(Editor’s note: As the World Bank is considering a $90 million loan to the Ugandan government for building health care infrastructure with assurances it will serve LGBT people, this chilling story is a reminder of a decade of broken promises and lost opportunities. Dr. Thomas Muyunga was a leading HIV expert in Uganda, until his government forced him out.
Why would two plainclothes operatives follow a well-known HIV physician into a bathroom and threaten him not to work with LGBT people, but to encourage him to focus on delivering babies and preventing malaria … or else? Because we are talking about Uganda. Even the health-care system has now been corrupted by the Museveni regime and three of the country’s leading HIV prevention physicians are now living in exile.
In the wake of the World Bank’s decision to support or defund a $90 million loan to the Ugandan government, it is important to tell the story of one of Uganda’s most committed yet unsung heroes, Dr. Thomas Muyunga.
Ugandan health care is politicized and gays are simply excluded
Muyunga’s story illustrates the complexities that result in the fusion of religion, politics and health, and what happens when good people are targeted by their governments with a different agenda. Can Uganda afford to educate her health-care professionals where there are only eight physicians to every 100,000 Ugandans and then chase them out of the country when they are threatened with death?
I first met Thomas four years ago in Uganda when we were looking for a director of the HIV program at St. Paul’s Equality and Reconciliation Center in Kampala. We had just won a grant from the Elton John AIDS Foundation to provide counselling, HIV testing and support to men who have sex with men (MSM) in a country that had refused services to this population for at least a decade. We (including the Ministry of Health) had no idea what the infection rate was among this community, half of whom were also married to women. It was a controversial program that ran contrary to the Ministry of Health’s policies and Ugandan AIDS Commission’s priorities to serve “most at risk populations” (MARPS). Fishermen and truck drivers were listed with sex workers and IV drug users, but MSM were not even mentioned.
Bishop Christopher Senyonjo, as head of the center, made the final decision not to hire Thomas who was known to be openly gay, because the project needed someone who could move freely in and out of religious and government health circles and Thomas was well qualified but controversial.
Thomas’ work with the LGBT community began a decade before I met him. He trained many of the now well-known leaders like Frank Mugisha and Pepe Onziama and their organizations like SMUG, FARUG, or Freedom and Roam. He was one of the few medical professionals who, early on, was asking the hard questions about Ugandan sexual practices in general and ran straight into the theologically-charged policy shift of Bush-era HIV priorities. He refers to this priority shift resulting in funding the “vanilla groups.” Married couples and children became the sole focus on PEPFAR and USAID funding and as early as 2007, Dr. Thomas was advocating a more inclusive approach with the U.S. Embassy in Kampala but American officials would simply not support his work. The “vanilla groups” became the focus of faith-based programs that received millions of dollars in aid over an eight-year period.
He describes the hidden outcome of this shift in funding to empower three new movements in Ugandan society – the rise of Pentecostalism and a more rabid form of fundamentalism, an emerging anti-gay agenda and the arrival of American pastors like Scott Lively (who told the Ugandan parliament to set an example for the Christian world and rid their country of homosexuality).
Today, as a result of these three influences, funded by the American taxpayer and churchgoer, the HIV infection rate among MSM is more than double the infection rate of mainstream Ugandan society (15% MSM). The wave of anti-gay persecution means that this number will only increase as people go underground and health providers are reluctant to risk serving a criminalized population.
It is ironic that three of Uganda’s top physicians, who tried for years to steer the Ministry of Health away from this path of failure, are all living in exile. Many of the health providers who reach out to MARPs are no longer meeting (like the Good Samaritan Consortium), afraid of being raided by the police and arrested for their work.
“We prefer to meet in ones and two’s in private but cannot meet as a group to do our planning and sharing of information that is necessary in a more normal climate. The Anti-Homosexuality Act has changed everything,” a local health care provider told me this week.
These health-care providers, many of whom are straight allies, also suspect their phones are being tapped and their Social Media accounts and emails checked. The climate of fear and terror has completely paralyzed an already weak response to the most vulnerable populations. How can the Ugandan government give assurances to the World Bank that it will protect LGBT people in Uganda and their equal access to health care when this climate of terror has been building for nearly a decade?
Thomas’ insights and experience provide a reality check for many of us who think the Ugandan government and churches are having second thoughts about their draconian policies and will do the right thing. This is not something we want to hear, but his story is relevant to today’s dilemma.
