Adolescent girls to champion HIV/AIDS 90- 90- 90 Targets in Uganda.

Adolescent girls and young mothers have come up to champion efforts of achieving the 90-90-90 strategy. A concept introduced by the United Nation’s programme on HIV/AIDS in 2013, 90-90-90 is a set of goals. The idea is that by 2020, 90% of people who are HIV infected will be diagnosed, 90% of people who are diagnosed will be on antiretroviral treatment and 90% of those who receive antiretrovirals will be virally suppressed. Viral suppression is when a person’s viral load – or the amount of virus in an HIV-positive person’s blood – is reduced to an undetectable level.

The strategy is an attempt to get the HIV epidemic under control and is based on the principal of universal testing and treating. What is central to “test and treat” approaches is that if one can identify people early on in their infection, and start treatment so they become virally suppressed, the onward transmission of HIV will be prevented and this will impact on HIV incidence at a population level.

In a bid to achieve this, president of the Republic of Uganda H.E Yoweri Kaguta Museveni March 2017 launched The Presidential Fast Track Initiative.  And in its report launched  in June year, people get an estimate of 884 get infected with HIV every day in Uganda and  20,000 deaths occurred as a result of the epidemic in 2017 alone.  Also, it is estimated that Uganda has 1,324,685 people living with HIV/AIDS. Unfortunately, 24% of these according to the report were young girls below the age of 19 years.

According to WHO 2015 state of global adolescent health, HIV/AIDS is the leading cause of deaths among young people 10 – 25 years in Sub- Saharan Africa. HIV infection still remains a big burden among young people in Uganda.

The HIV epidemic in Uganda continues to disproportionately affect young women. In 2014, HIV prevalence among young women aged 15-24 in Uganda was estimated at 3.72% and 2.32% for men, reaching the peak of 9.1 % among young women 20-24 years of age. These figures translate into 570 young women 15-24 acquiring HIV every week, according the 2014 UNAIDS data. UNAIDS further reported that 1 in 4 new infections among women aged 15 and 49 years in Uganda occurs in women aged between 15 and 24 years.

It is against this background that with support from HER VOICE FUND, Uganda Youth Health Forum-UYAHF, a youth led organization in partnership with the National AIDS Commissions held an orientation dialogue for adolescent girls and young women and key HIV stakeholder to facilitate dialogue and learning on the National HIV/AIDS and Global Fund Processes.

The Orientation and dialogue meeting organized under the theme: “Putting Adolescent Girls and Young Women at the Center of National efforts to achieving the 90 90 90 HIV targets”, was aimed at mobilizing adolescent girls and young women to enhance their knowledge on the National HIV/AIDS Response, status of the epidemic trends and Global Fund processes at national level, amplify their voices to demand for increased and meaningful adolescent girls participation in policy and programmatic decision making processes with a view of ensuring that National HIV/AIDS and Global Fund processes fully and directly address their specific needs and aspiration.

Carol Atuhaire, a young mother says that it is very important that the girls are involved in spreading the word to their peers about HIV/AIDS.

“I’m excited that I will be among the girls mentoring my peers. I have already been talking to the young girls about the misconceptions about HIV/AIDS, prevention methods and the importance of adherence to drugs for those who are already infected.”she said

Dr. Sabrina Kitaka from department of pediatrics, at Makerere University says that it is important that the young girls speak for the young girls. She also noted that the dialogue was timely as the latest figures on HIV prevalence among young girls are alarming. She noted that many of the young girls are not empowered to say no to sex while others don’t have the right information about the virus.

“We have a crisis in the country and we cannot just burry our heads in the sand as our young girls are dying as a result of HIV/AIDS. We need to support them with information and Sexual Reproductive Health Services.” She said.

Dr. Daniel Byamukama, an HIV/AIDS expert working with Uganda AIDS Commission said that whereas it seems obvious that young people have information about HIV/AIDS, the reverse is true that many of them are ignorant. He says that this could be one of the reasons why they are affected most.

“According to the Uganda Population HIV/AIDS Assessment report, only 45% and 46% of female and males respectively have accurate information about prevention. Whilst the age of sexual debut has been rising in Uganda, condom use remains low while inter-generational sex and trans-generation sex remains prevalent and uptake of HIV testing services and safe male circumcision remain low as well.” he said

Brian Ssensalire an HIV advocate from Uganda Network of Young People Living with HIV-UNYPA, noted that peer to peer model is the best strategy of engaging the young girls living with HIV/AIDS. He also noted that the young girls should be looked at as key stakeholders and should be involved in decision making at all levels instead of engaging them at the time of implementation.

