Judging from the headlines this year, you would think Ebola is the greatest challenge facing Africa. Yet, there are an estimated 35 million people worldwide who are living with HIV.
On World Aids Day we take a moment to celebrate the progress made since 1988 (the first World Aids Day), and the challenges remaining.
In Patongo in northern Uganda, where we work, HIV is on the increase, with infection rates at 11% of the population, against a national average of 7%. This is the legacy of the brutal twenty-two year war between Joseph Kony’s Lord’s Resistance Army and the Ugandan army: villages became squalid refugee camps as rural people fled from war zones; what little infrastructure existed soon collapsed; a prosperous farming culture died because it was too dangerous to leave the refugee camps to reach agricultural land.
Loss of livelihood led to poverty and depression amongst men who were no longer able to provide for their families. Their boredom and low self-esteem turned them to alcohol, which in turn led to a host of social problems such as violence against women and rape. Poverty forced women into transactional sex, and girls into early marriage. Families were torn apart, and lost was the age-old tradition of grandmothers educating their grandchildren about sex, amongst other things. And fuelling it all was a war in which people were abducted and forced to commit unspeakable atrocities against one another, resulting in untreated and widespread post-traumatic stress disorder.
But despite that challenging environment, there is hope: if people are tested and know their HIV status, half the battle is won. For instance, the sooner people start anti-retroviral therapy, the more likely it is the strain of HIV will be weakened. And providing safe, hospital-based childbirth for HIV pregnant women can eliminate transmission from mother to baby.
Yet, these interventions have no impact unless people know their HIV status. One of the main reasons why people don’t get tested is because of shame and the fear of social stigma.
In Patongo our team of HIV counsellors supports people living with HIV and those who are brave enough to come for testing. They offer continuing encouragement and they lead by example by being open about their own HIV statuses.
While we are proud that our work is bringing immediate and transformative results to hundreds of families, we recognise that behaviour change is a long and slow process:
-Barriers to diagnosis and treatment have to be overcome;
-Those who wield the power to challenge social norms need to be influenced;
-At-risk groups such as sex-workers face discrimination from medical staff;
-Young people become sexually active with little or no sex education.
But we can tackle these challenges:
-If we can offer “moonlight” testing, carried out under cover of darkness to protect people’s identities, meaning more people will come forward for testing and treatment.
-If we can target religious and clan leaders with training in HIV and sexual and reproductive health it will impact on cultural and social norms that perpetuate HIV such as polygamy and violence against women.
-If we can train health centre staff in best practice for treating high-risk people with HIV, groups such as sex-workers will not feel discriminated against and will be more inclined to be tested and have follow-up treatment.
-If we can support teachers in educating their pupils in sexual and reproductive health, young people will be better informed before they become sexually active, and girls will exercise ownership of their bodies.
-And if we advocate for linking HIV and sexual and reproductive health services, more people will be tested and treated.