STI and HIV in Uganda - Essay Example

?STI/HIV in Uganda Surveillance and Monitoring Cognizant of the HIV/AIDS threat – characterized to be both a crisis and systemic condition – that is posing against African communities (Poku and Whiteside 2004, xvii), the Uganda government, together with NGOs/civil society institutions, urgently prioritized and acted directly and openly on reducing HIV/AIDS prevalence in Ugandan communities (UNAIDS 1995, 5; Mukaire et al. 3002, 1). By 1986, Uganda had been one of the first African countries that collaborated with the World Health Organization [WHO] in drafting its own national aids control program consisted of 13 AIDS control programs (Alwano-Edyegu and Marum 1999, 7). The government and the Ugandan citizens’ combined efforts, supported by international organizations have paid off well, with Uganda today as the sole country in the world to have reduced significantly HIV sero-prevalence rates, specifically among young adults (Konde-Lule 1995, 31; World Bank [WB] 1999, 92; Boerma et al. 2000, 7; Hogle et al. 2002, 2; Green et al. 2003, 7-8; Bertozzi et al. 2006, 331). What made this possible can be gleaned from the results of Uganda’s surveillance1 and program monitoring,2 which have been proven effectively useful to Uganda’s campaign against HIV/AIDS in two important ways: First, these have provided “reliable data on the magnitude, trends, and distribution of HIV infection and AIDS disease… provid[ing] the basis on which to design and implement effective interventions” (Okware et al. 2001, 1115); second, these have shown that Uganda’s success is attributable to a combination of different factors, most notably, the significant reduction in multiple sexual partnerships as a result of a broad-based non-electronic behavior change communication, a strong political leadership with active multi-sectoral response (Hogle et al. 2002, 3-5, 9-10; Okware et al. 2001, 1113), and a combination of focused programs (e.g. Voluntary Counseling and Testing program [VCT], programs that identify and treat STIs, special programs for high-risk groups, and a good donor support) (Green et al. 2003, 9). Uganda’s surveillance and monitoring activities follows WHO’s Prevention Indicators, which essentially focus on awareness building (knowledge of disease and preventive practices), change in sexual behaviors (use of condoms, sexual relations with regular partner), support mechanisms (condom availability, effective treatment and management of STD cases), and documentation/reporting of STD/HIV cases (incidence of STD in men, and prevalence of STD/HIV in women) (Monitoring and Evaluation n.d.). As such, Uganda’s surveillance and monitoring activities have been aimed at capturing the trends in the population’s sexual behaviors, which include data on the following: age at first sex, age at first marriage, sexual relations with non-regular partners, and condom use (UNAIDS 1995, 11); and the population’s knowledge and perception about HIV/AIDS, STD prevention, role of VCT in preventing HIV/AIDS, prevention of mother-to-child HIV/AIDS transmission,3 HIV/AIDS-related services in communities (Mukaire et al. 2004, 1), covering both rural and urban areas, men and women across ages with specific attention to high risk groups – commercial sex workers (Kaiser Network 2008; Jitta and Okello 2010), police force (Womakuyu 2011), prisoners (UPS/UNODC 2008), pregnant women and adolescents (Hogle 2002; Neema 2000; Neema et al. 2006). Uganda’s STD/AIDS control programs exploit both the passive surveillance system – collects data from health facilities’ formal reports of AIDS cases based on WHO’s definition4 – and active surveillance system – collects data through a series of sentinel sites surveillance (Okware et al. 2001, 1115). Active surveillance in Uganda is conducted mainly using two complementary approaches. One common approach is the sentinel surveillance,5 established in Uganda in 1988 for STD and in 1989 for HIV/AIDS), using Antenatal Clinic surveillance (ANC)6 