BACKGROUND: On 21 March 2023, the Parliament of Uganda passed the Anti-Homosexuality Act (AHA) with overwhelming majority and re-approved a revised version on 2 May 2023. The AHA criminalizes homosexual behavior with sentences ranging from 10 years to the death penalty. The hostile environment created with passing of AHA and the fear of law enforcement has led to reduced access to Key Population (KP)-friendly services.
DESCRIPTION: The President’s Emergency Plan for AIDS Relief (PEPFAR) supports over 1.4 million Ugandans on HIV treatment. PEPFAR supports over 50 drop-in-centers (DIC) that provide HIV prevention and treatment services focusing on KP clients. Service delivery data from DICs is reported weekly and disaggregated by type of KP and services. To protect client safety and confidentiality at the DICs, we de-identified the three DICs used in this analysis.
LESSONS LEARNED: The AHA discourse increased in the Ugandan media starting in January 2023. Weekly data show a steady decrease in KP client visits to the 3 DICs, with the lowest being when the first version of AHA was debated and approved in the Parliament. PEPFAR instituted measures in early March, some of which are below:

• home delivery of anti-retroviral therapy (ART), and prevention products like condoms and Pre-Exposure Prophylaxis (PrEP)
• reinforcing safety measures at DICs
• scaling up multi-month dispensing (MMD) for eligible clients
• employing paralegal peers to offer legal support for KP clients

These supportive measures led to a resumption of KP clients accessing HIV services at these 3 DICS by April (Chart 1).


CONCLUSIONS: The AHA is not a law yet but shows significant negative consequences on access to HIV services. While these 3 DICs show that PEPFAR programs can rapidly implement supportive measures, over 20 DICs have not seen a resurgence of KP clients despite interventions. Punitive laws against KP have the potential to derail HIV epidemic control.