The Thursday raid by Ugandan police on a U.S.-backed HIV facility in Kampala could force a confrontation that international donors have been desperate to avoid.
As soon as the Anti-Homosexuality Act was signed, Ugandan Health Minister Ruhakana Rugunda began giving assurances to donors underwriting the country's HIV program. It would not affect efforts to control the epidemic nor would it curtail services to LGBT people, he asserted. Donors have continued to treat those pledges as credible even as the anti-LGBT rhetoric from Ugandan President Yoweri Museveni and other officials has continued to escalate, in part because donors worry about making the situation worse for LGBT Ugandans if Western nations can be portrayed as allowing people to die of HIV in retaliation for the law.
The raid on the Makerere University Walter Reed Project (MUWRP) — a research initiative of the U.S. Military HIV Program — was exactly what public health and LGBT advocates had feared could happen. And it could force the hand of donors at a time when advocates are already accusing the Obama administration of dithering and sending mixed messages about how the law will affect our relationship with the East African nation.
"The U.S. and EU are desperate to pave this over, and at every turn Museveni chooses to ratchet it up," said Mark Bromley, chair of the Council for Global Equality, which advocates for LGBT rights in U.S. foreign policy. "I'm convinced that the reason this is happening is [the U.S.] didn't come out strong enough fast enough [after the law was enacted]. ... we are in a complete policy conundrum."
Details of what happened yesterday are still murky. The most complete account so far comes from human rights lawyer Nicholas Opiyo, who was recently ousted as secretary general of the Ugandan Law Society because of his advocacy of LGBT rights. He spoke with police officers and gained access to testimony taken during their interrogations and reported much of his findings on Twitter. Opiyo told BuzzFeed that the officers involved, Edmond Nfutundinda and Francis Nsabimana, said they were "acting on an intelligence report that the clinic was promoting homosexuality."
Opiyo reported the arrest of two Ugandan employees of the project (although a statement posted on MUWRP's website only reported one arrest). U.S. Embassy personnel were able to quickly secure their release after arriving at the police station, he said. Police also seized materials including condoms, lube, and medical manuals concerning HIV and men who have sex with men, and took pictures of patients who were at the clinic of the time of the raid.
"The U.S. Embassy in Kampala registered its serious concern with senior Ugandan health, foreign affairs, and law enforcement personnel, and formally protested the detention of the MUWRP employee," said a State Department official speaking on background. "Attacks and intimidation of health care workers is unacceptable. ... Until we have greater clarity as to the legal basis for the police action we are suspending the operations of MUWRP to ensure the safety of our staff and the integrity of the program."
Police spokesperson Patrick Onyango later denied that the raid took place at all in a statement to the Associated Press, saying, "Yesterday somebody claiming to be a police officer went and arrested one of the workers there. ... We are not investigating that place at all." But Opiyo said the police officers had seen evidence that the police had been tracking the project for some time — they already knew the home address of one of those arrested before they did the raid and also had pictures of some of the patients on their cell phones.
The effort to walk back the raid suggests it may have simply been a boneheaded move by local police who were unaware of the geopolitical implications of their actions. But the timing makes it look like a deliberate provocation to some LGBT and HIV advocates. Museveni and other top officials of the Ugandan government are in Brussels this week participating in the EU African Summit, where the Anti-Homosexuality Act has been a major subject of discussion. A team of officials from several U.S. agencies also paid a visit to Uganda this week as part of a review process to adjust aid in response to the law.
"The government knows that the U.S. delegation is here and this was the best time to act" to demonstrate their independence, said Kikonyongo Kivumbi, executive director of the Uganda Health and Science Press Association. They may have had their eye on conflict over Uganda's military policy — in which the U.S. is also heavily invested, Kikonyongo suggested. During a "Thanksgiving Service" in celebration of the law on Monday, he noted, Museveni sent the message "I don't take orders" from the West.
And on Monday, a team of consultants for the World Bank will begin an investigation in the country to determine how a $90 million health care loan suspended after the law's enactment in February can proceed. On April 1, a coalition of 11 organizations sent a letter to World Bank President Jim Yong Kim out of apparent concern that the team's mandate would be drawn so narrowly as to ensure that they will find nothing to keep the grant from proceeding. They especially urged that the Bank not accept "written assurances from the Ugandan government regarding how discrimination … will be avoided when the law is in force," such as a March 7 letter from the minister of health to the World Bank president asserting "the constitution and relevant laws of Uganda guarantee the right to privacy and full access health care services" even with the law in place.
The Bank will now be under even more pressure to go beyond promises from Ugandan officials about how health services will be provided without discrimination. Not only does the incident appear to give lie to the ministry of health's promises, but the review team includes Opiyo, the human rights lawyer who investigated the arrests.
"We are alarmed by reports on the incident and are currently seeking more information. Over the last few weeks, our country office and health experts have been meeting with Ugandan officials, and we are still reviewing our $90 million loan," said World Bank spokesman David Thies.
And the challenge facing the U.S. government now also grows. The U.S. underwrites much of the Ugandan government's HIV program, allocating more than $400 million to the country's health care system in fiscal year 2013 alone. It has so far only announced a few changes to aid, affecting around $10 million in response to the law, including a $6.4 million cut in funding to an HIV program by one of the law's most important backers, the Inter-Religious Council of Uganda. And even this modest adjustment has become a major talking point among the law's supporters — almost every speaker at Monday's "Thanksgiving Service" warned that the West could cut off funding for lifesaving antiretroviral treatment for Uganda's 1.5 million people living with AIDS, and President Museveni declared that Uganda could afford to pay the cost of their treatment if they did so.
And the U.S. is facing criticism from HIV advocates to another change to funding in response to the law, the suspension of a program studying interventions with men who have sex with men and other high-risk populations, which it did citing concern about the safety of the employees and patients involved in the study. This created the appearance that the Ugandan government can effectively veto interventions with LGBT people, critics said, sending precisely the wrong message.
The raid, said the Council for Global Equality's Mark Bromley, highlights "the need for a serious response [to the law], but not one that backs away from the care and treatment for those we've pledged sustain."
If the U.S. had acted more forcefully sooner, he believes it could have avoided this situation. Now there are no easy solutions.
"Now we are where we are, and we have to figure it out," he said. "I'm at a loss just like everyone else."