sites distributed all over Uganda, to monitor STD/HIV/AIDS epidemics. According to the WB (1999, 88), countries commonly prefer sentinel surveillance because aside from detecting trends by capturing enough people with high-risk behavior, it is much cheaper than large-scale surveys. Upon realizing that sentinel surveillance is not enough to capture high-risk behaviors, the behavioral surveillance7 was initiated in 1995 via the WHO-funded population-based KBAP8 survey on HIV/AIDS/STD in the four districts of Uganda. KBAP results have provided reliable data that have validated and explained the trends seen in seroprevalence (Monitoring and Evaluation n.d., 1-4). Okware’s (2001, 1117) study has validated the effectiveness of Uganda’s behavioral surveillance, saying that “KBAP studies provide encouraging results on the priority prevention indicators and on selected key behaviours.” No study has evidenced the cost-effectiveness of Uganda’s STD/HIV/AIDS control program. As Staugard (n.d., 5) contends, “There is no evidence-based easy road or any short-cuts to a cost-effective prevention of HIV/AIDS…” Agaba (2009, S81) however noted Uganda’s low health spending, with only 1/3 of Uganda’s minimum health package being met. Agaba cited WHO data showing Uganda’s health spending only at US$14/capita, US$9 of which is shouldered by individuals, while only US$5 by the government and donor funding as against the needed US$28/capita. Moreover, the need for ARVs will cost the public sector US$40/capita on health. Nonetheless, international donors have had positively impacted on the monitoring and evaluation of Uganda’s HIV/AIDS control programs not only in terms of funding and technical assistance, but more importantly in requiring Uganda to use baseline indicators on any project, hence facilitating easy determination of the project impact (Monitoring and Evaluation n.d., 7). Economic, Gender and Religious Issues STD/HIV/AIDS control in Uganda is not without challenges, especially with regards to economic, gender and religious issues. Economically, Uganda is one of the world’s poorest countries in sub-Saharan Africa (Mavenjina 2003, 24). This poor economic state of Uganda brings about various interrelated economic issues, such as high rate of street children, prostitution, high crime rate, and trading that create conditions encouraging STD/HIV/AIDS high risk behaviors, hence must be considered keenly in Uganda’s campaign against STD/HIV/AIDS. Though Uganda is being lauded for reducing its HIV/AIDS seroprevalence, the disease however has orphaned many children, who oftentimes ended-up in urban streets tending for themselves, doing anything to survive. Currently, the number of street children in Uganda is estimated at 10,000 with more or less 2,500 in Kampala alone (Consortium for Street Children 2002, Friend of Children Association 2002, cited in Olson and Wilkins 2006, 255). Street children are among those at high risk of HIV for varied reasons – they lack basic shelter and food, which would mean a problem in hygiene and malnutrition; they could be easily induced to drugs, including injecting drug use; they could be easy targets of sexual exploitation including rape and enticement to commercial sex work. A study in 2003 of children prostitution in Uganda found that 48% were village orphans who ended-up in the streets of urban areas. (International Labour Organization Programme on HIV/AIDS and the World of Work 2006, 39). Prostitution in Uganda is illegal, yet a study (Karema 2011, 57) says, it is on the rise that even well-provided school girls go into it for more goodies. Besides, nobody has been convicted yet of engaging into prostitution. But, what drives girls as young as 14 years old into prostitution is poverty. Data show that commercial sex workers in Uganda are mostly comprised of school dropouts, AIDS orphans and other young girls of poor families (Jitta and Okello 2010, 2). Moreover, poverty oftentimes drives people to criminal activity. Crime rate in Uganda is