Enforcing Uganda’s Anti-Homosexuality Act

Kim Yi Dionne and I wrote a piece for the Washington Post’s Monkey Cage blog analyzing US-Uganda relations in the wake of Uganda’s newly passed Anti-Homosexuality Act, and in particular, following the raid of the Makerere University Walter Reed Project. The post is copied below.

Kim is Five College Assistant Professor of Government at Smith College. She tweets at @dadakim.

U.S. foreign policy and Ugandan domestic politics collide

By Melina Platas Izama and Kim Yi Dionne

Just weeks after the United States announced additional American troops and aircraft would be deployed to Uganda to hunt rebel leader Joseph Kony, Ugandan officialsstormed a U.S. military-affiliated research institution, the Makerere University Walter Reed Project, in the country’s capital, Kampala. The Walter Reed Project raid highlights challenges to U.S.-Uganda relations, strained both by the fractured nature of U.S. foreign policy toward security allies like Uganda and the lack of coordination across Uganda’s numerous security agencies.

Why was the Walter Reed Project raided? And by whom?
The Walter Reed Project was raided on Thursday, April 3, by plainclothes state agents without a search warrant, reportedly on account of the Walter Reed Project’s work with the LGBTI community. Uganda’s recently enacted Anti-Homosexuality Actprohibits both the practice of homosexuality as well as “aiding and abetting” and “promoting” homosexuality. The law is vague on what constitutes the promotion of homosexuality, leaving interpretation to Ugandan law enforcement. Walter Reed Project staff members were whisked away in an unmarked car and interrogated at a police station. American embassy officials subsequently contacted the Inspector General of Police, Kale Kayihura, who was unaware of the incident. Kayihura then instructed the police station to release on bail the Walter Reed Project staffer who had been placed under arrest.

Screenshot of New Vision article taken from <a href="http://webcache.googleusercontent.com/search?q=cache:http://www.newvision.co.ug/news/654211-panic-at-makerere-as-quack-cop-arrests-staff.html">Google Cache</a> on April 7, 2014 (Melina Platas Izama and Kim Yi Dionne/The Monkey Cage)

The next day, the government-owned daily newspaper New Vision reported that the raid was conducted by a “quack cop,” with one police spokesperson, Patrick Onyango, denying responsibility. The same day, government spokesman Ofwono Opondo said in a tweet that the Walter Reed Project was raided for “training youths in homosexuality.” He also accused a top diplomat of being involved. Another police spokesperson confirmed the arrest in a segment by Ugandan media house NTV.

tweet1

tweet2
By Monday, April 7, the New Vision story had been pulled from the newspaper’s Web site and both of the tweets above (screenshots) were taken down.

Public opinion toward same-sex practicing people is generally negative, with 97% of Ugandan respondents in the 2007 Pew Global Attitudes Project agreeing with the statement, “Homosexuality is a way of life that should not be accepted by society.” In the days before the raid, Ugandan President Yoweri Museveni was the chief guest of a “Thanksgiving service” to celebrate the passing of the Anti-Homosexuality Act. Hundreds of people swarmed Kololo airstrip in the center of the capital, many bearing signs with direct messages to President Obama. All heads of religious institutions, including the Catholic and Anglican churches, and the head mufti of the Muslim community, not to mention the evangelical bodies who played a key role in the bill’s success, were in attendance.

(Data: Pew Global Attitudes Project 2007; Figure: Kim Yi Dionne/The Monkey Cage)

U.S. response to anti-gay legislation
Obama released a statement condemning Uganda’s Anti-Homosexuality Bill before it was signed into law, and initiated a review of American aid to Uganda immediately following the bill’s passage. At the same time the aid review was taking place, however, the United States announced a significant increase in military aid to Uganda. As activists and observers have noted, the announcement was poorly timed if Washington wanted to send a clear message to the Ugandan government. Instead, the State Department’s actions look like a slap on the wrist quickly followed by the extension of an olive branch by the U.S. military establishment.

If mixed messages are an ineffective means of impacting policy, however, so too may be the economic sanctions and bullish diplomacy the State Department has attempted to employ thus far. American foreign policy must consider the constraints faced by those who publicly and privately oppose the anti-homosexuality law, including politicians. American policy must find ways to assist those who support rights for sexual minorities without creating a stand-off with either the Ugandan government or public. Such a stand-off can alienate Ugandan rights activists and also whip up nationalist sentiments, bolstering the anti-homosexuality movement.

