Tag: Uganda

Uganda tests out rubber band circumcision

With trousers around his ankles, Justin Igalla awaits a tight rubber band for his foreskin, an innovative non-surgical technique rolling out in several African nations to encourage circumcision and cut HIV infection rates.

The simple device – two plastic rings and an elastic band – cuts off blood supply to the foreskin, which then shrivels and is removed with the band after a week.

“I felt nothing, not even a little discomfort,” Igalla said after a procedure taking just minutes, noting there was no blood – unlike traditional circumcision where the foreskin is sliced off by knife – thus reducing the risk of infection.

Igalla, a father of two, said he opted to have his foreskin taken off for “health reasons”.

Scientists have found that male circumcision can significantly reduce the chances of HIV infection because the foreskin has a higher concentration of HIV-receptors than the rest of the penis and is prone to tears during intercourse, providing HIV an entry point.

As well as Uganda, the device is being used in Botswana, Kenya, Mozambique, South Africa, Zambia, Zimbabwe and other sub-Saharan countries. All have been identified by the World Health Organisation (WHO) as “priority” states where the risk of acquiring HIV is high and male circumcision, and access to conventional surgical procedures, is low.

Uganda hopes the device, called PrePex, will convince adult men to be circumcised as part of the battle against Aids, now resurgent in the East African nation after years of decline, with as many as 80 000 people dying of the disease every year.

PrePex, a non-surgical circumcision device. (Pic: AFP)
PrePex, a non-surgical circumcision device. (Pic: AFP)

From a peak of 18% infected in 1992, Uganda’s “ABC” strategy – Abstinence, Be faithful, Condomise – helped slash rates to 6.4% in 2005.

But rates have crept back up, to 7.2%  in 2012. As many as 1.8 million people in the country now live with HIV, and a million children have been orphaned after their parents died of Aids.

The makers of PrePex boast that a man “can resume work and almost all daily activities shortly after the procedure,” with the device “designed to be placed, worn, and removed with minimal disruption”, although they should abstain from sex for six weeks afterwards.

Doctor Barbara Nanteza, male circumcision project manager at Uganda’s Aids Control Programme, said that trials had shown that circumcision reduced risk of transmission from a woman to a man by as much as 60 percent.

Although some contest the validity of these studies, WHO and the United Nations Aids programme push circumcision as an additional prevention measure in high-prevalence countries where HIV transmission is predominantly heterosexual.

The WHO says there is “compelling evidence” circumcision reduces risk of heterosexually acquired HIV infection in men. The organisation has “prequalified” PrePex, meaning the device has been assessed and meets international standards for efficacy and safety.

And with health budgets already overstretched, the device offers a cheaper way to tackle the problem, Nanteza said.

“If circumcision can help reduce the cost, that could very good for the country,” she told AFP.

Uganda, long praised for its efforts in the fight against Aids, launched a general circumcision programme in 2010, when some 9 000 had the conventional treatment.

Since then 1.2 million men have been circumcised – or 13% of men over 15, including 800 000 last year alone, the health ministry said.

The introduction of the PrePex device is expected to boost numbers even further – but it’s still not enough, according to Nanteza.

Though the device greatly reduces the pain of traditional circumcision, she conceded the issue remained an awkward one for married men.

“It is difficult for them to explain to their wife that they want to get a circumcision to prevent HIV infection when they are supposed to be faithful to them,” Nanteza said.

Despite massive health awareness campaigns, problems remain.

James Brian, a counsellor with the Walter Reid Project, a US-based medical organisation supporting the programme, said it was essential to emphasise that while circumcision reduces the risk of infection, it does not prevent it.

“After circumcision someone should not think that they are immune against HIV,” Brian said, who works with patients to highlight the continuing need to practise safe sex.

Emmanuel Leroux-Nega for AFP

Alarm as Uganda moves to criminalise deliberate HIV transmission

Activists in Uganda, where HIV prevalence is on the rise, have warned that new legislation criminalising deliberate transmission of the virus will further undermine efforts to stem the Aids epidemic and erode the rights of those living with HIV.