believed to be among the highest in the world, with a quarter of it committed in the capital city of Kampala (Walters 1992, 44). Though it does not necessarily mean that apprehension of criminals correspond with crime detection, it does not negate the fact that this implies a higher number of prisoners, which are found among the high-risk groups of STD/HIV/AIDS infection. One study (UPS/UNODC 2008, viii) shows that “the general prevalence of HIV among prisoners was 11%, higher among female prisoners at 13% compared to their male counterparts at 11%.” HIV infection among prisoners is reportedly due to inmates’ involvement in high risk sex and high risk behaviors – men having sex with men, drug abuse, sharing of razor blades – and with a history of having contacted STD even before imprisonment (ix). The above issues if left unabated may further worsen as trading activities in Uganda heighten and cross border trading is common. Why this is so? Many (Klitsch 1992, cited in Condon and Sinha 2008, 136; Bond and Vincent 1991, Serwadda et al. 1985, Bond and Vincent 1991, cited in in Sengendo and Sekatawa 1999, 12) suggest that trade routes encourage commercial sex and multiple sexual contacts among traders, truck drivers, and sex workers, thereby causing high risk sex and high risk behaviors of STI/HIV infections. Religious beliefs greatly matter in Uganda’s campaign against STI/HIV, because religion is inextricably woven into Ugandans’ lives, influencing their sense of being, way of thinking, moral decisions, as well as perceptions of the disease (Kaleeba et al. 2000, cited in Marshall and Keough 2004, 111). Though, as has been noted earlier, religious organizations have been active partners of Ugandan government in its fight against the deadly disease, religious beliefs taught by Uganda’s three main religions -- African traditional religion, Christian, and Islam (Nwankwo 2003, 67) have also been obstacles to the efficacy of Uganda’s STI/HIV/AIDS control methods (the use of condoms/contraception and abstention from traditional religious rituals) for safer sex. For one, the Roman Catholic Church vehemently opposes the use of any contraception believing that sex is not for pleasure but only for procreation (Kunhiyop 2008,323. A study (Barker 2000, 60) also noted that many traditional religious practices in Uganda have unwittingly promoted HIV/AIDS epidemic – e.g. widow inheritance,9 lavish funerals which turned into dating parties, female circumcision “where any form of bleeding may be a transmission route of HIV” (Poku 2001, 69). Above all these are glaring gender issues, showing women, especially teenagers most vulnerable to the deadly disease. In their study, Sengendo and Sekatawa (1999, 9-11) have identified various factors that make Ugandan women more at risk of HIV infection than men. Among which are physiological vulnerability – scientific evidence has shown that women are twice at risk of HIV infection than men from unprotected sex, because men’s semen, where virus thrives, stays longer in women’s vaginal canal making women more exposed to the virus in the vagina and on the cervix, hence making teenagers, which vagina is not yet well lined with protective cells, more vulnerable; age at marriage – Ugandan girls are thought suitable for marriage at teens (14-15), while boys at 20’s and early marriage has been cited as a major factor in HIV transmission; polygamy with men having multiple sexual partners – an unsafe sexual practice causing HIV transmissions; wife-sharing;10 and marital infidelity both by men and women. Also, gender violence – found to highly correlate with HIV transmission – is prevalent and to a certain extent condoned in the country (Mbugua 2000, 2). These practices can be rooted out from the unequal power relations between men and women in Uganda. Suffice it to say that men transmit the disease and victimize women, yet women are the ones usually blamed. As Obbo (1993) suggests, men are the solution to control HIV transmission (cited in Akeroyd 2004, 