How is Uganda’s domestic security structured and why does that matter?
The Walter Reed Project raid and initial response by the police and government spokespersons suggest an additional complication — the lack of coordination across branches of the Ugandan security establishment. As noted above, the Inspector General of Police was unaware of the raid until after it had taken place and in the day following the raid, government officials were both claiming and refuting that the Ugandan police had been involved.

An investigative report by The Independent in 2009 found no fewer than 30 separate security agencies operate in Uganda, both constitutional and unconstitutional. The proliferation of security agencies, like the proliferation of districtscabinet portfolios, and members of parliament, serves to bolster a patronage system and ensure that no one institution or individual is strong enough to challenge the executive. However, such fractionalization comes with considerable financial costs, and is both inefficient and unpredictable, as the raid on the Walter Reed Project demonstrates.

Another potential by-product of the proliferation of security agencies is the bungling of international relations. It is entirely possible that, rather than an overarching government strategy to target organizations who serve LGBTI clients, a particular branch or branches of the security sector have taken matters into their own hands. The raid comes at a critical point in Washington’s review of programing in Uganda. Amulti-agency team of Americans was in Kampala last week for the explicit purpose of reviewing U.S. commitments in the wake of the Anti-Homosexuality Act. Meanwhile, Uganda’s Ministry of Health has been at pains to assure international partners that the law will not affect Ugandans’ access to health services. Thus, last week’s events suggest an internal struggle in government, between those playing to populist sentiments and those trying desperately not to irrevocably sever relations with donors.

The details of the raid suggest that at least some components of the state, much to the chagrin of the United States, have every intention of enforcing the anti-homosexuality law. Some hoped that the law would remain on the books but largely out of everyday activities of law enforcement. The plainclothes officers involved in the raid were in possession of personal information about Walter Reed Project staff, including where they live, suggesting substantial efforts have gone into gathering intelligence not only on members of the LGBTI community but also individuals who work with the community. Sources inside the police say that they have video recordings showing that the Walter Reed Project is a “gay training and recruiting center.” Some of the videos apparently feature American nationals.

The raid of a U.S. military-affiliated facility is a bitter slap in the face to Uganda’s longtime ally, but perhaps serves well to highlight the failure of U.S. policy on human rights in the region, particularly the protection and promotion of gay rights. Uganda’s political landscape and that of the region is complex. The United States has yet to demonstrate that it has a strong grasp on the stakes or dynamics at play. In the case of the anti-homosexuality law, U.S. sanctions, whether verbal or economic, may be ineffective at best and harmful at worst, as journalist Andrew Mwenda has argued. As noted in an earlier Monkey Cage post, the vast majority of Ugandans support anti-homosexuality legislation, some with fanatic zeal. This is true not only in Uganda but across Africa. U.S. policy must consider the public pressure and incentives the president and other politicians face. Attempting to strong-arm a president or others into overwhelmingly unpopular positions domestically, such as the protection of sexual minority rights, may backfire.

 

 

The Academy in the time of Influenza: American medicine and the Great Pandemic

American medicine up until the twentieth century was an unmitigated disaster. Or so argues (quite convincingly) John Barry in his fascinating book, The Great Influenza: The Story of the Deadliest Pandemic in History. The first two sections of the book cover a brief history of American medicine and medical research, and I’ve only just gotten to the outbreak of the pandemic that killed between 20 and 50 million people, according to the best estimates. For comparison’s sake, WWI claimed 16 million lives, and AIDS an estimated 33 million.

Barry highlights a strong link between war and disease, namely, the emergence of epidemics or even pandemics. I’ll return to a discussion of this thesis when I’ve finished the book, but for now, what has been most striking is the utter catastrophe that was American medicine up until relatively recently. While scientists and physicians in Europe, including Robert Koch, Pierre Louis, Louis Pasteur, and John Snow were pioneers in epidemiology, germ theory, and more, the study of medicine in America was stagnant, suggesting the importance of healthy academic and scientific competition on the European continent.

Evidence of the United States’ relative backwardness is abundant. Charles Eliot, who became president of Harvard in 1869, wrote in his first report as president that, “The ignorance and general incompetency of the average graduate of the American medical Schools, at a time when he receives his degree which turns him loose upon the community, is something horrible to contemplate.” When Eliot proposed reforms within Harvard, including examinations (of all things), Professor of Surgery Henry Bigelow, had this to say:

Charles Eliot, Harvard President 1869-1909

“[Eliot] actually proposes to have written examinations for the degree of doctor of medicine. I had to tell him that he knew nothing of the quality of Harvard medical students. More than half of them can hardly write. Of course they can’t pass written examinations…No medical school has thought it proper to risk large existing classes and large receipts by introducing more rigorous standards.”

