Box Turtle Bulletin
News and commentary about the anti-gay lobby“Now you must raise your children up in a world where that union of man and box turtle is on the same legal footing as man and wife…”
News and commentary about the anti-gay lobbyDecember 18th, 2009
The British medical journal The Lancet has just published an article warning about the detrimental effect Uganda’s proposed Anti-Homosexuality Bill would have on that nation’s fight against HIV/AIDS.
Reporter Zoe Alsop describes a talk that MP David Bahati, the prime sponsor of the anti-gay bill, gave before a cheering audience at Makerere University in Kampala (subscription required):
Before ceding the podium, Bahati had one last point to make. “This is not a Ugandan thing”, he said, his chest swelling with indignation. “Homosexuals are using foreign aid organisations to promote this. If an organisation is found to be promoting homosexuality, then their licence should be revoked.”
Shoulder to shoulder with Bahati’s supporters a half dozen or so Ugandans listened quietly. Several were doctors who had spent much of their careers toiling against a disease that has taken the lives of more than a million Ugandans. Their faces were stoic as they contemplated the implications of Bahati’s bill for the fight against HIV/AIDS not just among gay men but also among the wives and children of men who also have sex with men. They considered the long, lean years that had been spent quietly setting up networks to disburse information on HIV/AIDS to lesbian, gay, bisexual, transgender, and intersex Ugandans.
“As a doctor, the law infuriates me”, said one general practitioner, who is much sought after by sexual minorities for his willingness to treat them, and who asked that his name not be used for fear that he would be arrested for working with sexual minorities. “We are only now getting to a point where people understand there is a problem. This law is going to erase all of that.”
Zoe reports that in much of Africa, where AIDS is predominantly a heterosexual disease, many people including doctors believe that it’s impossible for gay people to become infected with HIV. Bahati’s proposed legislation, which would impose draconian penalties including death on anyone who is gay, would have a chilling effect on LGBT people seeking medical care from health authorities. And the bill’s provision requiring anyone who knows someone who is gay to report them to police within twenty-four hours would only serve to reinforce those fears among Uganda’s gay community.
All of that is only compounded by another provision of the proposed bill which punishes anyone who “promotes or in any way abets homosexuality and related practices” with seven years imprisonment. Medical doctors providing safe-sex information or who simply treats someone who’s gay can be seen as promoting or abetting “homosexuality and related practices.” These proposals have already had a chilling effect on HIV/AIDS workers:
In past years, Wamala says, Icebreakers (Icebreakers Uganda is an LGBT HIV/AIDS service organization) travelled around Kampala to meet with sexual minorities and sex workers. They offered counselling, condoms, lubricant, and medical referrals. This year, though, has been different. People seen attending meetings were blackmailed by neighbours, who threatened to report them to the police. “Nowadays, people are hiding”, Wamala said. “The blackmail and the arrests skyrocketed and we saw that it was not safe. At meetings we saw the number had really fallen, and even for those who came we were not sure whether we should be able to come the next time.”
Other groups say they have been able to work as long as their activities are carefully disguised. Thomas Muyunga, a doctor in the Most at Risk Populations Network, says he always makes sure that testing and counselling events include people who are heterosexual. “Originally we wanted to go to these people directly”, Muyunga said. “We realised that it was impossible. So the disguise is to address that. That’s why we have managed to even work today.”
Click here to see BTB\’s complete coverage of recent anti-gay developments in Uganda.
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THOMAS MUYUNGA
November 5th, 2010
CRIMINALISATION FUELS DISCRIMINATION AND INDIGNITY TOWARDS MSM/SEXUAL MINORITIES: LESSONS FOR SELF HELP ORGANISATIONS ADDRESSING SAME SEX ORIENTATION ISSUES IN UGANDA
INTRODUCTION:
There are self-help organisations seeking to set an agenda for service provision and hopes to improve on the status of MSM/Sexual Minorities. MSM/Sexual Minorities are faced with insecurity and this impacts on their decision-making, healthy practices, economic and social development. There is need to respect the principles of security and the state of law.
Without providing an environment within which MSM/Sexual Minorities enjoy respect, self esteem, fundamental rights, and where their violation is sanctioned, MSM/Sexual Minorities cannot realize their economic and social development.
