Over the past three months, 70 new cases of HIV have been reported in Sri Lanka, representing an increase from this time last year. The National STD /AIDS Control Programme says this is an upward trend for the country; and the programme's Director, Dr. Sisira Liyanage, has called for the government to take the crucial step of decriminalising homosexuality in order to tackle this concerning development.
Over 50% of these new cases were reported by men who have sex with men (MSM). MSM are one of the most vulnerable groups in terms of contracting HIV worldwide. In countries like Sri Lanka, which criminalise consensual same-sex relations between men, they are at even greater risk.
Homosexuality is punishable by up to ten years' imprisonment in Sri Lanka, thanks to an outdated law retained since British colonial rule. Although prosecutions in Sri Lanka are rare, persecution is not. This law has a chilling effect on the entire LGBT community, creating an environment in which blackmail, harassment, and discrimination against LGBT people are commonplace. This stigma and discrimination is having a predictable knock-on effect on the country's rates of HIV.
Stigma against MSM, stemming from criminalisation, exacerbates HIV epidemics for numerous reasons. It makes LGBT people less likely to seek HIV testing, treatment, and other necessary healthcare. It means MSM are more likely to engage in high-risk sexual behaviours, such as unprotected sex, which heighten their chances of transmitting or contracting HIV. It means that health education is not tailored to the specific needs of the LGBT community and medical professionals are not adequately trained in how to address these needs. It can lead to discrimination on the part of these health professionals, where they may provide sub-standard treatment or simply refuse to treat LGBT people. Finally, it also reduces the incentive and capacity for the government to set up programmes, such as awareness campaigns, specifically designed to address MSM as a target group.
The adverse effects of the criminalisation of homosexuality on HIV/AIDS can be seen all over the world. Last year, the UNAIDS-Lancet Commission provided yet more evidence that there was an indisputable link between criminalisation and increased rates of HIV. In Caribbean countries where homosexuality is not criminalised, MSM have a one in fifteen chance of being HIV positive. In Caribbean countries where homosexuality is a crime, that rate is one in four. To take another example, of the nine countries worldwide that have over 10% of their population living with HIV, all of them criminalise or have a recent history of criminalising MSM.
The law has a distinct effect on what people think is socially acceptable and thus engenders stigma against marginalised groups. Following the introduction of the misleadingly named Same-Sex Marriage (Prohibition) Act in Nigeria, which further criminalised LGBT people and fostered intense homophobia, the number of MSM who were afraid to seek healthcare increased by 12% in the space of three months. Not seeking healthcare means these men were more likely to go untreated and untested, expose the virus to others, and die of HIV/AIDS. However, these risks do not deter young Nigerian men who fear the repercussions from their communities should they seek help.
The criminalisation of homosexuality in countries like Sri Lanka forces LGBT people to be invisible in order to survive. They conceal their identities from their friends, colleagues, even families, because they fear they will be outcast or worse should they reveal their true selves. Hiding this way is a daily struggle, and despite the physical and mental health consequences, many LGBT people see it as worth enduring to avoid such fallout. It is a defence mechanism, a reaction to a society that has deemed you a dangerous element that needs to be locked up; but it turns out that for many LGBT people, hiding doesn't even improve your chances of staying alive.
The Sri Lankan government will never be able to fully address HIV/AIDS, and control these rates whilst they are still manageable, without addressing one of its most fundamental root causes. The same is true of the global epidemic. Homosexuality is still a crime in 78 jurisdictions worldwide, nearly half the globe, including almost all of the countries where HIV/AIDS is most prevalent. With the introduction of medical advances like PrEP, we can no longer say we don't have the technology. The battle now is against stigma, stigma which keeps the most vulnerable from coming forward. Let's hope that the Sri Lankan government takes the National STD /AIDS Control Programme's advice seriously; they will serve as an example of how to truly tackle the HIV/AIDS crisis if they do.