There has been appropriate moral condemnation of Uganda's proposed anti-gay law that originally included the death penalty. Evangelical uber Pastor Rick Warren led the way with a moving and powerful video directed to clergy in Uganda, followed by the Holy See, conservative Senator Tom Coburn and the Obama Administration. It is good to see ecumenism and bipartisanship. But in addition to the clear human rights issues, there are important public health principles at stake - as the current US Global AIDS Coordinator, Ambassador Eric Goosby, has rightly noted.
Gay men and women cannot be legislated out of existence. The practical impact of the law will be to undermine Uganda's efforts to combat its HIV epidemic. That would be a tragedy in any country, but perhaps more so in a place with a record of leadership and success on HIV prevention. UNAIDS launched a "know your epidemic" campaign a few years back. It makes great sense - if there is insufficient knowledge about the drivers of the spread of HIV in a country, or areas of a country, it is impossible to dedicate resources to the programs that are most likely to be effective. Recently, Ugandan officials have embraced that approach regarding discordant couples - where one person in a relationship is HIV positive and another is negative - because data show that transmission in such pairs was contributing significantly to the spread of HIV in their country.
What is unknown in Uganda, and much of Africa, is the contribution of men who have sex with men (MSM) to HIV transmission. While it is commonplace for officials to say MSM does not contribute significantly to HIV in Africa, the fact is that we do not know. The US President's Emergency Plan for AIDS Relief began to support MSM surveys in several African countries during the Bush Administration. Progress was slow and difficult due to cultural issues, which must be understood and respected to effectively move forward. The Ugandan law requires anyone who is aware of the homosexuality of any person to report them to authorities. Rick Warren was right to note that the requirement would make pastors policemen. But it also prevents public health officials from assessing the factors driving the spread of HIV. Without adequate knowledge of the drivers of the epidemic, it is not possible to effectively plan and implement programs to combat it.
In a related way, outlawing gay people, especially in such a draconian way, simply drives them underground where they cannot or will not access prevention, care and treatment services. Public health officials would not only be handicapped from effectively directing programs, the law would directly contribute to the spread of HIV and lead to increased sickness and death. That would counter the laudable gains Uganda has made in prevention and more recent advances in expanding treatment and care. Even if MSM do not currently contribute significantly to the HIV epidemic, if they are pushed away from services that could quickly change. This is a lesson learned the hard way in the US. While the epidemic has been stable or declining in previously high-risk populations, there has been an explosion in the inner cities and among African Americans, in particular women, who are often beyond the reach of prevention and care programs. For these reasons, President Bush talked about the need to deal with HIV in inner cities and prisons in a State of the Union Address and President Obama is developing a national HIV strategy.
Which brings us to the final point - stigma and discrimination are rarely good for public health. In addition to driving away people in need and at risk of spreading infection, stigma and discrimination cause others genuinely at risk to believe they are safe and need not act to protect themselves. And by ghettoizing a disease among what are considered marginalized populations, it lightens the pressure on policymakers to act quickly. We saw this phenomenon in the early days of HIV in the US, and we are seeing it today in Eastern Europe and parts of Asia.
Stigma and discrimination have in no small part fueled the HIV pandemic at the level of person-to-person interaction and at the highest levels of policymaking. It is also just wrong. For these reasons, President Bush directed his team to work to do away with one of the vestiges in the US - the unnecessary restrictions and bureaucratic hurdles for HIV-positive people to enter the US: a process that President Obama completed.
Sadly, Uganda is not the only country considering stigmatizing and discriminatory laws. Opposition to such measures pulls together a unique confluence of conservatives and liberals, people of deep religious faith and those more secular in outlook and principles of human rights and good public health. Seems like something worth standing up for.
That's not the whole story. Mr. Warren originally said that he didn't want to interject himself in the foreign affairs of other nations. Which, of course, is a bold-faced lie. He has had numerous meetings with the religious leaders of Uganda. Making Pastor Warren out to be some sort of savior-of-the-gays is disingenuous at best.
The author also fails to mention that impetus for the "kill the gays" bill originated with religious groups in the United States:
http://www.boxturtlebulletin.com/2009/11/25/16913
As a gay man, with low risk behavior on the menu, I get tested every six months (when I am active).
My heterosexual female friend is terrified of being tested because of the stigma attached to HIV/AIDS but she refuses, despite knowing there is good reason for her being tested...and she continues to have unprotected sex with male partners.
It's true. Homophobia is dangerous not only to gays but to straights.
Look at the whole business concerning the "Rapture"-they think they will be leaving the planet when things "get tough". Are they concerned about what happens to the planet or the people "left behind" when they leave? Of course not!
The Rapture is heresy, as it teaches you can escape death when Jesus taught us not to fear death and that we can conquer death but not that any born of woman can escape death...!
The Rapture is a classic Cult Device and perversion of Christ's sacrifice for us all, whethr you believe Him to be Divine or not...
There is no Rapture, in biblical terms or as far as Gospel only the Raising of the true Saints and Martyrs and that number is given us it's only 144,000 if you believe in Scripture but there is no Rapture of all Dallas Cowboy fans or all Republicans or TV Heretics...we are told and warned that in the Final Days there will be many False Prophets like Rick Warren or Pat Robertson and these heretics of the dangerous Cult of The Family...
Your blog, while quite accurate and to the point, is factual, and rationally based. It therefore, unfortunately, has little to do with the situation in Uganda.
The proposed Ugandan laws are ideologically and politically motivated, and, as such, have nothing to do with common sense or reason.
Unfortunately, none of these people are particularity enlightened individuals. They are brutes without morals who will perpetrate any crime or activity that will allow them to gain and/or maintain power.
Uganda is a clear example.
How to deal with people like this, without force, bribery, or some other form of intimidation is beyond me.
The sole statement to come from the Vatican was an ambiguous statement by a low-level Vatican representative, in a webcast to a U.N. committee discussion discrimination against LGBT people. The Vatican official did not even mention Uganda, but was thought to be speaking against Uganda's consideration of the death penalty for gays and lesbians.
Pope Benedict has been absolutely silent. When people talk about the Holy See making a statement, they almost always mean the Pope--not a low-level Vatican official.
The statement that the Holy See has spoken out seems to be disinformation. For many Catholics (and I'm one of them), Benedict's silence has been scandalous--and I do not wish to let him off the hook for remaining silent.