One of the most important fundamental rights is the principle of non-discrimination, through which every individual enjoys the fundamental rights and freedoms set out in the various international instruments without regard to gender, professions and belief.
DISCONNECT BETWEEN PERCEIVED AND UNMET NEEDS:
Under Ugandan Law, HOMOSEXUALITY is illegal and is penalised by Criminal Law (Penal Code). This exposes MSM to risk of violent repression. In Uganda, there are different forces that impact differently on this kind of activity ranging from; perception that MSM “need rehabilitationâ€, attribution of HOMOSEXUALITY as a culpable offence, outright state mistrust for activities concerning same sex issues and arbitrary arrests. This is what organisations friendly to same sex persons should understand and therefore first address in order.
REPERCUSSIONS OF POLICY:
It can be concluded that the situation within which same sex orientation prevails is alarming in Uganda.
As well as the discrimination resulting from this repression, the stigmatization and rejection of MSM/Sexual Minorities has impacted on public health. People who have sexual relations may not bargain/negotiate for safer sex and therefore present a higher risk of sexually transmitted diseases including HIV. Public health problems are linked to development, making the situation of MSM/Sexual Minorities doubly important.
The fight against discrimination and empowering same sex oriented persons through organised formal activity groups is one step to bring their voices to a platform where they are galvanised into action for self-development.
RECOMMENDATIONS:
• Involving MSM/Sexual Minorities in the conceptualization, design and inception of projects that are friendly.
• Avail choices and explore means of engaging MSM/Sexual Minorities as persons deserving dignity and whose rights need to be addressed. There is need to mobilise same sex oriented persons in formal groups with an agenda that demands formally; health, empowerment and psychosocial support (HEPs Model).
• Engage security agencies and “rehabilitation homes†in understanding handling of same sex oriented persons not as offenders but as human beings. This will decrease on abuses that these persons are arbitrarily subjected to.
• Take steps to engage MSM/Sexual Minorities in active participation, enjoyment of rights to free choice of profession, life, access to health information, care including integrated sexual/reproductive/ maternal health, post-abortion care and education, association among themselves and other networks and speech.
• Provide friendly methods that allow MSM/Sexual Minorities’ experiences to be heard. This will encourage evidence-based programming and application of best practices.
• Engage media to reduce shameful reporting by the press and ridiculing in the society.
• Mobilise MSM/Sexual minorities to benefit from seminars and workshops that will improve on their understanding of policy and programming that impacts on their welfare as a form of capacity building.
THOMAS MUYUNGA
November 5th, 2010
CULTURE, POLITICS & UNDERSTANDING HOMOSEXUALITY AS A STRATEGY TO FIGHT HIV/AIDS
Thomas Muyunga
WORLD VIEW AND ORGANISATION OF BUGANDA CULTURE
We can fight the war against HIV and win if we also decide to understand sexuality, gender and challenge patriarchal injustices. Amidst HIV pandemic, the chaos of trading animosity, criminalisation, finding a middle-ground and providing un-conditional health services I have tried to study why sexuality and gender issues are the cause of so much debate, self-righteous stand by some and outright tolerance for others when it comes to HOMOSEXUALITY in Uganda. I took time off and in the quiet of long nights read through writings by others who were shedding light on the shifting grounds. I have divided this essay into 4 parts: comparing notes through the writings of others, personal observations as I continued providing health services to marginalised communities, borrowing from my own Buganda upbringing and relating to the events following the Anti-Homosexuality Bill.
Social and moral lores in story form, nurturing or anecdotes inform our understandings of morality and culture. It is common today to find people lament the moral state of society and the decline of morality, especially among youth. There is individualism and a lack of concern for community involvement and civic participation causing the moral crisis.
But this view is challenged by Elliot (Elliot Turiel, 2002). He challenges these views, drawing on a large body of research from developmental psychology, as well as from anthropology and sociology. He also culls from social events, political movements, and journalistic accounts of social and political struggles in many places of the world. Turiel shows that generation after generation has lamented the decline of society and blamed young people.
Using historical accounts, he persuasively argues that such characterization of moral decline entail stereotyping, nostalgia for times past, and a failure to recognize the moral viewpoint of those who challenge traditions. People’s discontents with the unfairness of many aspects of societal arrangements, traditions, and established practices are often misinterpreted as a lack of commitment to society or community.
