HIV care suffers under Senegal anti-gay law
The introduction of harsh penalties for same-sex relations has created a climate of fear that is severely disrupting HIV services. Gilbert Nakweya reports.
Patients in Senegal are forgoing critical HIV care, including testing and antiretroviral drugs (ARVs), for fear of arrest or abuse following the implementation of a controversial anti-gay law. The law, which came into force at the beginning of April, 2026, has introduced harsher penalties, including doubling the maximum prison sentence to 10 years for “acts against nature“ and criminalising promotion of homosexuality. According to the HIV Justice Network, over 200 people have been arrested and dozens jailed under the law while others have been accused of deliberately transmitting HIV to others. The Network has also documented dozens of reports of forced HIV testing.
Patients have been left living in fear and others have gone to neighbouring countries such as The Gambia and Morocco. Amadu*, a gay man aged in his 30s, knew his life was in danger in March and April when arrests increased and his close gay friends were jailed. Worried about being arrested himself and running out of medication, he fled to a neighbouring country. “I was not able to access ARVs as access to clinics is dangerous. I had to leave Senegal within less than 12 hours. I couldn’t get enough ARV pills before leaving as time and risk management didn’t allow for that”, he told The Lancet.
“My economic privilege helped me escape, but I personally know of dozens of people who can’t leave for economic reasons yet they cannot access [HIV treatment] services”, said Amadu. “I rely on my network in this country to get medication, but there is always fear here as well. I know at least 20 other people who have had to leave Senegal for the same reason as me, some of them are also HIV positive and struggle to get medication”.
Speaking on condition of anonymity, one Senegalese public health expert who works with Mpact Global, a gay men’s health and rights advocacy non-governmental organisation, said that the new law is only worsening the risky environment for community health organisations helping LGBTQ+ groups access HIV preventive and treatment services. “An increase in HIV incidence among men who have sex with men should be anticipated with the legal changes and the social climate it has propagated. I haven’t seen official numbers but have heard anecdotes of people deserting HIV services facilities. There are reports of lower utilization of HIV services since the law was passed in March”, he said. There is some precedent for such an effect. The high-profile arrest of nine HIV peer educators in Senegal in 2008 had a chilling effect on LGBTQ+ organisations. Although no formal correlation has been established, HIV prevalence in gay men went from 17·8% in 2014 to 27·6% in 2024, according to CNLS (the National Council for the Fight Against HIV/AIDS), the government body responsible for coordinating efforts to combat HIV in Senegal.
The expert says that the biggest HIV service facility in the country, Fann National University Hospital, is experiencing a dearth of clients with the few who show up wearing sunglasses or hoodies to avoid being recognised and targeted. Community health workers who were engaged in HIV testing, treatment, and prevention services, such as distribution of condoms, HIV-preventive pre-exposure prophylaxis (PrEP) medication, and monitoring patients, have been arrested. “The laws are incompatible with public health and human rights. Decriminalisation, competent and adequate health services, and measures against stigma and discrimination are the only sustainable ways out”, he said.
Even health workers in government are worried. “The situation is quite complicated here. I just want to be careful to protect our patients”, said a senior public health officer who works with CNLS.
Senegal’s HIV response has already been weakened by US funding cuts on international assistance that came into force in January, 2025. The HIV prevalence among men who have sex with men is estimated to be 27·6%, compared with 0·5% in the general population.
Researchers warn that Senegal’s criminalisation of homosexuality is reversing years of gains in HIV control. “Such punitive laws [as Senegal’s] and policies have shown no evidence for effectiveness as public health approaches. They undermine both public health and human rights and have led to declines in HIV testing, use of PrEP, and support for people living with HIV infection in Uganda, Nigeria, and several other countries”, said Chris Beyrer, Professor of Medicine at Duke University, Durham, NC, USA. “This is very disappointing as Senegal had been on a path to achieving HIV control. These new policies will set the country back and only further discrimination and stigma.”
“Denying people health rights, regardless of their behaviour, drives people underground and does not improve public health”, Beyrer told The Lancet.
