By Alex Taremwa
On the 1st of December, Uganda will join the international community to mark the International World Aids Day, a day when unity and support is accorded to people living with the incurable virus and commemorating those who have died of the same. As one the districts labeled as high risk of infection areas, Mbarara District was selected to host this phenomenal event with the theme “Getting to Zero.”
Where Mbarara District in as far as HIV/AIDS is concerned?
Mbarara District is located in the South Western Uganda. It is located at a surface altitude of 1800metres above sea level with a surface area of 1846 square kilometers. The District is made of two countries and one Municipality, 14 Sub-Counties and 3 divisions, 77 Parishes, 6 wards, 716 villages and 52 cells in the Municipality and it is served by 5 Hospitals, 5 HCVs, 11 HCIIIs, 34HCIIs and over 250 primary schools. The District population stands at 457,950 with an average growth, rate at 2.9%
The threat from HIV/AIDS remains acute countrywide as over 2 million people have been infected since 1982. Every day, about 300 cases are reported daily amounting to an undisputed 130,000 infections annually.[i]
In Mbarara alone HIV/AIDS contributes to at least 9.1% of the total disease burden as its prevalence in people aged between 15-49 is estimated to be between 5.9-6.1 in 2005-2011 respectively.
Mostly the urbanites suffer much of the problem as shown by a Research on HIV/AIDS that has been conducted in three hotspot areas of Kijungu, Nyeihanga and Ruti in Mbarara that showed that the prevalence is at 12.6 per cent two times higher than the general prevalence in the district at 6.1 per cent and far above the national prevalence of 7.3 per cent.
Their rural counterparts on the other hand have their prevalence estimated between 2-3%, 8% in pregnant mothers and in every 100 new born babies, at least 1-3 are born with the virus in the district where at least 60% of the total population know their HIV status.
If the trend isn’t reversed, it’s projected that within a period of 5 years, there is likely to be 700,000 new HIV infections and at least 250,000 in new born babies countrywide.
According to Dr. Umar Masereka a lead HIV/AIDS Focal person for Mbarara District who also is the District Health Inspector, the rise in the prevalence of HIV/AIDS in the district and nationwide at large can be attributed to three major factors:
- Limited Focus on Sexual Behaviour
- Reduced solidarity and commitment amongst stakeholders
- Lack of a direct communication for behavioural change.
Masereka told Daily Monitor that the key drivers behind the rise of the epidemic in Mbarara are most geographical and cultural in nature.
“There are some of the busiest spots in the district with many bars and lodges and are frequented by trans-boundary travellers. Kizungu in Kakoba Division has many bars and lodges patronised and frequented by prostitutes, Ruti suburb in Nyamitanga Division is a station for truck drivers on long routes to DR Congo, Rwanda and Burundi whereas Nyaihanga trading centre located about 30 kilometres on Mbarara Kabale-road is frequented by local and international coffees, fish, sand and matooke traders,” he told Daily Monitor in a recent interview.
Where in Mbarara can one get HIV/AIDS services?
Unlike other areas, Mbarara is sophiscated in as far as accessibility to HIV, Counseling and Testing (HCT) services are concerned. In the entire district, at least 5 Hospitals, 4HCIVs, 12HCIIIs, 14HCIIs and 8 NGOs Health units offer counseling and testing services.
In addition to the above listed, people can also access ART services from 5 Hospitals, 4HCIVs, HCIIIs in Nyakayojo, Mwizi, Ndeija, Bukiro, Biharwe Kagongi, Rubaya, Bubaare, Rubindi Kakoba and Nyamitanga.
However not all the above mentioned offer ABC plus (HCT, PMTCT & Safe Male Circumcision services). In fact a research conducted in 3 key hotspot areas in the district by the Makerere University School of Public Health indicated that of the 245 respondents; 78, 87 and 80 in Kijungu, Ruti and Nyeihanga respectively, only 33% are circumcised whereas at least 62% were willing to get circumcised had they had access to the services.
The study also shows that of the respondents interviewed in the three Priority Prevention Areas (PPAs), 82% of them had good knowledge of where to go for an HIV/AIDS test and that indeed 76% of them actually taken at least a single test in the last 12 months.
Despite this sophiscation, Mbarara District faces challenges ranging from inadequate funding, derailed condom use and growing transactional sex ignited by the large urbanisation that transpires in the Central Business District.
According to a Makerere Joints Aids research Program (MJAP) on Mbarara, 29% of the respondents interviewed had ever received a gift or favour in exchange for sex, 26% had received help with expensed in exchange for sex, at least 24% had ever received cash in exchange for sex and at least 32% had ever paid cash for sex.
Whereas condoms are an inseparable component of an HIV/AIDS prevention mechanism, they are increasing becoming unpopular amongst the sexually active Ugandans with some claiming they are inefficient while others say they Uganda has taken a step in the right direction in attempt to cub the raging virus. But the question is; have we?
68% of the sexually active respondents interviewed confessed to using condoms occasionally whereas 21% confessed to not using condoms at all. Only 11% of the respondents agreed to having used a condom consistently and correctly every time they had sex.
When asked if accessibility to condoms was the reason for the inconsistent use of the protective mechanism, 84% of the respondents declined saying that it was easy for them to get a condom with only 18% of the sexually active respondents accepting that indeed condom access to them was a very big challenge.
One of the respondents Akampwera Kenneth who consented to an interview with the Daily Monitor said that condoms reduce his effectiveness in bed rendering him boring and irrelevant to his partner.
“There are some sex styles that one just can’t do with a condom on. I would rather be faithful that go in with rubber,” Kenneth said.
Other challenges that the district faces in terms of fighting HIV/AIDS are;
- Lack of focused programmes for youth in and outside school (secondary schools)
- Low male involvement in the PMTCT programmes.
- Increasing members of OCVs, Vs decreasing numbers of funders.
- Inadequate funds to fill gaps in the HIV/AIDS response
- Lacks of CD4 machines in the rural counties.
The key district focus is to a zero HIV baby infection somewhat related to this year’s World Aids Day theme “Getting to Zero”. And according to the District Health Officer Dr Amooti Kaguuna, strategies have already been designed on how to achieve this grand long term plan.
Among these are; strengthening PMTCT by recruiting more personnel in the health sector, scaling up HCT services to at least all the Parishes in the district, designing campaigns for male involvement and increasing accessibility to condoms through effective consistent supply of condoms to community outlets.
The district also plans to improve efficiency and effectiveness of HIV/AIDS service delivery by improving logistics management, strengthening and scaling up the school based and student led HIV/AIDS initiatives in addition to strengthening treatment and management of HIV/AIDS including ART up to Health Centre III and establishing a comprehensive care system for children with HIV/AIDS.
Dr Amooti also added that he believes that strengthening home based health care services for people living with HIV/AIDS, economic empowerment of people living with HIV/AIDS through agriculture, provision of economic and material assistance to people affected and infected with HIV/AIDS, strengthening district capacity to co-ordinate, monitor and effectively respond to the HIV/AIDS pandemic are key bottlenecks to achieving the district objectives although the district hasn’t accumulated enough resources to undertake them at once and it’s looking up to donations to implement them.
“But by and large, the district is doing well. We just need to consolidate our gains so far and strengthen Quality and access with special focus on prevention and systems strengthening,” Dr. Amooti said.