For many years, Uganda’s marketing campaign in opposition to H.I.V. was exemplary, slashing the nation’s loss of life price by practically 90 p.c from 1990 to 2019. Now a sweeping regulation enacted final yr, the Anti-Homosexuality Act, threatens to resume the epidemic as L.G.B.T.Q. residents are denied, or are too afraid to hunt out, essential medical care.

The regulation criminalizes consensual intercourse between same-sex adults. It additionally requires all residents to report anybody suspected of such exercise, a mandate that makes no exceptions for well being care suppliers tending to sufferers.

Beneath the regulation, merely having same-sex relationships whereas residing with H.I.V. can incur a cost of “aggravated homosexuality,” which is punishable by loss of life.

Anybody who “knowingly promotes homosexuality” — by hiring or housing an L.G.B.T.Q. individual, or by not reporting one to the police — faces as much as 20 years in jail. Scores of Ugandans have been evicted from houses and fired from jobs, based on interviews with legal professionals and activists.

Entrapment and blackmail — generally by the police — are rampant in individual, on social media and on relationship apps, based on interviews with dozens of individuals.

L.G.B.T.Q. individuals, and the advocates and well being care employees serving to them, have been topic to threats and violence.

The regulation has introduced international condemnation and has dealt a major blow to Uganda’s economic system. However it’s broadly standard amongst its residents. Many Ugandans see homosexuality as a Western affect and the regulation as a corrective. The nation’s Constitutional Courtroom is about to rule on the act’s legality as early as subsequent week.

In response to stress from international well being organizations, the Ugandan well being ministry in June assured well being care to anybody no matter orientation or id. It didn’t promise that sufferers can be secure from prosecution.

The nation’s well being ministry didn’t reply to a number of requests for touch upon the act’s impression on public well being.

However Dr. Jane Aceng, the well being minister, has stated on the social media website X that the federal government will guarantee entry to H.I.V. prevention packages and “stays dedicated to ending AIDS as a public well being problem.”

Others see a catastrophe within the making. Though the regulation targets L.G.B.T.Q. individuals, the ensuing stigma and discrimination could deter all Ugandans from searching for well being care, stated William W. Popp, the US ambassador to Uganda.

“Our place from the US authorities is, the entire regulation ought to be repealed,” he stated in an interview. “It’s a violation of fundamental human rights and places all Ugandans in danger.”

In interviews, dozens of L.G.B.T.Q. individuals, advocates and well being care suppliers in Uganda say they feared that the laws has had a devastating impact on public well being. Though agency information are onerous to seek out, clinics and hospitals estimated that the variety of individuals coming in for H.I.V. testing, prevention or therapy has dropped by a minimum of half.

Some shelters for individuals residing with H.I.V. have closed, and a few facilities that when disbursed H.I.V. providers on a walk-in foundation now see shoppers for restricted hours, typically solely by appointment, to reduce the prospect of raids.

Dozens of well being care suppliers and sufferers have been arrested.

“The federal government has tried very onerous to create the impression that the Anti-Homosexuality Act is just not actually being enforced, that it isn’t an precise menace to L.G.B.T. individuals, however that’s not true,” stated Justine Balya, a director on the Human Rights Consciousness and Promotion Discussion board, which represents lots of these arrested.

Uganda had been on the forefront of H.I.V. analysis and public well being coverage. The brand new regulation requires scientists to disclose the identities of research contributors.

“It’s troubling from a analysis and tutorial perspective, and troubling from a scientific perspective to really develop the medicines and instruments we have to confront illness epidemics sooner or later,” Ambassador Popp stated.

Worldwide, safety of homosexual rights is intricately linked to manage of H.I.V.

Homosexual and bisexual males residing in nations that implement legal guidelines criminalizing homosexuality are 12 instances as prone to be residing with H.I.V. as these in the remainder of the world, based on a current U.N. report.

“We’re struggling a lot, and our life is in peril,” stated Nathanian Issa Rwaguma, 34, a homosexual man and an activist.

Western supporters have supplied few sources wanted to guard L.G.B.T.Q. individuals, significantly those that have been outspoken, a number of stated. “Do you anticipate a lifeless human-rights defender, or an alive one?” requested Hajjati Abdul Jamal, a 29-year-old transgender lady, referring to assist organizations.

Many Ugandans who’ve been arrested weren’t charged below the act, however as a substitute with being a “widespread nuisance,” having “carnal information in opposition to the order of nature” or intercourse trafficking, even when the so-called trafficking means transferring from the lounge to the bed room of the identical home, Ms. Balya stated.

Practically all of these arrested are launched after a couple of week, however just a few may stay imprisoned for years awaiting trial, she added.

In March, three homosexual males and three transgender ladies who labored as H.I.V. educators have been arrested in Jinja, a metropolis in jap Uganda.

They spent 4 months in jail enduring sexual harassment, beatings and two rounds of pressured anal examinations, based on the physician who runs the clinic the place they labored and their legal professionals. One educator was so severely lashed with a cane that she couldn’t sit or lie down for 2 weeks.

In November, Mulindwa Benda, 24, a transgender man and educator, was in Busia, on the Uganda-Kenya border, to steer a workshop on sexual and reproductive well being. He was charged with selling homosexuality.

