A woman in Hoima District in western Uganda has been detained for allegedly killing her boyfriend after she reportedly found him swallowing anti retrial viral drugs (ARVs).
Police said on Thursday that Emmanuel Tumusiime, 35 was hacked to death at his home in Kijumba cell in Kigorobya town council at around 6pm on Wednesday.
The Albertine regional police spokesperson, Mr Julius Hakiza said their preliminary investigations had revealed that Tumusiime was hit on the head using an axe.
"Upon realizing that the lover was dead, the suspect locked the house and jumped on a Boda boda to Hoima central police where she reported a case of murder," Mr Hakiza said.
At police, the woman reportedly confessed to killing her partner.
She reportedly claimed that she was hurt and disappointed that her partner could have infected her with HIV/AIDS.
She was arrested and detained at Hoima Central Police Station on murder charges.
Police detectives rushed to the scene and cordoned it off to conduct further investigations, Mr Hakiza said.
The case is being investigated at Hoima Central Police Station under reference 1101/2019.
"We call upon the victims of HIV Aids to always inform their partners and attend counselling centres because falling victim of HIV/Aids isn't the end of life," ASP Hakiza advised.
There are many disheartening discoveries that we make in life, but for 32 year-old Samalie Nabitaka, a resident of Namayiba in Mukono District, that was discovering that she had HIV. Worse still is that she does not know how she contracted the virus.
“I surely cannot tell how it happened because I was okay by the time I got married. I only discovered in 2012, when I was four months pregnant during an antenatal visit at Mukono Health Centre IV,” she recalls, adding, “Though undeniably shocked, I was helped and subsequently started taking ARVs throughout the pregnancy.” The tone with which she speaks portrays a brave woman who has accepted the fate and decided to live happily with her family regardless of her status.
At the time of our meeting, she had brought her second child to hospital for a third blood test.
This mother of two girls (six years and one-and-half-years) does not, by any account look sick and only her story will justify what I had earlier learned.
Opening up to her husband about her condition was like delivering news of the death of a relative. She is thankful that with time, he agreed to go for tests and start on ARVs as the results had turned out positive. Counselling was of great importance during Nabitaka’s first preganancy and as soon as she got labour pains, she was rushed to hospital as the midwife had advised her. “I had been cautioned about the dangers of delivering from home and also urged to open up about my status to the attendant the moment I reached the hospital,” she shares.
She gave birth to her first child on May 8, 2012 at 9am, and given her status, Nabitaka received extra care during delivery in a bid to save the child from contracting the virus at birth.
She was accorded the same care during the delivery of her second child in February 2017. And because of that, they are both HIV negative.
Just as it is with other mothers, Nabitaka breastfed her babies right after delivery. “The babies were given a nevirapine syrup from day one for six weeks and later introduced to a septrin syrup that I administered until each made a year,” she adds.
Nabitaka, who has been married for eight years says she always feeds well during pregnancy and after delivery as this helps her get enough breast milk for the baby and stay strong.
“I have exclusively breastfed my children for six months and stop at exactly one year as long as the tests confirm that the child is negative, as advised by doctors,” she mentions, “I have also made sure that I take them to hospital for check-ups thrice; at one and a half months, one year and the other at one and half years and give them the medicine as prescribed by the doctors.” Breastfeeding stops at one year because at this time, they are developing teeth and can bite, causing wounds on the breasts which is not good. However, complimentary feeding starts at six months, just like for any other baby. Nabitaka is also very cautious to continuously check her breasts before breastfeeding. In case the breasts have a wound, crack or soar, doctors advised her not to breastfeed the baby. This was in a bid to avoid transmitting the virus to the child.
She adds that doctors not only talked about cracked or wounded breasts as being dangerous but also mentioned that if the baby has wounds in the mouth, breastfeeding them would predispose them to acquiring HIV.
“I have also been cautioned not to use the same sharp instruments such as razor blades that we use on the children,” she explains, “I keep ours separate from theirs to avoid infecting them.”
Nabitaka was also advised not to serve the children with bare hands when she gets wounds on her fingers or hands. “In case of a wound, I use a spoon to feed my babies rather than bottles because I believe I cannot get time to wash them thoroughly,” she explains.
She has continued to feed her children on a balanced diet as well herself; they never miss vegetables and fruits every day. So unlike other HIV positive people who fail to eat because of anxiety; Nabitaka is stress free and eats well.
“Although my husband and I are still on medication, our children are off and free from the virus. I have only been cautioned to feed them well and make sure I do not expose them to anything that might cause them to contract the virus,” she explains.
