14 June 2017

Uganda: Cultural Leaders Take Over VHT Role to Fight HIV in Karamoja

The HIV/Aids spread in the Karamoja region was minimal in the last decade. However, in the recent past more cases are being registered due to increased consumption of alcohol and resultant unprotected sex, stigma and poverty.

This has prompted district health workers and NGOs working in the area to lobby elders to join the efforts to curb the rising cases the HIV/Aids. Stella Nakiru from Kalapata village, Kaabong district has been living with HIV/Aids for the last four years; a disease she insists she does not know how she contracted.

"This came as a shock, when an NGO came to our village and was persuading people to have a voluntary test, jokingly, I gave it a try, but out of the blue I was told I'm HIV positive. I did not believe it," she said. "After a month, I decided to go to Kaabong district hospital, where I repeated the tests but still the nurse confirmed I was HIV positive. That is my status up to now and I have decided to live with it."

The 21-year-old mother-of-three explained through a translator that after being counseled by health workers at Kaabong hospital, she was given HIV drugs, which have become part of her daily life.

"There is a lot of stigma and discrimination here; people whisper a lot about us on drugs. Sometimes I hide when taking the drugs. It becomes hard when a visitor stays at our single roomed house overnight; in fact, sometimes I do not get a chance to take them," she said.

Nakiru also said sometimes she fails to get her ARVs in time from the hospital because of the distance.

"The distance to Kaabong is about 20Km from here and I can't afford going there every two weeks as the doctors told me, to go and check my CD4 count which had dropped due to the irregular use of drugs; I can't afford so, once in a while I miss," she said.

Nakiru mostly depends on elders who come to counsel her and bring her drugs from the hospital. At Kaabong district headquarters, I meet Muria Adele Adupa, an elder. She looks very weary, because she had just rode 15Km on a bicycle to meet some of her 'patients' in their homes.

She says the community elders could not just sit and watch HIV/Aids patients suffer from stigma, hunger and discrimination; they joined hands and formed a group that visits the sick on a daily basis.

"Me together with other elders move to homes of those affected by HIV/Aids to give them hope and also ensure that they take their drugs; people here fear taking their drugs because of stigma," she said.

She explained: "We don't have many village health teams (VHTs) or nurses that visit the community, so working with Kaabong district officials and nurses and other organizations like UN Women, we also empower women."

Adupa said HIV/Aids has led to domestic violence, especially if the husbands don't know their status yet their wives are taking ARVs on a daily basis. The 48-year-old mother-of-eight said most people, like Nakiru, are not aware how the disease is spread and counselling is what she does on a daily basis.

"As leaders we intervene at different levels; this region has high rates of forced marriages, widow inheritance and even wife sharing. It is our role to intervene and try to settle some cases outside courts," she said.

Martin Ninsiima, the communication and advocacy officer at UN Women, said the organisation is working with local organisations and leaders to have programmes that ensure that women and girls get medical services in time, and are empowered economically.

"UN Women, Irish Aid and Action Africa Help-Uganda (AAH) are working together to implement the Karamoja Economic Empowerment Project (KEEP) whose aim is to see that people in the region make some income," he said. "The scheme supports young women and young girls living with HIV and Aids, as well as persons at risk of the virus, to carry out practical economic activities and progress in their health and wellbeing."

Ninsiima said UN Women has over the years worked to realize efficient and effective national systems for prosecuting cases of violence against women by strengthening the capacity of the Karimojong cultural leaders.

"Cultural leaders have been trained on gender and HIV with the aim of increasing equitable gender attitudes, improving understanding of HIV transmission and prevention, and the role of gender relationships in the context of Women Living with HIV," he said.

Betty Acen, a legal officer at FIDA Moroto branch, said cultural leaders are used to solve cases such as widow inheritance, which can also lead to the spread of HIV/Aids.

"Apart from providing mobile legal clinics in the region, we use cultural leaders to solve cases of child neglect, early marriages, domestic violence and alcoholism; we believe taking the fact that they are here to stay, they have influence in the society," she said.

Leaders' take

Moses Oreka, the acting Chief Administrative Officer of Moroto district, said the district is working with cultural leaders through different programmes initiated by the district.

"Through cultural leaders, our women are trying to be organized; for instance, we have Village Savings and Loan Associations championed by women elders. We believe women who are economically empowered will be able to take ARV drugs regularly," he said.

Charles Otoi, the CAO Kaabong district, said they are working with UN Women to train 10 groups of women and girls on financial literacy.

"Our target is the HIV/Aids patients spread out in Kaweya, Kapedo and Kaabong town council for the start. These elderly women and men help solve gender violence and do counseling for the sick. We really appreciate them," he said.

Although cultural leaders have been praised as having perfectly taken over the duties of VHTs, HIV counsellors and social workers in the Karamoja sub-region, district leaders say they are not paid for their services.

"We do this on humanitarian grounds; no one pays us. It is only organizations such as UN Women and Irish Aid that give us facilitation. Our cry is that government also facilitates our movements," Adupa said.

Oreka also said that Moroto district has financial constraints, which make it hard to facilitate cultural leaders.

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