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REPUBLIC !OF !UGANDA !

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Ministry of Health Draft Guidelines for Health Workers Regarding Health Services for Homosexuals

APRIL 2014

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Table of Contents
Foreword .......................................................................................................................... Operational Definations ...................................................................................... Preamble, Purpose and Target......................................................................................... Guiding Principles........................................... Responsibilities of clients with homosexual orientation while seeking medical Care9 Amendents ................................................................................................................. List of References................................................................................................ 10 11 3 4 5 6

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FOREWORD

On 26th February 2014, H.E the President of the Republic of Uganda, Yoweri Kaguta Museveni ascented to the AntiHomosexuality Bill enacting it into the Anti-Homosexuality Act, 2014. Well aware that homosexuality is not a medical disorder nor an abonormality, those invloved in the practice may present with direct/inderect consquences that require medical care/treatment The Anti-Homosexuality Act desribes a homosexual as person who, Penetrates the anus or mouth of another person of the same sex with his penis or any other sexual contraption or uses any object or sexual contraption to penetrate or stimulate the sexual organ of a person of the same sex or touches another person with the intention of committing the act of homosexuality. This being a new law, some health workers / researchers might be in a dilemma on how to handle clients with homosexual orientation. This guideline therefore has been developed to guide health workers in Uganda who in the routine discharge of their medical duties may find themselves managing clients involved in Homosexual activities.

These guidelines will be used in conjunction with other existing guidelines in the general care of clients seeking health services. The other guidelines in place for example include the Ministry of Health Clients Charter; The Patient Charter and the Uganda Clinical Guidelines 2012, health workers ethical code of conduct, and health facility specific client charters.

Dr.Jane Ruth Aceng Director General Health Services Ministry of Health.

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Operational Definations
Medical Care or Medical treatment - includes medical diagnostic procedures, preventive, promotive, psychological care and nursing. Health facility - hospital, health centre or clinic. Health Worker - a health professional, administrative, scientific, and support staff employed in the health service. Patient - a sick person or any person requesting or receiving medical care. Clinician - a physician, dentist, nurse, midwife or any other professional recognized by relevant Registration Councils and so published in the official gazette as a health care provider. Medical Information - information that refers directly to patients state of physical or mental health, or to the medical treatment of it. Medical emergency - a situation threatening immediate danger to life or severe, irreversible disability, if medical care is not given urgently. Child means a person below the age of 18 years Promotion of homosexuality

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1. Purpose
The purpose of these guidelines is to clarify to health workers on how to handle Clients and patients involved in homosexual activities but not to promote acts of homosexuality

2. Target
This guideline has been developed for use by all health workers/researchers in the public and private health facilities and institutions.

4. Guiding Principles
4.1 Right of access to medical care A client with homosexual orientation in need of medical care is entitled to impartial access to treatment in accordance with the regulations, conditions, services and arrangements attainable at a given time in the health facility where the patient / client seeks treatment. Health care providers shall continue to provide services with equal opportunity of access to all clients including clients with homosexual orientation Should a medical facility be unable to provide treatment to the patient, it shall to the best of the facilitys ability refer him or her to a place where she/he can receive appropriate medical care. 4.2 Non Discrimination No health facility or health care provider shall discriminate patients on grounds of their sexual orientation, disease, religion, political affiliation, disability, race, sex, age, social status, ethnicity, nationality, and country of origin or other such grounds. 4.3 Confidentiality and Privacy Clients with homosexual orientation have a right to privacy in the course of consultation and treatment. Information concerning ones health and treatment may only be disclosed with informed consent except when required by law or on court order. The health worker may however break confidentiality either by advising the victim or the person responsible for the victim (parent, relative or caretaker) to report to the police in the following circumstances: a) Where a client is a child as defined by the laws of Uganda

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b) Where a person has been sodomised. c) In cases where a clients mental status is compromised d) Vulnerable groups e.g. soldiers, prisoners, refugees, People With Disabilities(PWDs) etc e) Cases of aggravated homosexuality as defined by the anti-hosexuality act

4.4 Appropriate Medical Care Patients /clients with homosexual orientation are entitled to appropriate health care, provided in a professional and ethical manner just like for all other clients/patients. 4.5 Professionalism: Health care providers shall deliver health services with the highest level of professionalism, integrity, transparency and honesty as per patient care guidelines; and act according to medical norms in management of all their clients including those with homosexual orientation.

