The scourge of LGBTQ criminalisation moving across African countries – and its impact on HIV

“The evidence is overwhelming: criminalisation does not prevent HIV – it fuels it,” Immaculate Owomugisha Bazare, Director of the Centre for Women Justice, Uganda, said in a plenary presentation at the 26th International AIDS Conference (AIDS 2026) held in Rio de Janeiro recently.

The conference had a prominent focus on how criminalisation – of identities, behaviours and HIV – impacts HIV outcomes. Research presented was mostly from sub-Saharan African countries, such as Uganda and Ghana, where criminalisation of LGBTQ people has been on the rise in recent years.

Grappling with multiple forms of criminalisation and funding cuts in Uganda

In 2023, Uganda passed the Anti-Homosexuality Act, a draconian bill aimed at criminalising LGBTQ people. This law was enacted in a context where sex work and drug use are already criminalised. “All these laws and policies continue to push people away from accessing services,” Bazare said.  

Criminalisation of LGBTQ identities, behaviours such as drug use and sex work, and sex while living with HIV are intricately intertwined: key populations such as gay, bisexual and other men who have sex with men (MSM) and transgender women are at a much higher risk of contracting HIV, as are injecting drug users and sex workers. In turn, these groups can be criminalised for both how they acquired HIV and allegations of exposing others to HIV.

Bazare stated that these laws have a devastating effect on health-seeking behaviour. For a member of a key population, if any aspect of their identity is criminalised, it leads to a fear of stigma, discrimination and arrest. This results in delayed or total avoidance of HIV testing, prevention and treatment seeking. For example, if a gay man contracts HIV, any sex that he has after that is doubly criminalised: because of his identity and because he has HIV. This may be considered an act of ‘aggravated homosexuality’ according to the Ugandan Act – if the person’s sexual partner “contracts a terminal illness as a result of the sexual act.” While HIV was removed from the final wording of the Act, this clause can be left open to interpretation and likely is aimed specifically at HIV – regardless of scientific advances such as U=U – and may result in a death penalty.

The 2025 US funding freeze – which abruptly halted HIV services for key populations globally – has only added to the terror created by criminalisation in Uganda. Ruth Kikonyogo, from Save the Youth Uganda, presented research at the conference on mental health among a sample of 111 gay, bisexual and other men who have sex with men. Survey data were collected at two timepoints: after the Act was passed and after the funding freeze.

The percentage of participants reporting symptoms that matched moderate-severe depression rose by 13 percentage points, as did those reporting experiences of stigma. Exposure to violence went up by 12 percentage points, while anxiety symptoms went up by 11 percentage points and suicidal ideation by 9 percentage points. There were declines in access to both HIV services (by 14 percentage points) and psychosocial services (by 12 percentage points). Approximately 6% of the sample had fled Uganda after the Act was passed: this was reflected in the final sample size, as 142 men had initially taken the survey.

“Community-based HIV and psychosocial services serve as a critical protective factor for MSM, and their disruption magnifies the harm caused by hostile legal environments,” Kikonyogo concluded.

Ghana’s new anti-gay law

Research from other African countries showed that these negative impacts on mental health were not limited to Uganda. As Bazare put it: “The fire moves from Uganda to other countries. We’ve seen Ghana, we’ve seen Senegal now where we have specific laws that criminalise people but also criminalise HIV.”

Dr Akua Gyamerah presented research with gay and bisexual men, transgender women and gender-diverse people from Ghana, looking at whether antiretroviral therapy (ART) adherence was impacted by social stressors, such as criminalisation, through pathways such as depression, alcoholism and suicidality.

The ironically named Human Sexual Rights and Family Values Bill is considered the most restrictive anti-LGBTQ bill on the continent and was passed by Ghana’s parliament in May 2026. If signed into law by the president, John Mahama, it would criminalise LGBTQ identities, advocacy, gender-affirming care, allyship and any specific programming directed towards LGBTQ groups. As with other similar laws, it also encourages citizens to spy on each other and report any suspected homosexual behaviour.

Researchers created a scale to measure the frequency of social stressors linked to the anti-LGBTQ legislation. This included questions related to violence, arrests, discrimination and economic insecurity, for example: “Due to the anti-homosexuality bill/law in Ghana, I have been blackmailed or robbed.” ART non-adherence was measured as missing four consecutive doses at least once during the prior three months.

Among 256 participants with an average age of 31, approximately 40% identified as cisgender men, another 40% as transgender women and the remainder as gender diverse. Most of the sample reported their sexualities as gay, bisexual or queer. Monthly median income was low, at $100 for the sample.

Social stressors related to gender and sexuality were high: 68% had been asked about their sexuality, 31% had been blackmailed or robbed, while 17% had been threatened with death. Over a quarter of the sample did not report crimes because of fear of arrest (28%) and had been threatened with being reported to the police (27%). Just under 10% had been arrested. Overall, 23% stopped going to group programmes, such as health discussions for LGBTQ people, and 5% stopped seeking HIV services.

On average, the sample had been on ART for five years. Over the three months prior to the survey, 31% reported ART non-adherence. Over a quarter of the sample were at a significant risk of suicide (28%) and met the criteria for an alcohol use disorder (26%). On average, the sample displayed significant depressive symptoms.

While a direct association between criminalisation-related stressors and ART adherence was not significant, Gyamerah and colleagues found that greater social stressors were linked to higher depressive symptoms, alcohol use disorder and suicide risk. In particular, depressive symptoms were highlighted as a pathway through which social stressors impacted ART adherence.

“Proposed punitive legislation – not just laws – can undermine HIV treatment by increasing risk of mental health through exposure to social stressors,” Gyamerah concluded. “Structural harm is an HIV treatment issue. Protecting ART adherence requires affirming mental healthcare and opposition to structural criminalisation.”

Bazare summarised it as: “Laws and policies are not simply legal issues, they are public health issues, they are human rights issues, and they are gender equality issues.”