Hagopian Amy, Rao Deepa, Katz Aaron, Sanford Sallie, Barnhart Scott
a Department of Health Services , University of Washington School of Public Health.
c Department of Global Health , University of Washington School of Public Health , Seattle , Washington.
Glob Health Action. 2017;10(1):1306391. doi: 10.1080/16549716.2017.1306391.
Gay men and other men who have sex with men are disproportionately burdened by HIV infection. Laws that penalize same-sex intercourse contribute to a cycle of stigma, homonegativity and discrimination. In many African nations, laws criminalizing homosexuality may be fueling the epidemic, as they dissuade key populations from seeking treatment and health care providers from offering it.
We analyzed the ways in which policies and practices of the US President's Emergency Plan for AIDS Relief (PEPFAR) program addressed pervasively harsh anti-homosexuality laws across Africa. Given the aim of the US PEPFAR program to reduce stigma surrounding HIV, we explored how PEPFAR may have used its influence to reduce the criminalization of homosexuality in the countries where it operated.
We assessed homosexuality laws in 21 African countries where PEPFAR funding sought to reduce the HIV epidemic. We examined PEPFAR Policy Framework agreements associated with those countries, and other PEPFAR documents, for evidence of attempts to reduce stigma by decriminalizing homosexuality.
We found 16 of Africa's 21 PEPFAR-funded countries had laws characterized as harsh in relation to homosexuality. Among the top eight PEPFAR-funded countries in Africa, seven had harsh anti-homosexuality laws. Most (14) of the 16 African 'Partnership Framework' (PEPFAR) policy agreements between African governments and the US State Department call for stigma reduction; however, none call for reducing penalties on individuals who engage in homosexual behavior.
We conclude that while PEPFAR has acknowledged the negative role of stigma in fueling the HIV epidemic, it has, so far, missed opportunities to explicitly address the role of the criminalization of homosexuality in feeding stigmatizing attitudes. Our analysis suggests mechanisms like PEPFAR Partnership Framework agreements could be ideal vehicles to call for removal of anti-homosexuality legislation.
男同性恋者及其他与男性发生性行为的男性承受着不成比例的艾滋病毒感染负担。惩罚同性性行为的法律助长了耻辱感、恐同症和歧视的恶性循环。在许多非洲国家，将同性恋定为犯罪的法律可能正在加剧这一流行病，因为这些法律阻碍了关键人群寻求治疗，也使医疗保健提供者不愿提供治疗。
我们分析了美国总统艾滋病紧急救援计划（PEPFAR）项目的政策和做法应对非洲普遍存在的严厉反同性恋法律的方式。鉴于美国PEPFAR项目旨在减少围绕艾滋病毒的耻辱感，我们探讨了PEPFAR如何利用其影响力减少其开展业务的国家中对同性恋的定罪。
我们评估了21个接受PEPFAR资金以减少艾滋病毒流行的非洲国家的同性恋法律。我们审查了与这些国家相关的PEPFAR政策框架协议以及其他PEPFAR文件，以寻找通过将同性恋合法化来减少耻辱感的尝试的证据。
我们发现，在接受PEPFAR资助的21个非洲国家中，有16个国家的法律对同性恋较为严厉。在非洲接受PEPFAR资助最多的八个国家中，有七个国家有严厉的反同性恋法律。非洲各国政府与美国国务院之间的16项“伙伴关系框架”（PEPFAR）政策协议中，大多数（14项）呼吁减少耻辱感；然而，没有一项协议呼吁减轻对从事同性恋行为者的处罚。
我们的结论是，虽然PEPFAR已经认识到耻辱感在助长艾滋病毒流行方面的负面作用，但迄今为止，它错失了明确解决将同性恋定罪在助长耻辱态度方面所起作用的机会。我们的分析表明，像PEPFAR伙伴关系框架协议这样的机制可能是呼吁废除反同性恋立法的理想工具。
