A farming field is being introduced by the Teso Diocese Planning and Development Office (TEDDO) to improve the nutrition and welfare status of people living with HIV in the area.

Speaking to Etop radio, Amos Okello, a programme coordinator at TEDDO, said the project will enable people to produce their own produce such as tomatoes, onions, cabbages and other vegetables.

The project is also expected to help households improve their livelihoods, Okello added.

The Ugandan Ministry of Health recently announced that it was rolling out mandatory testing to all people who go and seek medical services in health services.

Under the multimillion dollar programme, code-named ‘provider-initiated testing’, HIV counselling and testing will be incorporated into routine medical care, according to Dr. Alex Ario, the acting manager of the AIDS Control Programme.

But, echoing the views of many in civil society, Benson Ekwee, the executive director at the Public Affairs Centre of Uganda, said most heath units have inadequate staff to handle the counselling service, which means plans may have limited success.

Mandatory HIV testing was first piloted on expectant women attending antenatal care and other general patients at regional referral hospitals in 2009. The model is now due to be rolled out to cover health centre IIIs and IVs across the entire country during 2013.

The scholarships are to be awarded to winners of the GATE National Festival, an annual talent competition organised by the NGOs for out-of-school youth.

This year’s GATE, which takes place from February 14-16 at Nakuru High School in the Rift Valley, aims to reach at least 10,000 youth. More than 500 contestants are expected to participate in twelve categories.

Ekrah Ndungu, Principle of the German Institute, says the scholarships are important to the youth as it gives enables them to believe in themselves and make something of their natural born talents.

“Besides what the government is doing, besides what is being done by NGOs – jobs, training and mentorship can really make a difference to a young person who feels that they are hopeless. Give them hope, show them that there is a future for them and a place for them in this world, then a step towards an HIV-free generation will have begun,” Ndungu said.

This is the second year for the institute to sponsor the winners. In GATE 2011, the institute gave eight scholarships to young people, all of whom are still attending the institute. One of these is Charles Ndoo who recently scored the highest grade in German language of all the international students.

“We found all eight students to be diligent, hardworking and they also adhered to the college rules and regulations with ease. We appreciated that the organisers of the GATE Festival for providing a platform for the youth to be able to channel their talent and go further in life,” Ndungu added.

Ndungu notes that in the continued fight to reduce HIV incidence and end AIDS, the private sector needs to think outside the box.

GATE was developed in 2010. It calls upon youth individually and collectively to take charge and be active in protecting their health and futures by leveraging information, education, life skills, economic opportunities and resources. So far, GATE has linked 254 youth to market opportunities, established partnership with strategic private partners including HACO tiger brands, BIFA College and The German Institute.

Speaking on Monday (February 11) at a planning conference for the US Africa Command (AFRICOM) exercise known as Africa Endeavour 2013, Ambassador Mark Storella said: “Soldiers need to be in the best possible condition and we have a programme to fight diseases such as HIV inside the armed forces.

“We also have a programme of about US$ 300,000 per year to support training of Zambian military personal inside USA at our defence colleges. We are also pursuing a series of opportunities to train Zambian defence forces in Zambia…about six to seven different opportunities, and American military personal will come to Zambia and work with their colleagues in areas that are in the best interest of Zambia.”

The USA and the Global Fund to Fight AIDS, Tuberculosis and Malaria provide 80% of Zambia’s resources in the fight against HIV and AIDS.

At the end of last year, during an event to commemorate World AIDS Day, Ben Etonu, resident district commander of Soroti in eastern Uganda, blamed the spread of HIV in the district on an “infestation” of sex workers. He appealed to “all ladies in the whole of Soroti district and the whole world to take precaution that, if any man asks you for sexual love, tell him openly that you do not want to kill him, rather than receiving their money and keeping quiet with the virus.”

I thought I would speak to people in Soroti town to hear what they think Etonu blaming women, and female sex workers in particular, for the spread of HIV.

One woman Christine said: “Not all the women are responsible for HIV spread. He is blaming us as if it is women only who spread it alone yet it is all of us who are faced with the HIV pandemic. The point is how did the women acquire HIV? Did it come to them or were they given [it]?

