During a briefing on the Obama administration's worldwide five-year HIV/AIDS strategy, Ambassador Eric Goosby, the U.S. global AIDS coordinator, said he hoped "science would lead the way" in combating the disease in countries where homophobic attitudes often prevail.
Goosby was specifically asked about Uganda, where legislation is pending that would extend the punishment for engaging in gay sex to life imprisonment and introduce the death penalty for those who do so repeatedly or while HIV-positive -- acts termed "aggravated homosexuality" within the bill.
Though he declined to say how the administration would respond if the bill passes, Secretary of State Hillary Clinton took a firm stand Monday against targeting gays. "We have to stand against any efforts to marginalize and criminalize and penalize members of the LGBT community worldwide," Clinton said.
Canadian prime minister Stephen Harper and British prime minister Gordon Brown have both expressed opposition to the bill. The Swedish government has threatened to cut development assistance to Uganda if the measure becomes law.
Goosby had intimated in an interview last week that it was not his role "to tell a country how to put forward their legislation."
The Advocate asked Goosby, "As you know, there's a bill pending in Uganda -- have you considered what you will do if that bill passes and, more generally, how you will be working with some African countries that harbor homophobic attitudes and target gays?"
Goosby responded, "We have a similar evolution in our country -- we've had legislation that was put up every year during the early days of Ryan White that anything promoting 'homosexual behavior' was considered unacceptable and anything that did fall into that very large category was -- attempts were made to not have those funded within the Ryan White context, things that promoted homosexual behavior.
"We're familiar with that type of mind-set, and from a public health perspective it has no place in trying to engage and curtail movement of the virus into the population.
"Our collective experience globally in every country, both in developing and in resource-poor settings, has shown that every time your target a population in a negative way and put restraints and constrictions on their ability to reveal themselves to the society, to the community, you push that behavior further underground. When you push it further underground, individuals always come in later to care -- later stage of the disease -- and continue in that period off their antiretrovirals to participate in high-risk behaviors that further spreads the virus through that community.
"Our hope would be to -- in a collegial and respectful way -- to work with our colleagues in a country who are in policy-making decision places to understand that relationship, to understand the science of how the virus moves through populations and how you need, as the public health responsible entity, to position yourself in front of each of those expanding waves of seroconversion. And until you do that, that remains a conduit for the virus to reenter the general, not high-risk behavior population.
"So our hope is, is that the science will lead the way and that that dialogue can stay on that level and that the governments that are involved will realize that it's in their interest and the interest of the larger population for them to develop strategies that address these populations.
Goosby also outlined the following points of emphasis as the administration moves forward on its five-year HIV/AIDS strategy.
-Transition from an emergency response to promotion of sustainable country programs;
-Strengthen partner government capacity to lead the response to this epidemic and other health demands;
-Expand prevention, care, and treatment in both concentrated and generalized epidemics;
--ntegrate and coordinate HIV/AIDS programs with broader global health and development programs to maximize impact on health systems; and
-Invest in innovation and operations research to evaluate impact, improve service delivery and maximize outcomes.
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