4.6

Healthy and Safe Environment Homosexual Patients and Clients have a right to be treated in a healthy and safe environment that will ensure physical, mental and social wellbeing

4.7 Informed Consent Homosexuals have a right to be given adequate and accurate information about the nature of their illness, diagnostic procedures, possible cause(s) of the illness and proposed treatment in order to make an informed decision about their treatment / management. A health worker as prescribed by law, may offer health advice to the homosexual as he/she may deem fit for the good health of the client and in line with the ethical code of conduct However a health worker may withhold the medical information from the patient concerning his/her condition if the health worker has reason to strongly believe that by giving this information, it is likely to cause severe harm to the patents mental, social or physical wellbeing. Informed consent may be obtained as follows: a) Informed consent shall be in writing and witnessed in case of surgical intervention and research. b) In case of medical/surgical emergency, the procedure shall be conducted to save the life of the patient and informed consent shall be sought soon after the patient regains consciousness and is able to understand c) For non surgical cases informed consent shall be required for every new client/patient. d) Such informed consent should be sought for children from their respective parents /caretakers and an assent given by children 8 years and above as well

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e) Medical Care without consent A health worker may provide medical care to clients with homosexual orientation without consent in the following scenarios; a) When the patients physical or mental state does not permit obtaining his or her informed consent. b) Where it is impossible to obtain consent of the patients representative or guardian in the case of clients who are children or incapacitated. 4.8 Refusal of Treatment Clients with homosexual orientation may refuse treatment and such refusal shall be written and endorsed by the client/patient. However, such refusal will only be respected if non treatment of the patient does not endanger the life of self and others. In the later instance where the client may endanger the life of others, a health worker may administer treatment against the patients will if the facility management has confirmed the following; a). The patient has received full information as required to make an informed decision b). The treatment is anticipated to significantly improve the patients medical condition c). There is reasonable anticipation that the patient after receiving the treatment will give retrospective consent. 4.9 Disclosure of information of the patient The health worker may disclose information about his/her homosexual client / patient only in the following circumstances; a) When required by law or on court order. b) When disclosure is for the purpose of the patients treatment by another health worker. c) When disclosure of such information is vital for the protection of the health status of self and others or the public and that the need for disclosure overrides the interest in the informations non-disclosure. d) The disclosure for such information is for purposes of publication, research or teaching purposes where all details of the patients identity have been delinked.

5.0 Responsibilities of clients with homosexual orientation while seeking medical care
For appropriate care, clients / patients, with homosexual orientation, have some responsibilities that they need to observe. These include but are not limited to: a) Fully cooperating with the health Workers b) Treating health workers with courtesy and respect;

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c) Being fair, open and reasonable; d) Providing clear, accurate and timely information for proper diagnosis, treatment, counseling and rehabilitation purposes. e) Providing the health workers and managers of the health care facilities with feedback information about performance or quality of service received within two weeks after receiving treatment; f) Complying with prescribed treatment and / or rehabilitation procedures meant to improve their health g) Taking responsibility for consequences arising from their refusal to receive treatment or to follow treatment instructions/advice from the health worker. h) Respecting the rights of others and as well as the rights of the health workers including control of disease spread, avoiding indecent behavior, exhibitionism and any other acts not consistent with the laws of Uganda 6.0. Research on Homosexuality Health workers and facilities involved in research or care of homosexual clients shall be protected by law as long as their research was approved by the existing mechanisms i.e. Institutional Review &Ethical committees (IREC),Uganda National Health Research Organization(UNHRO), Uganda National Council of Science and Technology (UNCST), and Presidents Office. 6.1. It is the sole responsibility of the researcher, investigator, health worker or his/her facility to ensure no acts of promotion or recruitment of subjects into acts of homosexuality as stipulated by the anti Homosexuality Act, 2014 occur. In the event of promotion or recruitment, they shall be held accountable. 6.2 Clinical care in research settings Research entities offering care to clients within a research Institute shall operate under confidentiality as above but avoiding acts of promotion or recruitment into homosexuality.

7 AMENDMENTS These guidelines shall be reviewed not later than 3 years, but could be reviewed more frequently as need arises.

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List of references 1. The Constitution of the Republic of Uganda, 1995. 2. The Anti- Homosexuality Act, 2014
3. Ministry of Health, Patients charter; December 2009 4. Ministry of Health, Clients Charter; 2012/13 2014/15 5. Ethical code of conduct for health workers, year?? 6. Regional referral Hospital client charters for Gulu, Mbale and Masaka, 2013.

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