UNIVERSITY OF GHANA MEDICAL SCHOOL

COLLEGE OF HEALTH SCIENCES

DEPARTMENT OF COMMUNITY HEALTH

PUBLIC HEALTH ADVOCACY

UNAIDS IS PUSHING FOR COUNTRIES TO LEGALIZE HOMOSEXUALLITY AS

A STRATEGY TO CONTROLLING HIV/AIDS.

TAKE AS STANCE FOR OR AGAINST THIS AND ARGUE YOUR CASE.

JOSEPH APPIAH-KUBI

10753702

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INTRODUCTION

Acquired Immune Deficiency Syndrome (AIDS) was first recognized as a new disease in
1981 when increasing numbers of young homosexual men succumbed to unusual
opportunistic infections and rare malignancies (CDC 1981; Greene 2007).

A retrovirus, now termed human immunodeficiency virus type 1 (HIV-1), was subsequently
identified as the causative agent of what has since become one of the most devastating
infectious diseases to have emerged in recent history (Barre-Sinoussi et al. 1983; Gallo et al.
1984; Popovic et al. 1984).

HIV-1 spreads by sexual, percutaneous, and perinatal routes (Hladik and McElrath
2008; Cohen et al. 2011); however, 80% of adults acquire HIV-1 following exposure at
mucosal surfaces, and AIDS is thus primarily a sexually transmitted disease (Hladik and
McElrath 2008; Cohen et al. 2011).

Since its first identification almost three decades ago, the pandemic form of HIV-1, also
called the main (M) group, has infected at least 60 million people and caused more than 25
million deaths (Merson et al. 2008). Developing countries have experienced the greatest
HIV/AIDS morbidity and mortality, with the highest prevalence rates recorded in young
adults in sub-Saharan Africa.

CURRENT GLOBAL STATISTICS ON HIV/AIDS

According to the UNAIDS Global HIV & AIDS statistics-Fact sheet,

 HIV remains a major global public health issue, having claimed 40.4 million [32.9–
51.3 million] lives so far with ongoing transmission in all countries globally; with
some countries reporting increasing trends in new infections when previously on the
decline.

 1.3 million people were newly infected with HIV in 2022.

 There were an estimated 39.0 million [33.1–45.7 million] people living with HIV at
the end of 2022, two thirds of whom (25.6 million) are in the WHO African Region.

 In 2022, 630 000 [480 000–880 000] people died from HIV-related causes and 1.3
million [1.0–1.7 million] people acquired HIV.

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  There is no cure for HIV infection. However, with access to effective HIV prevention,
diagnosis, treatment, and care, including for opportunistic infections, HIV infection
has become a manageable chronic health condition, enabling people living with HIV
to lead long and healthy lives.

 By 2025, 95% of all people living with HIV (PLHIV) should have a diagnosis, 95%
of those should be taking lifesaving antiretroviral treatment (ART) and 95% of
PLHIV on treatment should achieve a suppressed viral load for the benefit of the
person’s health and for reducing onward HIV transmission. In 2022, these
percentages were 86(%) [73–>98%], 89(%) 75–>98%] and 93(%) [79–>98%],
respectively.

The UNAIDS is leading the global effort to end AIDS as a public health threat by 2030 as
part of the Sustainable Development Goals. This they plan to achieve using the following
focus areas:

 Community pandemic response

 Education plus initiative
 Global alliance to end AIDS in children.
 Equal access to cutting edge HIV technologies.
 Save lives: Decriminalize.
 Resources and financing

HOMOSEXUALITY AND HIV/AIDS

The American Psychological Association (APA), sexual orientation refers to an enduring

pattern of emotional, romantic, and/or sexual attractions to men, women, or both sexes.
Sexual orientation also refers to a person’s sense of identity based on those attractions, related
behaviors, and membership in a community of others who share those attractions
(APA,2008).

UNAIDS considers gay men and other men who have sex with men, sex workers, transgender
people, people who inject drugs and prisoners and other incarcerated people as the five main
key population groups that are particularly vulnerable to HIV and frequently lack adequate
access to services.

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The UNAIDS 2016–2021 Strategy calls for bold action to Fast-Track the AIDS response. It
incorporates a human rights-based approach to development and aims to leave no one behind
in the AIDS response. The strategy recognizes sexual and reproductive health and rights
issues, calls for comprehensive sexuality education and the removal of punitive laws, policies
and practices that block an effective AIDS response, including travel restrictions and
mandatory testing, and those related to HIV transmission, same-sex sexual relations, sex
work and drug use.

In 2016, outside of sub-Saharan Africa, key populations and their sexual partners accounted
for 80% of new HIV infections. Even in sub-Saharan Africa, key populations accounted for
25% of new HIV infections in 2016.

Figure 1.0 New infections of HIV occurring amongst gay and bisexual men.