“Young people are comfortable to talk with their peers confidently about matters of sex. But most of our health facilities have old people to attend to the young girls and thus many of them ignore health facilities resulting into wrong decisions.” he said

Whereas prevention remains one of  the major ways of prevention, the country is facing a national wide stock-out of sexual reproductive health commodities especially condoms as a result of donors changing priorities to fund. This means that the youth are not in position to access condoms resulting into risky sexual behaviors like unsafe sex and thus increasing the risks of contracting HIV/AIDS and other STIs. Additionally there is still a lot of stigma and discrimination attributed to adolescent and young people’s condom use for especially by the society siting morals and cultural values.

According to a survey dubbed, “Sexual & Reproductive Health Commodities: Measuring Prices, Availability & Affordability conducted by HEPS Uganda in 2017, Stock-outs of commodities were at 36% of all public health facilities.

However, Kitaka says that the government of Uganda has to up its game and prioritize financing the health sector internally and putting in place functional supportive and and protective laws that protect girls from various form of sexual and gender based violence, stigma, discrimination and other human rights violations.

Syson Namaganda, the National Coordinator of the Country Co-ordination Mechanism for Global Fund-CCM implored the young people to involve themselves in planning, implementation and monitoring the global fund process.

“The currently running three, year global fund grant amounting to about USD 400 million targets improving the health of all Ugandan citizens including; young people and if you are not involved in the process, it means that you will just be at the receiving end. You should be in position to guide the policy makers on the areas that urgently need funding because you know best of your needs.” She said. She also noted that the CCM operates under a board and constituencies and hence young women need to lobby to be represented on the standing committees of each constituencies.

Patrick Mwesigwa, the team leader at UYAHF said that the young girls have been left out in policy programing and decision making processes in regards to National HIV/AIDS Response and Global Fund and other girls centered HIV progams and that this is bound to change.

“We are glad that we are now setting the agenda to empower the young girls to make and amplify their voices on issues that affect their health and well-being especially HIV/AIDS. We are going to support the young women in this country to lobby for girls advisory committees for Ministry of Health, National AIDS Commission, UNFPA and other AIDS service organizations running HIV/AIDS programs that target adolescent girls.

Pre-eclampsia in pregnant mothers leading cause of maternal deaths

Salima Nanfuka, 36, a resident of Bunangwe Zone in Kamuli municipality started feeling dizzy, her face and feet started swelling and she was generally weak when she was five months pregnant. This was unusual from her three previous pregnancies.

“I was not feeling normal at all. But people kept on telling me that this was a sign that I was expecting twins or triplets. I was excited until when I went to hospital and I was told that I was suffering from a condition known as pre-eclampsia as a result of high blood pressure. The doctor told me that I had delayed to go for antenatal care so that the condition would be managed at an early stage of pregnancy.” she says

At seven months, Nanfuka delivered a prematurely, but the baby passed on after two weeks.

“Up to now am not sure what caused the condition. I want to have another child but am afraid my body may swell and lose the baby again.” she says

Lilian Nabalyango, a registered mid wife at Kamuli hospital says that most pregnant mothers delay to go for antenatal care and management of pre-eclampsia is complicated when the pregnancy is in advanced stages.

“Most mothers have no information about the condition as they tend to think that they are bewitched and instead of going to hospitals, they use other alternatives such as local herbs.” She says

A survey conducted by the Coalition for Health Promotion and Social Development-HEPS Uganda in several rural health facilities in Kamuli district revealed that many of them lack capacity to manage mothers with pre-eclampsia.

Nabalyango also notes that the frequent stock out of essential medicines for managing the condition such as magnesium sulphate complicates the situation.

“We receive atleast three mothers suffering from pre-eclampsia on a weekly basis and in most cases we have stock outs of magnesium sulphate which we use to stabilize the mothers. We tell them to buy from private facilities but there are those who are unable to afford so we get stranded.” she adds

Dr. Annette Nakimuli a Pre-eclampsia specialist at Mulago National Referral Hopsital says that the condition is a life-threatening, pregnancy-induced high blood pressure disorder that can lead to seizures or convulsions and other fatal complications in the last half of a pregnancy and postpartum.

She adds that in Uganda, 336 women die from pregnancy and childbirth-related causes per 100,000 live births. Hypertensive disorder during pregnancy, such as preeclampsia and eclampsia is one of the most common causes of maternal deaths after postpartum hemorrhage accounting for 6% of maternal deaths.

