A gay man with HIV stands in a clinic in Dar es Salaam, Tanzania. Due to the government’s crackdown on the gay community, the man has been afraid to pick his medicine up for two weeks, in spite of the massive risks to his health. (Kevin Sieff / The Washington Post)
East African nations have launched some of the world’s most vicious campaigns against gay men and women, outlawing same-sex liaisons and threatening to punish these with years in jail.
But in a move that has alarmed health workers, Tanzania is turning its anti-homosexual fury in a new direction – targeting HIV/AIDS programs that have helped tame a disease that once ravaged the region.
Last month, the minister of health announced that Tanzania will ban HIV/AIDS outreach projects aimed at gay men, pending a review. That forced the closure, at least temporarily, of U.S.-funded programs that provide testing, condoms and medical care to gays. About 30 percent of gay men in Tanzania are HIV-positive; now health workers say that figure could rise.
Tanzania’s actions appear to mark the first time that a country has suspended parts of the United States’ hugely successful foreign HIV/AIDS initiative in an attempt to crack down on the gay community. The U.S. PEPFAR campaign, backed by $65 billion since it was founded in 2003, has been credited with saving millions of lives.
The ban comes after months of bitter speeches and threats from Tanzanian officials aimed at the gay community and at organizations treating its HIV/AIDS patients. This year, police raided two U.S.-funded HIV/AIDS organizations and seized confidential patient information and supplies, officials said. In September, the deputy minister of health, Hamisi Kigwangalla, accused HIV treatment organizations of "promoting homosexuality."
"Any attempt to commit unnatural offenses is illegal and severely punished by law," Kigwangalla said in the statement. People convicted of same-sex liaisons in Tanzania can be jailed for up to 30 years.
The health minister, Ummy Mwalimu, explained in a statement last month that officials had suspended HIV/AIDS outreach programs for gay patients to review whether they promoted same-sex relationships.
The move has sent a shock wave through a community still grappling with the virus, even as modern medicine and treatment have dramatically improved victims’ chances of survival.
"In the short term, there are people who won’t go to [health] service centers, and if they aren’t on antiretrovirals, what happens? It’s a major concern," said Warren Naamara, a doctor who is the director of the U.N. program on HIV/AIDS in Tanzania, referring to the drugs that suppress the virus.
PEPFAR, or the President’s Emergency Plan for AIDS Relief, launched by George W. Bush with bipartisan support, has become one of the most important U.S. assistance programs ever in Africa. Tanzania is an example of its success. Since 2002, the overall HIV/AIDS rate in the country has declined from 12 percent to 5 percent. The number of people receiving treatment has grown in the past five years from 289,000 to over 700,000.
Other organizations, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, also have spent billions of dollars on HIV treatment on the continent.
But even as assistance programs have sharply reduced the death toll from AIDS, some countries in eastern Africa have been escalating their campaigns against homosexuality.
In 2014, Uganda’s parliament passed a law, later annulled, that imposed the death penalty on those found guilty of "aggravated homosexuality." This year, a Kenyan high court ruled that "anal tests" aimed at determining people’s sexual orientation were legal.
Even though Tanzania’s penal code refers to homosexuality as a "gross indecency," the government had long permitted organizations to help gay men who had AIDS or who were at risk of contracting it.
But since John Magufuli was elected president last year, the government’s tolerance on the issue has disintegrated. Although Magufuli has not said anything publicly about homosexuality, a number of his appointees have made harsh remarks. Critics of gay rights say this nation – which has large numbers of Muslims and Christians – must protect traditional values.
In an August speech, Paul Makonda, the regional commissioner of Dar es Salaam, the capital, threatened to arrest people who were linked to gay men on social-networking sites.
"If there’s a homosexual who has a Facebook account, or with an Instagram account, all those who ‘follow’ him – it is very clear that they are just as guilty as the homosexual," said Makonda, who is the equivalent of a governor.
The government also banned the distribution of lubricants that help ensure that condoms do not tear. Condoms are considered highly effective in preventing HIV transmission.
The U.S. government has hired health organizations such as Jhpiego, which is affiliated with Johns Hopkins University, to provide HIV tests, condoms and doctor referrals for gay men, sex workers and other vulnerable Tanzanians who are afraid to visit a public hospital. Those visits often take place in homes and informal community centers. The Jhpiego project was awarded $73 million over five years beginning in 2015. But such groups have had to cease their outreach efforts in gay communities.
"PEPFAR recognizes the importance of these key populations," said a U.S. official who spoke on the condition of anonymity because of the sensitive situation in Tanzania. "And in order to reach many of them, you have to go where they are."
Without access to those vulnerable communities, "it prolongs the epidemic in the end," the official said.
U.S. officials said they are hopeful that the outreach programs will soon be restored, noting that the health minister has said the government is considering which HIV services would be appropriate for the gay community. But members of that community are pessimistic.
"It’s clear that the government doesn’t care whether we live or die," said one 22-year-old gay man who spoke on the condition of anonymity because of fear of punishment.
A 29-year-old gay man in Dar es Salaam who is HIV-positive said that he was diagnosed four years ago. Since then, antiretroviral drugs have helped him stay relatively healthy and health workers have provided him with condoms, lubricants and information about safe sex so he does not infect his partners.
But now he had gone two weeks without medication. To get it, he would have to go to a public hospital, and he said he fears retribution.
"In this environment, it’s not safe to be a known gay man in the open," he said.
Each week a patient is off his antiretroviral drugs, the virus grows more crippling – what doctors call a "viral rebound."
"These interruptions in treatment are very dangerous," said Naamara of the U.N. program, known as UNAIDS.
Boris Dittrich, the advocacy director of Human Rights Watch’s LGBT division, said that "homophobic rhetoric from government officials will only drive already vulnerable populations underground. The government should reassure all Tanzanians they are protected from harm."
Homosexuality is criminalized in at least 76 countries, and at least 33 of them are in Africa, according to the U.N. Free & Equal campaign for lesbian, gay, bisexual and transgender rights. In many African countries, homosexuality is seen as a Western phenomenon, imported by aid groups. The U.S. government has dissuaded political leaders from interfering with HIV/AIDS treatment, but American condemnation of anti-gay practices often has fallen on deaf ears.
In Tanzania, the 29-year-old man recalled his first thought when he received his AIDS diagnosis: "This is the end of me." But medical treatment subsequently restored his health.
In recent weeks, however, he has returned to a sense of doom, he said. "Under this pressure, what can we do now?"