Examples of social events, political movements, and journalistic accounts of social and political struggles worldwide, show how marginalized populations often oppose cultural arrangements, and mobilize to change the societal status quo.
PLURALISM, GROWTH AND DEVELOPMENT IN MY GANDA CULTURE
Human dignity as a benchmark for all humans has brought forth various arguments and approaches to treatment of people of different sex, opinions, culture, trade and faith. This wave is increasingly replacing existing paradigms. Just because someone has had sexual intercourse with a person of the same sex should not stop one from administering a health tip or service to that person when need arises. Otherwise, one may be construed as being judgemental and discriminatory. But again in a majority world how many patients present as homosexuals (same sex)? Because of criminalisation surrounding this form of sexuality many would hide.
We are seeing more and more understanding of sexuality and gender, shedding light to the way we need to treat each other and these opposing perspectives are often proclaimed to be the wave of the future. This will in turn be basis for evidence to provide timely interventions and future directions.
The cumulative experience of social and moral development in adulthood stems from a child’s multiple social interactions. Children’s social relationships involve a combination of cooperation and conflict, as well as social harmony and social opposition. These are influenced both horizontally and vertically. As a muganda child one’s roles are set out once this child’s gender and sex are known.
Naming follows an intricate process witnessed by paternal and maternal clans. The child is made a duty bearer at an early age. A child is taught to endure injustices and to know that any opposition and resistance to injustices embedded in societal arrangements and cultural practices means being cast out or evicted. This is the morality arbiter that is so feared in my Ganda culture.
Ganda-lore ascertains that at maturity one has to beget children who will carry on the lineage. Again Ganda-lore ascertains that the living are a connection to the past ancestors and future. To have or not to have children is a choice that Ganda society makes for an individual. Homosexuality may or may not mean to give birth to children. The fact that it entails free-choice on whether to be in a relationship, to have or not to have children it then challenges the status quo. This is why same sex life is facing challenges. It challenges the traditional heterosexual family. It is also said to challenge the chain of Ganda transcendentalism.
GANDA MORALITY AND CONVENTION
A child belongs to a family, which in turn belongs to a clan, which in turn belongs to a nation. An individual child in Buganda goes through various learning phases: obedience, subservience, responsibility bearing, acknowledging inadequacies, failure and taking initiative. However, Children are not simply molded by the environment; through constant inference and interpretation, they actively shape their own social world (Elliot Turiel, 2002).
For a muganda, development of moral judgment is formed during childhood, adolescence and later on the evolving understanding of the conventions of Ganda social systems. A boy will be instructed in what a boy must do and the girl will be instructed in anticipation of motherhood. Like in many other settings, even for the Baganda, social judgements are ordered, systematic, subtly discriminative for heterosexual norms but overtly discriminative for homosexual norms, and related to behaviour. A muganda child generates social knowledge through social experiences that are as a result of sex, gender, religion, culture, education and future.
GANDA JUDGMENTS AND ACTION
Thoughtful humans are always deeply concerned with the moral nature of their actions and many events have further widened the scope of concern. We have different standards for making social decisions (Domain Theory): moral, conventional and personal. Factors that lead us to act on our judgments, or not, are critically examined using issues important to the day and time such as; prevailing infections, sexuality, culturalism, political pluralism, status, responsibility, miscegenation, abortion, visibility, academic prowess, accomplishments and risk taking. This has to lead to something tangible with the future. However, in all these, sexuality (HOMOSEXUALITY) causes so much controversy. Ganda judgements are more importantly influenced by one’s sex and gender with a future responsibility to prove one’s virility or fertility. This leads me to the next fibre, HOMOSEXUALITY.
What is this? Is it an act of God? I have met HOMOSEXUALS in the path of my work. They are as human as the next person. I did not run away from their troubles.
HOMOSEXUALITY IS BASED IN THEOLOGY AND BIOLOGY BUT DILUTED BY IDEOLOGY
Let us track a time when our bodies begin to push us towards actualising a much longed for sexual or intimacy debut. This is much different from parental or agape bonding. There are all sorts of bondings, attachments and intimacies as people grow. It is the basis of self-discovery, assertiveness, confidence-building and managing emotions.