The decade of destruction
Thomas would add that the government and churches deliberately targeted the LGBT community to be kept invisible and stigmatized, mainly through attacking their ability to organize and provide health and social services for their most vulnerable members. This policy was supported by American foreign policy priorities, particularly in the allocation of aid and to allow existing contractors to default on their commitment to smaller organizations who were working with vulnerable populations.
Many of these larger faith-based organizations who receive large lucrative contracts from USAID and PEPFAR often will make promises to serve MARP vulnerable populations and then cut ties with the organizations when funding is granted. Thomas’ story is a reminder that this dire hypocritical situation is part of the DNA of PEPFAR and will be very difficult to change in places like Uganda, even when there is a change of administration, personnel and policy. The Embassy has not used its power to convene bring both groups together or to censure contractors who are in non-compliance with the objectives of the grants. Thomas’ story is a sad reminder of American culpability in the systemic discrimination against LGBT people, and sadly, even professionals like Dr. Thomas Muyunga, who can no longer help them.
Growing up privileged and gay in Uganda
I asked Thomas why he wanted to be a doctor.
“My parents were professionals, my dad was an engineer and my mother a brilliant surgical nurse. I belonged to a very influential and respected family and clan with nine mothers and 49 children! We were Catholics and my parents sent me to one of the best schools in Uganda. We had friends who were Jesuits and at 13, I entered the seminary and even thought of becoming a priest. Sexuality of any kind was never discussed in Uganda and it was difficult for me, as a young gay man to discover who I was. I knew I was gay from the age of 6 or 7 but the subject was never discussed and I believe this is the way we are made … our sexuality is defined at an early time and it is not a choice. I fell in love with another Ugandan student in seminary and left when I was 17. This was a crisis in my life ... what was I to do now?
“There were two professions I really respected – the clergy and physicians. Both were about helping the human condition through empathy and healing. When I left the seminary, I wanted to know more about psychology and anthropology and understand what it meant to be gay. At Makerere University in Kampala, the Medical School offered courses in both subjects so I began an interest in these new fields. Human Sexuality was offered as a two-hour elective and many people were simply too embarrassed to take the courses. This was 1993, when many of my friends were struggling with HIV infection and eight of them died, some even overdosed on morphine. It was a very difficult time, yet when I finished Medical School, I tried to help my country deal with these new problems, knowing we had a difficult time to talk about sexuality in general, never mind discussing homosexuality.”
Uganda’s fascination with anal sex
Thomas’ formative years as a physician was both as a practitioner working on the Islands resort communities on Lake Victoria where Ugandans escape from the harsh realities of their lives to go on little vacations. He also became well known as a motivational speaker and lectured in many schools and universities where he spoke about human sexuality, HIV and even the subject of homosexuality. His daily work provided a kind of laboratory where he could teach others about what was going on behind the closed doors in Ugandan society.
“What surprised me most about working on these resort island communities was Ugandans’ hidden fascination with anal sex. I began working with transgender (survival) prostitutes who served the tourist population on the islands. They were principally serving heterosexual men who simply wanted to have anal sex. There were health problems that resulted in these encounters and many of the sex workers became infected with gonorrhea. In their ignorance, they thought it was simply nature’s form of sexual lubrication for anal sex, so there was a lot of work to do as a doctor to inform them and keep them safe and their clients safe.
“I was surprised how pervasive this hidden sex industry was and how these underground sex networks were largely supported by married heterosexual men who simply wanted to have anal sex. I started sharing my work and research with the Ministry of Health and our AIDS Prevention strategies. I was appointed “Most At Risk Populations Officer” in 2003 and we began to do some serious educational and intervention work with fisher-folk and truck drivers (who bought services from sex workers a lot), but it was still difficult to direct resources to the LGBT population. By 2008, we had shifted our priorities to “vanilla groups” and these large well-funded evangelical church movements became such important institutions that even the President became fearful of their power and influence.”
Don’t shoot the messenger
Thomas and other physicians like Dr. Paul Semugoma and Dr. Henry Nsubuga were the pioneers of early HIV strategies that did not fit the theological and cultural straight jacket that Uganda had voluntarily submitted to wearing for the next decade.
Health services in Uganda have been politicized for a long time, and by the early 2000s was heavily influenced by American politics and theology. This is when intimidation from government authorities began, like the encounter Thomas had with government operatives that opened this story. Then came the physical attacks by thugs and mobs who tried to kill him. He still carries bruises and marks from some of these beatings and was once left unconscious for dead.
Semugoma fled to South Africa, Nsubuga to the United Kingdom and Thomas escaped for safety to Kenya. His exile was also to expose him to the LGBT refugee community and a new chapter in his life began with a focus on asylum seekers.
