An asylum seeker from Uganda holds a rainbow flag during a Pride parade in Boston, Massachusetts in the U.S. Photo by: REUTERS / Jessica Rinaldi

BERLIN — In her plenary address at the International Conference on AIDS and STIs in Africa this month, Cindy Kelemi, executive director of the Botswana Network on Ethics, Law, and HIV/AIDS, called attention to missing political leadership in the HIV response.

"In our beloved Africa, there are many countries with anti-LGBTI policies and laws," she told the audience in Kigali, Rwanda. "We need political leadership to remove political and structural barriers."

“Everyone knew that people had been arrested because of who they are, because they identify as LGBT persons.” — Patricia Kimera, programs director, Human Rights Awareness and Promotion Forum

The very next day, ICASA officials announced that Uganda — a country that has recently renewed a crackdown on its LGBT community — would host its 2021 conference, the largest gathering related to HIV/AIDS on Africa’s calendar.

In sub-Saharan Africa, there remains a high rate of HIV transmission among transgender people and men who have sex with men, amid efforts to underscore the effect that criminalization of LGBT communities has on their ability to access HIV prevention and treatment services.

In that context, ICASA's selection of Uganda generated a mixed response from local and international activists, including Winnie Byanyima, UNAIDS’ new executive director, who called for the country to repeal its law criminalizing same-sex relations so that LGBT people can attend the conference.

Nigeria’s hidden HIV crisis In Nigeria, almost a quarter of gay men have HIV, but criminalization and discrimination means that most of them cannot access treatment.

To some, the choice reads as rewarding an administration that has repeatedly threatened the LGBT community.

For others, ICASA offers a new point of leverage to push for decriminalization, not only for LGBT groups but also for other marginalized communities that are disproportionately impacted by HIV, including sex workers and people who inject drugs.

Calling Uganda's consideration for ICASA a "testament to the power of the activism of people living with HIV and criminalized populations," Asia Russell, executive director of HIV activist group Health GAP, said Ugandan activists were still right to "point out that government must commit to rolling back criminalization of HIV, homosexuality, sex work, and drug use in order to bring the HIV response into line with evidence and human rights."

Advocates say there has been a new wave of violence against the LGBT community in Uganda since October, when Ethics and Integrity Minister Simon Lokodo threatened to introduce the death penalty for people convicted of gay sex. Existing anti-gay legislation from the colonial era allows for up to 14 years' imprisonment for people convicted of homosexual acts.

A week after Lokodo's comments, police arrested 16 activists from LGBT rights group Let's Walk Uganda and submitted them to forced anal examinations — a widely debunked practice meant to provide evidence of gay sex. Then, in mid-November, Ugandan police stormed Ram Bar in downtown Kampala, one of the few locations in the capital that is friendly to members of the LGBT community. Police arrested 127 people and charged 67 with causing a nuisance — which, advocates say, masks the real reason for their arrest.

"Everyone knew that people had been arrested because of who they are, because they identify as LGBT persons," said Patricia Kimera, programs director at the Human Rights Awareness and Promotion Forum, which is helping to provide legal services to those arrested.

Four of them were still in prison when ICASA announced Uganda as the location of its 2021 conference.

Some of those arrested have since been ostracized by their families or had trouble with employers. "This is the kind of harm they [the police] have caused," Kimera said.

The arrests and harassment also have implications for the country's HIV response, said Richard Lusimbo, research and documentation manager at the NGO Sexual Minorities Uganda. Though the Ministry of Health has put in frameworks and policies to provide services for the LGBT community and other marginalized groups, "people are scared of coming to access the services,” Lusimbo said. “And it gives an opportunity for discrimination. [The] health provider may have a mandate [to provide the service to LGBT people], but they feel they do not have to … and they will not be held accountable."

According to UNAIDS, the HIV prevalence rate among men who have sex with men is far higher than in the general adult population in Uganda, but far fewer of them are accessing antiretroviral therapy — echoing the trend in other countries where same-sex activity is criminalized.

ICASA has recognized the harm that criminalization does to an HIV response, as organizers included "punitive laws" and their impact on HIV risk as one of the themes of its Rwanda conference.

ICASA had not provided comment on the issue at the time of publication, but Lusimbo said ICASA officials did include members of Uganda's LGBT community in the conversation leading up to the country's selection for the biennial conference.

He said activists took that opportunity to push government officials to end the police raids and drop existing charges. Officials promised to address harassment of the LGBT community, according to Lusimbo.

Representatives from the Uganda AIDS Commission, which spearheaded the country's ICASA bid, did not respond to requests for comment, though the commission did issue a statement saying ICASA 2021 offered Uganda an "opportunity for further learning and re-tooling."

Lusimbo said activists were also encouraged by steps government officials had already taken to speak out against the new wave of harassment. For example, following a recent incident where a doctor attacked a patient whom he suspected of being a lesbian, the Ministry of Health put out a statement insisting that "all patients should be able to seek medical treatment without fear of discrimination, violence, personal vengeance or retaliation."

Neela Ghoshal, senior researcher for Human Rights Watch's LGBT rights program, said there were more definitive actions the government could immediately take to signal its commitment "to doing something to improve lives and access to health," including announcing a ban on forced anal examinations and issuing a statement that people should not be detained because of their sexual orientation.

Now, with ICASA planning underway, civil society members are promising to keep up the pressure on the government to take further steps. "We will continue to engage the government," Lusimbo said, "and to ensure the whole world is watching, the whole of Africa is watching."