New Vision (Kampala)

14 December 2012

Uganda: HIV Eating Up Islands and Fishing Communities

Until World AIDS Day on December 1, New Vision will publish HIV related stories daily. Today we explore some of the landing sites and islands in Uganda that have been hit by the HIV virus

Elizabeth Namulindwa sits on a bench in a corner of the only healthy facility in Koome Island in Mukono district, covering her face with a handkerchief. The visibly weak and tired HIV -positive woman in her mid-30s weeps uncontrollably as she narrates her ordeal.

"I was advised to come here to have my blood sample taken for a CD count test. This is my third visit without getting any help. I live on Kiimi island, 30km away, and I travel on water for four hours to get here," she says.

"It is getting late and I am in a rush to catch a boat to go back. The boat leaves at 3.00pm and if I miss it, I will be in trouble because don't have money to book a lodge here. We don't have a single health facility in Kiimi Island, not even a drug shop." Namulindwa laments.

The only alternative Namulindwa is left with to get treatment is at hospitals on the mainland like Mulago, Nsambya or Kisubi. Enoch Kasule, who came to Koome island 10 years ago, confesses that he acquired the HIV virus there. He also cannot access anti-retroviral drugs.

He previously used to buy ARVs from a doctor at the mainland, but he cannot afford them anymore. Kasule is amazed by the fact that one can access free ARVs. But his efforts have been futile since there are no health centres on the island.

He says organisations are reluctant to extend essential services like support, care and treatment for those living with and affected by HIV/AIDS. Kiimi Island located in Koome sub-county, Mukono district, lies on 79 acres of land on Lake Victoria and the only means of transport to and from the island is by water.

It takes five hours to travel by boat to the mainland at Ggaba or Kasenyi landing sites. The island is in a sorry state with few social services from the Government or nongovernmental organisations.

It is a concentration camp for thousands of people living in a slum comprising of shanty structures made out of papyrus and wood.

There are two camps on the island; Kiimi Kachanga and Kiimi Banga, which comprise of a mixture of tribes. According to the LC1 chairman, Gerald Kizza, there are over 4,000 people in both camps and the HIV prevalence is estimated at 75%.

Out of 20 people who are tested, 16 of them were found HIV-positive, according to a survey done by the Seventh Day Adventist church.

"The main source of income is fishing, but the men spend the money on alcohol and sex. The women engage in food vending and commercial sex to earn a living. One of the main reasons why HIV/ AIDS is spreading rapidly on the island is because the community consider the use of condoms a taboo, arguing that it is like eating a sweet in its wrapper." Kiiza says.

Christopher Kato, a volunteer health worker, says despite the high HIV/AIDS prevalence in the fi shing communities, the Government has not done much to help them fi ght the disease.

"None of the many HIV/ AIDS support organisations operating countrywide has focused on the fishing communities." Laments Kato. In Katosi a landing site also located in Mukono district at the Lake Victoria shore, HIV is spreading more rapidly than in the other fishing communities.

Emmanuel Sengendo, who has lived on the Island for the last four years, was also diagnosed with HIV and started taking ARVs at Kojja health centre about 20 kilometers away.

But, for the last one month, he has gone without medication because the health centre has not had drugs for more than two months now. He moved to almost all clinics and health centres but they all tell the same story that drugs are out of stock!

Sengendo's doctor referred him to Kampala with the hope that he could fi nd help, but even here, his woes were not over. He is told there are no drugs for him and yet the disease is advancing.

"Many of us here have no treatment now, this situation is unbecoming," he cries. In Katosi, the HIV prevalence average is 13.7%, according to Kyetume Community -Based Care Programme, 2008. The national prevalence average is 6.7%.

Atereire Jane, a midwife and proprietor of Katosi Maternity and Child Care, says the prevalence is going up because there is no behavior change.

"People here are still reckless with their lives. Five men can compete to sleep with a woman fi rst. Whoever has more money sleeps with her first and the rest also make sure they sleep with her.

They can either pay for live sex or protected sex," says Atereire. She says people keep on coming from the island and from other places to buy sex.

Both adolescents and married men compete for sex. For sex workers, if there are no customers or the customers are few, they proceed to other landing sites.

Kiimi, Koome and Katosi's lifestyle is representative of the many other fishing communities in the country, especially on the main lakes like Lake Victoria, Lake George and Edward, Lake Kyoga, Lake Albert and the Albert Nile.

The HIV prevalence rates are so high (more than three times higher than the national average). The living and working conditions in these communities have contributed to the spread of HIV.

24% of fishers on Lake Albert were HIV-positive in 2008, compared to 4% in nearby agricultural villages. In Kasenyi (Lake George), 81% of the few people who were able to access voluntary counseling and testing in 2008 were found to be HIV-positive.

Contributing factors

Numerous factors contribute to the vulnerability of fi shing communities to HIV/AIDS, these include men and women living away from their spouses people living in remote locations and fi shers moving from one landing site to another.

Atereire says fishing is a hard and dangerous work dominated by men and they reward themselves by drinking and having sex. Lack of savings culture is also a contributing factor.

Atereire adds that fishing at night and redundancy during the day has increased the sexual vulnerability of men and women. The ratio of men to women is higher at the landing sites so women are considered inferior to men.

"Fishing communities have also been neglected in the provision of a wide range of services like schools, electricity and health clinics to good roads and safe drinking water.

Only 20% of the communities on the lakes have access to improved sanitation and frequent outbreaks of cholera and dysentery were reported," says Atereire. She also says there are no savings facilities at the fishing communities which, could alleviate poverty.

Fishing communities have poor standards of living compared to other communities. With around 1,500 landing sites on Lake Victoria and over 600,000 people working in fisheries at the beaches, HIV is more likely to spread in this kind of environment.

Atereire suggests that some of the advocacy issues should include getting health facilities in these communities that are able to carry out medical check ups and counseling regularly. The health facilities should also be able to sensitise the youth on HIV/AIDS.

There should also be improvement of access to savings and credit facilities and empower women in fishing communities.

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