Criminalization of same sex practices as a structural driver of HIV risk among men who have sex with men (MSM): the cases of Senegal, Malawi, and Uganda
S. Baral1, P. Semugoma2, D. Diouf3, G. Trapence4, T. Poteat1, M. Ndaw3, F.M. Drame5, M. Dhaliwal6, C. Traore7, N. Diop3, S. Bhattacharya8, T. Sellers8, A. Wirtz1, C. Beyrer1
1Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Epidemiology, Baltimore, United States, 2Private Practice, Kampala, Uganda, 3Enda Tiers Monde / Santé, Dakar, Senegal, 4The Center for Development of People (CEDEP), Blantyre, Malawi, 5University of Saint Louis / ENDA Santé, St. Louis, Senegal, 6UNDP, Human Rights, Gender & Sexual Diversities, New York City, United States, 7UNDP, HIV/AIDS Practice, New York City, United States, 8UNDP, Sub-Regional Office for East and Southern Africa, Johannesburg, South Africa
Issues: Same sex practices among men remain criminalized in 78 UN member states. In many of these settings, including Senegal, Malawi, and Uganda, epidemiologic studies have demonstrated MSM to be at high risk for HIV. There has been an increasing trend of arrests of MSM in Senegal well as a new national bill proposed in Uganda prohibiting the provision of HIV prevention services for MSM and increasing penalties for same sex practices.
Description: In Senegal, Malawi, and Uganda a participatory policy analysis with MSM (n=85) and other key informants (n=22) was used to examine the downstream effects of the enforcement of the criminalization of sex among men on both the ability of health care workers to provide HIV services as well as on the uptake of these services among MSM.
Lessons learned: Enforcement of criminal penalties on sex between men has limited the ability of health care workers to provide essential HIV-prevention services for MSM including education, the provision of condoms and water-based lubricants, voluntary counseling and HIV testing, and treatment of sexually transmitted infections in Senegal and Malawi. Similar threats are likely to be seen in Uganda should current proposed laws pass. Where services are available, active enforcement of these laws limits uptake of essential programs among entire communities of MSM. Consequently, HIV vulnerabilities among these men, and the population as a whole, are increased.
Next steps: In responding to HIV among MSM, pragmatic public health approaches are called for which are both evidence based and rights affirming. Punitive law, policies and practices increase vulnerabilities and limit these men's access to essential services. The HIV/AIDS and public health communities need to be engaged in supporting evidence-based, comprehensive, and rights affirming approaches for MSM in Africa including efforts for 'healthy enforcement' and/or repeal laws which criminalize same-sex practices.
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