“We are driven by men for sex yet it is not always our wish. We don’t ask for it ourselves as the RDC claims. How can you blame women for spreading HIV? We cannot go for sex without men’s demands.

“One thing the RDC says is right; women do accept money for sex because we women are forced to receive it due to acute poverty, [a] lack of basic needs. We also want such things as new dresses, mobile phones, perfumes…and many others I cannot enumerate. Commercial love is for many people. It comes about because one [man] does not know how to seduce a woman but instead uses money to win the love affection.

“But we don’t sleep with men simply because of money but at times due to boredom, desire, nature, poverty, weakness. Other women are sexually starved while their husbands are far away. Others have lust; they want sex all the time. The moment they get a man, they fall in love…others fall in love after annoyance in a domestic brawl.

“Eventually you end up getting HIV and die. But the RDC himself cannot talk without understanding the public opinion, especially women’s needs. He cannot utter anything without revisiting his speech.”

James, a man I spoke to who pays for sex, was of the opinion that women have sex for money, regardless of whether they see themselves as sex workers.

“In Uganda, women fall in love for Christmas presents or for buying new dresses or clothes in exchange for sex during the celebrations and new year festivities,” he said.

He told me about a time in Kampala when he was having sexual desire and approached a sex worker. She told him to pay 100,000 shillings for unprotected sex. He resorted to paying 30,000 shillings for sex with a condom. He says he made this choice because this is all he could afford.

Men’s desire not to wear condoms was also discussed by Christine: “Yes it is automatic that men are equally responsible for HIV spread due to their refusal to wear condoms,” she said.

“Why does RDC apportion blame on us women only? Some men don’t wear condoms due to high sexual libidos. Others are rigid and can’t afford condoms. Others say they are expensive. Others are shy and fear condoms because it gives them hard time during sexual intercourse. In remote villages condoms are at times not available.”

A sex worker known only as Immaculate echoed Christine’s view. She said it is unfair to blame sex workers for spreading HIV as many clients refuse to wear condoms. She added that in Kampala a man living with HIV may pay as much as 5 million Uganda shillings in cash “so as to seduce you to have commercial sex with him at your own peril” and that some men will pledge up to 50 million for “homosexuality” with you [anal sex].

She added: “This makes it risky for you to have sex for money without wearing a condom which protects you from acquiring HIV. He does not care about the risk of contracting HIV but once you accept to go with him the risk is yours. The women are at high risks because of accepting the money in exchange for risky sex. It is risky for a living.”

Not understanding these issues means that those in power can give out the wrong messages on HIV prevention.

From the assertions Mr. Museveni and the government of Uganda are making, it appears they find fault with any other strategy that does not proclaim Abstinence, Being faithful and Condom use, the original ‘ABC message’ of the government when HIV first surfaced in the country in the 1980s. It is also not clear whether there could be some compromise between the government-led ABC strategy and the multiple approaches taken by NGOs.

Whether Uganda can revert to an exclusive ABC strategy to fight HIV after more than 23 years is a question that needs a lot of pondering. Can such a strategy succeed, with slight modifications? How relevant can such a strategy be in an environment of increased research and new challenges? Will the tools of so many years ago be relevant in tackling a problem that has metamorphosed and brought in so many new changes to the health sector?

In an effort to defeat the scenario of ‘too many cooks spoiling the broth’ – who are presumably based in the private NGO world – could a nationally funded campaign match the enormous resources pumped into the NGOs sector? It could be true that the NGOs are enormously funded for their variety of approaches to tackling HIV and AIDS, ranging from medical male circumcision to enhancing the greater involvement of people living with HIV and AIDS in HIV programmes. But the Ugandan government thinks ABC is the best strategy there ever was to fight HIV.

This is the strategy that was employed in the late 1980s and late 1990s, which saw Uganda drastically reduce HIV prevalence from 15% in 1991 to 6% in 2007. The world is her witness to this! Many of those who work to stop increasing HIV infections would of course wish the Ugandan government and all the proponents of the ABC strategy good luck. But unfortunately most of the funds for HIV and AIDS in Uganda come from foreign donations and the government of Uganda provide a minimal budget to the health sector for HIV interventions

We can just hope that the Ugandan government will be successful with its old strategy of fighting HIV using the ABC strategy since this is the big drum being sounded by the president of Uganda as he so strongly believes in it.

