Africa, Development & Aid, Headlines, Health, Human Rights, Poverty & SDGs

HEALTH-UGANDA: Fight Against AIDS Faltering?

Joshua Kyalimpa

KAMPALA, Aug 9 2008 (IPS) - Uganda’s approach to the fight against HIV/AIDS is under scrutiny by activists. The country has won international acclaim for its 20-year campaign against the AIDS pandemic, but the latest numbers lead some activists believe Uganda is now losing ground.

Uganda managed to bring yearly growth in the number of new infections down from about 30 percent in the mid-1980s to around 6.1 percent in 2004, according to national surveys by the ministry of health. But progress, at least by this measure, has stalled: according to the Uganda AIDS Commission, the rate of new infections has risen slightly to 6.4 percent.

Major Rubaramira Ruranga, a retired officer of the Uganda People’s Defense Forces who has been living with HIV for over 24 years, says Uganda’s government is bowing to pressures from powerful faith-based organizations in the U.S. who emphasize moralistic approaches such as abstinence and fidelity at the expense of promoting safer sex practices.

“The issue of condoms which are very fundamental have been left out completely. The money goes to churches but unfortunately this money has specifically been designed for what I would call moralistic behavior and so I am not surprised that there is an upsurge of HIV in this country.”

Between 2004 and 2006, the proportion of funding for AIDS prevention in Uganda going to activities promoting abstinence and fidelity increased from 50 percent to 60 percent. Ruranga attributes this to a shift in funding policy under the Bush administration’s Presidential Emergency Plan for AIDS Relief, which requires a third of HIV prevention money to be spent on promoting abstinence.

There has been steady growth in the influence of religious organisations within the country as well. In 2007, health authorities launched an investigation into the link between purported spiritual healings by powerful Christian pastors and increasing infection rates. The head of the Uganda National Council for Born-Again Churches, Apostle Alex Mitala last year insisted some people have been healed through prayer, but says he encourages people to go to health facilities.

“I have been a preacher for 33 years now, so when I believed Jesus and when I started reading the bible I knew that Jesus said go into the whole world and preach the gospel and also heal the sick in my name. We pray for the sick people, some of them get healed and some don’t. And if they don’t get healed we refer them to hospital. You can’t impose healing on some body if some body doesn’t get healed where does he go? To the hospital.”

Last year’s investigation by the Ministry of Health came to nothing. Christians wield significant political influence in Uganda. The president’s wife, Janet Museveni, is a born-again Christian; one of their daughters is a pastor of a church that advocates faith-healing.

James Kigozi, spokesman for the Uganda AIDS Commission, a body set up by the Uganda government to coordinate efforts against HIV/AIDS, concedes that there are faith-based groups seeking to influence polices, but insists Uganda has remained firm on all three aspects of the ABC strategy, Abstinence, Be faithful and Condoms.

He says that all the approaches receive due attention because AIDS prevention in Uganda is funded by a range of sources with different priorities. “There is a group, especially from the American community who has been funding initiatives that are basically faith-based in approach. They are stressing the approach of abstinence and being faithful. They wouldn’t promote any other initiatives and they had a lot of backing from certain quarters in this country. But in the Ugandan response, no single person can influence the response so much that other initiatives are not taken on board.

“The AIDS commission still promotes ABC as a strategy. In fact we are talking of ABC plus, because there are new initiatives that have come on board like medical male circumcisions, like anti-retroviral therapy, like increased voluntary counseling and testing and empowerment of women.”

Ruranga, who belongs to the National Guidance and Empowerment Network of People Living with HIV in Uganda, believes the international community is deliberately turning a blind eye to growing flaws in Uganda’s policy because they still want to tout it as a success story and justify continued millions being spent on HIV/AIDS programmes here.

“People in the communities are still having a lot of problems. People are still dying, even if drugs are there. There is not sufficient education about these drugs and so the problems are still very big. Many other people have come in religious institutions come in others says they can heal HIV, others have become very condemnatory. You find these new sects, saying people should not use condoms that condoms are not accepted and they should not even be promoted. There are what I would call conflicting messages that are going around.”

Kigozi says Uganda’s challenge is that over time its HIV prevention programme – built on open public acknowledgment of the pandemic and boosted by the participation of celebrities like HIV+ musician Philly Bongoley Lutaaya – has lost some of its power as complacency sets in among the population.

He says Uganda has developed a new national strategic plan to guide the fight against HIV/AIDS which involves locals to a greater degree than in the past. “We already have a collection of ideas from the grassroots. We can no longer plan anything at the national level without getting the involvement of the local communities. At the end of the day, that is where the majority of our people live.”

The campaign to prevent new infections is of course only part of any strategy. Dr Steven Watiti, senior medical officer with HIV treatment centre Mildmay International in Kampala says Uganda’s effort in the fight against the disease is also failing to adequately care for people living with HIV.

“Out of 1.2 million people who have HIV, 350,000 should be on ARVs. Now the figures we get from the ministry of health are that only about 150,000 people out of 350,000 are actually getting ARVs. But most people who need these drugs in Uganda are not getting them.”

According to the latest figures from UNAIDS, for every three people who gain access to ARV’s in Uganda, there are 5 new infections. If these findings are anything to go by Uganda’s much acclaimed HIV success story will rapidly evaporate.