At the end of the 19th century, Barry reports that American universities had “nearly two hundred endowed chairs of theology and fewer than five in medicine…” showing where both the money and the power lay.  It was ultimately the initiative of a few individuals, combined with big money from illustrious families such as the Hopkins and Rockefellers, that turned the ship around.

The Great Influenza is an excellent read, and fodder for thought not only for those interested in medicine, epidemiology, and virology (guilty as charged), but also for those interested in the academy as an institution – how it evolves or stagnates, and the factors that generate innovation and massive leaps forward in our understanding of the world.

Health information leads to…cheating!

Well, this is disappointing. A recent study in Uganda supported by Google and the Grameen Foundation, and implemented by Innovations for Poverty Action, has found a way to…increase infidelity.

When provided with information about sexually transmitted diseases via text messaging, cheating among participants more than doubled. Why?

Although the study and its findings have yet to be published, Bloomberg reports:

With the program in Uganda, which began in 2009, infidelity may have risen as women became more aware of the risks of cheating and insisted on going for testing with their husbands, said study author Dean Karlan, an economics professor at Yale University in New Haven, Connecticut. Some men resisted, leading women to deny them sex, which the men then sought from other women, Karlan said.

Basically, it appears that women wanted safer sex, while many men did not.

At first, this struck me as a classic case of unintended consequences, of good intentions paving the proverbial road to hell. However, having finished tearing my hair out (actually, gunning it through Ntinda wondering, what is wrong with these men?!), I realized we have actually learned something important despite the perverse effects of this intervention. Two things, actually. 1) men and women have different preferences regarding safe sex, and 2) women are willing and able to stand up for and protect themselves, at least in Uganda.

Now we need to understand why, faced with the same information as women, men made choices that did not improve their health and did not reduce their risk of contracting a sexually transmitted disease. We also need to find ways to support women to protect themselves and their families.

Looking forward to reading the paper; will update accordingly.

UPDATE: Ungated version of the working paper available here.

Uganda cabinet and army reshuffle — May 24, 2013

The Ugandan government, through the state-owned newspaper, The New Visionannounced President Museveni’s cabinet reshuffle this morning, described as “minor” changes. There are reports of new appointments in the army as well, but these have yet to be published. Is the timing of the reshuffle related to the ongoing tension regarding Gen. David Sejusa’s (aka Tinyefuza) letter? That’s an open question.

Notable changes include:

Gen. Aronda Nyakairima – Minister of Internal Affairs (replacing Hillary Onek)
Ruhakana Rugunda – Minister of Health (replacing Christine Ondoa)
John Nasasira — Minister of ICT (replacing Ruhakana Rugunda)

Other important posts including Prime Minister, Min. of Defence, Education, Energy, Finance, Trade, Foreign Affairs, and Local Government remain unchanged.

Full cabinet list here.

Full permanent secretaries list here.

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UPDATE: Press release from UPDF spokesman Paddy Ankunda details army reshuffle (New Vision).

PRESS RELEASE

His Excellency the President of the Republic of Uganda and Commander in Chief of  the UPDF has made the following promotions and changes within UPDF.

1.    Gen Aronda Nyakairima formerly the Chief of Defence Forces has been appointed Minister of Internal Affairs.

2.    Lt Gen Edward Katumba Wamala formerly Commander of Land Forces has been promoted to General and appointed the Chief of Defence Forces.

3.    Lt Gen Ivan Koreta formerly Deputy Chief of Defence Forces has been appointed Ambassador of Station to be announced later.

4.    Maj Gen Charles Angina formerly Chief of Staff of Land Forces has been promoted to Lt Gen and appointed Deputy Chief of Defence Forces.

5.    Maj Gen Fred Mugisha formerly the Joint Chief of Staff is appointed Head of the National Counter Terrorism Centre to be set up.

6.    Brig Wilson Mbadi formerly the 4Division Commander is promoted to Maj Gen and appointed Joint Chief of Staff.

7.    Brig David Muhoozi formerly Commander Air Defence Division is promoted to Maj Gen and appointed Commander Land Forces.

8.    Brig Samuel Turyagyenda, Commander Airforce is promoted to Maj Gen.

9.    Brig Leopold Kyanda formerly Chief of Personnel and Administration is appointed Chief of Staff Land Forces.

10.    Col Emmanuel Kanyesigye formerly 5Division Operations Officer transferred to 4Division as Division Commander.

We congratulate the Officers upon their well deserved promotions and appointments and wish them success in their new assignments.

