{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T08:17:45Z","timestamp":1793780265780,"version":"4.6.1"},"reference-count":40,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T00:00:00Z","timestamp":1757635200000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007936","name":"International AIDS Society","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007936","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>In 2023, the Ugandan government enacted the Anti\u2010Homosexuality Act (AHA), which included expanded and intensified criminal penalties for consensual same\u2010sex relations. While arrests, harassment and violence have been reported, evidence of the AHA's impact on HIV healthcare delivery is limited. Community\u2010led monitoring (CLM) is an accountability mechanism that uses community\u2010gathered evidence to advocate for improved healthcare quality and is well\u2010positioned to describe changes in access and quality of care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data from the CLM programme in Uganda were used to identify changes in healthcare delivery and use related to the AHA. As part of the CLM programme, routine survey data were collected from clients and managers in 320 public health facilities and 50 drop\u2010in centres (DICs) from 2022 to 2024. Survey data were analysed using a difference\u2010in\u2010differences logistic model to measure changes in indicator measures before and after the AHA was signed into law. Seven semi\u2010structured individual interviews were conducted with DIC facility managers, deductively coded and thematically analysed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In public health facilities and DICs, the proportion of respondents identified as men who have sex with men (MSM) declined significantly after AHA. In facilities, all categories of key populations (KPs) reported high levels of discrimination. After the AHA, MSM reported significant reductions in key HIV\u2010related services compared to other populations, including lower rates of pre\u2010exposure prophylaxis (PrEP) counselling, lower participation in support groups and having fewer friendly staff interactions. In DICs, all types of clients were less likely to be referred to health facilities, receive PrEP and find the DIC easy to access after the AHA was signed. DIC managers described experiencing harassment, violence and staffing challenges due to AHA, which they responded to by leveraging partnerships with local and global allies, providing virtual services, and seeking registration as full\u2010service clinics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Data from the Uganda CLM programme provide an early view of the impact of the AHA on service delivery in public health facilities and DICs. While DICs and health facilities developed strategies to build resiliency and adapt, the AHA created significant barriers to care. These findings provide empirical warnings of the barriers experienced by KPs when accessing healthcare services in a criminalized context.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.70030","type":"journal-article","created":{"date-parts":[[2025,9,13]],"date-time":"2025-09-13T06:34:42Z","timestamp":1757745282000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Impact of the Anti\u2010Homosexuality Act on HIV service delivery in Uganda: Evidence from community\u2010led monitoring"],"prefix":"10.1002","volume":"28","author":[{"given":"Allan","family":"Nsubuga","sequence":"first","affiliation":[{"name":"Sexual Minorities Uganda (SMUG)  Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Mugisha","sequence":"additional","affiliation":[{"name":"Sexual Minorities Uganda (SMUG)  Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Ajonye","sequence":"additional","affiliation":[{"name":"International Community of Women Living with HIV \u2010 Eastern Africa (ICWEA)  Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Mwehonge","sequence":"additional","affiliation":[{"name":"Health Promotion and Social Development (HEPS)  Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9642-4495","authenticated-orcid":false,"given":"Elise","family":"Lankiewicz","sequence":"additional","affiliation":[{"name":"Andelson Office of Public Policy amfAR  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Drake","sequence":"additional","affiliation":[{"name":"Data, Et cetera  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther Joan","family":"Kilande","sequence":"additional","affiliation":[{"name":"Health Promotion and Social Development (HEPS)  Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Kayongo","sequence":"additional","affiliation":[{"name":"O'Neill Institute for National and Global Health Law Georgetown University  Washington DC USA"},{"name":"School of Public Health Georgetown University  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6737-6168","authenticated-orcid":false,"given":"Alana R.","family":"Sharp","sequence":"additional","affiliation":[{"name":"Data, Et cetera  Washington DC USA"},{"name":"O'Neill Institute for National and Global Health Law Georgetown University  Washington DC USA"},{"name":"School of Public Health Georgetown University  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,12]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"International Lesbian Gay Bisexual Trans and Intersex Association (ILGA World).ILGA Database. Criminalisation of consensual same\u2010sex sexual acts. Accessed November 2024. Available from:https:\/\/database.ilga.org\/criminalisation\u2010consensual\u2010same\u2010sex\u2010sexual\u2010acts."},{"key":"e_1_2_11_3_1","unstructured":"Uganda Penal Code Act 1950.Chapter 128. Accessed February 21 2025.https:\/\/ihl\u2010databases.icrc.org\/en\/national\u2010practice\/penal\u2010code\u2010act\u20101950."},{"key":"e_1_2_11_4_1","unstructured":"Uganda Anti\u2010Homosexuality Act 2023. Act 6 of 2023. 26 May 2023. Available from:https:\/\/www.parliament.go.ug\/sites\/default\/files\/The%20Anti\u2010Homosexuality%20Act%2C%202023.pdf."},{"key":"e_1_2_11_5_1","unstructured":"Uganda Constitutional Court.Constitutional Court pronounces itself on the Anti\u2010Homosexuality Act 2023 of Uganda. Press release. 3 April 2024. 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Accessed February 21 2025.https:\/\/www.unaids.org\/en\/resources\/fact\u2010sheet."},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.09.071175"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1080\/16549716.2017.1306391"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/JNC.0000000000000281"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(22)00336-8"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2021-006315"},{"key":"e_1_2_11_20_1","unstructured":"Convening for Equality.Eteeka Lyayita (Vol 2). Unwanted outlawed and illegal: the cry of LGBTIQ+ Ugandans. May 2024. Accessed February 21 2025.https:\/\/drive.google.com\/file\/d\/1apa3HSkDJUDNzpcvctjSSgoCvSboMVmh\/view."},{"key":"e_1_2_11_21_1","unstructured":"Human Rights Awareness and Promotion Forum.Increasing violence and violations: the first 21 days of the Anti\u2010Homosexuality Act 2023. June2023. 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