As well as setting out fines and jail terms of up to 10 years for those found guilty of “willful and intentional” transmission, the HIV/AIDS Prevention and Control Bill, passed by Parliament on May 8 and now awaiting presidential assent, also obliges pregnant women and their partners to take HIV tests, and in some circumstances empowers health workers to unilaterally disclose a patient’s positive status to an at-risk partner or household member. It also obliges parents to tell their children of their status.

“Despite years of engagement and labouring to explain the dangers on an HIV-specific criminal law, Parliament has refused to be advised. When experts on HIV research and management attempted to speak, [lawmakers] still failed to heed to the key concerns,” Dorah Kinconco Musinguzi, executive director of Uganda Network on Law, Ethics and HIV/AIDS (UgaNet), told IRIN.

“If we have not managed to test 67% of Ugandans for HIV without a law that punishes transmission, will this number improve when citizens know that more legal burdens are added to testing? The answer is no. Will their behaviour improve because of this fear? No. Will we have helped the HIV situation then? No. We shall have more people transmit HIV in ignorance of their status. Laws do little to change behaviour, instead it takes behaviour underground,” she said.

Over the past five years HIV prevalence in Uganda has risen from 6.4% to 7.3%.

“The evidence from the Ugandan Ministry of Health shows clearly – criminalisation of HIV doesn’t work. It drives people away from services and fuels discrimination and fear,” Asia Russell of the HIV advocacy organisation Health GAP, told IRIN.

(Pic: Mujahid Safodien / IRIN)
(Pic: Mujahid Safodien / IRIN)

Alex Ario, the national co-ordinator of the ministry’s AIDS Control Programme (ACP), said “the Bill may not be that useful in my view. It does not add value to the current efforts. Actually, with dwindling support from donor communities to ACP as it is now, we would rather divert efforts to lobby government of Uganda to put more money for HIV activities rather than legislating against people with HIV.”

“We need to redirect legislative reform, and law enforcement, towards addressing sexual and other forms of violence against women, and discrimination and other human rights violations against people living with HIV and people most at risk of exposure to HIV,” he said.

Russell added that in conjunction with the Anti-Homosexuality Act, which passed into law in February 2014, this new law could lead “a sex worker apprehended for sex work, who is transgender and HIV positive, [to] be sent to prison for life.”

UgaNet’s Musinguzi said: “This [Bill] will hurt the women we have been encouraging to come up to take an HIV test such that they can have HIV-free children. But in this case, they will be forced to disclose their results and should they fear, and not do it in time, that means that they are potential candidates for [prosecution under] the Bill…

“There is high likelihood that justice will not prevail for the HIV-positive [people] found in this situation because of the high levels of stigma and condemnation that we have seen the HIV-positive go through,” she added.

More than 150 000 people are becoming HIV-positive every year; 1.5-million Ugandans are HIV-positive, according to Uganda Aids Commission statistics.

The Bill also flies in the face of the “rights-based” approach to HIV embodied in the regional HIV/AIDS Act passed in April 2012 by the East African Legislative Assembly.

Those in favour… 
Meanwhile, some MPs have been defending the Bill.

“Every piece of legislation is to prevent mischief. The Bill is both [a] legal and moral thing. We want to reduce down HIV deliberate infections,” Medard Lubega Ssegona, opposition shadow minister for justice and constitutional affairs, told IRIN.

“The Bill will encourage more people to go and test for their good. It will compel two consenting adults to test before they engage to each other because of the sanctions of false disclosure,” he said, adding: “The deliberate infections have caused a lot of burden [on] our economy. The government spends a lot of money on treating and taking care of people who have [been] deliberately infected by people with bad hearts. This is going to stop.”

Olivia Kwagala Kabaale, a legislator from the ruling National Resistance Movement party, said: “The mandatory disclosure will help to protect those who take care of the HIV sick people. Some of these people don’t want to disclosure their status yet they pose a risk of transmission of the virus to others.”

Laws in Burundi, Kenya and Tanzania also criminalise deliberate HIV transmission, leaving Rwanda the only member of the East African Community not to do so.

The new Bill also establishes the legal framework for an HIV Trust Fund to finance local-level programmes using money generated by levies on bank transactions and savings interest, air tickets, beer, soft drinks and cigarettes, as well taxes on goods and services traded within Uganda.

