Pabbo/Amuru — Internally displaced people in northern Uganda face a difficult choice - whether to return to their ancestral villages or stay in camps hoping for better access to healthcare, as antiretroviral (ARV) drugs are in short supply.
"Going back to the village to me means committing suicide because the village health centres do not provide us ARVs - they are constantly out of drugs," said Bosco Opiro of Pabbo, a former IDP camp in Amuru District.
Opiro said his village of Lalem, also in Amuru, had no health centre; he and other HIV-positive people in the camp have chosen to remain in Pabbo and continue to collect their ARVs from the health centre in town rather than go back to Lalem.
According to the Internal Displacement Monitoring Centre, since the 2006 cessation of hostilities in northern Uganda between the rebel Lord's Resistance Army and government forces, more than 90 percent of the region's 1.8 million IDPs have returned to their areas of origin or have resettled in new locations. Only about 182,000 IDPs were still in camps or transit sites as of December 2010.
The UN Office for the Coordination of Humanitarian Affairs has reported a lack of basic services, including healthcare, in areas of return.
But according to a local health worker, who preferred anonymity, even IDPs choosing to remain in camps often lack HIV medication. The health worker said in Pabbo sub-county alone, 538 HIV-positive patients had not received ARVs for months; at least 89 patients are bedridden due to opportunistic infections and six have died.
Supply chain problems
Patrick Odong, the district health officer for Amuru District, told IRIN/PlusNews one of the major problems with HIV management both in the camps and in towns was the irregular supply of drugs by the National Medical Stores.
However, Zainab Akol, AIDS programme manager in the Ministry of Health, said the fault often lay with the districts.
"The main problem is that these people wait until everything is finished in their stores and then they place their order [with the National Medical Stores]," she said. "Right now we have stocks at the medical stores so if they don't order, it causes supply problems for the patients."
Problems in the supply chain have also led to recent condom shortages in the north, hampering HIV prevention efforts.
No drugs at home, no drugs in town
"I am no longer taking ARVs. This is the third month because the health centre in Pabbo that provided the drugs said they are out of supply," said Patrick Komakech, who was coughing violently and complained of fever and loss of appetite.
"When I was taking ARVs I was feeling better, but now I feel very sick and weak - I don't eat well and most of the time I am in bed," he added.
Komakech said IDPs could not afford ARVs in private pharmacies, where a month's supply costs about US$52.
In the neighbouring districts of Nwoya and Oyam in Lango region, patients who have gone to their villages say they have to walk very long distances to collect their ARVs.
"I collect my drugs from Anaka Hospital, which is more than 8km from my village in Koch Lii," said Ocen Lakwo, who cycles to the centre even when he feels unwell.
Lack of training, health workers
At the Ongako Health Centre in Gulu District, a nurse who preferred anonymity said the centre was ill-equipped to handle HIV patients or dispense prophylactic ARVs to HIV-positive expectant mothers. "The situation is worrying but what can we do, the best I can do for these mothers is to help them deliver," she said.
"As far as I know, we have not done counselling and voluntary counselling and testing for either the pregnant women or patients here," she added. "We feel sorry for the patients but there is nothing we can do."
Amuru's Odong said many rural health centres lacked the capacity to handle HIV-positive patients.
"A number of displaced patients have returned to their village without health centres where they can access their treatment," he said, adding that his own district did not have enough health workers to go around.
According to the 2005 Demographic Health Survey, HIV prevalence in northern Uganda is 8.2 percent, higher than the national average of 6.2 percent. Urban areas in the north, where many IDP camps were located, have even higher levels of HIV - prevalence in Gulu District for example, is 11.9 percent.