Foreign Aid, Gay Rights, and Public Health in Africa

by Osefame Ewaleifoh and Kate Klein

The world is witnessing a pivotal time in human rights and the gay rights movement. On the one hand, the U.S Supreme Court recently reversed the Defense of Marriage Act and several states, including Illinois, have made same sex unions legal. On the other, close to half of the world’s countries ban homosexuality. The world witnessed this just last month as Ugandan President Yoweri Museveni passed a law making homosexuality illegal and punishable by life in prison. At the law’s signing, Museveni described homosexual people as “prostitutes” and “mercenaries” who were only acting that way for money and could be taught to be straight[1].

But Uganda is not the only place where homosexuality is illegal – far from it. In total, the United Nations estimates that 78 countries have passed laws making homosexuality illegal[2]. These countries, from Russia to Nigeria, have made it a criminal act for its citizens to be gay. These decisions are often met with widespread support of citizens. A recent PEW research study on global tolerance to homosexuality suggests that this support might be driven heavily by culture and religion. This study reported that Nigeria (98%), Senegal (96%), Ghana (96%), Uganda (96%) and Kenya (90%) believe homosexuality should not be accepted by society[3]. In 2004 former Nigerian president and elder statesman Olusegun Obasanjo said homosexuality is “clearly unbiblical, unnatural and definitely un-African”[4]. This widespread perception of homosexuality as “un-African” makes these recent anti-gay legislations wildly popular locally and makes it highly unlikely that simply withholding foreign aid will be effective in reversing the current tide. Infographics_Free&Equal_632-x-894

Just a week ago Uganda’s popular tabloid the Red Pepper printed, “EXPOSED! Uganda’s 200 Top Homos Named” on their cover[5].  In some countries the situation is getting worse, like Iran, where the penalty is the death sentence, and Cameroon, where people have been murdered for being gay.  Of course, in other countries there have been improvements. Colombia has begun allowing same-sex civil unions, and Vietnam had its first gay pride rally[6].

Despite the many countries that have anti-homosexuality laws, the Ugandan situation seems to have struck a nerve with the international aid community.  Similar perhaps to the anti-apartheid movement, some members of the international aid community are imposing sanctions on Uganda, delaying or cutting of bits of needed aid money that go towards things like healthcare and education programs.  Countries imposing sanctions so far include Denmark, Norway and the Netherlands. The US has been vocally disapproving of Uganda and is considering sanctions. While this move is noble, it should be pointed out that these same countries still have investments in and deliver aid to nearly all of the other 77 countries that support anti-homosexuality laws[7]. So, should we applaud these countries for what they are doing, or say it’s not enough? And will this move make any difference to Museveni? He’s already pronounced that he doesn’t need Western aid because he gets enough from China and other Asian countries. Or will it only harm to those caught in the crossfire, the citizens of Uganda? These sanctions could cause devastating blows to the health of Ugandans if health centers, for example, are unable to provide anti-retroviral medication to HIV positive patients or Prevention of Mother to Child Transmission programs are shut down.  Perhaps acting in reaction to these sanctions, the Ugandan Minister of Health, Dr. Ruhakana Rugunda said that despite recent laws they would not limit access to care for the gay community in Uganda. He stated that, “All people whether they are sexual orientation as gays or otherwise are at complete liberty to get full treatment and to give full disclosure to their doctors and nurses.”[8] Dr. Rugunda’s statement may be difficult to trust of course, given he is part of the Museveni administration.  At the same time, with the end of the Millennium Development Goals right around the corner, would Dr. Rugunda want to see his country fall way behind in health indicators just because of this law?

There is certainly a long way to go before we see equal rights for all despite sexual orientation. Until we get there, many people in these repressive countries will suffer, and the health of the country as a whole will suffer. The movement for gay rights has turned Uganda, and the health of its people, into a battleground. There are no easy solutions and there is no easy way out. Even the United Nations, which is expected to act as a collective voice of reason for member countries, has been slow to pass any treaty or resolution. In the midst of the current international uproar it is important to stay focused on the goal: the conversation about gay rights is a conversation about human rights with very major public health implications. As public health professionals we must find new ways to navigate these current unsavory political realities to ensure the citizens of these countries don’t suffer. We must have a say with those who make aid decisions, and look for new ways to demand protection of all human rights – including gay rights – while  keeping the health and welfare of the people we serve in mind at all times.



[1] Ugandan president Yoweri Museveni signs world’s toughest anti-gay laws, compares them to ‘prostitutes’,, February 25, 2014
[2] Towards a free and equal world. United Nations, January 8, 2014 [iii] Global [3]Attitudes towards Homosexuality. Pew Research . June 13th 2013
[4] Obasanjo backs Bishops over gays. BBC. October  2004
[5] Abedine, Saad and Elizabeth Landau. Ugandan tabloid prints list of ‘homosexuals’CNN, February 25, 2014
[6] Saner, Emine. Gay rights around the world: the best and worst countries for equality. The Guardian, July 30 2013.
[8] Uganda says healthcare is for all despite anti-gay law, February 25, 2014
About NPHR Blog (254 Articles)
The is the blog of the Northwestern Public Health Review journal. The blog and journal are both student run and contain research articles, opinions, interviews and other content pertaining to public health.

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