East African countries are in a dilemma over how to implement the latest World Health Organisation recommendation calling for the decriminalisation of drug use and homosexuality, as a way of checking the spread of HIV.

The global health body has issued a new set of guidelines for HIV prevention, urging UN member states to put in place policies and laws that decriminalise the use of hard drugs like heroin and cocain, and ensure homosexuals are not discriminated against.

WHO’s new guidelines focus on five key groups: Men who have sex with men, people in prisons and other closed settings, sex workers, transgender people, and people who inject drugs.

These key populations are the most-at-risk of HIV, yet the least likely to access services — a fact that “threatens global progress on the HIV response,” WHO says.

However, it is the guidelines on homosexuality and people who inject drugs that captured the attention of many East Africans. The two practices are illegal in East Africa and those found breaking the law can be charged in court, and if found guilty, sentenced to prison.

Hard drugs aside, even consumption of substances considered “soft,” like marijuana, is illegal in all the EAC countries.

All the five countries are members of the WHO, meaning that they have mandated the umbrella body to provide guidance on matters of health.

In Kenya, for example, the Constitution only recognises a marriage between a man and woman and not any other. Neighbouring Uganda, on its part, has passed a law imposing harsh penalties for homosexuality, defying warnings and criticism from rights groups and Western countries.

The law strengthened existing punishments for anyone caught having gay sex, imposing jail terms of up to life for “aggravated homosexuality” — including sex with a minor or while HIV-positive.

On users of illegal drugs, the WHO guidelines, recommend for the first time that such individuals should have access to naloxone — a medicine designed to reverse opioid overdoses.

WHO maintains that hundreds of thousands of lives will be saved if governments follow the above recommendation.

Caution needed

The former director of Kenya’s National Aids Control Council (NACC), Alloys Orago, said East Africans should be cautious in implementing the guidelines.

“We should be cautious in implementing the guidelines the way they are expressed given our cultural background. Nonetheless, we can still achieve our objectives without radically changing our laws,” said Prof Orago.

The former NACC official added that East African countries should accept that homosexuals, drug users and commercial sex workers do exist and should have access to medical services just like other groups of people.

Health Cabinet Secretary James Macharia said that, despite the activities being illegal, it is important that governments provide health services to the group referred to as the Most at Risk Population Suffering from HIV infections (MARPS HIV).

“The fact is that homosexuals and drug users are among us and we cannot ignore them. We have to protect them,” said Mr Macharia.

He said Kenya is already providing anti-HIV/Aids services to MARPS HIV and would continue ensuring that they access the services.

“As long as Aids exists, we cannot ignore such individuals, since they also contribute to new infections,” said Mr Macharia.

At a workshop held in Mombasa last year, public health officials revealed that homosexuals, drug users and female sex workers contribute up to 166,000 new infections in Kenya annually.

According to NACC data, 44 per cent of new infections in Kenya occur in heterosexual couples while 33 per cent occur among MARPS. Other causes like mother-to-child transmission and transfer of infected blood take up the remaining percentage.

The Kenya Red Cross Society, which was appointed the principal recipient for the Round 10 Global Fund HIV grant for non-state actors by the Kenya Country Co-ordinating Mechanism, has been working with the MARPS HIV.

The Red Cross has been providing HIV prevention services to 6,289 sex workers and 1,573 men who have sex with men.

Apart from providing 529 hard drug users with HIV prevention services, the organisation has also been distributing sterile needle and syringe to the target group.

Jackson Murigi, a human rights activist, urged other East African countries to do the same, saying the MARPS HIV group cannot be ignored, if the prevalence rate of the disease is to be kept down.

Data from UNAids shows that as at 2012, the Aids prevalence rate in Kenya was 6.1 per cent, Uganda was 7.2 per cent, Rwanda 2.9 per cent, Tanzania 5.1 per cent and Burundi 1.3 per cent.

Last year, UNAids expressed concern that Uganda was the only country in East and Southern Africa with rising HIV/Aids infection rates.

The 2011 Uganda National HIV Indicator Survey showed that prevalence rates among Ugandans between the ages of 15 and 19 were increasing.
The prevalence currently stands at 7.3 per cent, up from 6.4 per cent in the 2004-2005 survey.

Apart from decriminalisation, the UN body also wants countries to provide prevention and management of co-infections services, HIV treatment and care, comprehensive condom programmes and strengthening HIV testing and counselling.