Uganda's move to integrate HIV services into general outpatient departments (OPDs) is being hailed as a step toward more efficient health care--but it also raises questions about patient rights, privacy, and equity.
The shift comes after recent funding cuts to standalone HIV programmes, prompting the government to merge HIV prevention, treatment, and care with general outpatient services.
Previously, HIV-positive persons had special places at health facilities with their special days of picking drugs.
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However, they now access HIV services alongside sexual and reproductive health care, non-communicable disease management, and other medical services at a single service point.
Health officials and citizens have welcomed the integration as a way to sustain Uganda's HIV response and strengthen the broader health system.
However, civil society organisations warn that without strong safeguards, integration could inadvertently increase stigma and discrimination.
Nyasha Chingore, Regional Advisor on Human Rights and Law at UNAIDS, emphasised that integration must prioritise people over systems.
"Non-discrimination and equity must guide this transition. Integration must confront inequality, not conceal it," Chingore said.
Community advocates also raise concerns over operational challenges.
Moses Nusbuga, known as "Super Charger," highlighted long waiting times for patients, while Dr Augustine Kubanga, National Medical Director at AHF Uganda Cares, pointed to hospital congestion and service flow issues.
At district level, Azizuyo Brenda of ICWEA noted minimal supervision in hard-to-reach facilities and reports of unofficial payments.
Confidentiality remains a critical issue. Shared waiting areas and medicine dispensing points can increase the risk of involuntary disclosure.
Civil society groups recommend discreet numbering systems, stronger data protection, and enhanced staff training on patient privacy.
In response, a coalition led by the Centre for Women's Justice convened 20 national and local organisations to document rights violations and propose minimum human rights standards for integrated HIV service delivery.
Immaculate Owomugisha, an organiser, explained, "Our goal is to ensure that integration aligns with dignity, confidentiality, gender equality, and meaningful community participation."
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While integration promises cost savings and system efficiencies, experts stress that success will depend on balancing operational reform with rights-based safeguards.
Stakeholders emphasise that improving access should never come at the expense of dignity, privacy, or equity.
