By Morris Komakech
The healthcare system requires restructuring to treat the community more than the individual
A cloud of gloom has descended upon Uganda as global experts fear that the country is losing the gains it made in the early years in the fight against HIV/AIDS. Over the years, experts like Festus Mogae and Stephen Lewis have shown pessimism that Ugandans have become complacent owing to the advent of anti-retroviral therapies that provide hope for prolonging life for HIV/AIDS infected persons.
Further, the political will that previously elevation and sustained a high profile of the anti-HIV/AIDS campaigns among the population has been sapped by corruption, policy disunity, and other threatens to human rights.
This article intends to bring a critical perspective in the HIV/AIDS discourses and it intends to point out the critical gaps that current health service orientations have been unable to cover.
There are fundamentally three areas that requires urgent attention if Uganda is to gain its glorious path to curbing the spread of the HIV. Areas that need to be addressed include investment in an integrated behavioural change approaches, adhering to strict and accurate data collection and management, and expanding existing healthcare systems to care for communities, rather than individuals.
The Daily Monitor newspaper of May 18 quoted Musa Bungudu, the UNAIDS Country Coordinator as casting fear on the rising prevalence rate of HIV in Uganda. New cases of HIV infection show an increasing trend, from 124,000 in 2009 to 145,000 by 2011. These are not small numbers, but they also do not tell the entire truth due to many factors, but mostly that many Ugandans are still not testing their status.
Further, complacency brought about by the availability of anti-retroviral medication treatment, sustained beliefs in mysticism, witchcraft, and partaking in risky sexual expeditions are key domains of Uganda’s regular lifestyles.
It is empirically known that the most common route of HIV infection is through the sex and blood transfusion. Somehow, irrespective of unintended accidents, HIV can majorly gain entrance in the human body through the body fluid – blood.
In the early 90s, it was excusable for anyone to conduct themselves dangerously as to have unprotected sex with an excuse that they did not know how to access and use condoms. Many did not have explicit access to HIV screening or testing services.
These arguments should be stale in the current epoch because condoms have been with us for the last 30 years and with the advances in media coverage and telecommunication system in Uganda, not using condoms or testing for HIV and other preventable diseases is no longer justifiable.
Therefore, a behaviour change effort must be made through a combination of policies and a deliberate reflexivity from cultural standpoints if we are to tackle the HIV scourge. Further, Ugandan society is still largely patriarchal along its social and cultural landscapes.
What this means is that age and gender remains major factors of subordination. Males are still repressive of the females and older individuals are still repressive of the younger ones. In essence, women and young people – both boys and girls- continue to internalise their position in society as that of being submissive to the older and more so when they are men, making them easy prey.
This fact also corresponds to high prevalence rates among this group (15-19 at 7.3% and women at 8.3%). Further, the people on retroviral treatment appear to be healthy and yet, their health also becomes the resource for their silence that leads to the spread of the virus – most especially when they are “loaded” or acting as sugar-mommies/daddies.
Researchers have found that it is the men who are more reluctant to seek HIV testing and even when they know that they are infected, they still blame it on their sexual victims who happen to be women or younger individuals than them.
This brings me to the issue of HIV prevalence and incident rates. These are epidemiological terms meaning “new” and “existing” cases of HIV among a population of 1000 people. In Uganda, the estimated national prevalence rate is about 7% and the total estimated number of people considered to be HIV carriers are 2.2 million as of 2012.
These figures are contestable irrespective of whether they are World Health Organisation’s estimates or from Ministry of Health in Uganda. My contentions are as follows; most of Ugandans who seek HIV screening are urbanites and often they chance on the results upon seeking treatment for other symptoms.
In as long as Ugandans are asymptomatic, they would endure all sorts of silent killer diseases, like hypertension, diabetes and HIV infection, without seeking care. It is during this time that they will also distribute the virus indiscriminately.
Therefore, most HIV statistics are taken at focal points when it is too late and yet it is very difficult to draw inferences for deaths outside the hospital where rural autopsy would consign it as witchcraft, poisoning or suicide. Therefore, a conservative estimate would say that the national prevalence rate is about 13% and the total number of incidences of HIV at about 5 million people.
Healthcare system’s deficit
Further, the failures of our healthcare system to succinctly capture, record and follow children who are born with the virus adds weight to the numbers dilemma. In the early 90s when Rakai was symbolic of the HIV/AIDS epidemic, we were shown so many orphans whose parents had died due to HIV/AIDS.
Most of these children were born with the infection. Today, they have become of age and some of them are pretty humbled by their modest upbringing under churches and orphanages. Many of them are virgins while a host of them are the ones jumping helter skelter on the street with mind blowing minis and stilettos.
Unfortunately, the state cannot account for these and yet they could be adding to the increasing number of HIV prevalence in Uganda. The fight against HIV/AIDS is failing, not because of a single factor, but a multiplicity.
This also means that the solution to the HIV problem should be an integrated approach that focuses on behavioural change at all levels of society. Ugandans must become bold to reclaim their moral aptitude and begin to conduct themselves with some sense of purpose beyond hedonism.
Finally, the healthcare system requires restructuring to ensure that it is expanded outwardly to treat the community more than the individual. A combination of community based medical model which integrates social behavioural and biomedical sciences can help mediate between individuals and their precarious cultures.
This model offers a formidable fruitful venture in healthcare investment, at public and private sector levels. This will also imply that we stop treating symptoms, but we treat the disease, the people and community all at once and it comes at a lower cost to the public purse.
Morris Komakech is a Ugandan Public Health specialist in Chronic Disease and Injury prevention. Can contact via firstname.lastname@example.org