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| Jim Kim on Ugandan Law targeting Homosexuality |

By Sandeep Kishore Moderator | 27 Feb, 2014

Dear all,

This may be at its surface orthogonal to the NCD sphere, but at its core is
a powerful example of a public health leader with a conscience stepping up
to lead.

Jim Kim, President of The World Bank, raises his voice and the temperature
on structural discrimination in Uganda targeting homosexuals through
opinion pieces in the Washington Post. Thanks to those for sharing offline.


"These recent anti-gay laws, and many others that have been on the books
for years, are acutely ironic. Just 15 years ago, a small band of gay men
and women -- largely in the United States but also in Europe and parts of
Africa -- fought with all their intellect, energy and creativity to expand
access to treatment for all people with HIV/AIDS. In 2000, just 50,000
people in the developing world received AIDS treatment. Today, largely
thanks to the work of these gay activists and others, more than 10 million
people are being treated with AIDS drugs -- most of them African.

At the World Bank Group, we will have a full internal discussion over the
coming months about discrimination more broadly and how it would affect our
projects and our gay and lesbian staff members. My view is that the fight
to eliminate all institutionalized discrimination is an urgent task.

After all, the bottom line is clear: Eliminating discrimination is not only
the right thing to do; it's also critical to ensure that we have sustained,
balanced and inclusive economic growth in all societies -- whether in
developed or developing nations, the North or the South, America or



Alcade RUDAKEMWA Replied at 1:44 AM, 28 Feb 2014

Dear all,
I do not think homosexual people are not discrimated at extend of not
getting care wheather HIV/AIDS or Non HIV/AIDS. The law is targetting
gay and lesbians. How people are massively killed in some areas of the
world and none raise voice but things to be solved by diplomacy the
world raises? What behind?

Mbiydzenyuy Ferdinant Sonyuy Replied at 1:51 AM, 28 Feb 2014

Were they the only category of activists? were they the only once affected or infected? The fact that they advocated is a better reason that explains their value to the human society. They are valuable and must be helped to deny their practices which are detrimental both to their health and the health of the society. Any one who promotes gay and lesbian laws needs help. I don't care is it is a president or a peasant.

Ben Seligman Replied at 2:37 AM, 28 Feb 2014

Jim Kim is on-target. Denial of human rights ultimately becomes a disaster
for health, something that has been observed with previous abortion
restrictions in the West, with mass incarceration in the United States, and
trafficking of women in too many countries to number. The same will apply
to men who have sex with men, by making it difficult (optimistically) for
them to seek appropriate advice on practices to mitigate their risk and the
risk of their partners. Evidence that this is already the case in a
Southern African context is available here:

With all due respect to my African colleagues (and apologies if I have
misinterpreted the two previous e-mails), the rights of gays and lesbians
are human rights, and denying them their rights will cause grave harm to
gay men and women and their societies at-large.

Gerald Bloomfield Replied at 2:55 AM, 28 Feb 2014

This is not a one-sided issue but an issue worthy of respectful debate and discussion from all interested sides. I would be interested to hear me about the rationale for the Ugandan legislation from someone, maybe a Ugandan, closer to the issue. As one of my older Kenyan colleagues said to me recently as we were discussing research ethics, "all of our decisions [in health] are social and cultural at the same time" and "the Western approach is only one good idea". Interested in the lead-up and Ugandan national perspective leading up to the legislation if anyone has any more information.