Her six-year-old first born is already in school. “My child is so bright and is always among the best five performers. I will continue to take care of them and we are now planning to secure a plot of land, build a home where we can groom our children,” she discloses.
Nabitaka advises her fellow HIV positive mothers to not only breastfeed their children and avoid infecting them. She also urges them to be hopeful, take their medication in time and eat well to live longer.
Nabitaka and her husband operate a retail shop but she never leaves her children in the hands of other people, she normally creates space in the shop where they can be.
It is possible for HIV positive mothers to have HIV negative children, and they can also breastfeed them exclusively for six months as normal mothers do. Unlike negative mothers who breastfeed for two years, an HIV positive mother has to wean the baby at exactly one year.
However, taking care of a pregnant HIV positive mother starts during her antenatal visits where they are encouraged to take ARVs. They are usually given hospital appointments where doctors check on their progress. They are then given prior training of what they have to do during and after delivery.
At delivery, mothers have to come to hospital for proper care during delivery. After delivery, we initiate the babies on a nevirapine syrup that is administered for six weeks.
Mothers have to bring their babies to hospital after six weeks for the first check-up, where the baby stops taking the nevirapine and is introduced to septrine syrup. All this is to guard against the virus since it in the mother’s breast milk.
Mothers are advised to exclusively breastfeed for the first six months as introducing other foods at this time might create wounds in their mouth, making them prone to HIV.
At six months, the baby is introduced to complementary feeding and the second blood test is conducted to ascertain the baby’s status. When negative, they continue taking the septrine syrup unti one year as they breastfeed and have complementary feeds.
At nine months, another test is conducted and if it confirms that the baby is negative, they are taken off the syrup and at one year, the mother is advised to cease breastfeeding and another, six weeks after weaning.
At one and a half years, a confirmation test is conducted, if it comes out positive, they baby is initiated on ART drugs (ARVs for babies). However, mixed feed should be avoided least the baby’s gums are damaged making them prone to infection.
Sharifah Nakiwala, midwife at Mukono health centre IV
She looked at her hands as she spoke—two pairs of clean-cut nails and soft unworked skin. Clara*, a shy, quiet primary-aged girl, has called her orphanage home, ever since her parents passed on a few years ago. She has short hair, and wears a simple black jacket, shorts, and flip-flops. She says people sometimes call her a tomboy, even though she does not seem to be fond of it.
The afternoon rain pattering against the roof provided a soft soundtrack to her short, honest testimony.
“When I found out, I wondered, ‘Why didn’t my mum tell me?’” she said. “When I was younger, I was taking these medicines but I wasn’t told why. I went to the clinic [after coming to the orphanage] and the counsellors asked me, ‘Did anyone tell you [your HIV status]?’ and I said no.”
She began to think of the medication she took every day without explanation. After the doctors took a blood sample, her questions were answered.
This year, Clara learned she was HIV-positive, and realised the drugs she had been taking each day were antiretrovirals (ARVs). Although she has lived with the virus her entire life, it was not until after her parents died that the counsellors at Mildmay Hospital revealed her status. She said the process involved a great deal of questions and counselling.
“[The counsellors] told me, ‘We are going to tell you—will you feel bad?’ and I said, ‘No. But if you don’t tell me what is wrong, I won’t take the medicine anymore. But if you tell me, I will take it every day.’” And so they told her. Like most HIV-positive patients, Clara underwent heavy counselling before and after testing, as well as before and after status disclosure. Dr Jacquelyn Balungi Kanywa, the manager of Medical Care at the Baylor College of Medicine Children’s Foundation Uganda, explained there are many special considerations for disclosing to children.
“We use child-friendly approaches to tell them, and it’s a process,” Balungi says. “We don’t just say, ‘You have an infection.’ We encourage the parents to tell them, ‘You have weak blood,’ or something like that so it helps prepare their mind. Then we inquire to know how much knowledge they have about HIV. Based on that, we are able to add on into the knowledge gaps.”
In 2012, there were approximately 190,000 HIV-positive children in Uganda, according to AVERT, an international HIV/Aids charity.
If taken regularly, ARVs offer many HIV patients the opportunity to live healthy, full lives. But as with any medication, mental and physical side effects are possible. Balungi explains that certain drugs can have a variety of effects on adults, including skin rashes, diarrhoea, dizziness, and nightmares.
But how differently do these same ARVs affect children? In 2013, The World Health Organisation (WHO) released a set of consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. A few of these sections focused on proper medical dosages and counselling methods for HIV-positive children and adolescents.
