For many years, Uganda’s marketing campaign in opposition to H.I.V. was exemplary, slashing the nation’s demise price by almost 90 p.c from 1990 to 2019. Now a sweeping legislation enacted final yr, the Anti-Homosexuality Act, threatens to resume the epidemic as L.G.B.T.Q. residents are denied, or are too afraid to hunt out, essential medical care.

The legislation criminalizes consensual intercourse between same-sex adults. It additionally requires all residents to report anybody suspected of such exercise, a mandate that makes no exceptions for well being care suppliers tending to sufferers.

Beneath the legislation, merely having same-sex relationships whereas dwelling with H.I.V. can incur a cost of “aggravated homosexuality,” which is punishable by demise.

Anybody who “knowingly promotes homosexuality” — by hiring or housing an L.G.B.T.Q. individual, or by not reporting one to the police — faces as much as 20 years in jail. Scores of Ugandans have been evicted from houses and fired from jobs, in line with interviews with attorneys and activists.

Entrapment and blackmail — generally by the police — are rampant in individual, on social media and on relationship apps, in line with interviews with dozens of individuals.

L.G.B.T.Q. folks, and the advocates and well being care staff serving to them, have been topic to threats and violence.

The legislation has introduced world condemnation and has dealt a big blow to Uganda’s economic system. However it’s extensively standard amongst its residents. Many Ugandans see homosexuality as a Western affect and the legislation as a corrective. The nation’s Constitutional Courtroom is about to rule on the act’s legality as early as subsequent week.

In response to strain from world well being organizations, the Ugandan well being ministry in June assured well being care to anybody no matter orientation or id. It didn’t promise that sufferers could be secure from prosecution.

The nation’s well being ministry didn’t reply to a number of requests for touch upon the act’s affect on public well being.

However Dr. Jane Aceng, the well being minister, has stated on the social media web site X that the federal government will guarantee entry to H.I.V. prevention packages and “stays dedicated to ending AIDS as a public well being problem.”

Others see a catastrophe within the making. Though the legislation targets L.G.B.T.Q. folks, the ensuing stigma and discrimination could deter all Ugandans from searching for well being care, stated William W. Popp, the USA ambassador to Uganda.

“Our place from the USA authorities is, the entire legislation ought to be repealed,” he stated in an interview. “It’s a violation of fundamental human rights and places all Ugandans in danger.”

In interviews, dozens of L.G.B.T.Q. folks, advocates and well being care suppliers in Uganda say they feared that the laws has had a devastating impact on public well being. Though agency knowledge are laborious to search out, clinics and hospitals estimated that the variety of folks coming in for H.I.V. testing, prevention or remedy has dropped by no less than half.

Some shelters for folks dwelling with H.I.V. have closed, and a few facilities that after allotted H.I.V. providers on a walk-in foundation now see purchasers for restricted hours, usually solely by appointment, to reduce the possibility of raids.

Dozens of well being care suppliers and sufferers have been arrested.

“The federal government has tried very laborious to create the impression that the Anti-Homosexuality Act shouldn’t be actually being enforced, that it’s not an precise menace to L.G.B.T. folks, however that’s not true,” stated Justine Balya, a director on the Human Rights Consciousness and Promotion Discussion board, which represents a lot of these arrested.

Uganda had been on the forefront of H.I.V. analysis and public well being coverage. The brand new legislation requires scientists to disclose the identities of research individuals.

“It’s troubling from a analysis and educational perspective, and troubling from a scientific perspective to truly develop the medicines and instruments we have to confront illness epidemics sooner or later,” Ambassador Popp stated.

Worldwide, safety of homosexual rights is intricately linked to manage of H.I.V.

Homosexual and bisexual males dwelling in international locations that implement legal guidelines criminalizing homosexuality are 12 instances as prone to be dwelling with H.I.V. as these in the remainder of the world, in line with a latest U.N. report.

“We’re struggling a lot, and our life is in peril,” stated Nathanian Issa Rwaguma, 34, a homosexual man and an activist.

Western supporters have provided few assets wanted to guard L.G.B.T.Q. folks, notably those that have been outspoken, a number of stated. “Do you count on a lifeless human-rights defender, or an alive one?” requested Hajjati Abdul Jamal, a 29-year-old transgender girl, referring to help organizations.

Many Ugandans who’ve been arrested weren’t charged beneath the act, however as a substitute with being a “widespread nuisance,” having “carnal information in opposition to the order of nature” or intercourse trafficking, even when the so-called trafficking means transferring from the lounge to the bed room of the identical home, Ms. Balya stated.

Almost all of these arrested are launched after a couple of week, however a number of might stay imprisoned for years awaiting trial, she added.

In March, three homosexual males and three transgender ladies who labored as H.I.V. educators have been arrested in Jinja, a metropolis in jap Uganda.

They spent 4 months in jail enduring sexual harassment, beatings and two rounds of pressured anal examinations, in line with the physician who runs the clinic the place they labored and their attorneys. One educator was so severely lashed with a cane that she couldn’t sit or lie down for 2 weeks.

In November, Mulindwa Benda, 24, a transgender man and educator, was in Busia, on the Uganda-Kenya border, to steer a workshop on sexual and reproductive well being. He was charged with selling homosexuality.