As our bodies grow and develop there are bodily changes and expectations. Sexual intimacy is felt around this time. Deep sitted alarm bells go off. Sexual intimacy in turn is driven by the biological sex organs one is endowed with (atypical or not). However, ideology continues reminding all humans they are cast in two modes, female or male, and no in-betweens! This has been the basis of thought about what is considered “natural†or “unnatural.†This is where I believe is the problem. This has started or silenced major debates.
Anti-gay ideologies are mostly based upon traditions and religious beliefs; the subject of science is very much avoided partly because of socialisation, the school system and fact that science was made inferior to theology. Biologists discover that among animals there are times when same sexed animals pair with each other and this is “natural†and biological.
An animal may be compelled to pair with another of the same gender, this animal doesn’t question whether the urge to do so is biologically driven or if they are making a conscious choice, it happens because they are compelled to do it. This has not been much studied or given thought because of fear of answers. For humans, society has deemed certain behaviours acceptable, led to the accepting a comfort zone or blindfold known as “natural†and “unnatural.â€
We do the things we do; we are what we are and live the way we live because of so many factors: the way we are created, where we were created, the needs at hand, our capacities (or incapacities),norms, beliefs, culture, fate, destiny, survival, sex and gender.
If one bothered to look at the “homosexuals†onion one would peel off layers (of intolerance and negative regard) and find human beings who deserve dignity and understanding. There are men-who-have-sex –with-men (MSM), women-who –have-sex-with-women (WSW),Lesbian (L), Gay (G), Transgender (T), Intersex (I), Queer (Q) and Questioning (Q) or LGBTIQQ. All these are the “homosexualsâ€.
Homosexual Community in Uganda is faced with fear, ignorance of rights and uncertainty. Very few sustained interventions target their health (not only the absence of disease but full emotional, mental, cultural, social and spiritual well-being) needs.
Most existing interventions are selectively targeting legal rights which are more to do with visibility and breaking silence on same sexuality issues. But social and cultural rights which are at daily survival and interactive levels are given half-hearted kick starts. Where they are targeted they are given a veneered gloss and much lip service. Transgender people may not access services that are structured along male/female patterns, stereotyping and perceived structure of females and males may cause abuses against some otherwise effeminate males and masculine females. All these people may want to seek services ranging from: health, legal redress, psycho-sexual, psycho-social, economical and cultural and may fail to get help. Simply, because society has not provided training or tolerance for people with needs outside the male/female bio-prototype.
Problems among homosexual community should be tackled as a minimum package and should include: health, Legal reform, social-economical, psycho-sexual and psycho-social (HELPS MODEL).
This is what any person who seeks to show understanding of homosexuality should know and with that privileged knowledge use it to act informed. Homosexuality still faces misunderstanding. This is why a person said to be a homosexual has to live precariously in an environment that expects conforming to set norms. This in turn influences how that person is socially or economically placed, may affect expression and relation to access to health services, education, work and livelihoods, home, shelter and family.
STATE INFLUENCE:
ANTI-HOMOSEXUALITY BILL MOMENTS AFTER BEING PASSED INTO AN ACT
Uganda is a country of firsts; pearl of Africa, source of the Nile, multiparty-state, cultural institutions, open admission that led way to fighting HIV, and now the Bahati Bill.
The Bill once passed will provide a scenario that fits an Orwellian nation; there is no better way to create a binary state of affairs than by its antecedents. It has opened a Pandora box. Homosexuality bad, non-homosexuality good. All population groups that will hold dialogue will have to skirt such topics which include the Bill itself, sex, relationships and sexual intimacies. The primary culprit is the individual who harbours Homosexual thoughts. If at all one even has a thought about Homosexual tendencies then self reporting is advised and it will be a measure of patriotism.
The attendant culprits are numerous and include; parents, benefactors, head-teachers, firms, health facilities, employers, transporters, pilots, academia and anyone. How? Well, the home harbouring a father, mother or child with homonormative tendencies will have to report such tendencies to nearest police as a crime; persons taking care of others with homonormative tendencies are equally criminalised; head-teachers may be forced to expel whole streams which will harbour a homosexual/s.
