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Stigma reversing gains in Aids war - Besigye

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Stigma reversing gains in Aids war - Besigye

A health worker conducts an HIV/Aids test on a child in Kampala on Monday. Photo by Stephen Wandera. 



Posted  Wednesday, December 4  2013 at  01:36

In Summary

The effect of the stigma and discrimination that has been generated in our society has only served to drive the vulnerable sections underground and to generally undermine the necessary behavioural changes.

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I convey my gratitude to all those who have been, in one way or another, engaged in responding to the global HIV/Aids epidemic. I also wish to make observations and suggestions regarding Uganda’s national response.

It’s been about 33 years since HIV/Aids was first recognised as a human disease. Presently, more than 40 million people globally are infected with the HIV virus and a similar number has died from the disease. The World Health Organisation (WHO) has presented some good news that globally, the spread of the disease and Aids-related deaths have declined, though still quite worrisome.

Regrettably, in Uganda, the spread of HIV is on the increase. Uganda and Chad are the only African countries with this sad situation. Presently, about 1.4 million people live with HIV in Uganda; including about 200,000 children.

Those infected, who are between 15 and 49 years, have increased from 6.4 per cent to 7.3 per cent (this is higher for women at 8.3 per cent)! This means that in this age group, seven to eight people are infected in every 100 people. On Saturday, November 30, I heard several local FM stations give the wrong figure as 7 people in 1,000 that are infected.

It means that we are not providing an effective response to the HIV epidemic. Uganda Aids Commission (UAC) is the body set up by government to oversee, plan and coordinate response to HIV/Aids. It’s board and secretariat are appointed by the President. We have a whole industry of HIV/Aids-related NGOs, FBOs, and CBOs numbering over 1,000 under the loose umbrella coordination of Uganda Network of Aids Services Organisation (UNASO); Networks for persons living with HIV (PLHIV); several international organisations and alliances between these and local ones.

Causes of failed response
Huge amounts of resources have been committed to the fight against HIV/Aids in Uganda. The US government alone, under the Presidential Emergency Plan for Aids (PEPFAR) has spent close to $2 billion. The Global Fund (to fight Aids, TB and Malaria) has spent about $500 million. Although the funding from the Uganda government has been minuscule (5 to 10 per cent), the reversed trend of HIV spread cannot be put down to luck of resources.

There have been many and varied analyses of the Ugandan reversal of HIV/Aids spread. I still get the sense that there is no clarity on the causes of the failed response. In the circumstances, it’s not possible to design appropriate and effective changes to the management of the epidemic. I consider that three interlinked factors have been at the centre of Uganda’s failed Aids response; namely:

• Aids-related stigma and discrimination.

• Government’s failure to respect, protect and fulfill human rights, especially civic, political, social and economic rights.

• Government policies that undermine effective HIV/Aids response.

Stigma and discrimination are possibly the most unaddressed drivers of HIV spread. The Ugandan media and HIV/Aids-related organisations made commendable effort to deal with HIV/Aids stigma and discrimination during the early-to-mid 1990s.

By the beginning of the 2000s, most of this effort had significantly waned. President Museveni was, for sometime, credited with the positive trends in Uganda’s response to HIV. He definitely helped in supporting early openness and transparency in our national response.

Some other countries tried to cover up the epidemic for fear of affecting tourism and other economic benefits. However, right from the onset, Mr Museveni consistently cultivated and nurtured Aids-related stigma and discrimination. Mr Museveni has always depicted HIV/Aids as self-inflicted, a result of reckless indiscipline, immorality etc. He gave the imagery of HIV infection as similar to being beaten by a snake if you poke your hand in every hole you see; because snakes are known to reside in holes! Before ARVs became widely available, he personally decided on who should access treatment at public expense.

When I challenged him in the 2001 presidential elections, he addressed a press conference of local and international media, saying that I was an Aids victim and that the presidency was not for invalids. To be recruited into the UPDF, Uganda Police and others areas of public employment, it was (and still is) a requirement that one gets tested and certified to be free from HIV. Those who were in service and were known or deemed to have HIV/Aids were not promoted or were laid off in retrenchment exercises.

A 2006 United Nations Research Institute for Social Development (UNRISD) programme paper entitled: “The Politics of HIV/Aids in Uganda” presents more detail on the cultivation and promotion of stigma and discrimination in Uganda. Since the coordinator and overseer of the national response to HIV/Aids, the UAC is appointed by and entirely accountable to the President (UAC Act 1992). It’s easy to see how his views permeated liberally into the national responses to HIV/Aids.

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