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Criminalising homosexuality threatens the fight against HIV/AIDS

2014; Elsevier BV; Volume: 383; Issue: 9919 Linguagem: Inglês

10.1016/s0140-6736(14)60403-7

1474-547X

Ashton Barnett‐Vanes,

Sex work and related issues

Homosexuality is criminalised in more than 70 countries,1Office of the High Commissioner for Human RightsTackling discrimination on grounds of sexual orientation and gender identity.http://www.ohchr.org/Documents/Issues/Discrimination/LGBT_discrimination_A4.pdfGoogle Scholar with severe implications for the health and wellbeing of the lesbian, gay, bisexual, and transgender (LGBT) community. Recent developments in several countries such as India, Uganda, and Nigeria—where HIV/AIDS remains a pressing public health issue—to reintroduce or strengthen criminalisation of homosexuality holds deep ramifications for patients and health-care workers tackling HIV/AIDS. Although temporarily thwarted in Uganda, the alleged proposal to criminalise a failure to “report” gay persons adds to the alarm.2Smith D Ugandan MPs rush through draconian laws against homosexuality. The Guardian (London), Dec 20, 2013.http://www.theguardian.com/world/2013/dec/20/uganda-mps-laws-homosexualityGoogle ScholarThe success of the global campaign to reduce HIV transmission, radically improve antiretroviral therapy access, and maintain patient adherence has been rooted in the basis that tackling the heterosexual and homosexual epidemics collectively, through a respect for the rights of all people, including those most vulnerable to HIV, is the optimum approach.3UNAIDSUNAIDS expresses concern over proposed ‘Anti-Homosexuality Bill’ in Uganda.http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2011/may/20110510psuganda/Date: 2011Google Scholar Criminalising homosexuality might do untold damage to HIV treatment and prevention efforts that have succeeded in engaging with the homosexual community, a feeling recently expressed by HIV/AIDS physicians in Europe.4Alcorn K European physicians condemn impact of Russian anti-gay law on HIV prevention and care.Nam Aidsmap. Oct 16, 2013; (accessed Jan 27, 2014).http://www.aidsmap.com/European-physicians-condemn-impact-of-Russian-anti-gay-law-on-HIV-prevention-and-care/page/2780967/Google Scholar LGBT persons might already encounter stigma and discrimination at home and the workplace, making engagement with health-care programmes challenging; the prospect of criminal prosecution could dissuade them from seeking medical help altogether.Will health-care workers be afforded protection to treat homosexual patients in confidence? Or will they be under actual or perceived duress to report members of the homosexual community to authorities? These questions hold implications not only for the HIV/AIDS community, but the medical community as a whole. They threaten both the trust placed in health-care professionals and their efforts to achieve universal health coverage. Finally, public attention and advocacy should rightly be invested in campaigning against legislation changes in countries; however, equal attention is needed in settings in which they are already in law.The ambitious goals to tackle HIV by 2015 as outlined by UNAIDS, particularly to halve the number of countries with “punitive laws and practices around HIV transmission, sex work, drug use or homosexuality that block effective responses”5UNAIDSUNAIDS Strategy 2011–2015.http://www.unaids.org/en/aboutunaids/unaidsstrategygoalsby2015/Google Scholar cannot be achieved if we are going backwards and not forwards. If homosexual communities are further marginalised or isolated by national policies, the prospect of undoing progress in HIV/AIDS care is real. The international health community, together with those in law, human rights, and equality, can ill-afford to not make this case heard.I declare that I have no competing interest. Homosexuality is criminalised in more than 70 countries,1Office of the High Commissioner for Human RightsTackling discrimination on grounds of sexual orientation and gender identity.http://www.ohchr.org/Documents/Issues/Discrimination/LGBT_discrimination_A4.pdfGoogle Scholar with severe implications for the health and wellbeing of the lesbian, gay, bisexual, and transgender (LGBT) community. Recent developments in several countries such as India, Uganda, and Nigeria—where HIV/AIDS remains a pressing public health issue—to reintroduce or strengthen criminalisation of homosexuality holds deep ramifications for patients and health-care workers tackling HIV/AIDS. Although temporarily thwarted in Uganda, the alleged proposal to criminalise a failure to “report” gay persons adds to the alarm.2Smith D Ugandan MPs rush through draconian laws against homosexuality. The Guardian (London), Dec 20, 2013.http://www.theguardian.com/world/2013/dec/20/uganda-mps-laws-homosexualityGoogle Scholar The success of the global campaign to reduce HIV transmission, radically improve antiretroviral therapy access, and maintain patient adherence has been rooted in the basis that tackling the heterosexual and homosexual epidemics collectively, through a respect for the rights of all people, including those most vulnerable to HIV, is the optimum approach.3UNAIDSUNAIDS expresses concern over proposed ‘Anti-Homosexuality Bill’ in Uganda.http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2011/may/20110510psuganda/Date: 2011Google Scholar Criminalising homosexuality might do untold damage to HIV treatment and prevention efforts that have succeeded in engaging with the homosexual community, a feeling recently expressed by HIV/AIDS physicians in Europe.4Alcorn K European physicians condemn impact of Russian anti-gay law on HIV prevention and care.Nam Aidsmap. Oct 16, 2013; (accessed Jan 27, 2014).http://www.aidsmap.com/European-physicians-condemn-impact-of-Russian-anti-gay-law-on-HIV-prevention-and-care/page/2780967/Google Scholar LGBT persons might already encounter stigma and discrimination at home and the workplace, making engagement with health-care programmes challenging; the prospect of criminal prosecution could dissuade them from seeking medical help altogether. Will health-care workers be afforded protection to treat homosexual patients in confidence? Or will they be under actual or perceived duress to report members of the homosexual community to authorities? These questions hold implications not only for the HIV/AIDS community, but the medical community as a whole. They threaten both the trust placed in health-care professionals and their efforts to achieve universal health coverage. Finally, public attention and advocacy should rightly be invested in campaigning against legislation changes in countries; however, equal attention is needed in settings in which they are already in law. The ambitious goals to tackle HIV by 2015 as outlined by UNAIDS, particularly to halve the number of countries with “punitive laws and practices around HIV transmission, sex work, drug use or homosexuality that block effective responses”5UNAIDSUNAIDS Strategy 2011–2015.http://www.unaids.org/en/aboutunaids/unaidsstrategygoalsby2015/Google Scholar cannot be achieved if we are going backwards and not forwards. If homosexual communities are further marginalised or isolated by national policies, the prospect of undoing progress in HIV/AIDS care is real. The international health community, together with those in law, human rights, and equality, can ill-afford to not make this case heard. I declare that I have no competing interest.