Driving on the road to an AIDs-free Uganda

In the mid-1980s to early 1990s, the then new National Resistance Army (NRA) government of Uganda was grappling with the uphill task of reorganising a country ravaged by instability, economic adversity and human capital inadequacies, among which a sick and unproductive population was a significant concern.  
HIV/Aids prevalence peaked at 18 percent, a disease the populace barely knew how to manage, let alone acknowledge its existence.  Families were decimated and children were orphaned at the hands of this virus.

In her memoir, “My Life’s Journey”, First Lady Janet Museveni details the efforts in establishing the Uganda Women’s Efforts to Save Orphans (UWESO), an NGO which has been in operation since 1986 to help scores of children whom the HIV/AIDs epidemic had orphaned. The revered African culture of taking up an orphan, usually by relatives, had collapsed at the hands of the epidemic calling for such admirable efforts as UWESO and various other organisations. Such was the depth of the problem.
The task of leading the Ugandan population out of this situation fell on the then-new NRA government, a success story that has been lauded worldwide. Currently, of the 1.4 million people living with HIV, more than a million people are enrolled in care.  HIV/AIDs is still a concern, but with hindsight, we can now truly appreciate the journey and probe it for current planning and execution. As we speak, Uganda is on the arduous but positive fast track to ending HIV/ Aids for good.

On June 16, 2017, President Museveni launched the Presidential Fast-Track Initiative (PFTI), which aims to end HIV/AIDs by 2030 as one of Uganda’s public health threats. The President holds the right view that HIV/AIDs is not just a health problem.  It comes with profound economic, political, and social consequences. It is common wisdom that HIV/AIDs is both a cause and an outcome of poverty, and poverty is both a cause and an effect of HIV/AIDs. It, therefore, demands a multi-faceted, multi-sectoral response with an HIV component embedded in all sectoral plans.

The infrastructural and transport sector is one of the critical sectors in combating HIV. The government of Uganda has, over the years, prioritised Infrastructure Development as one of the core areas to drive social-economic transformation. In the roads sector alone, through the Uganda National Roads Authority (UNRA) under the Ministry of Works and Transport, more than 6,000 kms of the national road network have been paved, with 11 ferries plying the waterways.

The growth in road infrastructure we have had in the country speaks to something more profound. It's not just about a new shiny paved road; it is about a pregnant mother getting easy access to prenatal HIV testing and counselling. It is caseworkers reaching their destinations with ease and speed. It is the growth that follows a road project which boosts the skills and incomes of the communities hence improving their access to HIV prevention tools and facilities. It is the ability to use public transport to disseminate information. It is a girl escaping early marriage because a bridge was built to connect her to a school.

Indeed, road development may have a bi-directional effect on HIV. On the one hand, the social-economic transformation that comes with this developed infrastructure has positive outcomes for the HIV fight. HIV rates are inversely related to household incomes, directly correlating with improved infrastructure and other positive correlations, including improved healthcare access and information dissemination.
On the other hand, road development may pose some risks to the HIV fight. During construction, the congregation of project workers, usually away from their families, may increase their predisposition to engage in risky behaviours. This has been fully demonstrated in what has come to be termed the “payday syndrome”, where there’s an influx of sex workers at construction sites on the day payments are made.  Further, the improved mobility which comes with constructed roads may facilitate HIV transmission.

Conscious of these risks, UNRA implements an HIV / AIDs, Gender Based Violence Occupational Safety and Gender Programme as part of Civil works contracts for all road projects.  This includes activities to increase awareness of the dangers of HIV/AIDs to promote appropriate preventative measures and help reduce the impact on those already infected or affected by HIV.  It also involves sensitisation on gender issues and addresses projects' occupational safety and health aspects. This programme focuses on four major themes, which include; HIV/AIDs awareness and control among the workforce and communities, gender mainstreaming and prevention of gender-based violence, child care and protection, and occupational health and safety.
The programme includes undertaking HIV/AIDS sensitisation among workers and communities, encouraging and conducting voluntary HIV testing, condom education and distribution to target communities, and distributing information and Educative and Communication (IEC) materials on HIV/AIDs/ Gender Based Violence (GBV).

A sneak peek into some of UNRA’s projects can paint a picture of the efforts.  In the last quarter, on the HIV/AIDS/ GBV front, several activities were conducted on all the ongoing projects. To mention a few, we had six sensitisation engagements on the ongoing Kiira-Matugga project, reaching out to 169 workers and members of the communities, 15 sensitisation engagements reaching out to 666 workers and community members on the Busega-Mpigi expressway project, ten sensitisation engagements reaching out to 4199 workers and members of the community on the Muyembe-Nakapiripit project and 21 sensitisation engagements reaching out to 1,214 workers and community members on the ongoing Kapchorwa-Suam project. These resulted in increased awareness of HIV prevention, with 988 people tested for HIV in the last quarter alone.

Let’s take a moment to reflect on how far we have come regarding the HIV fight in Uganda.  In line with this year’s World AIDs Day theme, let us put ourselves to the test and achieve equity to end HIV.
Let's all play our part, on a national scale, in supporting the Presidential Fast-Track Initiative (PFTI) to end HIV/AIDs by 2030 while taking responsibility for our lives on an individual level. The goal to end Aids by 2030 is a genuinely achievable one.
At UNRA, we acknowledge that there is still a lot to be done, but the lessons we’ve learned along the way tell us we are on the right path.
 Authored by Allen Kagina
Executive Director, Uganda National Roads Authority (UNRA).