HIV/AIDS in Uganda

 

Rolling through the dusty roads of suburban Kampala in the Ugandan school bus, the HIV/AIDs prevention signs seemed a bit out of place among the open-faced strip malls selling hand-woven mats and basic cooking supplies.  “375 Ugandans contract HIV every day,” one sign read, baffling us American college students. Several prevention methods have been identified apart from the public advertisements, each aimed at reducing the incidence of HIV, whether it be through education, calls to action, or acknowledgement of future circumstances.

 

We have spent our past few days at the Rakai Health Sciences Program (RHSP), an HIV research institute in the Rakai district of Uganda. RHSP does important prevention and research work in the area. RHSP has been working to stop the spread of the virus since its appearance in 1982. Rakai is still home to a high infection rate. The overall rate of infection in Uganda is 7.3%. This rises to 12% in Rakai. Rakai is a rural district, home to many small farming villages. Through our time here and with our homestay families, we have seen that educating the community about how HIV is spread and how to prevent infection has been vital in the fight against the virus in Rakai.

 

Health education is one of the most effective prevention methods RHSP has implemented. RHSP staff travel to different parts of Rakai to teach better health practices to small groups of residents. They have found that theater and drama troupes are the most effective in promoting their educational messages. Men seem to be the hardest group to reach, but they respond well to the scripted dramatizations of various HIV health topics. The clinic at RHSP also has a health education presentation every morning for the patients. Each month focuses on a different topic such as family planning or condom use. We were lucky enough to be able to spend some time at the clinic and see one of these presentations firsthand. The session was greatly attended and informative. A lot of what we learned from the Dr. Alice was also presented to the attendees.

 

RHSP’s biggest innovation in health education, however, has been their “Stylish Living” event. This fair-style event brings HIV education to the community through dancing, live performances, and competitive games. They are even able to offer prevention methods on site. These include male circumcision, family planning counseling, couples HIV counseling, and HIV testing. The event is highly attended and considered a huge success. We saw the “Stylish Man Van” firsthand and all agreed that the event would probably be a fun and educational experience.

 

Another strategy towards HIV/AIDS prevention in Rakai and elsewhere is condom use. Doctor Alice, a health worker at the clinic narrates, “Free condoms are given to the female attendants to use in their households but feedback from them shows their husbands or partners find this inevitable, opting for unprotected sex.” She also adds, “In most areas in Uganda, certain brands are free of charge, though a lot of youths fear being noticed picking them up from conspicuous places.” There is a lot of cross generational sex, during which the adults in respect of “experience” don’t want to use condoms. In some areas they don’t know the proper use of condoms due to illiteracy, so they cannot read the public advertisements or educational material. Most pregnant mothers only learn that they are HIV/AIDS positive when first tested in the clinic, which is mandatory for every pregnant woman in Uganda. In this case, they do not want to be noticed and do not disclose this to anybody, because most fear being pregnant. The challenge is that implementing the eMTCT  (elimination Of Mother To Child Transmition) strategy could turn out to be ineffective due to lack of follow up for the identified HIV/AIDS positive cases. The doctor also thinks interventions like this being passed on billboards would be most effective in literate urban populations but not in rural areas in Rakai.

 

                Circumcision is another strategy used to reduce HIV/AIDS. Circumcision reduces the risk of HIV infection by 60%.The government has strived to get the male population involved in safe male circumcision through different mobilization channels (drama/film shows, village meetings, soccer) where different circumcision messages are passed to the community members. Free circumcision services are also given to the community members at different health centers. The circumcision rate in Uganda is low due to different fears and misconceptions.  For example, women usually complain that men no longer meet their sexual demands once circumcised; while others think their men will have many sexual partners since they believe they are safe from HIV/AIDS.  However, the Rakai health center has plans and strategies, such as the mobile circumcision camps and the health campaign, to increase circumcision rates and to reduce the different perceptions on circumcision.

 

     The first HIV/AIDS case in Uganda was in Rakai in 1982, and HIV/AIDS was referred to as “slim disease” since most people with HIV lost a significant amount of weight. Furthermore, the hospital recorded at least 5 HIV/AIDS cases every day. Increases in prevalence since the virus’s appearance are attributed to poor attitudes on condom use, illiteracy (some people can’t interpret the different health education messages), many sexual partners, and poverty. Poverty can lead people in the area to become involved in commercial sex. The incidence is much higher among the truck men, fishermen, and business people who work in bars.

 

                An important aspect of the public health intervention on HIV is the social balance between prevention and clinical treatment, and the allocation of funds dedicated to the cause.  A notable circumstance is location: the balance may be different in the United States as compared to Uganda.  To reiterate, the prevalence of HIV in Uganda is 7.3 percent, so the government will spend a larger percentage of time and resources on the intervention as a whole.  As to what the balance should be in Uganda, the answer is largely subjective.  Some people we have spoken to argue that prevention should be the main focus, as it will eventually lead to less necessity for treatment anyway.  On the other hand, some prevention methods are not effective, so the focus should be on reducing the negative impact on the lives of those already affected by HIV/AIDs and increasing their lifespan.  Dr. Alice told us that clinical treatment is funded in the Rakai district of Uganda by a grant from the United States, and other districts by other countries. Luckily, this allows prevention to thrive as well as treatment. The circumstances in Rakai breed necessity for both prevention and treatment, which is why both are essential in a society as riddled with HIV as Uganda.

 

                Please continue to check for future blog posts from the Hopkins/ Makerere study abroad group. Happy New Year!