Eric Goosby: No Hold on PEPFAR Funds for Uganda

Stigma is anathema to effective public-health work, but that's never stopped homophobic crusaders from mucking up the fight against HIV/AIDS before. Now, just as the South African government is finally changing its tune on the matter, Uganda is emerging as the world's new problem country. The recipient of $287 million in PEPFAR funds last year, Uganda is also the site of a vicious campaign against homosexuality, which took a turn for the worse last month when the "Anti-Homosexuality Bill" was introduced to Parliament. The bill threatens harsher punishments for actual or even perceived homosexual activity, which is already illegal under Ugandan law; convicted offenders could face the death penalty. "Promoting homosexuality" would also be illegal, as would a failure to report any of the above to police within 24 hours.

Even by regional standards, such penalties would be exceptionally harsh, especially since they would effectively criminalize the work of HIV/AIDS prevention efforts under the "promotion of homosexuality clause." The thinking behind them is just as disturbing, since this latest round of antigay fervor was kicked off at a conference held by by American missionary groups that went to proselytize about the twin evils of Nazism and homosexual behavior in Kampala earlier this year. Just to hammer home how far-out that is, this means the Ugandan government got its advice from the author of a book called The Pink Swastika: Homosexuality in the Nazi Party, which claims the Nazi movement was "entirely controlled by militaristic male homosexuals throughout its short history." The result has been a vigilante campaign against the country's LGBT community, whereby gay detainees are tortured and tabloids publish the names, places of employment, addresses, and physical descriptions of gay-rights advocates under headlines that scream "TOP HOMOS IN UGANDA NAMED." It would seem the stuff of Orwellian parody, but it's real.

As the witchhunt in Kampala has heated up, so too have calls for U.S. policymakers to take a stand. In an article for the Los Angeles Times, TNR editor James Kirchick called for PEPFAR to withhold its funding for HIV/AIDS programming in Uganda unless its legislators abandon the legislation, which has been tabled for now. But in an interview with NEWSWEEK this week, PEPFAR chief Eric Goosby said he didn't have a dog in that fight:

I'm very concerned about any decision that any country—including our ownwould make to target a group that's in the population, and that's always been in the population, by excluding them from a service or passes legislation that criminalizes their behavior. Every time you do that, you push the behavior underground. It never works. Rather than minimizing the spread of the virus, it actually amplifies it.

The U.S. policy is trying to work with governments to say exactly that. I think I would do more harm than good by connecting our resources to respond to the epidemic to making them dependent on a behavior that they're not willing to engage in on their own. My role is to be supportive and helpful to the patients who need these services. It is not to tell a country how to put forward their legislation. But I will engage them in conversation around my concern and knowledge of what this is going to do to that population, and our ability to stop the movement of the virus into the general population.

So, for all those who hoped that PEPFAR funding might be used as a hammer to pressure the Ugandan powers-that-be to abandon their crusade: no dice. The Obama era is the dialogue era; don't pick fights, but persuade through elegant theses. That said, since the moral argument clearly hasn't convinced the Ugandan authorities of the errors of their ways, one can only hope that Goosby's public-health argument will.