Intended for healthcare professionals

Feature HIV and AIDS

How homophobia is fuelling Africa’s HIV epidemic

BMJ 2010; 340 doi: (Published 11 May 2010) Cite this as: BMJ 2010;340:c2245
  1. Bob Roehr, freelance medical journalist
  1. 1Washington, DC
  1. BobRoehr{at}

    Attitudes to gay people are impeding the response to HIV and AIDS in Africa, Bob Roehr reports

    Rumours of a gay wedding spark a riot at an HIV clinic in Kenya, closing it for two days; a pair of men who plan to wed are jailed for months without bail in Malawi; a law before the Ugandan parliament seeks to impose the death penalty for homosexual acts and would prosecute parents, colleagues, and healthcare workers for not immediately reporting people whom they think might be gay to the authorities.

    This is the face of homophobia that is imperilling the fight against HIV and AIDS in Africa. UNAIDS director Michel Sidibe, like his predecessor Peter Piot, has been adamant about tackling homophobia. It is unacceptable that 85 countries still have laws on the books criminalising sexual activity between adults and seven reserve the death penalty for homosexual acts, he told journalists in New York City in March.

    “We must insist that the rights of the minorities are upheld. If we don’t do that . . . I think the epidemic will grow again. We cannot accept the tyranny of the majority,” he said.

    The response to AIDS should be based on a foundation of human rights and a scaling up of treatment, according to Jeffrey O’Malley, director of the United Nations Development Programme’s HIV Group. The group is charged with developing and implementing a coordinated HIV policy across all UN agencies.

    “Instead, we often have situations where laws and their arbitrary, inappropriate enforcement are increasing risk and vulnerability—thereby imposing formidable barriers to effective HIV responses for those most vulnerable and the general population,” he says.

    Even within countries with a generalised HIV epidemic, men who have sex with men are among the most deeply affected. They are 4-19 times more likely …

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