Dizzy and sweating, 25-year-old Kevin Amoding sits with her eyes closed in the HIV clinic, as her tiny little daughter begins to cry. She walked three kilometres from her village to Asuret Health Centre III and has spent the last 10 days here, in the hope of checking her CD4 count.
The tired looking Amoding badly needs to have her blood taken for a routine CD4 count - a test that measures the health of her immune system. However the clinic cannot provide the test as its only CD4 count machine was recently stolen, along with a microscope.
Amoding is one of 4,391 people living with HIV who access care and treatment at this health centre. "I have been coming here since a fortnight ago to test my CD4 count but the health workers just counsel us and tell us to try to come next time just in case a replacement has been brought."
If Amoding opts to travel to Soroti Regional Referral Hospital, 20 kilometres away, she will have to pay for a taxi to take her there. It costs US$4 for a journey to and from the hospital, a cost she can't afford.
The theft of the count machines means health workers are unable to monitor the effectiveness of the antiretroviral treatment in this rural area. Hundreds of clients who were supposed to have been tested have missed out since the machine was stolen.
"Over the last nine days, more than 400 HIV patients who were due for CD4 count test missed out," said a nurse at the clinic.
CD4 machines save lives
When a person is diagnosed with HIV, monitoring their CD4 count is vital to helping them stay healthy. The current HIV treatment guidelines recommend that care providers order a CD4 test every three to six months when a person who has been diagnosed with HIV starts antiretroviral treatment, to see how well they are responding.
If a person living with HIV has chosen not to start treatment for the moment, then keeping an eye on their CD4 count will help that person and a doctor assess how safe it is to continue without treatment. For example, if the CD4 cell count is 200 or below, the person is at risk of developing serious illnesses and infections.
The theft of the CD4 count machine comes at a time when local health workers are warning that HIV is on the rise in the district. Martin Amodoi, Soroti district health educator, said the theft of the CD4 count machine is a big blow to the HIV response. He noted that HIV prevalence has risen from 4.3 per cent to 6.2 per cent since 2005.
Lax security blamed
Calvin Elenyu, chairperson of Local Council Three in Asuret sub-county, suspects that the theft of the equipment could be an inside job. "Local residents can't steal the machines because they don't know how to use them," he said.
He wonders how thieves could target the clinic when there is a police post about 30 metres away. Elenyu blames those in charge of the health centre for lax security, saying a solar-powered system used to run office computers and some electronics were stolen from the same clinic in March.
Two members of staff at the clinic have given statements to the police about the theft. Juma Hassan Nyene, East Kyoga police spokesperson, has confirmed someone had been arrested, in connection with the theft.
It is not the first time a CD4 machine has been stolen in Soroti. In 2012, another machine was stolen from Uganda Cares, a partnership to improve access to treatment. It was discovered under the bed of the hospital security guard who worked for The Aids Support Organization (TASO). Seven suspects were arrested in connection with the theft of the machine, including the guard, but the case did not come to court.
How can thefts be stopped?
According to police, the theft of life-saving equipment like CD4 count machines can only be stopped by ensuring that health centres are secure. "By adequate security, we mean having trained security guards working 24 hours a day and having a fence around the health facility. Without that, expect no miracles," said Nyene.
But some analysts believe that low wages paid to health centre workers, along with the booming business of providing health services for a fee, are also contributing to the thefts.
Benson Ekuwe, executive director of Public Affairs Centre of Uganda, a civil society advocacy group, said: "So many people have opened medical clinics which don't have adequate medical equipment, so they are ready to buy any which is available.
"The people working in those health centres are poorly paid, so they take advantage of lax security to steal without knowing they are putting the lives of people living with HIV at risk."