“For the mother, complications of preeclampsia and eclampsia cause illness for an extended period of time and are strongly associated with the future development of a range of debilitating non-communicable diseases such as cardiovascular disease, type II diabetes and renal impairment.”she notes

Flavia Nambi an enrolled midwife at Nankandulo HC IV, in Kamuli district says that the health center is facing challenges in managing mothers with the condition. She says that the facility has a non- functional theater ad Blood Pressure machine.

“We receive an average of 30 pregnant women who come for antenatal services on a daily basis and record at least 80 deliveries every month. But sometimes we fail to take their blood pressure because our machine is non-functional. Also those whom we diagnose clinically are referred immediately to Kamuli hospital where there is a functional theatre.”

The referral system of mothers from lower health facilities to the main hospital is also a challenge since there are no ambulances.

Robert Kizito, the Assistant in Charge of Nabirumba HC III says that mothers have to use motor cycles to reach Kamuli hospital. He however notes that sometimes the mothers are stranded especially in the night when they cannot get access to motor cycle riders.

Moses Lyagoba, Kamuli district Assistant District Health Officer in charge of maternal and child health says that most health workers in the district also lack capacity to manage the condition. He says that the knowledge gaps among the medics can lead to wrong diagnosis thus endangering the lives of mothers.

Lyagoba also says that mothers need to be sensitized about the condition so that lives are saved. “Hypertension cannot be self-detected. This means that mothers who report to hospitals late are treated of eclampsia instead of pre-eclampsia which is very deadly.” he says

The situation is not unique to the rural health facilities as records from Mulago National Referral hospital also have almost similar challenges.

Dr.Evelyn Nabunya, the clinical head of the Directorate of Obstetrics and Gynaecology in Mulago hospital says that in 2017, the ward received 520 mothers with severe pre-eclampsia, 132 with eclampsia, 14 Postpartum Eclampsia and 12 maternal deaths. She notes that the frequent stock-out of essential drugs such as Magnesium Sulphate is the biggest challenge the hospital faces in managing mothers with pre-eclampsia.

Denis Kibira the Executive Director at HEPS-Uganda says that the frequent stock outs of essential medicines puts the lives of pregnant mothers at risk.

“Magnesium Sulphate is a must have drug by all health facilities at any time for proper management of mothers with Pre-eclampsia. But this is not the case as in-charges have reported that they never have the drug at the time it is needed most.” he says.

However, with the support from Uganda’s policy makers, there is hope that the situation will be addressed. During a breakfast meeting organised by HEPS-Uganda on 25th May 2018 at Sheraton Hotel, the Speaker of Parliament Rt.Hon. Rebecca Alitwala Kadaga pledged to move the issue to the floor of parliament.

 

Refugees in Uganda deprived of basic services- Report

People living in Uganda’s refugee hosting districts – both people from host communities and refugees – are deprived of basic services like water, sanitation and shelter.

 This is according to a study on Child Poverty and Deprivation in Refugee Hosting Areas  conducted by the Economic Policy Research Center (EPRC), the University of Cardiff and UNICEF, which assessed child poverty, deprivation and social service delivery in refugee and host communities in West Nile, the South West, and Kampala.

“This study represents the first attempt to compare child poverty and deprivation in host and refugee communities in Uganda” said Sarah Ssewanyana, EPRC’s Executive Director. “Globally, it represents the first application of a consensual approach to measuring poverty and deprivation in emergency situations.”

The study also found out that refugee children are more deprived than children from host communities, ranging from 8 per cent to 32 per cent depending on the item.  For example, the report states “refugee children are much less likely to receive gifts on special occasions and less likely to have new sets of clothes than host children.

” For some basic services such as water, sanitation and shelter, recent arrivals are the most deprived. Within five years of residence, however, deprivation rates among refugees are on a par with those of host communities; the reason being that levels of deprivation among host communities are already high.” reads part of the study

“We need to go beyond emergency response to build the systems and capacities of all social services in refugee hosting districts,” said Dr. Doreen Mulenga, UNICEF’s Representative in Uganda.  “Only by doing so – with health, nutrition, education, water, sanitation, and child protection services, among others – will we reduce the multiple deprivations experienced by tens of thousands of refugee children and children in host communities.”

The study recommends expansion of access to basic social services and improve quality and efficiency; improve institutional mechanisms for delivering social services; boost household food security; introduce the accelerated education programme and improving the balance between refugee and host community programming.