An Institutional Perspective of HIV/AIDS in Uganda - Report Example

An al Perspective of HIV/AIDS in Uganda Introduction The first incidences of HIV/AIDS in Uganda were reported on the shores of Lake Victoria and in Rwenshama on Lake Edward, as well as among populations within the major stopping centers for truck drivers along the trans-African highway. These environments had a critical significance as the powerhouses of president Yoweri Museveni’s political as well as military power, yet they were at high risk of extinction due to HIV/AIDS scourge, which killed many people and left scores of children orphaned (Sayson & Meya 542); besides that, these areas had unique features in common including backwards cultural practices coupled with poor medical and social infrastructure. The shift from cultural practices that aggravate risks of HIV/AIDS infection such as wife inheritance and sharing of wives, between brothers, cousins, as well as friends in African countries such as Uganda has been touted as a positive influence on the outcomes of HIV/AIDS prevention programs. Similarly, medical and social infrastructure initiatives like the establishment of hospitals that are fully equipped with HIV screening facilities have also been found to help curb the spread of the disease. The Ugandan government ministries and institutions, Non-governmental Organizations, faith-based organizations, as well as the civil society in addition to the public and private sector enterprises have taken a proactive approach by initiating institutional efforts to curb the spread of HIV/AIDS. This paper will provide an institutional perspective of HIV/AIDS in Uganda while evaluating the effectiveness of institutional programs in the HIV/AIDS prevention and treatment campaign in the country form a political, religious, environmental, as well as economic perspective. Background of HIV/AIDS management in Uganda Uganda suffered high rates of HIV infection during the ‘80s and ’90s, which necessitated the need for individuals to establish their HIV status from the country’s National Blood Transfusion Service, which always conducts routine HIV tests to verify the purity of blood donated for the purpose of transfusion. With the heightened need for HIV testing and counseling services, local NGO’s including the AIDS Support Organization (TASO) Uganda Red Cross among others combined efforts with the Ministry of Health and formed the Aids Information Center in 1990, which was mandated to offer testing and counseling services to clients who wanted to know their HIV status. Following this massive milestone, Uganda became the first country ever to establish a Voluntary Counseling and Testing (VCT) clinic in Africa, thereby pioneering the popularity of voluntary HIV testing centers in Sub-Saharan Africa. The Ugandan leadership under President Yoweri Kaguta Museveni has touted the novel invention of the VCT clinics as the national government’s most effective response to the HIV pandemic in Sub-Saharan Africa and a significant milestone in the fight against HIV/AIDS. Generally, Uganda’s approach to HIV/AIDS transcends the health dimension since the country adopted a multi-sectoral Aids Control Approach in 1992 and the Uganda AIDS Commission has contributed to the establishment of a national HIV/AIDS policy in the country. Over the years, Uganda has pursued a wide range of approaches to AIDS education including promotion of condom use and abstinence only programs; similarly, the country has implemented birth practices and safe infant feeding counseling as part of its broad strategy in establishing a comprehensive HIV/AIDS program. Political perspective Uganda has adopted a policy of openness and political commitment in the fight against HIV/AIDS, thereby contributing to greater awareness of the disease among the populations concerning the dangers of the diseases as well as means of prevention (Tumushabe 15). Since its open announcement of the HIV/AIDS pandemic in 1986, Uganda’s National Resistance Movement (NRM) government established Aids Control program which was mandated to investigate the prevalence and mode of infections while strengthening safety of the national blood bank. The government also put in place mass education and sensitization campaigns concerning the HIV/AIDS menace with the president himself taking the frontline in the 198801989 nationwide AIDS education effort. Established in 1992 by a statute of Parliament, the Uganda Aids Commission (UAC) has been coordinating policy development and implementation of HIV/AIDS guidelines, forging integration and harmonization of HIV/AIDS control efforts while monitoring the disease in the country. The HIV/AIDS pandemic still remains a crucial health issue in Uganda with current findings showing that the adult HIV/AIDS prevalence in the country has risen from 6.4% by 2006 to 7.3% by 2011 (Ahaibwe & Kasirye 2); Uganda’s public health priority is establishing the most effective programs that can help control spread of the disease. The prevailing HIV/AIDS control programs in the country have previously emphasized on the Abstinence, Being Faithful and Condom use (ABC) strategy (“HIV & AIDS in Uganda”); however, the increasing epidemic of HIV/AIDS has prompted the adoption of additional programs to curb the spread of the disease. The recent programs adopted by the Ugandan government in the fight against HIV/AIDS include male circumcision and counseling as well as testing (Ahaibwe); it is estimated that increasing male circumcision to nearly 66% of the uncircumcised male population between the ages of 15-19 years would result to significant reductions in the HIV infections through 2020. Similarly, the government has embarked on a program to scale up VCT to full coverage (100%) among the same population range, a drive that further aims to avert 113,813 new HIV infections through 2020. The Ugandan government has also adopted the “World of Work” policy response to the HIV/AIDS epidemic addressing the workplace environment, which comprises workers, employers as well as the socioeconomic aspects and/or relations