HIV & Gulu

Prior to coming to Uganda, I had never taken an AIDS test before.  Ironically, since working at Gulu Referral Mental Health I had conducted several HIV pretest and post-test counseling sessions.  I was however wholly unprepared for the existential fears that emerged while I anticipated my results, or conversely the exhilaration I felt when I received my negative test result.

Recent statistics from the Ministry of Health in Gulu reports that infection rates in Gulu for the year 2011/ 2012 stood at approximately 10 percent, which is higher than Uganda’s average figure of 5.3 %.  One of the reasons Gulu’s rates are much higher than the national average is because of the expanding trade between Uganda and South Sudan.   With Gulu being located right in the transport corridor to South Sudan, it serves as a convenient stop-over for business people and truckers.  An inadvertent byproduct is a booming sex industry in the municipality.  According to the district’s HIV/AIDS spokesperson, hospitality workers are particularly at risk.  They are most likely to be approached, exposing many to the risk of contracting the virus.  Gulu’s Ministry of Health has launched targeted HIV/AIDS campaigns to raise awareness with hospitality workers, boda boda drivers, truckers and traders.

Beyond Gulu, the infection rate has climbed to 7.4% in Uganda, with 1.4 million people believed to be living with the virus per annum (Daily Monitor, 2012).  This is a surprising and somewhat disappointing reversal in trend.  In 1990, Uganda was considered a role model in the fight against HIV/AIDS, with a drop in infection rates from 18% to 5.4 % (Daily Monitor, 2012). The troubling fact is that this number includes an estimated 94,000 pregnant mothers who are not coming forward to receive treatment that could prevent the transmission of HIV to their unborn babies (Uganda Aids Commission, 2012).    Ten years ago, the Ugandan government created a program called Prevention of Mother – To – Child (PMTC) transmission, which was designed to address obstacles such as stigma, lack of information, access and cost constraints.  The program is however still struggling with reaching full penetration beyond Kampala.

In trying to understand the increase in infection rates (despite increased funding from USAID, the CDC, and the Ugandan Health Ministry), I sat down with an Administrative Officer at The AIDS Support Organization (TASO) Uganda.  She theorized that historically, when HIV/AIDS was at crisis levels in Uganda, funding and campaigns were geared almost exclusively toward care, support and treatment.  Less attention was paid to prevention.  Today, TASO’s initiatives are shifting more toward the preventative arm of their operation.  This includes reinforcing attitudinal and behavioral shifts with programs such as positive living, respecting the health and dignity of yourself and your neighbors and counseling discordant couples (i.e. couples where one person is positive and the other is not).

Gulu Referral’s Mental Health Unit has started a process of testing any patient that walks through our doors.  This is not only a protective measure for staff and patients, but a straightforward means of ascertaining if a patient’s psychosis is organic, due to late stage untreated full-blown AIDS.