The police ridiculed him for “dressing like a person,” and held him for 72 hours in a tiny jail cell with eight ladies and a rest room that didn’t flush, Mr. Benda stated in an interview.

Outreach employees in Lugazi, Mbarara and several other different cities have been arrested for distributing lubricants and condoms. Cops typically affiliate the merchandise with same-sex intimacy.

“It’s a part of the general local weather of persecution and violence that strikes worry into well being employees, in addition to homosexual and bisexual males and trans ladies who want supportive, stigma-free H.I.V. providers,” stated Asia Russell, government director of the advocacy group Well being Hole.

About 13 p.c of Ugandan males who’ve intercourse with males are residing with H.I.V. Many are actually lower off from care.

Mulago Hospital’s clinic for sexually transmitted ailments, among the many largest in Kampala, used to deal with greater than 100 L.G.B.T.Q. sufferers a day. Now, fewer than half come into the clinic, stated Dr. Afunye Anthony Arthur.

“The others cover out, so you need to search for them,” he stated.

Dr. Afunye stated he had been accosted by offended individuals at a restaurant and his dwelling, the place he lives together with his spouse and three younger youngsters.

To make visits safer for shoppers, Ark Wellness Hub, a clinic in Kampala, now stays open late into the night and presents personal appointments.

Though three of the clinic’s seven employees members have been evicted from their houses, “you need to discover a manner of going forward along with your work,” stated Brian Aliganyira, its government director.

Some clinics have resorted to stashing lubricants out of sight or utilizing euphemisms to seek advice from them. At many clinics, employees and volunteers proceed to offer care, spending their very own cash to ship medicines.

Nonetheless, lots of of sufferers have dropped out of contact with Mulago and Ark Wellness. Some are intercourse employees who would possibly go the H.I.V. to others as their virus ranges rise with out therapy, Dr. Afunye stated.

In an interview, a 32-year-old homosexual man stated he had taught shoemaking however was pressured to depart his job in July after he was accused of selling homosexuality on the college. He was identified with H.I.V. in 2021 and took his final anti-viral capsule on Dec. 6.

Two of his associates died in August of H.I.V.-related problems after discontinuing therapy. However he was nonetheless too afraid to go to a clinic: One other pal was stoned to loss of life in his village in Masaka district, he stated, after an acquaintance acknowledged him on public transportation.

Ivan Melisa Kakuru, 26, a transgender lady, nonetheless picks up her H.I.V. medicines on the Mulago clinic. However she typically doesn’t manage to pay for to eat, she stated. Ms. Kakuru stated she fled her hometown when her father tried to kill her and doesn’t have a spot to stay.

Her pal Carlos Bahuriire, 36, a transgender man, stated he was evicted by his landlord and had been staying with a sympathetic pal.

President Yoweri Museveni has known as L.G.B.T.Q. residents “disgusting” and “irregular,” and has stated that they’ve “a sort of illness.” He has additionally blamed the West for bringing homosexuality into the nation.

Ugandan police have falsely accused activists or educators — like these arrested in Jinja — of recruiting youngsters into homosexuality and making pornographic movies. Some authorities officers even have conflated homosexuality with pedophilia.

“If you happen to begin raping youngsters and so forth, we kill you,” Mr. Museveni stated final yr of the regulation.

Dr. Aceng, the well being minister, celebrated the passing of the regulation. “Our tradition and dignity is upheld and the Ugandan Youngsters Protected,” she wrote on X.

The criminalization of homosexuality really is a leftover of colonialism and takes Uganda out of step with the remainder of the world, stated Matthew Kavanagh, director of the International Well being Coverage and Politics Initiative at Georgetown College.

The President’s Emergency Plan for AIDS Aid gives greater than $400 million in H.I.V. funding to Uganda every year. Greater than 96 p.c of that’s applied by organizations outdoors the Ugandan authorities.

Now the Biden administration has redirected $5 million of the remainder away from the federal government, Ambassador Popp stated.

As of Jan. 1, the US has eliminated Uganda’s entry to the African Progress and Alternative Act, which gives duty-free entry to the U.S. market. Washington has additionally sanctioned Johnson Byabashaija, commissioner common of the Uganda Prisons Service, for torture and human rights abuses.

However Dr. Kavanagh and different specialists stated the Biden administration may do extra to impose monetary sanctions or stress the Ugandan authorities to repeal the regulation.

Mr. Byabashaija’s sanction was primarily based partially on proof from the March 2020 arrest of Henry Mukiibi, who leads an H.I.V. clinic and shelter, together with 19 others.

The group was held for 52 days, throughout which they have been tortured and overwhelmed; some had their genitals burned with a chunk of firewood, Mr. Mukiibi stated in an interview.

“Every time I speak about this occasion, I get nightmares,” he stated. “It traumatized me.”

Final July, the group was once more raided and the clinic was shut down. Undeterred, Mr. Mukiibi has moved to a brand new safe location.

Mr. Mukiibi stated he felt it was vital to talk up. “Typically after we cover issues, or when the one that’s talking turns into nameless, individuals don’t perceive the precise state of affairs you’re passing via,” he stated.