Stigma, ignorance hinder health service delivery to LGBTQI+ Ugandans

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This story by Jessica Sabano, which was originally published by Daily Monitor on 1 December 2019, is part of a series produced with support from the Arcus Foundation and Heinrich Böll Stiftung Southern Africa. It emerged from an October 2019 journalism training workshop in Cape Town, South Africa.

Lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) Ugandans have long been denied access to medical services due to ignorance and stigma among medical personnel. This reality has encouraged LGBTQI+ people to self-medicate, a dangerous practice.

Now some doctors and activists are coming out to condemn medical discrimination against LGBTQI+ people.

“When these [LGBTQI+] people come to seek health services, we do offer them because they have a right to medication, but we also counsel them after treatment,” said Sam Bukenya, a professional medical specialist at Kawolo Hospital outside Kampala. “The problem with some is that they don’t identify themselves to us when they come for medication.”

Fear prevents many LGBTQI+ people from discussing their
sexual practices or gender identities with medical professionals and from accessing medical services.

Bukenya says Uganda’s Constitution guarantees everyone,
including LGBTQI+ people, the right to health services and that medical personnel are bound by law not to discriminate against anyone. Recent incidents show these laws are not being upheld.

In October, a doctor at Mukwaya General Hospital in Kampala allegedly attacked a female patient with an iron bar after learning she is a lesbian. The doctor Ben Kiwanuka Mukwaya was later summoned to Kabalagala Police Station to answer charges of assault. He denied the allegations and was released on police bond.

Annet Mutesi, a private clinical officer, says discrimination against LGBTQI+ people makes it impossible to gather statistics that would ensure their health needs are being met.

“Some people think the LGBTQI+ community has no rights, thinking they promote sexual immorality, but they are human beings and should not be isolated or discriminated against accessing medical care,” she said. “Let us welcome them to our health facilities to have them treated. The LGBTQI+ community needs to be vibrant in their advocacy on such demands as well.”

Frank Mugisha, executive director of the NGO Sexual Minorities Uganda, has seen LGBTQI+ people who cannot safely access professional medical care sometimes take matters into their own hands.

“LGBTQI+ people end up getting what is not right for their health, as some people resort to self-medications that are dangerous to life,” he said. [Discrimination] also affects Uganda in terms of capturing the number of people living with HIV/AIDS and other related illnesses, hampering healthcare service delivery for everyone.”

Kikonyogo Kivumbi is the executive director of Uganda Health Association, which advocates for inclusive public health policy and law for sexual and gender minorities. He agrees that access to medical care remains a major challenge in Uganda.

Despite a recent Uganda AIDS Commission report showing 53,000 new cases of HIV/AIDS infection in Uganda in the 2018/2019 financial year, Kivumbi says too little is being done to find out how such infections occur.

He commended Uganda’s Minister of Health Dr. Jane Ruth Aceng for issuing a press release in October acknowledging that LGBTQI+ people should have access to medical services and condemning the recent attack at Mukwaya General Hospital but cautioned that when such services, including lubricants and condoms, are removed from LGBTQI+ people upon their arrest and used as exhibits against them in court, discrimination remains inevitable.

Uganda’s Penal Code Act Section 145 punishes “carnal knowledge against the order of nature,” which includes same-sex sexual activity and heterosexual oral and anal sex, with life imprisonment.

“We have found that the highest [proportion] of people living with HIV/AIDS is women who have sex with fellow women and men who have sex with men. So if you deny such people access to medical services, it affects all of us,” Kivumbi said. “We are living in a society where there is diversity. People should not be isolated.”

Richard Lusimbo, a research and documentation manager at Sexual Minorities Uganda, said they have sensitised health providers and also created awareness in societies to address such concerns.

“We have also put interventions such as opening up clinics for the LGBTQI+ community. We started this intervention in 2012 and we are improving. So far, we have clinics in Kampala including a clinic in Mulago hospital,” he said.

Lusimbo adds that the government is aware of problems facing the LGBTQI+ community and that efforts are being made to find solutions.

“The Ministry of Health is supporting us to access health services from any health facilities,” he said.

Brant Luswata, executive director of Icebreakers Uganda, which runs the country’s leading LGBTQI+ community clinic, said many health officers hold negative attitudes about offering sexual and gender minorities health services because they are ignorant about their needs.

“We call upon all health practitioners to be informed and avail health services to the LGBTQI+ community. We are not promoting homosexuality but health as a human right,” he said.

One source, a lesbian whose name has been withheld to protect her identity, said she faced discrimination at a Kampala hospital in May 2018 when a doctor denied her treatment.

“I had some injuries in my private parts and also needed some lubricants. After explaining this to the doctor, he called other nurses to come and look at me and they laughed,” she said.

She left without receiving help and vowed never to return to a health facility.

“I started getting treatment again after a community leader referred me to a clinic that attends to our needs as the LGBTQI+ community,” she said.

The Ministry of Health publicly acknowledges that patients should be able to “seek medication without fear of discrimination, violence, personal vengeance or retaliation.” Following the minister’s recent statement condemning the alleged attack at Mukwaya General Hospital, Uganda’s LGBTQI+ community hopes that homophobic attacks, discrimination and stigmatization will be a thing of the past at health facilities.

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