“The Bill is creating [an] HIV trust fund which is going to help the government raise local funds to support the HIV programme. It’s a right time for us now as a country to mobilize our own resources to fight the epidemic. We have been depending on donor support for our HIV fight,” said Kabaale.

‘Rescuing’ gay people from Africa is no answer to homophobic laws

The recent passing of the anti-gay law in Uganda and the South African government’s mealy-mouthed reaction to it demand attention.

Internationally, South Africa sponsored and is leading the first ever UN resolution on sexual orientation and gender identity. South Africa also boasts a post-apartheid Constitution that explicitly affirms equality and non-discrimination on the basis of sexuality and gender. Yet our government cannot muster the political stealth to speak against (rather than just about) homophobia when it really counts – as is the case with the recent passing of the homophobic law.

Uganda President Yoweri Museveni signs an anti-homosexual bill into law at the state house on February 24 2014. (Pic: Reuters)
Uganda President Yoweri Museveni signs an anti-homosexual bill into law on February 24 2014. (Pic: Reuters)

In a statement shortly following the law was passed, the government said that “South Africa takes note of the recent developments regarding the situation of Lesbians, Gays, Bisexual, Transsexual and Intersex persons (LGBTI) worldwide….[and] will, through existing diplomatic channels, be seeking clarification on these developments from many capitals around the world.”

But what’s to clarify? This indicates a deep reluctance to name recent events in Uganda and to take a position on them. It also implies, through the seeking of clarification, that there might be some legitimate rationale for criminalising your own citizens because of their sexual or gender identity.

The South African Human Rights Commission took a bolder position and “strongly reject[s] the notion that the freedom to live and love without fear of violence and regardless of one’s sexual orientation is part of a rights framework from western countries. The struggle for these and other freedoms has been at the heart of liberation struggles throughout the African continent.”

The ANC blocked a motion in Parliament against the law, reflecting its ambivalence to speak out. On the contrary, the former president of Mozambique Joaquim Chissano’s open letter to African leaders is an example of the kind of leadership present persecutions demand.

The anti-gay law and other legislation of its kind give state legitimacy to violence against people on the basis of their real or perceived sexual orientation and/and gender identity. It will also, as is already the case, prompt the forced migration of some LGBTI people.

The law feeds a narrative that positions citizens with non-conforming sexualities and genders as outsiders to the dominant culture of the nation. This is linked to the false notion that homosexuality is unAfricanand, therefore that homophobia isn’t.

In its self-appointed leadership role on LGBTI equality internationally, the South African government should readily offer a counter-narrative to those that peddle prejudice in the name of “Africanness”.

Homophobia in Africa represents a set of complex and intersecting issues – deeply routed in the continent’s colonial past. Violent inscriptions of race, sexuality, ethnicity and gender took place under colonialism and are linked to present-day norms around sexuality. These historical continuities, and how sexuality is racialised, are mostly entirely absent in discussions on homophobia.

Drawing on the ‘savages-victims-saviours’ construct of law professor Makau Mutua (pdf), the west has a keen interest in homophobia that is often framed within these sets of relations. Lurking within much of the public discourse on homophobia in Africa is the notion of the civilising mission of Eurocentric culture (and its human rights frameworks) that will save African culture, and the victims thereof, from its barbarism and its savagery.

One example of this is a recently launched online fundraising effort initiated in the US.

It is a “Rescue fund to help LGBT people escape Africa” and is aimed at “Gays, lesbians, bisexual and transgender people persecuted and trapped in African countries that criminalise their sexuality”. The campaign states that “by contributing to this Rescue Fund you will help me [the initiator of the fund] to save more gay, lesbian, bisexual, transgender and intersex people from Africa escape terrifying persecution.” An online counter shows the money is flowing in. If one donates to “save” an LGBTI person in Africa one is granted a status recognition originally titled as “ultimate saviour”. There are also prizes for donors such as “Nelson Mandela coins” for “passport providers”.