Gaddo Flego Replied at 3:32 AM, 28 Feb 2014

Dear all, as health professionals we all know that any kind of discrimination leads to worse health conditions of those selected groups, and that's why our professional attitude has always been, practically, against discrimination. Health professionals have often broken the law: they did it in California in order to provide health care to illegal immigrants, and they did the same in many other countries. In doing so we are protected by our deontological codes: that doesn't mean impunity (deontological codes are not laws), but that we are doing the right thing. Often health care regulations differ significantly from other laws: in Italy illegal immigration is forbidden and punished, but health care to illegal immigrants is mandatory (obviously, that didn't happen by chance, but through the recognition of the impossibility for an health professional to deny assistance or connect it with expulsion or imprisonment). For someone there might be no connection from a moral point of view between an illegal immigrat and an homosexual person, but then, what's the use of moral issues on sexual behaviour for an health professional who is supposed to give assistance and care and not being judgemental, and we also know that in some people's minds in some Countries illegal immigration is a social plague more than homosexuality. As for the World Bank, I would simply remind that some ideological, not evidence-based macro-economic policies (I'm thinking here at the European Union too) have led or are leading to health crisis related to higher unemployememt rates and lack of funding for health systems with bigger impact than discriminatory laws based on sexual behavours. But this is not a good reasons to ignore or dismiss their advice.

Catherine Kyobutungi Replied at 4:15 AM, 28 Feb 2014

Gerald, it's good that you appreciate the social-cultural role in some of
these decisions. Several factors have led to where we are. Speaking as a
Ugandan, this is my 50 cents' worth on how a configuration of different
factors has led to the radical decision taken by the Ugandan president.

1) The major driving force behind the legislation is the outrage and
desperation of many parents whose children are sexually molested in
single-sex boarding schools. Traditionally school heads have managed to
"prevent" heterosexual sex by separating girls from boys either by running
single sex schools (and putting high walls around the girls') or separating
the sleeping quarters for boys and girls in mixed-sex schools and ensuring
the two don't mix - with severe consequences if they are caught "mixing" at
the wrong time. In Uganda the majority of secondary school goers are in
boarding school - though the proportion of day-school goers is increasing.
The best schools happen to be boarding schools and so attending one is
unavoidable for millions of young Ugandans

2) In most boarding schools, there are traditions for "initiating"
newcomers - usually 12-14 year olds who join secondary school. Some of these
are some form of bullying and could range from handing over your pocket
money, to reciting phrases one may not understand, hazing etc..). A young
newcomer has no rights and is usually at the mercy of the older students.
Around the mid-90s these traditions started extending beyond initiation
rites and grabbing pocket money, to sexual molestation. It took a long time
for authorities in the education sector to catch up on this and by then,
there were cohorts of sexually abused young people. The psychologists among
us may better explain how the abused in such a context can turn abuser but
the reality is that as time went on there was a growing number of older
students ready to abuse newcomers. The traditional models of preventing sex
among boarding students were (and still are) completely useless now since
the protagonists sleep in the same rooms, use the same showers etc..

3) The education sectors has struggled for many years to deal with the
problem of this new form of bullying and when it became a well-known fact
that abuse was happening, most schools responded by expelling students that
were either caught or suspected to be engaged in the abuse. In many
instances, the abused were expelled with their abusers - who then joined
other schools and carried on. These expulsions were however mostly framed as
homosexual acts rather that sexual molestation and so the battle lines were
drawn from then on.

4) In a setting where counseling services are limited, most of the
abused either turned to drugs, dropped out of school or became abusers
themselves or became delinquent. For the few families (mostly well-to-do and
highly educated) that decided to seek professional help, the picture of
abuse only started emerging from the counselors. With some awareness, some
of the abused started fighting back, but encountered obstacles from school
heads in denial, or they were themselves punished for engaging in homosexual

5) Reading carefully through the text of the law, there are three main
issues: 1) Aggravated homosexual acts (with a minor, repeated, if HIV+) 2)
Recruitment (e.g. of young vulnerable boys and girls) and 3) Failure to
report (e.g. by head teachers to whom abused students have reported) . The
whole debate about nature vs. nurture is partly about whether only naturally
homosexual boys and girls are singled out for molestation and whether those
that turn into molesters themselves were those who would have been
homosexual if they had not been molested.

6) The LGBT community in Uganda and elsewhere got into the fray at some
point after realizing what was at stake if a sweeping law against
homosexuality was passed. As usually happens in this part of the world, the
underlying societal issues were swept under the carpet by vocal and
enthusiastic activists and it became about the rights of consenting adults
in love with each other and less about the young voiceless people whose
issues go beyond whether they are homosexual (by choice?) or not. Enter the
evangelicals, and the issue became one of morality. For the last five or so
years, it has been about who is more vocal of the two camps: Evangelicals
vs. the LGBT community. Given the reach of the former, the LGBT stood no
chance in this fight.

