Toward an AIDS-Free Generation

U.S. Chargé d’Affaires, Virginia Blaser made a statement recently about the on-going support by the USA for healthcare in Uganda and for the fight against HIV/AIDS in particular. You can read the statement in full here.

This statement of support comes at an interesting point in time. The Uganda Ministry of Health has just recently announced that a recent survey shows the prevalence of HIV has increased to 7.3% of adults, that’s about 1.2m people, more than double the number estimated 7 years ago.

In Uganda, with the support of Target TB, Touch Namuwongo (IMF) has improved access to health education and HIV testing in the community through outreach work. Here a fully trained community healthworker undertakes blood tests at a mobile clinic.

In June the Government of Uganda announced that the allocation of national budget to the Healthcare sector would be reduced from 9.8% in 2011/12 to just 7.6% this year. Depending on the exchange rate this is equivalent to about $307m.

In her statement, Blaser starts by reminding us that since 2004, the American people have invested over $1.7 billion in support of the national HIV response in Uganda. Most of this has been channelled through PEPFAR, for which we should always give a note of thanks to former President George W. Bush.

In 2003, Bush launched the President’s Emergency Plan for AIDS Relief (PEPFAR), pledging $15 billion to end the suffering and save lives threatened by the AIDS epidemic. In 2008, Congress agreed to provide $38 billion more.

In Uganda an estimated 600,000 people living with HIV need to be treated with ARVs but only 330,000 are currently receiving these life-saving drugs and of those the USA directly supports funding for 314,000. Antiretroviral treatment, ART, means that a person living with HIV can expect to live as long as their fellow countrymen who are HIV infection free.

We know that ensuring early and sustained access to ART for all those that need it will be a very significant intervention in the fight to reduce the growing numbers of new infections. So it is good to hear Blaser state:

the PEPFAR program in Uganda will review its programs to ensure that we prioritise treatment expansion to ensure all who need ART receive it

On July 5th Blaser stated that $425m will be given in Aid to boost Uganda’s health sector. This is more than 60% of the total Aid being given by USA to Uganda and is some 40% more than the GoU budget allocation.

That budget allocation is coming under increasing scrutiny. Blaser urges the GoU to increase the allocation to the 15% committed in the Abuja Declaration. Whether or not the country can afford to reach that target, it should perhaps be a little more circumspect before revealing that it spends some $150m to send VIPs overseas for healthcare treatment.

It is clear to me that fighting HIV is more than just about GoU budget or Aid from USA. That budget and Aid need to be used more effectively, we need to focus our attention on proven interventions that we know will work. Implementation will involve many different partners from all parts of the health sector and as Blaser says:

By working together, we can free Uganda from this terrible epidemic.  Let us all fight together for an “AIDS-free generation.”

KCCL, HIPS and IMF Project in Kasese – Case Study 2

By Clodagh:

Mr X lives in Kahendero and married 7 years ago. His two sons were born over the next two years, both of whom are HIV negative. Mr X had to leave the village and live in Kasese in order to earn enough money to support his family. During this time he reckons that his wife was “with many men”. His wife then left him after two years to marry another man and has subsequently had two children who are both HIV positive.

Mr X was tested at an outreach clinic 5 years ago and was found to be HIV positive. He is on ARV treatment and is doing well. According to him he would have been dead by now if it weren’t for the community project.

Communities Being Served – KCCL, HIPS and IMF

By Clodagh:

Kasese is in the West of Uganda and this programme is operating in communities on the shores of Lake George.

All three of the communities being served, which have an approximate total population of 10,000, suffer from extreme poverty. This is mainly due to their near sole dependence on small-scale fishing, the produce of which is sold in the local market. The local people are unable to afford large fish so the fishermen must catch small, immature fish. As well as being illegal, this may be putting the future sustainability of this activity at risk.

The simple fishing boats used in the area

Inhabitants of both Kahendero and Hamukungu are unable to farm the land as they are within the boundaries of Queen Elizabeth National Park. They are forbidden from growing crops by the park authorities and any cattle owned by the community members are under constant danger from predators such as lions. As a result the population survive on a diet almost solely comprising of fish.

Living conditions are poor with housing consisting almost entirely of small wattle and daub houses with one room per family. Most do not contain a bed and are only furnished with a couple of cooking utensils. Additionally, toilets are few and far between and the majority of the locals are forced to resort to the bush despite the obvious dangers from the park’s wildlife.

Typical housing in the area

Water is also a problem as many of the inhabitants of the community have no access to a fresh, clean supply and so they are forced to drink the lake water. This is the same water that is used for washing, bathing etc. and has lead to numerous outbreaks of diseases such as cholera, dysentery and typhoid.

All of the communities contain a primary school and Hamukungu has its own secondary school. Yet there is a major problem with absenteeism as many pupils go out fishing on the lake instead of attending.

The communities receive little other healthcare and any problem that can’t be dealt with by the project must be referred to Kagando or Kilembe hospitals. Yet this in itself can cause problems as the hospital can be up to 40km away from the patient’s house and many cannot afford the cost of transport. Even at these hospitals there is no access to facilities such as X-ray, scans etc.

This poor socio-economic status in the communities has lead to feelings of hopelessness. This, coupled with the boredom of small town life and lack of activity, has caused many to resort to alcohol. The resulting problem with alcohol abuse, in conjunction with the large number of sex workers in the area, has lead to an increase in HIV high-risk behaviours and therefore greater vulnerability to HIV infection. Additionally, it perpetuates the vicious cycle of poverty.

Map KCCL

IMF Working with Kasese Cobalt Company Limited: Update

Thanks to Carolyne for this update:

International Medical Foundation has been working with Kasese Cobalt Company Limited since October 2006 to provide basic health services to the poor living in three communities close to the KCCL facility in Kasese, West Uganda; Muhokya, Kahendero and Hamukungu.

This programme has been supported by Health Initiatives For The Private Sector, HIPS, a USAID funded project.

Together we have provided HIV voluntary counselling and testing to 4,151 adults, of which 638 tested positive. We have enrolled 467 onto our treatment and care programme and currently 161 are receiving anti-retroviral therapy, ART.

Those enrolled are able to have regular health checks, including a CD4 test which provides a clinical indication of the strength, or weakness, of their immunity system. When the CD4 count has fallen to a given threshold the client is then started on ART.

From time-to-time we are able to provide other health related support, such as these, which we were able to provide in 2011 thanks to the additional funds from HIPS:

Jadelle (long term family planning)

202

Safe medical male circumcision

308

Depo (short term family planning)

416

Mosquito nets for pregnant mothers

440

Mama kits for use during delivery

280

Sometimes of course it doesn’t work out and sadly in 2011, 17 of those enrolled on ART died from AIDS related conditions. These individuals joined our programme too late for the treatment to make a long-lasting impact on their infection. That’s why its important that we continue to conduct regular, community based, outreach in which we can provide health education and encourage people to come forward and be tested, before they start to feel sick.

The programme is, we think, a good example of how companies and agencies can work together, sharing cost, resources and expertise, to provide life-changing health services to those that need it most.