97), but how to make Ugandan men “to take on responsibility for the sexual health and the lives of themselves and of their women partners and thereby, too, of their children have yet to be fully worked out” (Akeroyd 2004, 97). Reference List Agaba, E. 2009. Funding the promise: Monitoring Uganda’s health sector financing from an HIV/AIDS perspective. African Health Sciences 9 (S2): S81-S85. Akeroyd, A. V. 2004. “Coercion, constraints, and “cultural entrapments”: a further look at gendered and occupational factors pertinent to the transmission of HIV in Africa.” In HIV and AIDS in Africa: beyond epidemiology, eds. E. Kalipeni, S. Craddock, J. R. Oppong and J. Ghosh, 89-103. Malden, MA: Blackwell Publishing. Alwano-Edyegu, MG and E. Marum. 1999. “UNAIDS Case Study: Knowledge is power: Voluntary HIV counseling and testing in Uganda.” UNAIDS Best Prcatice Collection. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS (UNAIDS). http://data.unaids.org/publications/irc-pub02/jc680-knowledgepower_en.pdf (accessed September 23, 2011). Barker, J. 2000. Aids. Geographical 72 (8): 60. Bertozzi, S., N. S. Padian, J. Wegbreit, L. M. DeMaria, B. Feldman, H. Gayle, J. Gold, R. Grant, and M. T. Isbell. 2006. HIV/AIDS prevention and treatment. In Disease control priorities in developing countries. 2nd ed., eds. D.T. Jamison, J. G. Breman, A. R. Measham, G. Alleyne, M. Claeson, D. B. Evans, P. Jha, A. Mills and P. Musgrove, 331-370. Washington, DC: Oxford University Press and The World Bank. Boerma, T., Pisani, E., Schwartlander, TM. 2000. A framework for the evaluation of national AIDS programmes. Measure Evaluation. University of North Carolina: Carolina Population Center. http://malawiresearch.org/system/files/EvalFramework00-1.pdf (accessed September 22, 2011). Condon, B. J. and T. Sinha. 2008. Global lessons from the AIDS pandemic: Economic, financial, legal, and political implications. Heidelberg, Germany: Springer. Crampin, A.C., A. Jahn, M. Kondowe, B.M. Ngwira, J. Hemmings, J.R. Glynn, S. Floyd, P.E. Fine and B. Zaba. 2008. Use of antenatal clinic surveillance to assess the effect of sexual behavior on HIV prevalence in young women in Karonga district, Malawi. Journal of Acquired Immune Deficiency Syndrome 48 (2): 196-202. Green, E. C., P. McDermott, L. Mworeko, S. Schmidt, S. Smith and P. Waibale. 2003. USAID/Uganda HIV/AIDS assessment. Submitted to USAID Uganda. The Synergy Project. Washington, DC: TvT Global Health and Development Strategies. http://pdf.usaid.gov/pdf_docs/PNACU842.pdf (accessed September 22, 2011). Hogle, J., E. Green, V. Nantulya, R. Stoneburner and J. Strover. 2002. Project lessons learned case study: What happened in Uganda? USAID. Washington, DC: The Synergy Project. http://www.usaid.gov/our_work/global_health/aids/Countries/africa/uganda_report.pdf (accessed September 21, 2011). International Labour Organization Programme on HIV/AIDS and the World of Work. 2006. HIV/AIDS and work: Global estimates, impact on children and youth, and response. International Labour Organization. Jitta, J. and M. Okello. 2010. Prevention of HIV/AIDS infections among female commercial sex workers in Kampala, Uganda. African Medical and Research Foundation Discussion Paper Series 004: 1-40. http://www.amref.org/silo/files/amref-discussion-paper-0042010.pdf (accessed September 21, 2011). Kaiser Network. 2008. HIV/AIDS cases increasing among commercial sex workers in Uganda. Aids Care Watch. http://aidscarewatch.blogspot.com/2008/05/hivaids-cases-increasing-among.html (accessed September 23, 2011). Karema, C. N.. 2011. Disabusing sexuality. Bloominton, IN: Author House. Kartikeyan, S., R.N. Bharmal, R.P. Tiwari, and P.S. Bisen. 2007. HIV and AIDS: Basic elements and priorities. The Netherlands: Springer. Konde-Lule, J.K. 1995. The declining HIV seroprevalence in Uganda: What evidence? Supplement to Health Transition Review 5: 27-33. Kunhiyop, S. W. 2008. African Christian ethics. Nairobi, Kenya: WordAlive Publishers. Marshall, K. and L. Keough. 