 People stand on a float holding signs in reaction to Uganda's law banning homosexuality. Hundreds of people gathered on the streets of Green Point in Cape Town, South Africa, on March 1 2014 to take part in the Gay Pride Parade. (Pic: AFP)
People stand on a float holding signs in reaction to Uganda’s law banning homosexuality. Hundreds of people gathered on the streets of Green Point in Cape Town, South Africa, on March 1 2014 to take part in the Gay Pride Parade. (Pic: AFP)

The forced flight of LGBTI from persecutory regimes will require interventions to provide places of refuge and safety. However, promoting an “escape” from Africa to “greener” US pastures, without simultaneously addressing the underlying conditions that force this migration, is dangerous and opportunistic. Dislocated from Africa-based struggles for social justice these feel-good interventions offer no long-term solution to the systemic issues that drive homophobia. At best they are palliative and patronising, at worst they reinforce the victimhood of Africans and the saviour status of westerners.

This is part of the logic that keeps the “homosexuality is un-African” discourse in play.

Other more pernicious saviours are those US religious conservatives who have actively promoted homophobic ideologies across the world and are now pushing such legislation in the US. There is much to be done to challenge these religious groupings and leaders on their home soils to expose their active undermining of sexual and gender rights both domestically and transnationally.

State-sponsored homophobia serves to keep certain power relations intact. Battles over power and identity are increasingly being played out on the bodies of LGBTI people. These battles relate to, among others: contestations around what it means to be “authentically” African; citizens’ pressuring for democracy, inclusion and leadership accountability; basic needs being met in a context of global inequality wherein rich elites govern over the poor; and women increasingly asserting their sexual rights. The scapegoating of LGBTI people and other “deviants” deflects from this inter-connected matrix of issues in which all Africans have a stake.

In this context, South Africa’s tiptoe diplomacy on homophobia in Africa exposes the troubling underbelly of current leadership on democracy and human rights. Whilst Jon Qwelane remains Ambassador to Uganda, in the face of his imminent court appearance for homophobic hate speech, perhaps government’s tread is more firm-footed than might appear.

Melanie Judge is an activist and social commentator. Follow her on Twitter: @melaniejudge

Concrete jungle: Kampala is obsessed with malls

Month by month, Kampala is becoming more and more characterised by shopping malls than its hilly, green and scenic landscape. Malls unpacked with containers from China and India, small malls, large malls, finished malls, unfinished malls, malls next to malls, and somehow when you step into one you will notice that we can’t quite fill them up or keep product moving off the shelves.  Why the need for all this shelter in a tropical climate? What are we running away from?

(Pic: Melinda Ozongwu)
(Pic: Melinda Ozongwu)

In the past, visitors to Uganda used to be charmed by street-side shopping, bargaining for inexpensive arts and crafts, while residents would prefer to seek foreign goods at extortionate prices. It made sense then, we weren’t spoilt for choice as we are now. Going to a shop that would sell pulverised Walkers crisps from England at four times the price was something I was guilty of. The increase of local manufacturing doesn’t seem to compete with products from South Africa and Kenya and lately even they are losing out to the competition of Chinese products.  Mall after mall is stocked with anything and everything that they think might sell. It may read ‘electrical goods’ on the signage but stay in the store long enough and the sales assistant just might show you a suitcase filled with edible panties, I kid you not.  Then she will tell you they are from America –  to which you will jump in delight and fork over your money, to the business, or her pocket, it’s hard to tell.

The recent launch of the first KFC, in Village Mall in Bugolobi, probably attracted more attention than the government announcing its HIV/Aids control programme through distribution of free anti-retroviral drugs. It adds value to a mall like no local business could ever draw in. I’ve never seen KFC as any sort of luxury brand, but the novelty and foreignness of it in Uganda makes it date-worthy, special and even fancy.

When I think of mall culture, America comes to mind, where there are more shopping malls than schools. My first teenage US mall crawl left me completely dwarfed in the magnitude of the experience. Stopping to gasp at every single in-store demonstration, I was perfect bait for promotions, sample testing and ‘free promotions’ that only cost me surrendering all my personal data of course. The ‘mall rats’ that hung around after school looking for dates, the compulsive shoppers, the power walkers and the food court buzz – every time I want to feel frustrated rushing through a mall in Kampala because I can’t get past the family taking pictures in front of a shop or blocking my way as they walk at snail’s pace to take it all in, I am reminded of my awe.