7) The current president, being the shrewd politician that he is was
trying to have it both ways - appease the evangelicals and a largely
conservative population, and the donor community by stalling and raising
questions. Things came to a head when the threats started coming - cutting
off aid and "reviewing relationships" - if he assented to the bill. The
international community drew a line in the sand and Museveni crossed it and
drew his own. Now the issue has become one of national sovereignty,
"African" culture and values, double standards, the poisoned chalice that is
international aid and even democracy!

One may ask: what is the likely impact of this law?

1) Hopefully (thanks to the publicity from the media from all over the
world), a child molested on his/her first day in secondary school will
report the molester to the head teacher knowing that something will happen
to the molester. The incentives (big stick hanging over their heads) for
taking action are very strong for head teachers. Some of the molesters will
think twice before abusing any more children. The biggest losers in all this
- the current cohort of child molesters who if they had been protected five
or ten years ago, wouldn't be what they are.

2) Sadly, some of the consenting adults in love with each other will
suffer - most probably at the hands of mobs - rather than law enforcement

3) Ten years from now (hopefully sooner), I believe Uganda will be
ready for a different narrative.

Gaddo Flego Replied at 6:03 AM, 28 Feb 2014

Thank you Catherine Kyobutungi for giving a whole picture.

Duncan Matheka Replied at 6:13 AM, 28 Feb 2014

Catherine, That is Wholesome and Great Contribution! We appreciate that
there are socio-cultural differences that are playing a big role in all
this, and thus why we ought to have the BIG PICTURE and employ
'Systems/Wholesome thinking'

Gerald Bloomfield Replied at 8:06 AM, 28 Feb 2014

Catherine, thank you for the thoughtful response. By the time these stories get to the international level, the nuance of the local situation and drivers are sometimes lost and I am thankful that you took the time to share your perspective as a Ugandan. By the time hot button issues like this are co-opted by various advocacy groups, the shades of gray are lost and they can inadvertently become black/white issues with the sides usually being defined by those external to the actual situation. As Sunny started by saying, although this topic is not necessarily NCD-related, I think this thread is a great example of social media actually being useful.

Joseph Lunyera Replied at 12:29 PM, 28 Feb 2014

Hi YPers,

Thanks Sunny for initiating this thread. I am a Ugandan physician currently attending graduate school at Duke University. I am currently undertaking a class on bioethics, and I can clearly see the significance of this debate to a global health practitioner, including those of us in the NCD section. Before giving my short discourse, let me say that I do agree with Catherine's background discussion on the build-up to this legislation. I actually attended a school that would be classified in the category that she mentioned, and I remember loosing a teacher in high school on similar grounds.

As a preamble to my discourse, I will share another experience that I had about 2 years ago while at the Makerere medical school in Kampala. I remember waking up one morning to chants of students in my hall of residence as if a thief had been caught (mobbish response to criminal, or perceived criminal, offenses is not uncommon in Uganda), but, to my surprise, the students had ganged-up against suspected homosexual students. Having lived in the US for about 6 months now, I certainly know that no sober US citizen would even conceive of such acts. This is an extreme example of the socio-cultural differences that exist between different cultures, communities and countries; but such differences must be embraced, and sound bioethical principles should guide us as we navigate our way through them. This is something that researchers and practitioners in global health must own, for it cannot be left to politicians, who, as Jerry noted, often lose the perspectives to the problem that are relevant to these communities. Some of the relevant bioethical concepts that are vital tools in these discussions include social responsibility, solidarity, and egalitarianism, and how these constructs relate to decision-making in each of these communities. I guess this is another reminder that we should not just be satisfied with having a section on "ethical consideration" in our research proposals, but rather to seek to engage in meaning discussions with our peers, and with the goal of carving out respectful, and culturally-sensitive approaches to global health practice.


