Rwenzori sub-region decries unequal access to SRH/HIV services

People who do not identify themselves exclusively as men or women are demanding a non-discriminative environment at health facilities in the Rwenzori sub-region. This is in a bid to ensure the delivery of equitable and quality sexual reproductive health (SRH) and HIV services. 

These people, who fall under the evolving acronym of LGBTQI+ (lesbian, gay, bisexual, transgender, queer, and intersex), say their access to these services has become erratic and inadequate since the Anti-Homosexuality Act 2023 came into force last year.

The Act has drawn widespread condemnation from the international community, with some countries, such as the United States and the United Kingdom cutting funding to critical sectors and placing sanctions on officials they claim are involved in serious human rights abuses.  

On April 3, 2024, the Constitutional Court, while upholding most provisions of the Anti-Homosexuality Act 2023, struck down sections that restricted healthcare access for LGBTQI people. Despite the ruling, though, queer people say access to services at health facilities, especially in rural districts, is still hard.  

When Baseme, a transgender woman who prefers to be identified by one name, visited Bugoye Health Centre III in Bugoye Sub-county, Kasese district, she expected to be served like any other community member.

“I explained to the health worker that I needed lubricants. She asked if I was a man or a woman because she could not tell just by looking at me. Then, she asked why I needed the lubricants. I demanded to know why she was interrogating me like this. In the end, I received the lubricants, but only after the other nurses laughed at me,” she says. 

Baseme adds that the nurses accused her of promoting homosexuality in the community. “Visiting a health facility can put you at risk of being reported to the police. Most health workers in rural facilities do not understand the unique needs of queer people. They think we are not human. Yes, we have focal people who help us access some of these services but that is mostly in the urban areas,” Baseme adds.

After her ordeal, Baseme stopped going to that health centre. Now, she sends other people to get consumables on her behalf from another health centre.  

Homophobia

Oscar Ayebare,* a gay man living in Ntoroko District, says he was also bullied by health workers. 

“The health workers laughed at me. Even patients in the outpatient department ridiculed me because I identify as a woman. All the health workers become homophobic once they realise you do not fit into their narrow standards,” he says.

Dr Stephen Bagonza, the Kasese District health officer, disputes this, saying there is no discrimination at the health facilities in the Rwenzori sub-region. 

“Health facilities are ready and willing to serve every citizen of this country equally. Now and then, we send health workers for refresher courses on handling patients. I have not received any reported incidents of discrimination or stigmatisation against gay people. These people access condoms, HIV supplies, testing kits and other services. I think some of them just fear to seek the services because they lack self-esteem,” he says. 

Fundamental right

Access to health services is a fundamental right guaranteed by the Constitution. Dr Peter Kyambadde, the coordinator of the Key Populations Programme in the Ministry of Health, says as part of the essential healthcare package, SRH services and commodities are offered free of charge to everyone.

“As long as it is a public health facility, and as long as the commodities are available, they are free of charge, irrespective of tribe, colour and sexual orientation. If a service or a commodity is not available at a Level Two health centre, then one can access it at a Level Three health centre,” he says   

Baseme and Ayebare did not report their experiences to the police or the relevant health authorities. 

“We cannot report because we fear that we will be imprisoned. How can you tell a stranger that you are gay and that you have been denied access to services because of your sexual orientation?” Ayebare asks.

Jophes Bubu*, a gay man who lives in Fort Portal City also fears being reported to the authorities. He accuses health workers of leaking patients’ information to the public.

“I once went to a health centre and gave them my background information, including my gender identity. At the time, my parents did not know that I was gay. However, within a few hours, they got to know, after the nurse had called them. People hate gay men. So, when I need SRH services, I access them through friends that I send to the health centre,” he says.  

Privacy

Matyansi Bwambale, the in-charge of the ART clinic at Bundibugyo General Hospital, says the law does not permit health workers to disclose patients’ information. 

“We receive these people (LGBTQI), however, some of them become too emotional when we try to request their information to keep records. When we do this, some of them think we are trying to interrogate them about their sexuality,” he says.

Dr Kyambadde says it is the norm for the Ministry of Health tools to capture an individual’s information.

“Of course, we capture if someone is a man or a woman. Some SHR services are specific to different sex. We cannot provide cervical cancer screening to a man just because he identifies as a woman. He does not have a cervix. Also, some family planning methods are specifically meant for women,” he says. 

Peter Masereka, the programme’s officer for We for All Rwenzori (WEFORI), a community organisation that supports LGBTIQ people’s access to SRH services, says most SRH services are provided through referrals to LGBTQI-friendly health facilities.

“Unfortunately, some of these facilities have insufficient services. These people need special health services and consumables, such as female condoms, lubricants, douching machines hormonal therapy, HIV testing Services, pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), and anti-retroviral therapy (ART). They also need information on how to use these commodities on themselves and how to live a healthy life, free from sexually transmitted diseases,” he says.

The organisation carries out outreach services at border points in the region and areas near Lake Albert that target the LGBTQI community and steelworkers. 

“These are vulnerable groups, living on the fringes of society. Accessing health care is difficult for them because most are alcoholics or addicted to drugs. However, the community perceives us as promoting homosexuality, yet we do not promote it,” Masereka says.

Gay sex is illegal in Uganda, and this makes finding non-discriminatory healthcare services challenging, even in urban areas.