Uganda Anti-Homosexuality Law & Women's Health

• The report analyzes the impact of the Anti Homosexuality Law (2023) on access to Sexual Reproductive Health and Rights (SRHR) services for Lesbian, Bisexual, and Queer (LBQ) women in Uganda.
• The main objective is to systematically explore how the law affects access to SRHR services for LBQ women, document their experiences seeking SRHR services, identify successful strategies to increase access, and provide recommendations to stakeholders.
• The research employs qualitative methods, gathering primary data through virtual Focus Group Discussions (FGDs) and In-depth Interviews (IDIs) with LBQ women, and Key Informant Interviews (KIIs) with healthcare workers, LBQ organization leaders, representatives from Civil Society Organizations (CSOs), and donors. Secondary data is collected through a desk review.

Key Findings

• LBQ women commonly need UTI/STI treatment, HIV/AIDS testing services and information, cervical cancer screening, In Vitro Fertilization (IVF) services, shelters, counseling services, legal aid, safe abortion care, and fibroid screening and treatment.
• The Anti Homosexuality Law (2023) has negatively impacted LBQ women's access to SRHR by shrinking safe spaces, increasing fear of being reported to the police, and reducing willingness to seek services.
• Negative experiences include dehumanizing interrogations, sexual harassment from healthcare workers, insults, high prices for SRHR services, being ignored by health workers, judgmental looks from other patients, and pressure to undergo conversion therapy.
• Key successful strategies include establishing strong partnerships and collaborations, implementing peer-to-peer and community outreach models, creating Key Population (KP) focal points at health centers, LBQ Drop-in Centers, and mental health support spaces.

Recommendations

• Oppose the Anti Homosexuality Law due to its obstruction of healthcare access.
• Enact laws protecting LGBTQ people's right to non-discriminative healthcare.
• Hold government and private facilities accountable for discrimination against LBQ women accessing SRHR services.
• Decriminalize homosexuality.
• Sensitize and train healthcare workers, arrange for remuneration of Key Population contact points, ensure LBQ-specific medication availability, create a fund for gynecologists supporting LBQ clients, strengthen confidentiality policies, and accredit LBQ Drop-in Centers.
• Invest in data collection for advocacy, empower LBQ women economically to afford SRHR services, create partnerships for referrals, invest in mental health support, expand services to rural areas, and create safe spaces.
• Encourage community outreach, reduce bureaucratic barriers, train healthcare workers on LGBTQ issues, develop mechanisms for reporting discrimination, and designate LGBTQ-friendly KP focal points.
• Implement police training on LBQ issues and justice for LBQ individuals.
• Increase research funding led by and for LBQ women, direct funding towards LBQ SRHR issues, support LBQ women's advocacy, provide flexible funding, and encourage donor inclusion.
• Hire specialized doctors, conduct community outreaches, and advocate for Drop in Centers accreditation.
• Collaborate on SRHR initiatives, amplify LBQ women's issues, and provide legal aid.
• Promote education, empathy, and acceptance in communities to reduce violence, report Gender Based Violence (GBV), and create safe spaces.

Study Background

• Despite state and non-state interventions to promote universal access to SRHR in Uganda, there are significant gaps specifically for LBQ womxn.
• There's limited focus on SRHR needs specific to LBQ womxn, which leads to them being overlooked in HIV/AIDS responses.
• LBQ womxn face gender inequality, homophobia, heteronormativity, and invisibility limiting SRHR access.
• The anti-homosexuality Law (2023) prescribes life imprisonment for same-sex relations and the death penalty for "aggravated homosexuality," including "promotion" of homosexuality.
• The law has led to increased stigma, discrimination, and violence against LGBTQ persons, causing fear and unrest.
• LBQ womxn organizations, Drop in Centers, and shelters have been forced to seize physical operations, creating barriers in accessibility of SRHR services.
• Healthcare seeking sharply declined among LGBTQ persons following the law's passage, attributed to fear of being reported and the closure of LGBTQ organizations.

Key Objectives

• Analyze the Act impact on access to SRHR services for LBQ women in Uganda.
• Document experiences of LBQ women trying to access SRHR services under AHA (2023).
• Identify strategies to boost access to SRHR in the context of the AHA.
• Understand how the law has affected access to SRHR services by the LBQ community.
• Provide possible ways for LBQ tailored SRHR interventions and inclusive policies.

Research Methodology

• The study assessed impacts of the Anti-Homosexuality Act (AHA, 2023) on Sexual and Reproductive Health and Rights (SRHR) access for LBQ womxn through qualitative methods.
• Data came from 11 districts across Uganda's central, western, northern, and eastern regions.
• Primary participants were LBQ womxn, selected with help from LBQ organization leaders. They participated in Focus Group Discussions (FGDs) and In-Depth Interviews (IDIs).
• Secondary participants were healthcare workers, LBQ organization/DIC leaders, ally CSOs, SRHR program donors, and independent consultants.
• Two online FGDs were conducted, with 2 LBQ womxn from each of the 11 districts, and five individual IDIs were done.
• 26 online Key Informant Interviews (KIIs) were conducted: nine with LBQ leaders, four with CSO leaders, four with healthcare workers from key population health centers, two with government healthcare workers, four with LGBTQ leaders, one with a donor, one with an LBQ shelter leader, and one with an independent Consultant.

Ethical considerations

• Participants gave informed consent to study participation (understood the research purpose and the use of collected data).
• Participation was voluntary, and all participants were able to withdraw their participation at any time.
• The study prioritized respondent confidentiality (the report does not include participants personal information).

Challenges

• Some Participants found talking about their experiences distressing (discussing sexual orientation, gender identity or practices isn't acceptable).
• The research didn't gather the views of policymakers (they feared the consequences of stating their official position).
• Poor internet connectivity made interviews hard (using phone calls to conduct research).

Study Findings and Interpretation

• The most common sexual and reproductive health needs for LBQ women in Uganda include treatments of: urinary tract infections/sexually transmitted infections, cervical cancer, and HIV/AIDs, as well as access to: safe abortion care, and fibroid screening
• The number of LBQ women who undertake cervical cancer screenings is higher than average because they are encouraged by services organized by LBQ organizations.
• A significant number of LBQ women are seeking HIV/AIDs related information, and undergoing self-testing, indicating that LBQ women do engage in HIV/AIDs risk activities, but are overlooked.
• More LGBTQ people need shelter than before, often because LGBTQ people were rejected by their landlords and family, who were bigoted.

This report analyzes the impact of Uganda's Anti-Homosexuality Law (2023) on Lesbian, Bisexual, and Queer (LBQ) women's access to Sexual Reproductive Health and Rights (SRHR) services. It explores the law's effects, documents experiences, and identifies strategies to increase access. Qualitative methods include virtual discussions and interviews.