Pierre Bush, PhD Replied at 1:11 PM, 28 Feb 2014

You have made good points. Healthcare professionals cannot descriminate when providing care.
The Ugandan Law is out of touch with what is going on in today's society in general. The world is now like a unique country. Ugandans are not going to be the only ones living in Uganda. There many visitors to Uganda. Ugandans are blind to what happened to them in the past, when they were under Iddi Amin. They want to isolate again that beatifull country. The law will probably be repealed by Museveni's Successor.

Modi Mwatsama Replied at 1:43 PM, 28 Feb 2014

Hi Catherine

Thanks for this really insightful and nuanced background to this sorry tale.

Ben Seligman Replied at 4:06 PM, 1 Mar 2014

The cultural context is interesting, and thank you Catherine for trying to
give an explanation. Is molestation in boarding school really the impetus
for this, though? That seems like an institution quite removed from the
lives of the many Ugandans who oppose the rights of the LGBT community.
Can I get some clarification as to why it would be so important?

Further, if child abuse is the issue, why not go after child abusers?
Molestation happens to girls, too, and a law against homosexuality isn't
going to protect girls from male teachers. How did that get lost in a
discussion on child abuse?

There is also a relevant point to made from Western experience: a great
deal of homophobia here was justified as protecting against child abuse.
Of course, this did little to stop child abuse, in no small part because
child abusers identify as heterosexual, because of the power differentials
between abused child and abuser, and because such laws can be used to scare
the kids from reporting anything to the authorities.

Jonathan Liberman Replied at 1:12 AM, 2 Mar 2014

Thanks for posting this piece, Sunny.

Eloquently underlines that discrimination against LGBT people (and others) is an issue of development, as well as of health and human rights.

Good to see the World Bank addressing it in this way.

Best, Jonathan

Sandeep Kishore Moderator Replied at 9:53 AM, 2 Mar 2014

Dear YP,

I began this conversation in YP proposing it as orthogonal to the NCD
space, but I now firmly believe this issue of non-discrimination,
preservation of fundamental, universal human rights, including the right to
health of all, anywhere in the world, are important values that YPers
affirm as a matter of social justice and human dignity.

This is crucially important for the basic human and health rights of all

In that context, would kindly also ask members to continue to be
respectful, preserve the safe space we have sculpted on this network to
ensure non-discrimination of any member or group in the first instance.



Ariella Rojhani Replied at 12:04 PM, 2 Mar 2014

Thanks, Sunny.

I think this thread is the perfect opportunity to reaffirm that we as YP stand for not only the right to health for all, but for the protection of ALL human rights and zero discrimination.

We talk a lot about true progress as only possible if rooted in systemic change. For the World Bank to take a stand against institutionalized discrimination is important and commendable, particularly as an entity tasked with shaping the wellbeing of some of the most vulnerable populations in the world.

I would be remiss not to mention that the discussion in this thread is valuable in its own right, and a strong reminder of my gratitude to be a part of this community.

Modi Mwatsama Replied at 3:44 PM, 2 Mar 2014


I spent a year in a Kenyan boarding school (the norm for state secondary schools in east Africa) and can relate to what Catherine said. Education is something most Africans value and like health it's a popular political issue.

In answer to your questions:

1. Is molestation in boarding school really the impetus for this, though? Your "relevant point to be made from the Western experience" could also apply in the non-Western world. It could be dog whistle politics or it could be molestation.

2. Can I get some clarification as to why it would be so important? Most people, rich and poor alike, are opposed to child molestation & bullying

3. Further, if child abuse is the issue, why not go after child abusers? Good question. Catherine has explained how the law, flawed as it is, is trying to do this.

The discrimination against homosexuals in this law is wrong. The law's discrimination against women is equally wrong, though interestingly this (and its consequences) has had comparatively less media coverage. Jim Kim's piece provides a useful overview of the extent of discriminatory laws globally (homosexuals, women, children, minorities). Sadly, hardly any of us live in countries where there is zero discrimination. In the UK today it's the poor and immigrant groups whose rights are being eroded, with adverse impacts on health. Those of us interested in human rights have many battles to fight - I think we should fight them all together rather than separately.

The Uganda experience is a useful reminder that the policy making process in this complex world is neither simple nor straightforward. We should watch and learn from it.