“I think the only way to prevent Aids is through abstinence and being faithful to each other for those who are married,” he has said on several occasions.

But what about serving this purpose by incorporating issues of the changing times? Such as the focus on zero new HIV infections through preventing parent to child transmission, the reduction of stigma, and strategies aimed at key populations most at risk? Uganda still needs more HIV counselling and testing services funded from the public sector.

And as if on prompt, government owned and sponsored electronic media have been running a series of ABC messages of recent. As before, the emphasis is on abstinence for youths and faithfulness for those who are married. The slightest variation of these messages from the ones of the 80s and 90s is the slim caution that those already found to be HIV positive should seek medical attention.

One wonders whether Uganda can afford the blame game at a time when new HIV infections are increasing. The 2011 Uganda AIDS Indicator Survey finds that prevalence of HIV among adults increased from 6.4% in 2005 to 7.3% in 2011. The Ugandan Ministry of Health indicates that new infections increased by 11.5% between 2007/8 and 2010/11.

Even when it appears that some ABC messages have been overrun by time –such as the failure to recognise the important place of people living with HIV in Uganda’s response and the vast research that calls for several other interventions – it is debatable whether the success stories of the past, when Uganda gained world acclaim for promoting the ABC strategy and drastically cutting infection rates, can be repeated in 2013.

In my work with persons living with HIV I come across many stories. But there are some stories which move me a lot and echo the difference in human beings. This true story relates to the real challenges that people living with HIV face and how some of them are determined to ensure that those that do not have HIV don’t get it. Their actions illustrate what it really means to be committed to ensuring there are zero new HIV infections.

It is also important to note that, despite the vast knowledge about HIV and AIDS, many people do not perceive themselves to be at risk and may not seek HIV testing services. Many people’s perception of whether someone else has HIV seems to operate by stereotypical appearance only, as is the case in the following story.

There is a female member of Kalagala PHA who is a widow and living positively with HIV. But because this lady takes good care of herself, and is really nice, cute and attractive, she is a centre of attraction to many men. It was therefore not long after the death or her husband that one of the men from her village admired her and sought to have sex with her.

The woman says this man came to her with the following words: “I love you and I would like you to be my partner and we can enjoy life and have fun together. It is not true that you are HIV positive.”

The requests from this man came in several times to the extent that the woman began to feel uncomfortable. She was being confronted by the same man many times as he kept pestering her for love and for sex.

On each of these occasions the woman gave him the same answer: “I am living with HIV and I do not want you to fall in this HIV trap. There is no way I can let you in unknowingly. When we have sex without protection you can get HIV and you may have very many difficulties. You will take this HIV to your wife and other partners.”

Not satisfied with his efforts, and failing to convince this lady, the man started paying her home visits at awkward hours of the night, insisting that they have unprotected sex. This was too much for her. The woman decided to confide in the Kalagala PHA group members for guidance about this man who seemed to be stubborn enough to give up his life.

After a lot of deliberations by the group members it was decided that, since the group conducts regular HIV and AIDS drama sessions, they should take the drama piece to this man’s village where the woman would make a public disclosure about her HIV status.

This is what was done. The ‘pestering man’ was invited for the drama and the lady went public by announcing to the whole community that she was HIV positive and was happily living positively with HIV.

During the performance she said these words: “I urge all of you that are not sure of your HIV status to go and get tested, and live in the know not in darkness. Do not live in doubt. Those who have ears should hear.”

But after the public declarations the same man would have none of it. He still insisted that the lady was not HIV positive. But when he was contacted to go and be tested for HIV he refused. And he went on pestering the woman for a sexual relationship.

The actions of Kalagala PHA can be taken as commendable engagement as advocated in the Greater Involvement of People Living with AIDS (GIPA) and Meaningful Involvement of People Living with AIDS (MIPA). They are committed to ensuring there is less risk of new infections. Others in the community should follow their fine example.