Health facilities will have to lay off humane staff who do not discriminate by orientation; employers will have to forego that employee who inspite of a said orientation does perform with quality; Open skies will be jammed with planes because of no fly zones caused by Bill’s extra-territorial powers; academia is to shut down libraries, faculties and research facilities having printed materials on homosexuality. Eventually, all commerce will collapse for fear of being perceived as a purveyor of homosex. Informers/ whistle-blowers will now jam police stations and parliamentary pigeon boxes with information of who is in a homosexual relation (perceived or real) and it will be a lucrative business.
IMPLICATIONS: There are implications that are far reaching and give a different context to all that has been and will be achieved. The Bill resonates with calls that stoke the fires of stigma, fear, discrimination and impunity.
The Bill has, now pegged homosexuality in same league with murder, illicit drug commerce and conniving to topple a government. It has “contrabandised†homosexuality and contra-branded it too.
In the process; it disrupts predictions of regional statistics; disrupts National plans and systems; disrupts access to HIV treatment; disrupts access to social services; misses understanding of Modes Of Transmission and therefore leads to misdiagnosis; and there is disruption of Domestic HIV/AIDS services dispension. All population groups that make up what is known as MARPs (same sex oriented persons, sex-workers, in-mates, substance users, long –distance truckers, armed services, youths and fisher-folk had been reached by interventions). The Bill once passed will make it difficult for same sex oriented people to access services. It will fuel discrimination.
The Bill puts same sex oriented persons, actors, stakeholders and implementers in precarious state of affairs. It already aggravates misfortune. Indeed it is held accountable for “aggravated misfortuneâ€.
It fuels inequalities among Uganda’s dispensation of services. There is grinding poverty due to the following state of affairs- lack of food, effects of drought, needs for returnees, need for shelter, need for clean water, and evacuation of people due to land-slides and basic medical care or public health for the whole of Uganda. We need to address these issues.
Now the Bill provides a proximate cause that in turn makes it far worse for those it is intended to curb. The ascribed inferiority heaped on same sex orientation already breeds contempt, stigma and discrimination. Even while formulating it one did not have to give it defensible corner stones because it is foregone conclusion; homosexuality is immoral and detestable.
Policy in place does not promote studied approach to nature of homosexuality. It rather promotes ridicule and casts aspersions at same sex orientation and sexuality as a topic. To most it equates to a form of sexual intercourse that is unnatural requiring ridicule. Yet not all homosexuality is consummated as sexual intimacy.
Gender has been used to control people in society. Sexuality, homonormativity, heteronormativity, orientation, socialisation, productivity, masculinities, femininities, sex, relations, growth, development and self actualisation have been used as recipes for debating and affirming gender and meeting or denying individual needs of autonomy, empowerment and human freedom.
NEW GENERATION INDICATORS: The nurture systems include; established mechanisms to address HIV/AIDS in Uganda for same sex oriented persons and the lessons one can draw from development economics postulated by two protagonists, Amartya Sen and Nicholas Stern.
Sen suggests that development should be freedom to lead the life people have reason to value. Stern then factors in empowerment as a means to provide improvements in health and education as well as relief from poverty. This nurture system approaches concerned concentrated groups and addresses social gradients in health within these concentrated groups and country as a whole. It ensures that people have freedom to lead lives they have reason to value.
This would in turn lead to active involvement and participation by beneficiaries in deciding what applies to them. It would lead to marked capturing of issues formerly missed, therefore marked diagnosis and reductions in health problems.
Human freedoms play a central role in health. This is the tenet for social action and moral obligation that prompted Ministry of Health through the Most-at-risk-Populations’ Initiative- MARPI to involve same sex community in the fight against ill health in Uganda.
A physician has moral obligation to understand and improve things. This is a social action to improve health for all patients as a moral obligation and a matter of social justice. A concentrated population group may be the one with a high prevalence of an infection or an unstudied prevalence.
There is need to improve the public health and to reduce health inequalities among social groups where these are avoidable. It is the basis for evidence-based policy recommendations or insights in improving health of marginalized.
Diseases can be controlled using three cornerstones; by understanding mechanisms, promoting social and political action. Because the Bill has underestimated all this it should be thrown out.
Sexuality, influences how people negotiate for sex, has an influence on patterns and appearances of diseases. If people are not facilitated to have safer protected sex they may be at a risk of infections.