How long, oh Lord, how long?
Thomas spent three months in Kenya waiting for approval of his transit to the USA, working with HIAS (a well- established refugee and asylum program) who helped him navigate a complicated system.
“I am currently working with 72 Ugandans who are in Kenya waiting for some form of relief and security from the international community. This system is very broken and even though we have evidence that people were beaten, abused and their life and safety were threatened as a result of the Anti-Homosexuality Law, many of these Ugandan victims are still not getting the help they need to get out. The American government cannot provide a direct way for people like us to get out of harm’s way, even though we can prove we are risking our lives by remaining in Uganda,” he said.
But what can Thomas do to help these people?
“I started an online counselling service where I can begin to assist these unfortunate victims, but more needs to be done to expedite their safety and security. Even in the refugee camps in Nairobi, LGBT people can be subject to violence and only last month two gay people were beaten to death in the camps. There are problems for others like their three- or six-month passes (allowing them to stay in Kenya) run out, or they need medication, food or clothing,” he said.
“We need to establish some form of case-management system where they are supported and prepared for their new life. Like me, many are also victims of torture and violence and need counselling. I was one of the lucky ones. I got a visa to the USA and came to the East Coast first where local religious communities in Worcester, Mass. assisted me. Once people are here, there are other needs like finding a pro-bono attorney to process your asylum claim and help with food, housing and clothing because we are not allowed to work until a work permit is approved. This can take up to a year, so we are often well qualified to work, but not allowed to do so until our application is formally presented. There are many communities, like San Francisco where I now live, who are open and welcoming to people like us. But the challenge remains getting people safely out of harm’s way and finding a legal way to get them here.”
This has become Thomas’s new mission.
Sustaining the journey through economic independence
Thomas is spending a lot of his volunteer time on his online counselling service, building a support system for his fellow Ugandan exiles and looking forward to building an economic platform for all Africans here. He is working on an expo to be held in Los Angeles in August where “African Empowered Communities USA,” working in conjunction with the L.A. Chamber of Commerce, will find growth opportunities for the African diaspora, including the LGBT community. The events will run from Aug. 15 to Sept. 2 and include art, music, food, business opportunities, seminars and exhibitions.
“We want to contribute to American society and learn how we can move into a globalized economy where everyone can be helped, including LGBT people,” Thomas concluded.
Although he is a very busy man and learning to navigate a new city and build new friendships in San Francisco, Thomas has not forgotten to pay attention to his first love and calling -- practicing medicine and when he finds the funds and stability, he will return to medical school so he can practice medicine in this country. “We have a phrase in Uganda which has helped me in my journey: ‘Every challenge has its father, its mother and its siblings.’”
Thomas’ story is as much about the triumph of the human spirit to do good and to deal positively with the unexpected trials of life. He senses God is not quite finished with him yet and there are many more things for him to do, even in a foreign land. You might be able to take the doctor out of Uganda but you cannot take Uganda out of the good doctor. His life is as much about deferred potential and the demonic power of prejudice, especially when it is fueled and funded by fundamentalist ideology from the USA.
For better or for worse, now he is here to tell us how effective our taxpayer dollars are working for good in most of the world. Others will surely be coming. How can the World Bank or the State Department possibly consider giving additional funding to the Ugandan Ministry of Health when it treats its own expert medical leadership so badly? If this is how they treat their professionals, how on earth can they give assurances to protect their clients?
Dr. Thomas Muyunga will be visiting Palm Springs on May 27, San Diego on June 1 and Los Angeles on June 6. While in San Diego, Thomas will attend a celebration brunch in honor of St. Paul’s Foundation Day at noon at the Penthouse, 3535 First Ave. Tickets are $25 per person or $40 per couple. Thomas will also participate in a panel discussion moderated by the Rev. Canon Albert Ogle at 9 am at St. Paul’s Cathedral, 2728 Sixth Ave. Also on the panel are Angeline Jackson, founding executive director of the only lesbian organization in Jamaica, where homosexuality is still criminalized and corrective rape is socially acceptable; and Erasing 76 Crimes blogger Colin Stewart. Contact Ogle for more information or call 619-559-3826.
RGOD2, written by the Rev. Canon Albert Ogle of St. Paul’s Cathedral in San Diego, looks at faith and religion from an LGBT point of view. Ogle is known around the world for his work in support of LGBT rights and HIV-prevention efforts. He is president of St. Paul’s Foundation for International Reconciliation. Donations to the foundation can be made by clicking HERE RGOD2 appears on SDGLN and GLBTNN.