Acacia Mall in Kampala. (Pic: Kampala Night Life / Facebook)
Acacia Mall in Kampala. (Pic: Kampala Night Life / Facebook)

Ugandan mall politics are a bit different from your typical American mall. The customer is always right only if they are white, or black and rich. Everyone else will most likely be followed around in suspicion or flat out ignored. Shopping arcades were conceived as a solution to shelter the wealthier from the rain. We have no rain but like the olden days, the malls are still for the wealthy. I’ve always loved cities like London that have maintained high-street shopping versus malls, utilising the strengths of the city and making solutions for the weaknesses, while still allowing for aesthetically pleasing commercialism. Creating an illusion that we are all the same, as we brush shoulders in the sale, regardless of how far it may be from the truth, is an art yet to be mastered here. Walk into a mall in Uganda and the illusion is placed in exclusion. Poorer people dress up in their Sunday best to experience a supermarket, even if just to buy a bottle of water, yet foreigners think everything is so cheap. Working-class Ugandans know better than to pay four times the cost so they only buy the essentials and shops end up with a lot of dusty and unbought stuff.

As I write this, I can hear yet another construction site, another mall being born. No surprise there.

Melinda Ozongwu is a writer based in Kampala, Uganda. She writes television scripts and regular opinion pieces on the subtext of urban culture in African countries. Her blog SmartGirl Living is a cocktail of thoughts, recipes and advice for the modern African woman. Connect with her on Twitter

Hunted in Uganda: Save us from this ‘sexuality genocide’

This is an SOS to the whole world: Help the LGBTI community survive this “sexuality genocide” in Uganda, writes a transgender woman from Kampala.

The situation in Uganda is horrible, with people getting harassed, detained and forcefully evicted.

The morning after President Yoweri Museveni signed the anti-gay Bill, we woke to the news of a gay friend of ours that had been lynched by a mob. His partner was badly beaten up and is now in hospital in critical condition.

I am not surprised by this. Signing the Bill at a fully televised function and the comments he made during the event, Museveni made it clear that LGBTI people are considered an anomaly, suggesting that violence against them would not be frowned upon. More than ever, LGBTIs are a target. Over the past two days, the Red Pepper, a popular local tabloid, has taken to publishing the names and photos of LGBTI people, including their places of work and residence.

The tabloid 'Red Pepper' plays a lead role in the witch hunt for LGBTI Ugandans. (Pic: AFP)
The tabloid ‘Red Pepper’ plays a lead role in the witch hunt for LGBTI Ugandans. (Pic: AFP)

Two hundred people have been forcefully outed so far, making us easy targets for blood hungry homophobes. We have heard cases of people fleeing to Kenya. Some in a refugee camp at Kakuma in Kenya have suffered even more, since all refugees fleeing Uganda are apparently considered to be LGBTI. We have heard a case of a trans man’s travel documents being taken away at an airport.

The situation is dire. The cutting of aid from overseas has only served to exacerbate issues as now every ordinary Ugandan will blame LGBTI for their economic plight, further validating their prejudices of western imperialistic imposition on African states.

The whole debate has been misconstrued and our health and identities moralised and politicised. With emotions running high, it is hard to even hold any conversation around LGBTI issues in Uganda right now.

Constitutional challenge
All that remains is the constitutional challenge to the Act in Parliament but it will take ages for a positive ruling to materialise – if ever.

In the meantime, the safety and security of LGBTI people is of the utmost importance and we need countries to loosen their asylum regulations and grant the exposed LGBTI people an emergency exit as the fight continues.

That is the message we need to get out there as no foreign mission has come out clearly on this. They fought alongside us against the legislation and it would be unfortunate for them to abandon our members now.

There are several warning signs of a sexuality genocide brewing, incited by the government, including the president, the media and religious leaders.

This is an SOS to the whole world. My boyfriend and I have been under self-imposed house arrest since the passing of the Bill. My mum comes over at night to bring food.

We need to get out to safety, but not just me. It needs to be a collective mass action. If there is any help you can offer – the need is so urgent! Everyone, please get the word out there.