DECRIMINALIZING HOMOSEXUALITY AS A CONTROL STRATEGY

According to the UNAIDS, decriminalization of homosexuality is a critical element in their

quest to end AIDS by 2030. Greater gains have been achieved in countries where laws have
advanced human rights protections, particularly those that protect rights to non-
discrimination and responded to gender-based violence.

Countries that criminalize key populations have seen less progress towards HIV testing and
treatment targets over the last five years—with significantly lower percentages of people

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living with HIV knowing their HIV status and achieving viral suppression than in countries
that avoided criminalization.

However, despite the compelling evidence, many discriminatory and punitive laws remain.

Punitive laws have been shown to block HIV service access and increase HIV risk. Harmful
laws include the criminalization of same-sex sexual relations, transgender people, HIV
exposure, non-disclosure and transmission, drug possession and use, and sex work.

Communities are advocating for change and are helping to build a growing movement for
decriminalization of homosexuality.

ARGUMENT AGAINST LEGALIZATION OF HOMOSEXUALITY

Fenton and Pathela (2019) assert that some societies strongly oppose homosexuality based on
cultural and religious beliefs. Legalizing homosexuality may be perceived as challenging
these deeply ingrained values, potentially causing social unrest and undermining efforts to
combat HIV/AIDS. Cultural and religious contexts must be considered when formulating
public health strategies to address HIV/AIDS.

Secondly, there has been a lot of ethical concerns that have been raised by critics on the
legalization of homosexuality.

Gupta et al. (2020) highlights ethical concerns related to the promotion of homosexual
behavior. Some of the ethical concerns raised are as follows:

Concerns about the wellbeing of individuals: Some people argue that homosexuality could
lead to negative consequences for individuals involved, particularly in societies where
LGBTQ+ individuals may face discrimination, stigma, and potential harm.

Reproduction and Population Growth: In societies where the focus is on maintaining

population growth, there might be concerns about the potential decline in birth rates if
individuals pursue same-sex relationships, which generally do not lead to biological
reproduction.

Children and Family Life: Some individuals argue that allowing same-sex couples to adopt or
raise children might not be in the best interest of the child, as they believe children should
ideally be raised by opposite-sex parents.

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It would interest you to know that Netherland, one of the first countries to legalize same sex
marriage has not yet achieved the target 95-95-95 set by the UNAIDS. On the other hand,
countries like Rwanda, Botswana, Eswatini, Zimbabwe and Tanzania have been able to
achieve the target 95-95-95 set by the UNAIDS even though they have not legalized
homosexuality, indicating that legalization of homosexuality is not the way to controlling
HIV/AIDS.

Finally, legalization of homosexuality may lead to a potential negative public health

consequence. Homosexuals have a higher predisposition to having mental health disorders
such as depression and anxiety and resort to drug abuse as a coping mechanism. Drug abuse
is also associated with negative effects like cancers amongst other. This then put pressure on
the little resources available in the healthcare facilities.

CONCLUSION

While controlling HIV/AIDS is a critical public health goal, using the legalization of
homosexuality as a method to achieve this is objective is neither ethical nor effective.
HIV/AIDS is a complex issue that affects diverse populations, and any response must be
based on evidence-based, comprehensive strategies that promote education, prevention, and
equal access to healthcare for all individuals regardless of their sexual orientation.

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REFERENCES

Barre-Sinoussi, F., Chermann, J. C., Rey, F., Nugeyre, M. T., Chamaret, S., Gruest, J.,
Dauguet, C., Axler-Blin, C., Vezinet-Brun, F., Rouzioux, C., et al. (1983). Isolation of a T-
lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome
(AIDS). Science, 220, 868–871.

CDC (1981). Kaposi’s sarcoma and Pneumocystis pneumonia among homosexual men—
New York City and California. MMWR Morb Mortal Wkly Rep, 30, 305–308.

Cohen, M. S., Shaw, G. M., McMichael, A. J., Haynes, B. F. (2011). Acute-HIV-1 Infection:
Basic, clinical and public health perspectives. New England Journal of Medicine, 364, 1943–
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Greene, W. C. (2007). A history of AIDS: Looking back to see ahead. European Journal of
Immunology, 37(Suppl. 1), S94–S102.

Gupta, G. R., Parkhurst, J. O., Ogden, J. A., Aggleton, P., & Mahal, A. (2020). Structural
approaches to HIV prevention. The Lancet, 393(10180), 2213-2224.

Hladik, F., McElrath, M. J. (2008). Setting the stage: Host invasion by HIV. Nature Reviews
Immunology, 8, 447–457.

Safren, S. A., Perry, N. S., Blashill, A. J., O'Cleirigh, C., & Mayer, K. H. (2021). The role of
multiple identities in adherence to medical appointments among gay/bisexual men living with
HIV. Journal of Health Psychology, 26(2), 244-256.