HIV/TB exposure risk in the event of same-sex criminalization Uganda

Thomas Muyunga, Ssemujju Nganda, Werikhe Jude, Grace Kabayaga, Nabaggala D.

Introduction: Criminalisation as a result of legislation and hate campaigns by religious and society towards same sex relations in Uganda can result in negative trends and a rise in HIV prevalence for marginalised communities. Legislation that criminalises same sex relations leads to incarceration and ill treatment. This exacerbates exposure to infections for same sex practicing persons. The Health of all people under incarceration or captivity is of concern to the captors much as it is for the captured or their own relatives and friends. This report shows the frequently demanded health needs by in-mates. This report is as a result of following up 7 incarceration/ rehabilitation centers in Uganda where same sex practices are occurring it was limited to HIV/AIDS issues among in-mates.

Methods: 120 (17-58 years) in-mates (MSM) in 7 in mate correction centers were followed for 3 months in 2010. In this period 3 ex-in mates who were also MSM were exposed to TB and were referred for treatment. Reviewing rehabilitation center records, anecdotal recollections from ex-in mates and desk review of literature by organisations working with in-mates show that there are unique needs faced by in-mates. The list shows: Lack of protection for all the time they had anal sex, Living with HIV-AIDS in a prison setting is a very crucial issue to deal with; TB care needs, children prisoners posed unique needs including parental love, skin diseases, and sexually transmitted diseases, food supplements for debilitated in-mates, wound dressing needs and psycho-social support.

Results: Clearly sexual reproductive Health issues among in-mates seem to be less stressed. This also means un-addressed issues of Sexually Transmitted Diseases/Infections. There is denial that in-mates do not have sexual-reproductive needs. This has led to a general neglect of these health needs. Where HIV is concerned, co-infections especially with TB is mis-diagnosed. If only SRH services were fully extended to rehabilitation services there would be earlier detection of highly infectious diseases.

Conclusion: Carrying out HIV specific messaging and testing for in-mates as a right enables earlier diagnosis and disclosure issues. This enables separated couples as a result of incarceration to know their status and plan accordingly. Discordance issues that may arise are dealt with in time. Other underlying HIV related infections are treated in time. An infection like TB is handled well and its spread reduced in rehabilitation settings and further into communities for ex-inmates. Morbidity of in-mates as a result of TB is reduced and exposure of TB to others in/outside prison settings is also controlled.