17 February 2016

Uganda: Why the Next Ugandan Government Should Focus On HIV

Photo: Daily Monitor
As Ugandans go to the polls, the Uganda Communications Commission says they have blocked social media platforms over security concerns.

It's a sunny afternoon, and the wind is blowing very hard, as hundreds of residents of Katakwi District flock to Katakwi Sports Grounds, the venue for a campaign rally of one of the presidential candidates.

Among the people going to listen to the campaign message is Samson Ekusai, who is living with HIV.

"I have come here so that I can hear for myself what this candidate has to offer for me, as a person living with HIV," he says. "We normally experience antiretroviral stock outs in health centres and also the distance from my village to the nearest facility offering antiretroviral therapy is very long. I have to spend money to travel monthly.

"I will vote for a candidate who will promise to ensure continuous antiretroviral stocks in health centres, and bring them to the health centre near my village," Ekusai says.

Manifesto pledges

As Ugandans gear up for the 2016 general election, HIV is a hot issue. With declining standards of healthcare in the country, people infected with or affected by HIV are likely to be attracted by a candidate or a party with a promising manifesto: one that gives them hope. But do any actually offer this?

The ruling National Resistance Movement (NRM), whose thirty year rule in Uganda is being challenged by seven other candidates, has pledged to increase availability of drugs in health facilities, increase the HIV awareness campaign and access to antiretrovirals.

The manifesto of the leading opposition party, Forum for Democratic Change (FDC), does not specifically mention HIV but says: "FDC-led government will increase remuneration of health workers, invest in the national and regional referral hospital system; establish a national health insurance scheme for all citizens who do not have insurance from private health service providers or work-based insurance scheme."

Go Forward/TDA(U) is led by John Patrick Amama, president Yoweri Museveni's close associate for over a decade and a former prime minister. It pledges affordable medical insurance for all - but whatever that means remains a mystery.

The smaller parties - including the Independent Coalition, led by Joseph Elton Mabirizi, and People's Development Party, led by Dr Abed Bwanika - do not mention anything to do with HIV, although they do promise to introduce free healthcare schemes.

If these manifestos are anything to go by, people living with HIV need to demand clear answers from these candidates on how they plan to address HIV if they are elected into office.

Increase in prevalence

Despite the fact that new infections have declined over the past three years, latest estimates by Uganda Aids Commission show that 380 new infections still occur daily. This means that annually, 138,700 new infections are added to the 1.6 million people already living with HIV. These statistics, according to Uganda Aids Commission, make Uganda the third leading contributor of new HIV infections in Africa, after Nigeria and South Africa. Concerted government efforts should be geared towards people who are the most vulnerable to the disease.

The Ugandan government had expressed its commitment by increasing the budget allocation to the health sector to 1.28 trillion Ugandan shillings in 2014/15, according to the briefing paper by the Ministry of Finance, Planning and Economic Development. However, the allocation reduced by 4.7 per cent in 2015/16 to 1.2 trillion, despite the fact that the health allocation covers the Uganda Aids Commission's budget as well.

It is also noted the sector allocations as a proportion to the total budget decreased from 8.9 per cent to 7.9 per cent, way below the Abuja declaration target of 15 per cent. The low funding is going to have a heavy toll on the HIV sector as it is projected that by 2020, the number of people living with HIV will have increased.

Impacts of HIV law

In 2014, the Ugandan Parliament passed the HIV Prevention and Control Bill 2010 into law. The law includes mandatory HIV testing for pregnant women and their partners, and allows medical providers to disclose a patient's HIV status to others. It also criminalises HIV transmission, attempted transmission, and behaviour that might result in transmission by those who know their HIV status.

"That law will have a negative impact on the HIV response as people shy away from prevention, treatment, care and support services. This may increase HIV prevalence", said Stella Kentutsi, executive director, National Forum of People Living with HIV/AIDS Networks in Uganda.

Homophobia on the increase

In Uganda, homosexual acts are illegal and punishable by prison sentences of up to 14 years. In 2014, parliamentary speaker Rebecca Kadaga sought to approve a controversial anti-gay bill that introduced the death penalty for some offences. This was thrown out of the constitutional court on grounds of lack of quorum but, ever since the bill was tabled by David Bahati in 2009, homophobia has been heightened in Uganda.

Due to the criminalisation of same-sex relations, men who have sex with men are often fearful of being tested, in case they have to disclose their sexual orientation. This leads to HIV being transmitted more easily and rapidly among this vulnerable group. They also face homophobic stigma and discrimination from all levels of society.

None of the presidential candidates or their manifestos mention anything to do with lesbian, gay, bisexual or transgender community. When the bill is re-tabled, one can't help but wonder if it will incorporate important issues aimed at improving access to HIV services for this at-risk population, which is central to reducing HIV transmission in Uganda.

As Uganda gets ready to vote, is vital that the next president should be able to address HIV and not just window dress it.

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