The Observer (Kampala)
Shifa Mwesigye
2 July 2008
He dreams of a HIV-free Uganda, a place where Karuhanga and Nalumansi can enjoy their love worrying about anything but the AIDS virus. "Tragedy," he likes to call it. But 20 years later and billions of dollars spent, his dream has not come true.
While Dr. Sam Okware, the Commissioner of Health Services in the Ministry of Health, is proud that the pandemic has come down from 30% in 1992 to 6.4% today, he also knows that the prevalence has stagnated and is going up in some places.
This was the dilemma facing the HIV/AIDS Implementers Meeting in Kampala last week.
But Dr. Okware thinks that if Ugandans came out and tested for HIV, then the spread of the virus could be controlled because those who know their status are three times more likely to protect themselves and their partners.
He knows that counselling and testing is only possible if people freely come out. People fear knowing their status because of stigma, discrimination, and violence attached to an HIV-positive result in many settings, particularly for women.
And as Ugandan participants discovered, Uganda has a long way to go in that direction.
During a presentation at the meeting, Roland Swai of Tanzania's Ministry of Health shared with participants his country's laudable experience in this area.
Tanzania launched a national testing campaign targeting political commitment. President Jakaya Kikwete was brought on board to encourage testing. He became the poster boy championing people knowing their status. Some of the posters show the casually dressed president and his wife taking the test.
Seeing their leader make such as 'bold' move, 3.2 million Tanzanians (8.4% of the country's population) jumped at the chance to know their status too. This number equalled the total population of Tanzanians who tested between 1990 and 2003.
"Leadership at all levels was essential for the success of the campaign. Leadership from the president, including their public testing, ensured high media coverage which encouraged people to test," Swai said.
When Uganda tried this move by making testing services available to Members of Parliament, less than 10 of the 333 MPs took the test.
And when push came to shove in Tanzania, creativity came to life. The Financial Times in April this year outlined a programme aimed at providing financial incentive to encourage people in Tanzania to 'avoid unsafe sex'.
The programme funded by the World Bank and the Population Reference Bureau aims at financially rewarding people who avoid unsafe sex and thus halt the spread of HIV.
The $1.8million trial - to be launched this year - will counsel 3,000 men and women aged 15-30 in southern rural Tanzania over three years, paying them on condition that periodic laboratory test results prove they have not contracted sexually transmitted infections.
Each participant will be paid $45 per year (Shs 75,600), money that is equivalent to a quarter of some of the participants' annual income.
After the three years, participants who are still negative would take the money and use it as they wish while those who are infected would get counselling and treatment.
The measure sounds tempting for those who live on less than a dollar a day but not tempting enough for the well-to-do.
To some people, the fear of sitting in that waiting room, heart skipping a beat every time the lab technician's door opens and going through the counselling before the results are given is nothing money can buy.
At one of their usual girls' night out in Buziga, one of the 25 year old 'corporate' girls suggests a group HIV testing; another wonders whether she's "stupid."
Yet another suggests that she already knows she is fine because she told the two men she 'messed' around with to take the test. Their results are her results. Whether they lied or not is beside the point. As long as they reassured her that she is fine, there's no need for her to take a test to reconfirm that she is actually fine - like she thinks.
One open minded girl points out that every pregnant woman is required to take a test; at least that is what she has been told.
"That is the only time I will ever take a test; until then, I don't want to know," she adds.
Only pregnant women take a compulsory HIV test in Uganda at some hospitals. Others require the partner to take a test too.
This is done for early prevention of mother to child transmission of the HIV. 25% of infections occur from mother to baby. If found positive, the mother is given nevirapine to minimise the chances of transmission at birth and during breast feeding.
The compulsory testing of pregnant mothers notwithstanding, only 10% of Ugandans are aware of their status.
"Despite funding, we will not catch up if we don't stop the new infections," said Dr. Kihumuro Apuuli, Director of the Uganda AIDS Commission.
During the implementers meeting at Imperial Royale and Serena Hotel, President Museveni announced that the US government has increased its Presidential Emergency Plan For AIDS Relief (PEPFAR) funding to Uganda from $236 million to $283 million (Shs 481billion). The Global Fund also committed $36.3 million.
But the meeting which attracted about 1,700 delegates ended in twists and turns.
Vehement anti-condom campaigner Janet Museveni jolted the gathering when she appeared to soften her stance against condom use as a way to combat AIDS, admitting that HIV is going up among unfaithful married couples.
"Faithfulness and abstinence is most effective, yet I have come to believe that it is in order for couples to use condoms," she said.
Her anti-condom stance, the First Lady said, had made her "unpopular among certain circles" but she insisted that would not "derail me."
The conference ended with the same conclusion it had started with; that HIV/AIDS is still a big problem. ARVs, President Museveni said, are making the problem even bigger, as people now perceive AIDS as a manageable chronic illness.
For Okware, the solution lies in more testing.
But as the 'corporate' girls group demonstrates, it is easier said than done.
The conference was a precursor to the International AIDS conference in Mexico in August, where the same research papers will be presented.
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