Despite the language barrier I have been able to talk to people around me and they have said the health system here is trying hard to reduce HIV prevalence by testing for the virus early and conducting preventing parent to child transmission programmes.

The good news is that antiretroviral drugs are free at all government hospitals and clinics. However, issues of gender based violence, poverty and unemployment are still a great concern.

Flooding in places like the Gaza province is also a challenge at the moment but I am happy to see local well wishes and stakeholders such as the Maputo Coca Cola Company helping out rather than Maputo being dependent on foreign aid alone.

Joseph Nturo, the senior laboratory technician, says they have been sending samples to neighbouring Kabale district for major laboratory examinations such as CD4 counts, haematology tests, renal and liver function tests.

He added: “This would create backlog because they would accommodate only a limited number of samples given that they receive from other facilities. Now we just sit and the patients come. We currently conduct 100 CD4 counts a week, compared to 20 previously.”

Kisoro Hospital is the main referral health facility in the district, which was carved out of Kabale in 1991. It serves an estimated population of 250,800 people including an ever-increasing refugee in-flow from the neighbouring countries of Rwanda and the Democratic Republic of Congo.

The laboratory comes courtesy of the PEPFAR/USAID-funded Strengthening TB and HIV/AIDS Response in the South-Western region of Uganda (STAR-SW) project. It is furnished with new machines for CD4 count testing and processing plus hemogram/hematology machines. Other equipment includes an air conditioner to regulate room temperature and a refrigerator.

Dr. Edward Bitarakwate, the country director STAR-SW, says the laboratory has been equipped with state-of-the-art equipment to match the testing requirements of a district referral health facility.

“We comprehensively remodelled the laboratory infrastructure to create more space, a reception room/waiting area, and laboratory store. All this was completed in November 2012”, says Dr. Bitarakwate.

“We are also going to facilitate the hospital with a motorbike and rider to transport samples from other facilities to the hub and to return results quickly”, he added.

Reports indicate that many civic activities have stalled following the declaration by the separatist group Mombasa Republican Council (MRC).
The Tana Delta clashes, which has claimed hundreds of lives and displaced thousands from their homes, has also chilled activities, with renewed conflict looking possible as Kenya edges closer to the March 2013 polls.
 But the Kenya National Bureau of Statistics (KNBS) is certain that the national wide survey will roll on despite the tensions being reported.

“The security apparatus are in place to protect the survey”, says Samuel Ogola, population and social statistics senior manager at KNBS.

“This is a government exercise and we expect it to go on as scheduled.”

In October, the Kenya National AIDS and STI Control Programme (NASCOP) announced plans to roll out the second KAIS at a cost of US$7.5 million (about Ksh. 630 million).
The survey will provide informed details to enable technocrats to establish HIV and AIDS prevalence.

“The evidence that we will gather through this survey will inform the production of the next HIV and AIDS strategic plan”, says Dr. Patrick Mureithi of the National AIDS Control Council.

All Kenyans are expected to participate in the survey which will culminate to a report in September 2013, according to NASCOP officials.
 In the 2008/09 KAIS, the national prevalence of HIV was placed at 6.3% with women recording a higher prevalence at 8%.

The use of technology in the coming survey is expected to raise interest among Kenyans as it will be the country’s first population-based survey to use information technology. Researchers involved in the survey say the 40 field teams will be equipped with net books for data collection and transmission.

“They will be used in household based surveys”, says Dr. Davies Kimanga, the strategic information, surveillance and research manager at NASCOP. “Data will be collected directly though the gadgets and then transmitted to the national server for analysis.”

According to him, a team has been trained on how to use the portable gadget, which functions like any other computer, only that it is smaller.

For regions that are not connected to the electricity grid, batteries that last at least 12 hours plus a back up pack will be supplied to ensure the full 24 hours are covered.

“We are going to use about 280 net books,” Dr. Kimanga added. “We will also use social media for mobilisation to let people know about KAIS and ensure this information is passed on to the entire country.”

Institutions funding the survey include the Kenyan and US governments, the World Bank, Japan International Cooperation Agency and UN agencies.