PADDY ANKUNDA psc
Lt Col
DEF/UPDF SPOKESMAN

Angelina Jolie’s choice, our challenge

Today the New York Times published a very personal and, for many people, unexpected op-ed by actress, director, and humanitarian Angelina Jolie. Ms. Jolie, a carrier of the gene BRAC1 with a mutation that significantly increases breast cancer risk, recounts her decision and experience undergoing a preventive double mastectomy — the surgical removal of both of her breasts. There should be no shame in undergoing such a procedure. Still, Ms. Jolie feels compelled to note: “On a personal note, I do not feel any less of a woman.” This is a real concern for many women.

The more we talk about women’s health and the unique health experiences women face, the better. The same goes for men. Our bodies are often imbued with such greater expectations than their basic purpose, to allow us to live our lives. We make judgments about each other based on shape and size, and spend countless, wasted hours making these judgments about ourselves.

I applaud Ms. Jolie for her contribution to this important conversation. It also raises important issues for women’s health beyond the New York Times readership. Ms. Jolie writes,

For any woman reading this, I hope it helps you to know you have options. I want to encourage every woman, especially if you have a family history of breast or ovarian cancer, to seek out the information and medical experts who can help you through this aspect of your life, and to make your own informed choices.

I wish this were more true than it is. For many women around the world, there are not many options. Ms. Jolie is well aware of this, and I believe she will be one among many fighting to change the status quo. In the meantime, there are sobering facts to face at home in Uganda.

  • Breast cancer is the third most common cause of cancer among women in Uganda, behind cervical cancer and Kaposi’s sarcoma (the latter of which are largely preventable).
  • There are two mammography units in Uganda.
  • The vast majority of Ugandan women present at late stages in the cancer’s progression, at which point there is little chance of survival.
  • The estimated budget of the Uganda Cancer Institute is approximately Ushs 5.5 billion, just over US$2 millon (Sector Budget Framework Paper). The State House budget is 36 times that, over Ushs 200 billion.
  • The cost of testing for BRAC1 and BRAC2, as Ms. Jolie notes, is US$3,000 in the United States, and completely inaccessible for almost all women in Uganda.

In comparative terms, Uganda has relatively low rates of breast cancer. But it’s hard to know how accurate these figures are due to poor surveillance and diagnosis in much of the developing world.

Citation: Bray, Freddie, Peter McCarron, and D. Maxwell Parkin. "The changing global patterns of female breast cancer incidence and mortality." childhood 4 (2004): 5.
Citation: Bray, Freddie, Peter McCarron, and D. Maxwell Parkin. “The changing global patterns of female breast cancer incidence and mortality.” childhood 4 (2004): 5.

Uganda: The Health of the Nation

Published online Nov. 4, 2012 in The Independent.

The Health of the Nation
By Melina Platas Izama

Since Uganda hit 50 recently, it seems as good a time as any to check its vitals. There is the heartbeat of the economy and the temperature of the masses, the pressure of the politics and the weight of history. The health of this nation in one word? Resilient.

The Jubilee celebration was not made up of unfettered jubilation, as one might expect at 50 years of independence, but instead doused with a heavy coat of introspection.

The pristine Kampala Road, captured in black and white photos, is hardly recognisable today – a bustling, grating and downright stressful stretch of earth.  Cynics wandered and wondered aloud, are we better off now than we were a half-century ago? Teachers are striking, projects stalling, health clinics leaking staff, money, and drugs. This version of events is familiar. We listen to it every morning and read it every day. Frankly, it’s exhausting.

The health of the nation is in part a function of the health of its people. And here we have some great stories to tell. The greatest story of all is the about the survival of children. In the last fifteen years, death in infants and young children has fallen by nearly 40%. The drop in child deaths was faster in the past five years than it has been in decades.  This is fantastic news.

When Uganda raised her flag for the first time, mothers across the newly birthed state could expect more than one in five of their children to perish before age five and 13% of newborns would not survive their first year. This year, as the flag was raised once more, the death of a child is not foreign, as it should be, but neither does it go hand in hand with motherhood.

The results of the most recent round of the Demographic and Health Surveys (DHS), which have been instrumental in documenting these trends, have just been released for Uganda. Conducted across the country in more than ten thousand households, the DHS has been conducted in 1988, 1995, 2000, 2006 and 2011. While there are a number of improvements to report, the story of child survival, particularly in the last decade, stands out. It is perhaps the greatest achievement of the new millennium in Uganda. Continue reading “Uganda: The Health of the Nation”

What’s up with West Nile?

