Member Research and Reports

Member Research and Reports

Washington: Anti-Gay Laws Hinder HIV Prevention Efforts, PEPFAR Misses Ample Opportunity

In Nigeria, anti-gay laws can lead to punishments including 14 years in prison or even death by stoning. Gay men and women are banned from holding meetings or organizing in groups, and anyone who supports the union of a gay couple could spend a decade behind bars.

[Photo: Dr. Amy Hagopian]

A new study from the University of Washington School of Public Health suggests laws criminalizing homosexuality, like those in Nigeria, reinforce stigma in ways that harm efforts to stop the HIV epidemic. In African countries, anti-gay laws create fear and block access to vital HIV prevention, care, and treatment.

The U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, recognizes the negative role of stigma in the fight against HIV. However, researchers say, the program has done little to address the primary driver of stigma in Africa—anti-homosexuality laws.

In particular, while most (14 out of 16) partnership policy agreements between PEPFAR-funded African governments and the U.S. State Department called for stigma reduction, none even mentioned anti-homosexuality legislation. Researchers from the UW School of Public Health say this was a missed opportunity.

“Some people may rightly question whether PEPFAR has any business trying to influence legislation in other countries, even if well motivated,” says lead author Dr. Amy Hagopian, associate professor of health services and global health at the School. “We note in the paper, however, that most of Africa’s anti-homosexuality laws were first motivated by Christian colonialists and the doubling down on the harshness of these laws has been fueled by modern-day missionaries of various ilk.”

Dr. Hagopian and her research team used a 2014 analysis produced by the U.S. Law Library of Congress to assess anti-homosexuality laws in 21 African countries receiving PEPFAR funding. They also examined each country’s PEPFAR Partnership Framework agreements. The agreements were originally “aimed in part to foster a policy environment that would help reduce the pace of the epidemic,” according to the study, but the program has since abandoned the approach, at least for now.

Findings showed 16 of Africa’s 21 PEPFAR-funded countries had laws characterized as harsh against homosexuality. Among PEPFAR’s eight most-funded countries in Africa, seven had harsh anti-gay laws, including Nigeria, Kenya, and Uganda. These countries are all former British colonies, which—compared to countries with other colonial legacies—have been found to have the harshest laws criminalizing homosexual conduct.

Since the creation of PEPFAR in 2003 under George W. Bush, the U.S. has been a global leader in responding to the urgent need for the treatment and prevention of HIV/AIDS. Barack Obama renewed the program and tripled the investment in 2008. The U.S. has dedicated approximately $60 billion to HIV/AIDS efforts in more than 60 countries, but the future of the program is in doubt due to possibly severe budget cuts proposed by the new administration.

The study authors note that PEPFAR previously promoted legislation in Africa that attempted to criminalize the transmission of HIV despite evidence that criminalization promoted HIV stigma. “This model legislation is no longer advanced by PEPFAR as, under subsequent administrations, the U.S. acknowledged evidence that criminalization probably made HIV epidemics worse,” Dr. Hagopian said.

Study authors also note that decriminalization of homosexuality is really only a “midterm goal in the public health agenda.” Focus will next need to turn to eliminating discrimination for gay people in employment, housing, and other social determinants of health.

“We found evidence for LGBT human rights movements across Africa pre-dating conservative U.S. influence. In this sense, it is similar to other historical struggles for equality, such as in apartheid South Africa, where we found the U.S. on the wrong side at first,” said Dr. Hagopian. “In retrospect, it’s not hard to know which side of social movements were right. The trick is developing an instinct to know in advance.”

Study co-authors include Dr. Deepa Rao, Mr. Aaron Katz, Ms. Sallie Sanford and Dr. Scott Barnhart, all from the UW School of Public Health.


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