The police ridiculed him for “dressing like a person,” and held him for 72 hours in a tiny jail cell with eight ladies and a bathroom that didn’t flush, Mr. Benda stated in an interview.

Outreach staff in Lugazi, Mbarara and several other different cities have been arrested for distributing lubricants and condoms. Law enforcement officials usually affiliate the merchandise with same-sex intimacy.

“It’s a part of the general local weather of persecution and violence that strikes concern into well being staff, in addition to homosexual and bisexual males and trans ladies who want supportive, stigma-free H.I.V. providers,” stated Asia Russell, govt director of the advocacy group Well being Hole.

About 13 p.c of Ugandan males who’ve intercourse with males are dwelling with H.I.V. Many are actually reduce off from care.

Mulago Hospital’s clinic for sexually transmitted illnesses, among the many largest in Kampala, used to deal with greater than 100 L.G.B.T.Q. sufferers a day. Now, fewer than half come into the clinic, stated Dr. Afunye Anthony Arthur.

“The others conceal out, so it’s a must to search for them,” he stated.

Dr. Afunye stated he had been accosted by indignant folks at a restaurant and his residence, the place he lives along with his spouse and three younger kids.

To make visits safer for purchasers, Ark Wellness Hub, a clinic in Kampala, now stays open late into the night and presents personal appointments.

Though three of the clinic’s seven employees members have been evicted from their houses, “it’s a must to discover a means of going forward together with your work,” stated Brian Aliganyira, its govt director.

Some clinics have resorted to stashing lubricants out of sight or utilizing euphemisms to discuss with them. At many clinics, employees and volunteers proceed to supply care, spending their very own cash to ship medicines.

Nonetheless, a whole bunch of sufferers have dropped out of contact with Mulago and Ark Wellness. Some are intercourse staff who would possibly move the H.I.V. to others as their virus ranges rise with out remedy, Dr. Afunye stated.

In an interview, a 32-year-old homosexual man stated he had taught shoemaking however was pressured to go away his job in July after he was accused of selling homosexuality on the faculty. He was recognized with H.I.V. in 2021 and took his final anti-viral capsule on Dec. 6.

Two of his pals died in August of H.I.V.-related issues after discontinuing remedy. However he was nonetheless too afraid to go to a clinic: One other good friend was stoned to demise in his village in Masaka district, he stated, after an acquaintance acknowledged him on public transportation.

Ivan Melisa Kakuru, 26, a transgender girl, nonetheless picks up her H.I.V. medicines on the Mulago clinic. However she usually doesn’t come up with the money for to eat, she stated. Ms. Kakuru stated she fled her hometown when her father tried to kill her and doesn’t have a spot to stay.

Her good friend Carlos Bahuriire, 36, a transgender man, stated he was evicted by his landlord and had been staying with a sympathetic good friend.

President Yoweri Museveni has referred to as L.G.B.T.Q. residents “disgusting” and “irregular,” and has stated that they’ve “a sort of illness.” He has additionally blamed the West for bringing homosexuality into the nation.

Ugandan police have falsely accused activists or educators — like these arrested in Jinja — of recruiting kids into homosexuality and making pornographic movies. Some authorities officers even have conflated homosexuality with pedophilia.

“Should you begin raping kids and so forth, we kill you,” Mr. Museveni stated final yr of the legislation.

Dr. Aceng, the well being minister, celebrated the passing of the legislation. “Our tradition and dignity is upheld and the Ugandan Kids Protected,” she wrote on X.

The criminalization of homosexuality truly is a leftover of colonialism and takes Uganda out of step with the remainder of the world, stated Matthew Kavanagh, director of the World Well being Coverage and Politics Initiative at Georgetown College.

The President’s Emergency Plan for AIDS Aid supplies greater than $400 million in H.I.V. funding to Uganda every year. Greater than 96 p.c of that’s applied by organizations outdoors the Ugandan authorities.

Now the Biden administration has redirected $5 million of the remaining away from the federal government, Ambassador Popp stated.

As of Jan. 1, the USA has eliminated Uganda’s entry to the African Progress and Alternative Act, which supplies duty-free entry to the U.S. market. Washington has additionally sanctioned Johnson Byabashaija, commissioner normal of the Uganda Prisons Service, for torture and human rights abuses.

However Dr. Kavanagh and different consultants stated the Biden administration might do extra to impose monetary sanctions or strain the Ugandan authorities to repeal the legislation.

Mr. Byabashaija’s sanction was primarily based partly on proof from the March 2020 arrest of Henry Mukiibi, who leads an H.I.V. clinic and shelter, together with 19 others.

The group was held for 52 days, throughout which they have been tortured and crushed; some had their genitals burned with a bit of firewood, Mr. Mukiibi stated in an interview.

“Every time I discuss this occasion, I get nightmares,” he stated. “It traumatized me.”

Final July, the group was once more raided and the clinic was shut down. Undeterred, Mr. Mukiibi has moved to a brand new safe location.

Mr. Mukiibi stated he felt it was essential to talk up. “Typically after we conceal issues, or when the one that’s talking turns into nameless, folks don’t perceive the precise state of affairs you’re passing via,” he stated.