The tragedy of Uganda's queer population: caught between homophobic laws and healthcare cuts

Gloria recalls that she had been in her new home for barely two months, after being evicted from her previous apartment by a landlord who accused her of engaging in “demonic activities,” when she heard on the radio that the United States was going to cut funding for the health programs of USAID, its aid agency . Three weeks later, this bisexual woman who works as a prostitute went to a walk-in clinic in her neighborhood, on the outskirts of the city of Gulu, in northern Uganda, hoping to restock on condoms, HIV test strips, and PrEP (pre-exposure prophylaxis ) pills. But she was surprised to find one of the workers telling her the center would be closing soon. “I was worried. I need HIV drugs to protect myself every time I have sex with my clients,” recalls the 32-year-old woman, who prefers not to give her full name.

The counselor tried, in vain, to reassure her by telling her they had to wait for the government to intervene, but Gloria had reason to be nervous. In 2023, Uganda enacted a harsh anti-homosexuality law , and since then, a climate of hostility toward LGBTQI+ people has erupted within conservative communities. This woman has not only experienced discrimination when renting an apartment, but also when she needs to access healthcare. Because of this, Gloria attends walk-in clinics, which in Uganda operate as "safe spaces" for sexual minorities, sex workers, people who inject drugs, or those at risk of contracting HIV, such as truck drivers, fishermen, and coal workers. There, sexual and reproductive health services are provided, including HIV testing, counseling, contraceptives, and other medications.

But, following President Donald Trump's order to dismantle USAID, the Ugandan Ministry of Health announced the closure of these clinics due to lack of resources and planned to integrate their services into public hospitals throughout the country. This forces LGBTQI+ people seeking access to sexual and reproductive health services to blend in with the general population. As a result, some stopped attending for fear of being stigmatized or harassed by more conservative groups.

For Gloria, this prospect was terrifying. “I’ve been stigmatized enough, and I can’t risk my life by going to a public hospital as a bisexual,” she explains. So she contacted Brenda Lamwaka, who had helped her obtain compensation when her landlord illegally evicted her. “I asked if she could pick up HIV preventative medication on my behalf,” she says, and Lamwaka agreed.

Lamwaka is a transgender person who, for personal reasons and for his own safety, has so far kept his female name. In this report, he prefers to use the male pronoun, his true identity, to refer to himself. Lamwaka knows what it means to be marginalized for his gender identity. In addition to offering free legal services since 2018, the office he rents "is almost a community service center," he says. For example, if LGBTQ people are detained by the police, he helps them obtain bail, connects them with lawyers for legal assistance, or guides them through completing legal documents.

I've been stigmatized enough and I can't put my life at risk by going to a public hospital being bisexual.

Gloria, Ugandan sex worker

Increase in HIV infections

Lamwaka's passion for helping other queer people was born in his teens. At 16, he ran away from home after his mother forced him into marriage. “I was raped by a man who was supposed to be my husband. I was also stigmatized; people called me names for who I am: a transgender man. I was close to committing suicide,” he recalls.

After that ordeal, she learned that a local NGO trained those who wanted to volunteer as counselors and mentors, and she was inspired. “I was already offering counseling services. Sometimes, queer people would come to my house to pick up HIV prevention pills. They felt safe with me,” Lamwaka adds.

HIV and sexually transmitted diseases are the second leading cause of death in Uganda and the leading cause of death among women, according to the World Health Organization (WHO). Although the rate of new HIV infections has declined in the country over the past 30 years—currently 0.9 cases per 1,000 inhabitants—it is still higher than the rate for the African continent (0.6) and the global rate (0.2).

The problem, however, is that the suspension of USAID and other cuts to international aid risk a reversal in the fight against HIV. USAID, according to research by ISGlobal , had managed to reduce the number of HIV deaths by 74% over the past 20 years. Another study, published in The Lancet , estimated that if the cuts continue, the world would record between 770,000 and 2.9 million HIV-related deaths and up to 10.8 million new infections in the next five years, primarily in sub-Saharan Africa.

For example, in the city of Gulu, where Gloria lives, the interruption of USAID funding has forced one of the main public hospitals to lay off 20 counselors who were responsible for organizing health education activities, administering HIV testing, and offering counseling to at-risk groups.

One of the health workers, who has been serving the queer community at a public facility but prefers not to give his name, revealed that “HIV infections have increased significantly” in the city of Gulu since the USAID programs were suspended.

Fear of stigma

Recently, Lamwaka went to a public hospital in Gulu City because she had run out of medicines. “My clients feel safe when I pick up medical supplies for them, and they don't have to go to public hospitals,” she explains.

There, she met with healthcare professionals who provide sexual and reproductive health services to LGBTQI+ people. The healthcare worker told Lamwaka that many queer people are still reluctant to go to the hospital for fear of stigma. “Many queer people stigmatize themselves,” the worker said.

The situation isn't easy, but Lamwaka remains hopeful. For now, she has to work hard to "ensure that people are offered all the necessary services." "The most painful thing about the stigma is that, once you experience it, it consumes you day after day. But I'm here to help my people feel safe when they come to pick up their groceries at my office," she says.

For Gloria, it's essential to create a safe environment where all LGBTQI+ Ugandans have the same access to sexual and reproductive health services as before USAID funding was cut. "It's difficult being queer in Uganda, but Lamwaka has always supported us through thick and thin," she emphasizes. "We pray that queer people in our country are treated as human beings and not with disgust," she confides.

The difficult path described by Ugandan minorities contrasts with the optimism of Ugandan authorities. “The government, through the Ministry of Health, has assured the country that the supply of HIV medications has not been affected by the USAID funding cut,” says Sheila Nduhukire, spokesperson for the Uganda National Medical Reserve.

According to this official, the country has suffered previous cuts, such as when the World Bank stopped funding projects due to the homophobic law. "They thought we wouldn't survive, but that wasn't the case. We've stayed afloat for two fiscal years," she said, congratulating herself.