Last March, WHO added a supplement to these guidelines in chapters five, seven, nine, and 11. Chapters five and seven specifically added information regarding early infant diagnosis and optimising antiretroviral therapy (ART) for children and adults.
Various physical, mental and social effects are associated with daily ARVs (see side story), but they do not daunt Clara, who dreams of going to university and becoming a pilot. As she sits in a small nurse’s office behind the privacy of a white, lace curtain, she talks about her favourite songs, even singing a few of them. Her voice is soft and lovely, as is the song she chooses to sing—she already demonstrates the ability to make an impressive alto.
Clara has gotten used to her daily drug regimen. She goes to school each day, then comes home to bathe, eat dinner, and take her medication. But she says the drugs can sometimes be bitter, and hurt her stomach without food. Unlike children in boarding schools, she doesn’t have to worry about finding privacy to take her medication at school.
She says her school teaches HIV, and does a good job of explaining it to others. When asked about facing stigma in school, Clara shrugs.
“There are 140 kids in my class, so it is impossible to know who cares whether I am positive or not,” she says. “I know of another girl in my school [who is positive], although she is not in my class. We are friends.”
One of the most challenging parts of ARV treatment is simply remembering to take it each day. For Clara, this is not difficult. She and Olivia*, another HIV positive child in her orphanage, help remind each other to adhere to their drug regimen.
“If she falls asleep, I wake her up and tell her to take it,” Clara says. “We remind each other.”
When asked about the future or other kids discovering her status, Clara remained unfazed.
“Some of them [kids in the orphanage] already know about my status, and they do not care,” she says. “I can play with them and joke with them about it.”
She is asked again about the future. With a smile, she answers, “No, I’m not scared.”
Making it easier for them
While there is not much to be done regarding physical or mental side effects (except taking the child off the drug), Dr Denis Tindyebwa of The African Network for Care of Children Affected by HIV/Aids says much can be done to remove the stigma children sometimes face. The first is to improve education within schools.
Tindyebwa says having aware, knowledgeable teachers that understand taking drugs is helpful will help the child stop being stigmatised.
“Many people think other children would stigmatise the child if they see them taking medication, but it is not true,” he says. “They can joke and play about it, but once they understand they could be taking medications just like this child from something else, they start understanding it’s not anything out of the ordinary. Most important is the involvement the adults provide.”
Despite stigma and other effects, Clara remains brave and optimistic. She is living proof for other positive children that with proper medication, life after diagnosis is possible.
*Names has been changed to protect her privacy
what to consider when treating children
When to tell them matters
The age for letting the child know they have HIV depends largely on the intelligence of the child. Most doctors recommend beginning disclosure around the age of seven, when the child begins to question why they are taking daily medication. From there, doctors, counsellors, and guardians take into consideration the mental age of the child, and whether they are mentally prepared to comprehend the information.
Although 10 is the age most doctors expect children to have been told, Tindyebwa states this age can vary.
“Telling them about HIV is a gradual process, not a one-time event,” he says. “We advise talking to them about illness when they can appreciate the difference between being sick and being well, and that they must continue taking medicine.”
Nurse Magdalene Kaggwa (pictured right) of M-Lisada Children’s Home explained that counselling children before and after testing and disclosure is a sensitive process.
“Even before testing for HIV, we do counselling,” she says. “We cannot force them to get tested, but we keep on talking to them and counselling them until [he or she] accepts. We also do counselling before revealing the results, and it is very sensitive. After children cope, they slowly get used to the situation. But you have to be very sensitive when revealing results.”
Being “sensitive” requires careful wording and patience. Doctors and counsellors must use kind, simple words the child can understand, without causing fear or confusion.
They must also be willing to take the time to slowly approach the subject, rather than bluntly state that the child has a virus.
Do not treat the child as abnormal
Although children and adults take many of the same medications in different doses, some medicines have not yet been approved for use on children. One of these, Effaverance (EFV), is not used for children under three years due to its side effects on the brain.
But even these drugs do not have lasting effects.
“[Effects] tend to be transient—they last two to four weeks and tend to disappear,” says Tindyebwa.
In fact, ARVs can actually improve neural development and cognitive delays depending on the age and brain of the child.
“The drugs themselves hardly cause problems,” Tindyebwa says. “It is the stigma, the social interactions that the child has with others, that causes the mental problems, such as depression.”
Doctors suggest the strongest effect of daily ARVs on positive children is the social stigmas associated with treatment. Balungi explained children in boarding schools are especially sensitive because they are not provided the privacy of their own home.