at the place of work (“Uganda National Policy…” 6); response to HIV/AIDS at the world of work covers not just workers and employers, but also the surrounding community. The workplace environment is highly predisposed to the spread of HIV/AIDS since it brings together individuals of opposite sexes; migrant labor populations and long distance driver’s in the transport sector are some of the high-risk workplaces. Uganda’s national world of work policy provides a fundamental framework for curbing further spread of HIV/AIDS and its socio-economic impact at the workplace; this policy seeks to promote HIV/AIDS prevention, management and mitigation activities while eliminating stigma and discrimination at the workplace. The country has an anti-stigma policy that has unsuccessfully attempted to avert discrimination of people with HIV/AIDS since there is mounting evidence of discrimination of people living with HIV/AIDS particularly in the Army where the president has categorically decreed that people living with HIV/AIDS (PLWHA) cannot serve. There are numerous practices in numerous areas of the private sector in Uganda, which violate the non-discrimination against PLWHA in the country including mandatory HIV testing before recruitment, forceful termination, and denial of permission as well as ostracism by other workers. The numerous government policies concerning prevention of HIV/AIDS notwithstanding, the country has remained reluctant to adopt an over-arching national policy on HIV/AIDS since earlier days, in spite of UAC’s recommendations. The UAC’s 1999 complete draft guidelines for an HIV/AIDS policy did not receive approval by the relevant health ministry and so did 2004 draft submitted to the office of the president (Tumushabe 18); the UAC has expressed great constrains in curbing HIV/AIDS infection rates given the lack of a national HIV/AIDS policy. The high incidences of new HIV/AIDS infections in Uganda, which have resulted to the government’s inability to cope up with the ever-increasing demands of care for PLWHA, have prompted the government to adopt home-based care for PLWHA. Shifting the burden of care for PLWHA from hospitals to home-based care is the government’s way of reducing pressure on health units; families and relatives of HIV/AIDS victims now take full responsibility for HIV/AIDS care. However, the lack of clear national implementation guidelines and referral system has prompted NGO’s alongside other community groups’ involvement in the implementation of home-based HIV/AIDS care programs. The country’s Ministry of Health has collaborated with the NGO’s in the development of training tools and training of health workers to offer guidance on aspects of home-based care; beyond the government’s recognition of the critical role of the affected relatives and community members as caregivers in the management of HIV/AIDS and its effects, there are no clear mechanisms, resources or systems to promote sustainable livelihoods in households with AIDS victims. Environmental perspective The fight to curb HIV/AIDS in Uganda has received a major boost from various non-governmental agents including PLWHA, NGO’s as well as Community Based Organizations, sensitized native healers, as well as the mass media and the private sector. As of 2001, there were nearly 717 agencies and organizations involved in the initiatives to curb the HIV/AIDS menace in Uganda; PLWHA have been at the fore front in the fight for elimination of stigma and discrimination against HIV/AIDS as well as access to appropriate care and treatment (Tumushabe 21). However, PLWHA’s efforts have only resulted to minimal outcomes in the fight against HIV/AIDS given the myriad challenges encountered by the group including absence of national laws protecting the legal, ethical as well as social rights of PLWHA, which eventually limits their access to resources for supporting their livelihoods. NGOs and CBOs have played a visible role in curbing the spread of HIV/AIDS through their initiatives to increase HIV/AIDS awareness while offering counseling services and economic support to PLWHA; The Aids Support Organization (TASO) remains the most influential agency in the provision of post-test counseling as well as support to PLWHA in Uganda. TASO offers numerous other services including capacity building and training, medical care, social support as well as provision of education and sensitization services while maintaining a resource center. Mass media campaigns about the HIV/AIDS epidemic supported by both the government and NGOs in the early ‘90s have further resulted to greater sensitization and education of the public concerning the adverse health effects of the disease and prevention mechanisms (Tumushabe 16). The country’s free press environment typified by the liberalization of mass media that led to the onset of private radio and television broadcasting in the 1990’s has allowed the Ugandan population to address the HIV infection issue by talking about it freely. Radio and TV programs have greatly sensitized the public concerning the epidemic particularly on matters of transmission of HIV and coexistence thereby consequently shattering the high discrimination and stigmatization of victims of AIDS. Communities and families of PLWHA continue to play a key role in the fight against HIV/AIDS since they bear the heaviest burden of the epidemic; communities in Uganda have established numerous interventions partly in collaboration with various government agencies and NGOs. Families and informal communal groups have come to be recognized as the first line care and support providers since they offer palliative care while ensuring material wellbeing of PLWHA and their initiatives have greatly impacted the HIV/AIDS situation in the country. Community assistance groups and families play a great role in managing the overwhelming challenges of livelihood, which originate from the high incidences of morbidity as well as mortality due to HIV/AIDS; common approaches used by CBOs include farming of food crops that require less labor such as cassava, supporting