homosexuality Bill on 24th February 2014, amidst protests from human rights defenders, applause from some religious leaders and fear from the LGBTQI+ community.

After assenting to the bill, President Museveni gave a speech in which he said;

“Since my original thesis that there may be people who are born homosexual has been disproved by science, then the homosexuals have lost the argument in Uganda. They should rehabilitate themselves and society should assist them to do so”.

This, according to Sanyu, was the most stigmatising and dangerous statement in the President’s speech.

“My President was telling me that I need rehabilitation, as if I am sub-human or an outlaw. He put his political survival above my rights and sparked off a wave of verbal and physical attacks against the LGBTQI+ community in Uganda,” she said.

Although the Anti-Homosexuality Bill was later annulled, Sanyu says it has not changed attitudes towards the LGBTQI+ community in Uganda. And she says this stigma has prevented her and her peers from accessing healthcare.


In 2015, she fled a Catholic-owned health facility in Wakiso District after coming under verbal attacks from a health worker who she says claimed to be fulfilling the President’s directive.

“I went for an HIV test and when asked about my partner, I was honest with this health worker— I told her I am a lesbian sex worker,” Sanyu says. “Initially, she seemed okay with it. Before giving me the results, she took me to the counselling room, but believe me, it was not counselling, but a grilling. I couldn’t wait for the results. I walked out.”

Sanyu’s experience is not uncommon in Uganda, where members of the LGBTQI+ community say discrimination towards them affects their ability to access health services.

This runs contrary to the Uganda Medical and Dental Practitioners Council (UMDPC) Code of Professional Ethics, which states that a medical practitioner shall “not carry out any specific actions that constitute a violation of bill of rights enshrined in the Constitution of Uganda and international human rights law”.

Uganda’s constitution also says that no person shall be discriminated against on the grounds of gender, race, colour, ethnic origin, tribe, birth, creed or religion, social or economic standing, political opinion or disability.

But as Richard Lusimbo, Research and Documentation Manager for Sexual Minorities Uganda (SMUG) says, the reality at health facilities can be very different.

“They are Ugandans, who should be treated equally, but to my surprise and disappointment, they are stigmatised and on many occasions denied access to services they are entitled to,” said Lusimbo.

Some LGBTQI+ rights activists are particularly critical of faith-based health facilities, which they say are often reluctant to open their doors to the gay, lesbian and transgender community.

“Much of the anti-LGBTI rhetoric was coming from faith leaders,” said Kikonyogo Kivumbi, the Executive Director of Uganda Health and Science Press Association (UHSPA) and an LGBTQI+ advocate.

“So we have been engaging with government and religious institutions to say that look, much as there is a social discussion or dialogue going on about LGBTI rights in Uganda, access to health should be a basic human right.”

The Inter-Religious Council of Uganda (IRCU), comprised of the Uganda Muslim Supreme Council (UMSC), together with the Catholic, Anglican, Orthodox, Seventh Day Adventists and Pentecostal churches was at the forefront of advocating for the anti-homosexuality law, releasing a statement about “the dangers of homosexuality and lesbianism.”

Haji Nsereko Mutumba, the Public Relations Officer of UMSC told The Community Agenda that UMSC has a zero-tolerance policy for homosexuality saying that it goes against Islamic teachings. Like other faith organisations, UMSC owns several health facilities around the country.

In the wake of the 2014 bill being passed, UHSPA’s Kivumbi was among those who sought a presidential moratorium on access to health. Not long after, the Ministry of Health implemented a policy shift, issuing a circular letter to all health facilities, stating there should be no discrimination towards any patient based on sexual orientation, identity or expression.

“State policy in this country has acknowledged that in order to safeguard the overall health of Ugandans, no one should be left behind. That the health of people you may not agree with is tied to your own health. That it is a public health matter and it should not be negotiable on who gets it and who doesn’t,” Kivumbi said.

Dr. Nelson Musoba, the Director General of the Uganda AIDS Commission (UAC), a government body that coordinates HIV/AIDS programs, says the UAC has identified key populations among whom there is a higher rate of HIV—as high as 25 percent. It includes the LGBTQI+ community, members of the armed forces, fishing folks, long-distance truck drivers and sex workers.

He told The Community Agenda that although homosexuality is criminalized in Uganda, the Ugandan government now officially implements a no-discrimination approach in health facilities.

“We are working with the Ministry of Health to ensure that people access services and stigma is reduced,” Musoba said, adding that Uganda is striving to meet UNAIDS’ “90-90-90” goal—a target designed to ensure that 90% of people living with HIV know their status, receive access to care, and achieve viral suppression by 2020.

It is not only government-run public health facilities that have embraced the policy shift. Kamya Mary, an independent midwife who owns a private clinic in Mukono said she has opened doors to the LGBTQI+ community after consultations with her District Health Officer (DHO).

“When I consulted the DHO, he said our duty is to offer the services and ensure confidentiality of the clients,” she said.

Ddumba Isaac, the HIV/AIDS Focal Person of Mukono District Local Government said the Ministry of Health’s policy on access to health is now very clear: “No discrimination. Health workers are under oath to serve without discrimination”.

He said that health facilities now have at least one USAID-trained focal person for at-risk populations, who have been trained to ensure that clinics are safe spaces for LGBTQI+ patients.

The policy includes faith-based health facilities. A doctor working with one of them told The Community Agenda that he would treat anyone who comes to him regardless of his or her sexual orientation or identification.

“If we can treat criminals, why not homosexuals,” he said on the condition of anonymity.

Despite these gains, in its 2017 report, SMUG states that sometimes people are still turned away if the focal person is not on duty.

“We have been calling for conversations about how to sensitize more than one person in a health centre so that even when that one person is not there, we can still have non-discriminatory health services,” the report says.

Advocacy work to ensure fair access to health for the LGBTQI+ community isn’t stopping there. The Community Agenda has established that two members of Uganda’s LGBTQI+ community have recently won seats on the country’s board of the Global Fund to Fight AIDS, Tuberculosis and Malaria. And last week, gay rights activists worldwide welcomed the appointment of Winnie Karagwa Byanyima, a Ugandan national, as the new Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS). Byanyima is known as an LGBTQI+ ally.

These recent developments are likely to further the country’s commitment to ensuring equal access to health services for sexual and gender minorities, as well as greater visibility for the LGBTQI+ community in Uganda.