Anti-homosexuality laws interact with homonegativity to reinforce stigma and discrimination, in ways that are counterproductive for HIV prevention, care and treatment efforts. This population suffers extortion, humiliation, discrimination and violence, including rape, based on sexual orientation and gender identity. Homonegativity is heightened by the physical, psychological or sexual violence against gay men and other men who have sex with men. In 2012, the independent Global Commission on HIV and the Law, convened by the United Nations Development Program on behalf of the Joint United Nations Program on HIV/AIDS (UNAIDS), produced a report, ‘Risks, Rights and Health,’ which pointed to higher rates of HIV among men who have sex with men in countries where same-sex sexual activity is criminalized, compared to countries where it is not criminalized.
Men who perceive their behaviors to be associated with shame, judgment, fear or even legal consequences are less likely to disclose sexual behaviors to health care providers, less likely to receive prevention and treatment care, and more likely to contribute to the HIV epidemic. In particular, laws that penalize same-sex intercourse contribute to a cycle of stigma, homonegativity and discrimination, and therefore serve to fuel the epidemic. Intersectional stigmas, associated with homosexuality, HIV, poverty and race, interact in several ways to subvert HIV care, prevention and treatment. Punitive laws incite deeper levels of stigma. Generalized homonegativity or heterosexism (both words have been used in the literature ) leads to and is reinforced by criminalization of sexual behaviors. High levels of stigma and discrimination are associated with a punitive social and legal environment for men who have sex with men. In many African nations, laws criminalizing homosexuality may be fueling the epidemic, as they dissuade key populations from seeking treatment and health care providers from offering it. Most troublingly, gay men and other men who have sex with men often acquire HIV early in life. The median HIV adult prevalence in the population of men who have sex with men in Africa, at 15%, is the highest among the World Health Organization’s regions. Indeed, while HIV prevalence may be declining in other populations, prevalence is reported to be rising among gay men in many locations, with the risk of infection up to 20 times higher in several African nations.
Gay men and other men who have sex with men are disproportionately burdened by HIV infection. Our analysis suggests mechanisms like PEPFAR Partnership Framework agreements could be ideal vehicles to call for removal of anti-homosexuality legislation. Most (14) of the 16 African ‘Partnership Framework’ (PEPFAR) policy agreements between African governments and the US State Department call for stigma reduction however, none call for reducing penalties on individuals who engage in homosexual behavior.Ĭonclusions: We conclude that while PEPFAR has acknowledged the negative role of stigma in fueling the HIV epidemic, it has, so far, missed opportunities to explicitly address the role of the criminalization of homosexuality in feeding stigmatizing attitudes. Among the top eight PEPFAR-funded countries in Africa, seven had harsh anti-homosexuality laws. Results: We found 16 of Africa’s 21 PEPFAR-funded countries had laws characterized as harsh in relation to homosexuality.
We examined PEPFAR Policy Framework agreements associated with those countries, and other PEPFAR documents, for evidence of attempts to reduce stigma by decriminalizing homosexuality. Methods: We assessed homosexuality laws in 21 African countries where PEPFAR funding sought to reduce the HIV epidemic. Given the aim of the US PEPFAR program to reduce stigma surrounding HIV, we explored how PEPFAR may have used its influence to reduce the criminalization of homosexuality in the countries where it operated. Objectives: We analyzed the ways in which policies and practices of the US President’s Emergency Plan for AIDS Relief (PEPFAR) program addressed pervasively harsh anti-homosexuality laws across Africa. Laws that penalize same-sex intercourse contribute to a cycle of stigma, homonegativity and discrimination. Background: Gay men and other men who have sex with men are disproportionately burdened by HIV infection.