West Nile virus, that is. A widespread outbreak in the U.S. has attracted renewed attention to the virus, which acquired its name from West Nile, Uganda, although there is no evidence that it originated there. Unfair, isn’t it? The virus was first isolated in Omogo, West Nile district, Uganda, in 1937, by researchers at the Yellow Fever Research Institute, then based in Entebbe. According to a 1940 article by Smithburn et al. in the American Journal of Tropical Medicine and Hygiene:

In attempting to isolate virus numerous persons were seen who were suffering either from an illness suggesting yellow fever, or from pyrexia of unknown cause. From many such persons blood was drawn, and as soon as possible thereafter the serum was in oculated intracerebrally2 into mice. Subinoculations were done from mice which became ill. In this manner several transmissible infective agents were isolated.

The purpose of this paper is to report the isolation of one such agent, which we call the West Nile virus, and to describe some of its properties. Although this virus was isolated from the blood of a human being, the circumstances of its isolation were such that nothing is known regarding the illness produced by the virus in the human subject.

That the virus was identified in West Nile should, if anything, be a testament to the medical contributions that have been made from the region, but it is more likely to have inspired notoriety. West Nile virus outbreaks have occurred all over the world, but the virus was not identified in North America until 1999.

West Nile virus is carried by mosquitoes, which acquire the virus from infected birds. In rare cases (only about 1 in 150 cases), severe viral infection is characterized by “high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness and paralysis“, according to the CDC. Up to 80% of those infected, however, do not experience any symptoms.

Current map of West Nile activity in the U.S.:

CDC surveillance of West Nile virus in the U.S., activity as of August 21, 2012

Dying to be President

Meles Zenawi of Ethiopia is only the most recent of a series of African leaders to die while in office. Prof. John Atta-Mills of Ghana passed away in July, and Malawi’s Bingu wa Mutharika before that. Rumors continually swirl about the health of other current presidents, including Zimbabwe’s octogenarian, Robert Mugabe. The health of leaders is often veiled in secrecy, which can make it difficult to plan for potential transitions.

In the days immediately following the death of Atta-Mills, many of those I spoke to in Ghana were sad, but also a little angry. How could he dance and jog on his return from a medical check-up in the US when he knew he was so sick? Former president Jerry Rawlings gave a frank, if rather callous, assessment on the BBC: “I think had he been advised and done something wiser, you know, earlier on, he could have probably survived, you know, for, I don’t know, for another six-seven months…” There was a feeling expressed by some people I spoke to that Prof. Atta-Mills should have taken time off, and taken care of himself. This calls to a more general problem — the secrecy enshrouds the health of leaders sets up governments for moments of crisis. Fortunately, Ghana and Malawi have both managed to pull through with successful transitions, but others may not be so lucky.

Songwe and Kimenyi examine this issue in their op-ed, “The Health of African Leaders: A Call for More Transparency” at Brookings:

As the number of ailing presidents increases, three major issues are emerging: First, the continent demands more transparency regarding it’s leaders’ health; second, democracies need clear term limits; and third, successful democratic transitions require transition processes outlined in the constitution, that are understood and familiar to all. With these safeguards in place, the risks of administrative paralysis, political tension, internal conflict and instability that characterize situations in many African countries could be mitigated. Unfortunately, in many African countries today there is a general lack of clarity around term limits and even less clarity and agreement on succession: Term limits are changed on a rolling basis, and constitutions are amended frequently.

News on Uganda’s Ebola outbreak

An outbreak of Ebola that started in Kibaale district, western Uganda, has spread to Kampala, say government officials (including the president). So far 14 people have died from the Ebola virus, and at least a dozen more have been infected. As more information becomes available, I will post it here.

Many of the cases so far are reported to have come from the same family, in addition to a health worker in Kibaale, Clare Muhumuza, who was transferred to Mulago Hospital, where she died.

According to the Centers for Disease Control (and common sense), a critical factor in stopping the epidemic is to recognize an outbreak and respond quickly. It appears as though this is the third week since the outbreak in Kibaale. Let us hope not too many people were infected before news of the outbreak and government response became public.

Some of the recent stories are below:

Museveni warns of Ebola threat, BBC news

Ebola in Uganda alert, World Health Organization

6 more patients admitted with possible Ebola, AP

Ebola kills Kampala doctor, Chimp Reports

Ugandans told to avoid handshaking, Reuters