2004. Mind, heart, and soul in the fight against poverty. Washington, DC: World Bank Publications. Mavenjina, C. A. 2003. “People with HIV and youth in especially difficult circumstances can contribute to their own development.” In Partnership experiences against urban poverty, ed. W. Maffenini, 23-34. Milano, Italy: Franco Angeli. Mbugua, W. 2000. Gender and HIV/AIDS: Leadership roles in social mobilization. Addis Ababa, Ethiopia: UNFPA African Development Forum. http://www.unfpa.org/africa/newdocs/hivaidsbreakoutpanel.pdf (accessed September 23, 2011). Monitoring and Evaluation of National HIV Prevention, AIDS Care and STD Control Programs (Uganda case study). n.d. http://www.heart-intl.net/HEART/Internat/Comp/uganda.pdf (accessed September 23, 2011). Mukaire, PJ., D. K. Kisitu, J. B. Ssekamatte-Ssebuliba and J. J.Valadez. 2004. LQAS monitoring report: Assessment of HIV/AIDS related knowledge, practices, and coverage in 19 districts of Uganda. Uganda AIDS Commission. The Republic of Uganda. http://gametlibrary.worldbank.org/FILES/1370_LQAS%20Uganda%20Final%20Report.pdf (accessed September 21, 2011). Neema, S. 2000. Research on adolescent sexual and reproductive health in Uganda. A Documents Review. Uganda: Delivery of Improved Services Project. http://www.ugandadish.org/resources/aa/aa.shtml (accessed September 21, 2011). Neema, S., F. H. Ahmed, R. Kibombo and A. Bankole. 2006. Adolescent sexual and reproductive health in Uganda: Results from the 2004 national survey of adolescents. Occasional Report No. 25. New York: Guttmacher Institute. Nwankwo, B. O. 2003. Institutional design and functionality of African democracies: a comparative analysis of Nigeria and Uganda. Berlin: Tenea Verlag Ltd. Okware, S., A. Opio, J. Musinguzi and P. Waibale. 2001. Fighting HIV/AIDS: Is success possible? Bulletin of the World Health Organization 79: 1113-1120. Olson, T. D. and R. G. Wilkins. 2006. “The family, youth and AIDS: Hope and heartbreak for Africa.” In Overcoming AIDS: lessons learned from Uganda, eds. D. E. Morisky, W. J. Jacob, Y. K. Nsubuga and S. J. Hite, 225-250. US: Information Age Publishing. Poku, N. K. 2001. “The crisis of AIDS in Africa and the politics of response.” In Security and development in Southern Africa, ed. N. Poku. Westport, CT: Greenwood Publishing Group. Poku, N. K. and A. Whiteside. 2004. Introduction. In The political economy of AIDS in Africa, ed. N.K. Poku and A. Whiteside, xvii-xxii. England: Ashgate Publishing Limited. Sengendo, James and Emmanuel K. Sekatawa. 1999. Uganda’s experience: Country report. UNESCO. Staugard, F. n.d. Cost-effective strategies for HIV?AIDS prevention and control. http://www.intrac.org/data/files/resources/199/Cost-Effective-Strategies-for-HIVAIDS-Prevention-and-Control.pdf (accessed September 24, 2011). Uganda Prisons Service/United Nations Office on Drugs and Crime [UPS/UNODC]. 2008. A rapid situation assessment of HIV/STI/TB and drug abuse among prisoners in Uganda Prisons Service: Final Report. Kampala, Uganda: PEM Consultancy. http://www.unodc.org/documents/hiv-aids/publications/RSA_Report.pdf (accessed September 21, 2011). UNAIDS. 1995. A measure of success in Uganda: The value of monitoring both HIV prevalence and sexual behavior. UNAIDS Best Practice Collection 98 (8): 1-13. http://www.who.int/hiv/strategic/surveillance/en/una98e8.pdf (accessed September 22, 2011). Walters, G. D. 1992. Foundations of criminal science: The development of knowledge. Madison, NY: Greenwood Publishing Group. Womakuyu, F. 2011. Uganda: HIV silently eating up police force. The New Vision. http://allafrica.com/stories/201108170964.html (accessed September 23, 2011). World Bank [WB]. 1999. Confronting AIDS: Public priorities in a global epidemic. Revised ed. New York, NY: Oxford University Press. World Health Organization [WHO]. 2011. M2: Behavioral surveillance. Zagreb, Croatia: WHO Collaborating Centre/Knowledge Hub for Capacity Development in HIV Surveillance. http://www.whohub-zagreb.org/trainings/m2 (accessed September 21, 2011). Read More