To understand disease causation and rates of change, one has to also pay attention to the fact that some heterosexual people also secretly engage in homosexual relations. Policy makers therefore need to understand the complexity of society and avoid making policies that are discriminative.
Social gradients in health, predisposition to risk factors [this Bill if passed sets the stage as a risk factor/pathway] and exposure risks to infections will be recurrent factors that reverse the fight against HIV/AIDS and other illnesses. Special vulnerabilities once this Bill is passed will revolve around; poor adherence, sexual violence, rape, falsified claims, extortion, blackmail, early and forced marriages, dysfunctional relationships, lack of educational access, lack of economic and learning power and lack of ownership to redeemable property. There will be restricted opportunity for people to lead flourishing lives that provide; dignity, opportunity, empowerment, security, autonomy and social participation. This Bill hurts even the sponsors themselves. They are all standing in the risk pathways. They may have relatives as culprits.
Same sex oriented persons can play a crucial role in reducing HIV/AIDS if supported. Collective efficacy can be capitalized upon through using their social networks. This will in turn improve on the health of this community and that of the country at large. The ‘go together know together’ promotion of HIV testing is timely but what will the Bahati Bill do to it? I want to end with a scenario of improved tracking of HIV Drug Resistance (HIVDR) vis-à -vis a passed Bahati Bill.
Some achievements will be reversed and with greater repercussions. Persons undergoing appropriate Anti-Retro viral Therapy (ART) regimen having been initiated properly on ART will be lost to follow up [dropped] or may be forced to default. There will be poor or none on time clinic appointment keeping. These and many others are barriers to long-term ART success.
Bahati Bill will set stage for emergence of HIV Drug Resistance (HIVDR) in form of acquired HIVDR or transmitted HIVDR. Uganda has approximately 1.1 million adults and children country wide currently infected with HIV. This is already straining resources and there is no need to follow it up with compounding factors.
Uganda’s HIV epidemic is severe, mature, generalized and heterogeneous, affecting different population sub-groups. The patterns of transmission of HIV are dynamic and change over time. It is therefore probable that the main risk factors and drivers of the epidemic may have changed over time as evidenced, for instance, by the occurrence of a significant proportion of new infections among discordant couples in union.
In order to adapt prevention strategies to changing patterns of risk, we need to regularly monitor the behaviours that put people at risk of infection and how new infections are distributed among risk groups (Modes of Transmission, 2008). There is insufficient understanding of the current modes of transmission of HIV in Uganda as well as where and among whom incident HIV infections are occurring.
This lack of clear understanding of where new infections are occurring may imply that national HIV prevention plans are not driven by evidence and may result in a mismatch between populations most at need and those that receive the available resources. Incidence modeling reveals that of all new HIV infections in adults (15-49 years) in 2008, 43% were among people in discordant monogamous relationships in the past 12 months while 46% were among persons reporting multiple partnerships and their partners.
Commercial sex workers, their clients and partners of clients contributed 10% of new infections. Men-who have sex with men (MSM) and Injecting Drug Users (IDU) contribute less than 1%. Mother to child transmission is estimated to have contributed about 20,500 new HIV infections. In all (including incidence through MTCT), 37% of infections (adults and children) are attributable to multiple partnerships, 35% occurred within discordant monogamous couples, 18% were due to mother to child transmission while 9% arose in commercial sex networks.
CONCLUSION: The Bill may be, with all intent and purpose, bent on organising the country but it [the country] will be disorganised through failure to meet needs of autonomy, empowerment and human freedom.
The Bill seeks to shake the privacy in which lie all circumstances of un-disturbed thought processes that have produced great personalities. It seeks to patent private thought. It seeks to control circumstances in which people live and work without providing control and opportunities for full social engagement.
It does not allow for freedom sense of development: freedoms to lead the life people have a reason to value. The Bill should have borrowed from Social justice frameworks that promote: dignity, opportunity, empowerment and security. This will provide relief to inequalities and poverty.
As a health advocate and a natural attorney of the poor there is a social problem before us. This problem will continue tilting the social gradient of health precipitously there by creating uneven ground for HIV/STDs and drug –related ills to remain undetected.
Bahati Bill deprives whole communities of capacities in controlling and socially engaging in reducing diseases and infections.
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