Mbiydzenyuy Ferdinant Sonyuy Replied at 2:52 AM, 3 Mar 2014

Though Uganda is on the right track in outlawing homosexuality, there is no law against health care to such persons. The law is against their personal dead practices. There are indeed vast differences between the cultures. That explains why we should all be flexible in accepting the virtues in a particular cultural setting. Health care is same to all.

Mbiydzenyuy Ferdinant Sonyuy

Cameroon Baptist Convention Health Service,
PO box 1, Nkwen, Bamenda,

Tel: (237) 74733730/ (237) 93936065
 "In the CBCHS for the CBCHS with the CBCHS"

Ben Seligman Replied at 3:02 AM, 3 Mar 2014

Mbiydzenyuy, why is it exactly that you support this law? I'd like to hear
your reasons.

Our point is that these laws *de facto* harm the health of the LGBT
community. It seems as though, under this law, telling your physician that
you have sex with men could obligate the physician to report you to the
police. This certainly makes seeking care difficult, maybe impossible,
even if the clinic would not turn you away at the door.

Benn McGrady Replied at 4:44 PM, 3 Mar 2014

Thanks to Catherine and others for providing the cultural context in which the laws in question were passed. It is probably worth adding that it is one thing to describe that cultural context in order to better understand how the law came about (as Catherine and others do) and another thing entirely to seek to justify the law on the basis of that cultural context.

Relating this back to Jim Kim's speech, the big issue that Catherine's description of events raises is what role the state and church should have in the provision of medical care. More particularly, how should the World Bank and others approach funding organizations that provide a significant amount of care in low resource settings, but also provide political support for discriminatory policies that violate fundamental rights?


Rajesh Vedanthan Moderator Replied at 5:08 PM, 3 Mar 2014

There are many young girls and women who are also the victim of childhood sexual abuse, in Uganda and elsewhere. Many of the perpetrators/abusers are men.

Why hasn't heterosexual sex therefore also been deemed illegal?

This would be as (il)logical as the current law that has passed in Uganda.

Phillip Baker Moderator Replied at 6:09 PM, 3 Mar 2014

Thanks for some great perspectives and Catherine for your very insightful
description. Im erring caution against moral relativism in this case and
would like to state simply that persecution against LGBT people is wrong
whichever way you look at it and in whatever socio-cultural context that
persecution occurs. A human rights framework is I think the starting point
for interpreting the Ugandan situation. A really important question here
that some have raised is whether or not rich countries should cut bilateral
aid to Uganda? Many have or are considering it. With potentially tragic
outcomes for health. How do we weigh this up ethically?

Nkunzi Herve GASHABUKA Replied at 4:17 AM, 4 Mar 2014

Its with great interest i have been following the discussion about this new
Ugandan law targeting homosexuality. From any aspect we may take a look at
this, either socio-cultural, religious or political...etc here again I
would say that Western-developed countries have always been a good or in
some cases bad examples to the underworld...but here again is a president
facing his own nation in the centre of Africa...about a crucial decision
making. Yes discrimination is wrong and against human rights, but trust me
if you are a born african and raised in Africa; there are things you dont
say, dont do, dont accept, dont beleive...just to make peace with your
family and me you dont want to behave as a travesti in
the middle of kampala on day time !!! My point is that H.E. Pr. Museveni
cant change the culuture, which is unfortunate but true; is it right
putting a law against that? No it is not !!! But he must or the population
will behave in such a cruel and evil way that even the international
community wont be able to stop that; being a leader isnt easy and sometimes
you are forced by your own people to make the choice they want you to do.
Remember the prohibition area in the U.S. ?? The dry movement gained slow
by slow the whole country and of course it was used by politics to gain
voices, it event went far by being included in the constitution as the
XVIII amendment in 1919 till 1933 after being repealed by the XXI
amendment... If a referendum was needed it will be more clear about
public's opinion in Uganda and maybe wont be called Discrimination !!!!

This Community is Archived.

This community is no longer active as of December 2018. Thanks to those who posted here and made this information available to others visiting the site.