Uganda’s PEPFAR Grant Likely to Go Ahead, as UN Human Rights Office is Closed
HIV and AIDS 07/08/2023 •
A woman prepares for an HIV test in Uganda.

Most of the $500 million in US support for Uganda’s HIV/AIDS epidemic, financed by the US President’s Emergency Plan for AIDS Relief (PEPFAR), is likely to go ahead next month despite the country’s draconian new Anti-Homosexuality Act, according to sources close to the process.

However, it is still possible that some parts of the PEPFAR grant being delivered by the Ugandan Health Ministry may be re-assigned to other implementing partners. 

Health and human rights activists have been pressurising PEPFAR to re-route four particular contracts designated for the Ministry of Health to groups that will uphold LGBTQ rights, describing Health Minister Dr Jane Aceng as  “a key proponent” of the AHA.

The future of Uganda’s PEPFAR grant has been in limbo since April when US officials called off a meeting to discuss the Country Operational Plan for 2023 (COP23) because of the draconian Act, which was passed in March . The AHA  includes the death penalty for “aggravated homosexuality”, prison sentences for gay minors and fines for people offering services to LGBTQ people, including landlords and lawyers.

Uganda’s Health Minister, Jane Ruth Aceng

US continues to ‘evaluate actions’ 

While neither confirming nor denying that the PEPFAR grant would go ahead, a spokesperson for the US National Security Council told Health Policy Watch that, “as directed by President Biden, the US government will continue to evaluate additional actions to promote accountability for Ugandan officials and other individuals responsible for, or complicit in, undermining the democratic process in Uganda, abusing human rights, including those of LGBTQI+ persons, or engaging in corrupt practices”. 

“As the President said in May, we will continue to reassess on an ongoing basis the impacts Uganda’s Anti-Homosexuality Act (AHA) may have on our ability to safely deliver services under PEPFAR and other forms of assistance and investments, which is meant to benefit all Ugandans,” according to the NSC spokesperson.

“HIV remains a serious threat to global health and economic development, and thus the focus of any support the United States provides through PEPFAR is intended to continue saving lives among all communities without discrimination, including in Uganda.” 

Visa travel sanctions have been imposed on some Ugandan politicians in the wake of the AHA.

Uganda’s PEPFAR dependence

Over 90% of Ugandans living with HIV are reliant on PEPFAR-sponsored antiretroviral treatment – 1.3 million of the 1.4 million on treatment, according to UNAIDS figures.

Treatment interruptions for them would have serious consequences for their health and for the country’s fight against HIV and AIDS.

But one of the cornerstones of PEPFAR’s approach to combatting HIV globally is targetting “key populations” who are most vulnerable to HIV – including men who have sex with men (referred to as such as many do not identify as gay, particularly in countries where they would face persecution if they did).

Shortly after the AHA was passed, PEPFAR head Ambassador John Nkengasong wrote to all parties involved in the Uganda COP process – government and civil society organisations – announcing the postponement of a meeting intended to authorise the plan.

“This postponement will allow us more time to collectively and effectively assess the legal and programmatic implications of the evolving legislation and broader environment in Uganda, which impacts PEPFAR-supported HIV/AIDS programs, and make relevant adjustments in order to resolve COP23 plans as appropriate,” Nkengasong explained.

In June, Dr Henry Mwebesa, Uganda’s Director General of Health, sent a letter to all health facilities urging them to deliver health services without discrimination, and to respect patients’ confidentiality and safety.

His letter was copied to all UN agencies, PEPFAR, the World Bank, the Global Fund and other agencies that provide aid to the country.

UN Human Rights office closed

However, despite the threat of international sanctions, Uganda further alienated itself from the human rights community by refusing to allow the UN  Human Rights Commission to continue to operate in the country.

Expressing “deep regret” at the closure of his offices over the past weekend after 18 years of operations, UN High Commissioner for Human Rights Volker Türk warned that “serious human rights challenges remain in the path to full enjoyment of human rights for all”.

 

Türk has been an outspoken critic of AHA, describing the Act as “probably among the worst of its kind in the world”.

In his statement last Friday, Türk expressed particular concern about the human rights situation in Uganda ahead of the 2026 elections, given the increasingly hostile environment in which human rights defenders, civil society actors and journalists are operating.

He noted that most of the 54 NGOs that were arbitrarily suspended in August 2021 remain closed and warned against retrogression from Uganda’s commitments under the international human rights treaties it has ratified, including in the passage of the “deeply discriminatory and harmful anti-homosexuality law, that is already having a negative impact on Ugandans”.

Unusual move by US Ambassador to Uganda

In an unusual move, Natalie Brown, the US Ambassador to Uganda, addressed the International AIDS Conference in Australia last month about the impact of the AHA.

Brown and Dr Vamsi Vasireddy of the US Department of Defense Walter Reed Army Institute of Research in Uganda presented a late-breaking abstract reporting that the “hostile environment created with the passing of AHA and the fear of law enforcement has led to reduced access to key population (KP)-friendly services”.PEPFAR supports over 50 drop-in-centers (DIC) that provide HIV prevention and treatment services focusing on KP clients.

“Punitive laws against KP have the potential to derail HIV epidemic control,” warned Brown and Vasireddy.

To mitigate against this, PEPFAR has started the home delivery of anti-retroviral therapy (ART), condoms and Pre-Exposure Prophylaxis (PrEP) and multi-month dispensing.

It has also employed paralegals to offer legal support for KP clients, and introduced greater security at drop-in centres, including biometric access and locked cabinets for client files.

Since the Act was introduced, there has been an increase in attacks on people perceived to be LGBTQ,

Image Credits: 2011, Sokomoto Photography for International AIDS Vaccine Initiative (IAVI).

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