“At home it’s easy because the family knows you are on HIV treatment, so it’s okay to take your pills,” she says. “But it is so difficult for them [adolescents in boarding schools] to get out their medication and take it privately. So many times they don’t take their medications.”
Dr Charles Namisi of Nsambya Home Care also states that lack of support often prevents children from taking their medication daily and regularly.
“They miss class because they have to go to the clinic, which can affect performance in class,” he says. “Parents are supposed to be supportive, but they often lack support. Instead of support, there is stigma.”
Stigma in the community can be very challenging for children and their families.
“The stigma in the community is to just stay away from the positive family,” says Balungi. “If a homestead discovers the other homestead has HIV, they tell their children, ‘Don’t interact with those children.’ And when those people come over, they ask them to leave,” Balungi says.
“Stigma is perpetuated by adults who want to know why the child is taking medicine, instead of being supportive,” Tindyebwa says. “That is what perpetrates the stigma. If the adults would just appreciate that any child suffering from any disease is well off from taking medicine, then it stops being stigmatised.”
Manage medication well
“Unlike the standard adult dose, dosages in children are highly dependent on a child’s body weight,” Jacquelyn Balungi Kanywa, manager of Medical Care at Baylor College of Medicine Children’s Foundation explains. She reveals a chart from the WHO, which offers dosing instructions based on children’s weight. She provides an example adopted by the Ministry of Health.
“If you’re going to give them a combination of AZT, 3TC, and Nevirapine and the baby is 3.5 – nine kilogrammes, you give them one tablet twice daily,” Balungi explains. “If you’re going to give them a different drug, you just look down the column.”
Similar to adults, children can experience physical side effects from ARVs. However, these effects depend on the type of drug. Nevirapine is known for causing liver disease and skin reactions, while AZTs are known for causing anaemia and suppressing the bone marrow.
Dr Denis Tindyebwa of The African Network for Care of Children Affected by HIV/Aids emphasised that these side effects are just possible, not common, and appear far more in adults.
Balungi states that when doctors do notice physical changes, they immediately stop using the drug and find an alternative. She also says these side effects usually appear within the first two months of treatment, then wear off.
“HIV is more dangerous than the drugs,” she says.
Katakwi. Leaders in Katakwi District are investigating reports that anti-retroviral drugs (ARVs) are being used for preserving local brew (Ajon) and distilling crude waragi in Magoro Sub-county.
Mr Kizito Okello, the Apeero Village chairperson in Magoro, told Daily Monitor at the weekend that he had received reports indicating that sellers of the brew use the drug for preservation to avoid incurring losses.
“Previously, I knew that Panadol was used for preserving local brew, now it is ARVs,” Mr Okello said.
He said some people engaged in the act do not take their ARVs.
Mr Julius Angedu, the officer-in-charge of Magoro Health Centre III, said: “Those drugs are not sold in open markets, they are offered to only people living positively, with a proven record of taking their drugs.”
He said there has not been any evidence about the reports, adding that they are also carrying out their own investigation.
Asked about how many people are on ARVs in Magoro, Mr Angedu said such information is confidential but said the drugs are harmful to HIV-negative people.
“The drug boosts the immune system, and to give it to those living negatively, it undermines their immunity and sometimes interferes with the body organs,” he said.
Mr Angedu said the side effects of ARVs include vomiting and nausea, but added that he is yet to find out whether people treated for taking such brew had such signs.
Mr James Alemu Omongot, the sub-county chairperson, said, he had not yet heard about the claims.
“I enjoy Ajon, but I have not come across that suspicious liquor, perhaps it is in Magoro Trading Centre but we here in Opeta Parish, the liquor given to us has not presented such suspicious signs and smell,” he said.
Mr Sam Amali, the district health officer, said he would engage his team in the area to establish the claims.
“There is no compromise, unless it is those who abscond from adhering on the use of the drug that are using ARVS for such purposes,” he added.
Many communities in the area brew Ajon as a business to sustain their families.
Ms Grace Akiteng, a dealer in the brew, said authorities should subject all those in the trade to compulsory HIV testing so that investigations focus on those who are living positively.
Last year, it was reported that some residents of Kitgum District were using ARV drugs in brewing alcohol and enhancing the weight of domestic animals.
Local leaders said the residents would mix the drugs with animal feeds to fatten pigs and chicken so that they attract high prices.
Fr Julius Odeng of St Simon Catholic Church Magoro Sub-county, in his Sunday message recently urged all Christians who drink to report the cases to health workers and local leaders. “These drugs are given to you to preserve life, this is wastage, and putting our lives at risk,” Fr Odeng said.