Uganda HIV/AIDS Legal Environment Assessment for Key Populations Report Launch | Kampala, Uganda | Friday, September 2, 2022
Remarks by U.S. Ambassador Natalie E. Brown | (as prepared for delivery) | Speke Resort Munyonyo.
Good afternoon! I am delighted to be part of this historic moment as we launch the Uganda HIV/AIDS Legal Environment Assessment for Key Populations report. Let me first say the fact that we are gathered here in person is testimony to the progress we have made in the fight against COVID-19. Despite this progress, however, this fight is not over yet. I trust all of you are fully vaccinated and boosted, if eligible. This is especially important for those living with HIV/AIDS as they are particularly vulnerable to COVID-19. The United States has donated over 18 million vaccine doses to Uganda and we’ve been working closely with the Ministry of Health to get them to people in the most remote areas of the country. So, please encourage your friends, family, colleagues, and loved ones, including children, to get their COVID-19 vaccine jabs too and to observe all SOPs and guidance from the Ministry of Health.
Uganda has achieved tremendous progress in the fight against HIV and AIDS, and epidemic control is almost within sight. However, we still have some distance to go, and that will require a lot of work. As we approach epidemic control, no one can be left behind, especially not key populations who are often stigmatized and face discrimination. This includes men who have sex with men, transgender persons, sex workers, people who inject drugs, and people in prisons and other confined settings. These vulnerable populations are often the most difficult to reach because of the unfair way they are treated.
Data show that key populations bear the highest burden of HIV. Globally, such individuals and their partners constitute approximately 70 percent of new HIV infections. In Uganda, approximately 25 percent of new HIV infections are among members of these key populations and their partners.
It is estimated that key populations in Uganda total approximately 310,000 individuals; of whom:
- 130,000 are female sex workers
- 22,000 are men who have sex with men
- 7,500 are people who inject drugs
- and more than 150,000 are people in prisons.
The number of people living with HIV among these populations can be up to five times higher than in the general population. Therefore, it is critical for Uganda to provide tailored support for key populations to prevent HIV and attain epidemic control.
A conducive legal and policy environment is necessary for continued progress toward HIV epidemic control. Through this report, achieved through the collaborative work of experts from Makerere University School of Public Health, Makerere School of Law, the Ministry of Health, and the Uganda AIDS Commission, we now have evidence that Uganda’s laws, policies, and their implementation need to be updated to enable Uganda to meet President Museveni’s commitment to end HIV as a public health threat by 2030.
Uganda needs laws, regulations, policies, and practices that are free of discrimination and are all-inclusive and responsive to the unique needs of populations at greatest risk of HIV infection and transmission. Why is this important when we’re talking about health?
Let’s take this opportunity to recognize the impact that human rights violations, violence, stigma, and discrimination have on the fight against HIV and AIDS in Uganda.
We know that U equals U, meaning “undetectable equals untransmissible.” So, if someone with HIV begins and stays on life-saving antiretroviral treatment (ART), their level of HIV virus can get to an undetectable level and these persons cannot transmit HIV further. People who are living with HIV need to enroll on life-saving treatment, or they risk getting sick and dying, and they risk transmitting HIV further. But if these same people are instead living in fear and avoiding public health facilities and drop-in centers because of reports of human rights violations, or organizations being raided, they risk poor health outcomes for themselves, as well as further transmission of HIV. Additionally, certain cultural practices, along with harmful laws and policies against key populations, seriously hamper the government’s ability to finally gain control of the HIV/AIDS epidemic and achieve the 2030 goals.
There can be no tradeoffs between public health and human rights; we must actively pursue both and reverse the health inequalities in Uganda. All people, whether prisoners, people who inject drugs, female sex workers, and LGBTQI+ communities, must have equal access to health services. It is in the best interest of all Ugandans for these communities to be healthy.
We also need to take this opportunity to recognize the critical roles civil society and the private sector play in supplementing government efforts in health service delivery, especially for key, vulnerable, and hard-to-reach populations. We implore the government to re-establish a conducive environment for civil society organizations to work with these populations in order to achieve HIV epidemic control. These organizations should be empowered to work freely in concert both with the government and with development partners without fear of harassment or being shut down.
I thank the team that conducted this legal environment assessment. The report contains important recommendations to various stakeholders across the country. For example, the assessment recommends removing provisions of the HIV Prevention and Control Act of 2014 that criminalize HIV transmission, exposure, and non-disclosure. It also recommends
- legal reform to amend the Penal Code to decriminalize same-sex sexual acts between consenting adults,
- review of laws and provisions misused against sex workers, and
- involvement of these communities in law review and reform processes.
Finally, the report recommends community awareness and sensitization campaigns to reduce stigma and discrimination of key populations. A multi-pronged approach, including legal reform and community engagement, is necessary to foster an environment where it truly is possible to end HIV and AIDS in Uganda.
And now that we know the facts, it is incumbent on us all to ensure that the efforts that have gone into this great work will not be wasted and that the recommendations are used to inform legal and policy reviews to improve programming and to inspire further research.
The U.S. government, through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and other programs, is committed to supporting the Government of Uganda to sustainably address the structural barriers in the fight against HIV. This legal environment assessment gives additional context and recommendations to consider when setting our priorities.
I thank the Government of Uganda, the PEPFAR staff, and our implementing partners who have made this assessment possible; and who continue to do everything they can to prevent disease and promote health and wellbeing in the community. Thank you!