needy orphans and widows as well as provision of community health and HIV/AIDS education. Traditional therapies and healers continue to play a great role in the treatment of opportunistic diseases that result from HIV, especially among the poor rural populations (Quaye & Kipanda 65). The Traditional and Modern Health Practitioners Together against Aids (THETA) is a collaborative initiative between native healers and biomedical practitioners in the fight against HIV in Africa, which aims to establish a sustainable collaboration between traditional and modern approaches in curbing HIV/AIDS. The use of traditional therapies and healers to curb opportunistic diseases allied to HIV/AIDS has proven quite effective with results that are highly comparable to or even greater than those of biomedical drugs in some instances. Economic perspective The HIV/AIDS pandemic has resulted to great economic challenges in the country with adverse effects of the high morbidity and mortality rates associated with the disease trickling down across all spheres of life, from households, to communities, to the public and even private sectors. HIV/AIDS has far greater consequences for the most vulnerable groups including the poorest members of the community, women and children in the country since it accentuates the risks of gender and social inequalities, as well as child labor; similarly, the pandemic disrupts the production systems through its direct and indirect impacts on the working populations of the country. Loss of working hours due to sickness-related absenteeism coupled with the high health and welfare costs accruing to workers and their immediate family due to the HIV/AIDS epidemic result to overwhelming economic hurdles; similarly, high turn-over levels and loss of .workers due to deaths related to the disease results to serious skills shortage at the workplace, which necessitates additional human resource training costs for firms. Increased pressure on both government and private savings due to HIV/AIDS prevention and treatment initiatives coupled with the reduced investment incentive reduces the overall purchasing power in the country, consequently reducing productivity across all sectors thereby slowing the country’s economic growth. The slowed economic growth aggravates the poverty levels in the country eventually perpetuating a vicious cycle that somewhat undermines the HIV/AIDS prevention and treatment campaign in the country by reducing households’ expenditure on health and nutrition. Unfortunately, the corporate sector’s response to the HIV/AIDS epidemic in Uganda has not been upbeat as the country’s business community has generally trailed other players, often taking a defensive role in the fight against the HIV/AIDS scourge by merely making occasional philanthropic contributions to local HIV/AIDS agencies. The Federation of Uganda Employers has previously attempted to mobilize its members to institutionalize HIV/AIDS policies as well as services at the workplace, though with little success. Religious perspective Uganda’s Faith Based Organizations (FBOs) initially perpetrated HIV/AIDS stigmatization and discrimination of PLWHA, partly due to inadequate information concerning the pandemic and partly due to moralistic concerns and the fear of the sensitivity of issues to do with sexuality and death (Otolok-Tanga et al 55). However, FBO in the country have recently scaled up efforts to curb HIV/AIDS related stigma and discrimination through promotion of openness concerning HIV statuses among the clergy and among the congregations, as well as in the leadership of PLWHA. The religious approach to HIV/AIDS prevention, care and support campaigns has had significant impacts in the fight against the HIV/AIDS pandemic across the country (Perkins); findings from a recent case study establish strong correlations between religiosity levels and incidences of HIV/AIDS infection rates in the country (Kagimu et al 17). FBO promote HIV/AIDS prevention campaign since they encourage commitment to the particular behaviors that encourage HIV prevention including sex abstinence before marriage as well as monogamy in marriage. FBO present in Uganda such as the Islamic Medical Association of Uganda, the Anglican Church Human Services, as well as the Catholic Church have contributed immensely to the reduction of HIV/AIDS infection rates by promoting the behaviors that support HIV prevention. Conclusion Overall, it is clear that the government of Uganda in collaboration with other key stakeholders has made some commendable progress in response to the HIV/AIDS epidemic since it broke out in the mid ‘80s; the somewhat proactive participation and commitment of many local and international groups and individuals in the HIV/AIDS prevention, support and care initiatives is noteworthy and commendable. From an institutional perspective, Uganda has been able to address the HIV/AIDS epidemic with considerable success since the Country’s institutions, including government ministries, Non-Governmental Organizations, Faith Based Organizations, as well as the civil society, in addition to the public and private sector enterprises have taken a proactive approaches by initiating institutional efforts to curb the spread of HIV/AIDS. Works Cited Sayson, Rossette & Meya, Andrew. “Strengthening the roles of existing structures by breaking down barriers and building up bridges: Intensifying HIV/AIDS awareness, outreach, and intervention in Uganda.” Child Welfare, 80.5, (2001): 541-50. Quaye, Randolph, & Kipanda, Moses. “Traditional healers and HIV / AIDS prevention and care in Uganda: A research note.” Journal of Multicultural Nursing & Health, 9.2, (2003): 65. Tumushabe, Joseph. “The Politics of HIV/AIDS in Uganda.” Social Policy and Development Programme Paper Number 28: (2006). 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Perkins, Anne. “Religion and sex in Uganda: The power of the pulpit—Is the abstinence message promoted by the church behind the halt in the fall of HIV transmission in Uganda?” (2008). Web. 28th April, 2014. Read More