Threats, accusations and assault: the dangers of running an LGBTQ+ health clinic in Uganda | Global development

ecommuting to work one morning last summer, Brian Aliganyira was forced to veer off the road and into a ditch by motorcyclists flanking his car on either side. He was left bruised and still suffers from shoulder pain.

He later received a text message saying he had been targeted for his work running a health clinic for the LGBTQ+ community in Kampala. Uganda. The statement said the attackers wanted to “protect the children”.

“The narrative has been created in Uganda that once you operate as an organization [like ours]or an activist, you’re recruiting children into homosexuality,” says Aliganiira.

Ark Wellness Hub, founded by Aliganyira, 36, in 2019, operates in an increasingly hostile environment. Ugandan law, passed last year and only partially amended after a court challenge imposes sentences of up to life in prison for consensual same-sex relationships. “Aggravated homosexuality” is punishable by death, and “promoting homosexuality” can lead to 20 years in prison.

Aliganyira is factual as it lays out the problems the law has caused healthcare workers providing care to gay men. “If you’re supporting people and providing services and giving them lube, giving them condoms, giving them sexual health information that’s LGBT-friendly — that’s to be accused of promoting their sexuality.”

Ark Wellness Hub, a health clinic for LGBTQ+ people in Kampala. Several employees had to leave due to threats and pressure. Photo: Courtesy of Ark Wellness Hub

The clinic has had to remove health information leaflets aimed at the gay community and cannot provide the “complete health care” with open conversations that people need, he says.

Also, staff are wary of new patients, Aliganiira says. Propaganda circulating on social media accuses the clinic of human trafficking and ‘recruitment’ children in homosexuality.

Aliganiira says that “spies” come to the clinic trying to trick the staff into admitting that these false claims are true.

“[They ask] do you connect people to find a “sugar daddy” somewhere abroad? Do you want to take me abroad?” he says. “Sorry, but we only provide health services.”

The national NGO regulator visited the clinic last summer “and asked us so many questions about our legality to operate,” he says. “They asked questions about our registration, what our main purpose is … like trying to understand the loopholes in our legal existence.”

At the same time that the law limits the services the clinic can offer, the anti-LGBTQ+ environment exacerbates health problems, Aliganiira says. People have lost their jobs, been evicted or been unable to continue their education because their family has withdrawn funding because of the law, he explains. Some turn to transactional sex “to survive” or become dependent on potentially abusive partners.

A member of the LGBTQ+ community holds a poster at a clinic in Kampala. Misinformation spreads in the absence of public health information. Photo: Abubaker Lubowa/Reuters

This shifted the type of work Aliganyira and his colleagues do from medical care to social support aimed at creating “safety and security.”

Meanwhile, myths fill the vacuum left by the lack of clear public health information for the community.

A young man came to the clinic and asked PrEP, drugs taken regularly that can protect against HIV infection, Aliganiira says. The patient lived with and was dependent on a partner who had multiple other sexual partners.

He came to the clinic every month to get refills of the drug, but on the fourth visit he tested positive for HIV.

“He was silent for a few minutes. Then he said he never ingested that PrEP,” says Aliganiira.

While collecting the medicine, he was persuaded not to take it. “He says, ‘I came home and told my friend about it. And they told me it was a lie. They even showed me a video online that says these drugs are supposed to turn me from a man to a woman, that they are lying to us.

He describes other patients whose care has been compromised by an anti-LGBTQ+ environment. They include a couple with HIV living in a refugee camp who had to travel eight hours by bus to Kampala to get antiretroviral drugs (ARVs) that stop the replication of the virus in the body.

People listen to proceedings at the Kampala Constitutional Court on April 3, 2024, as the court upheld the country’s tough anti-LGBTQ law. Photo: Isaac Kasamani/EPA

A transgender woman was attacked and beaten late last year, he says, and taken to a hospital emergency room. When the staff treating them found out they were transgender, “they called the press instead of getting the person the care they needed.”

Just eight hours later, the patient, who by then was in a coma with a swollen brain, attracted the attention of a sympathetic doctor at the hospital, who called the clinic. “Our clinic also doesn’t have the capacity to handle such a case,” says Aliganiira, but they were able to coordinate treatment at a private facility.

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“It shows you how much homophobia displaces the value of someone else’s life,” he says.

Tthe clinic has a core staff of eight people. Last year, three left “because the environment was very disturbing for them,” Aliganeira says. “So many threats from outside. Also, some of their families were telling them to leave this kind of work because it was illegal. We have a very strong attachment to our families, traditions and religion. Three of our doctors left last year because of this pressure.”

Many patients assumed the clinic would not be able to continue.

“All the propaganda, all the debate has led to a reduction in clients accessing services. They were scared. They were afraid to come to the clinic. They were afraid to even be called out for things like tracking.

“Customers who were coming in and getting test kits wouldn’t take them. Customers who were living with HIV had problems returning and picking up [up] their ARVs.

Aliganria says people are now afraid to come to the clinic, and others believe it is closed. Photo: Anselm Ebulue/The Guardian

“It was really, really hard to communicate with customers.”

He says sometimes the clinic would approach customers who hadn’t taken a refill and hear, “Oh, you guys are still open, I thought you were closed.”

Asked how it feels to hear accusations that Arc is a trafficker or corrupter, Aliganiira is at a loss for words.

“It’s the worst form of,” he begins, pausing for a moment.

“I don’t know… there are some things you can’t even explain. Where even if he tries to explain, something cannot come out.

“Everybody knows that’s not what you do. But you can’t even explain it. Basically, it’s like you’re being judged in front of everyone for something you can’t even defend against.”

He describes a social media video with thousands of views that makes false accusations against the clinic, saying “we’re recruiting kids, we’re giving money to people to come out, we’re recruiting them to homosexuals, all these things,” he says. “And I watched this video with a lot of pain.”

Aliganyira says international support can offer the clinic some protection, adding: “We need more of it.”

He worries about the future and that the rates of HIV and other sexually transmitted infections will increase. Crackdowns on LGBTQ+ people are already causing mental health issues to rise, he says.

“I see a lot of trouble coming, and I see it right now.”

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