Report on Media Engagement for Editors in Uganda
1. Introduction: The breakfast media engagement café that took place at Café Javas Lugogo in Kampala on the 16th of November bringing together 25 participating editors of different media houses in Uganda, an expert and an activist in the fight against the HIV epidemic in Uganda.
2. Objectives
The four hours breakfast meeting’s objective was to update media editors on HIV prevention methods and debate about the possibility of Uganda ending HIV in 2030, a goal set by government 10 years ago. The engagement involved sharing information by the experts and an open up discussion with questions from the editors.
3. Workshop Justification and Methodology.
Justification of the editors’ breakfast was to share information, strategies, research data and statistics about Uganda’s journey to end HIV by 2030. Participants learnt from experts’ presentations as well as through question and answer discussions.
Summary of Presentations and experiences.
The breakfast engagement was moderated by Hilary Beinemugisha, editor at the New Vision.
First Presenter: Dr. Nelson Musoba, the executive director, Uganda Aids Commission (UAC)
Dr. Musoba started by rephrasing the question Esther Nakkazi asked him, “if Uganda can be able to end HIV by year 2030?” to “if Uganda can end Aids by 2030?” He said Uganda should work to end Aids by 2030, but the HIV will still exist and the country should continue to work on reducing HIV new infections by 2030. He acknowledged ending Aids as an ambitious goal but also a possible one.
He talked about the various HIV vaccines research developments that are going on in the world as one of the best ways of ending HIV but the ever-changing variants of the virus makes it challenging to come up with an effective vaccine. As a result of this he emphasized employing available strategies, and guidelines put in place by the Ministry of Health and its partners to reduce the spread of HIV and stop Aids by 2030.
He talked about the need for proper messaging which bring everyone on board including social workers, law enforcers and the judiciary to ensure that people living with HIV are not stigmatized, and that employees have information on HIV and how its transmitted, how they can protect themselves, where they to test, and seek treatment.
He gave an example of a young engineer working at Karuma while his family stays in Kampala. Such an engineer is likely to get involved in extra sexual activates and he would need access to condoms and information. Dr. Musoba also informed participants that it was 4 decades since the first case of HIV Uganda was identified. In the past years the previous HIV prevalence rate was 6.2% but now it’s down to 5.4%. Even with the decline in the general prevalence rate, the prevalence differs in various groups of people as shown below in some groups. Sex workers- 31.3%; Sex workers’s partners- 17%; PWIDs-17% ; MSM-13%; Prisoners-4%.
In 2020, Uganda registered 36,000 new HIV infections and 22000 deaths. Dr. Musoba acknowledged that Uganda was faring well in its effort to fight HIV new infections, but emphasized that HIV is still a burden globally and in Uganda as a country. He encouraged participants to look at the Uganda Aids Commission latest report for more information. He said by 2020 Uganda was one of the few countries to attain the goals of 90% of the population to test and know their HIV status; 90% taking the medication; 90% of those start medication and adhere to it.
Now government set up new goals of the 95,95 95. With this government plans to optimize its goals by ensuring that people have access to medication and improved monitoring to achieve the first 95%. He noted that people come into care, are tested and started on treatment, but follow up becomes a challenge so some people don’t comeback for various reason including: relocating to other places, domestic violence, giving birth outside health facilities etc. He said that because of the above hiccups government has not been able to achieve the first 95% and is at now 90%, but hoped that in the remaining five years the first 95% will be achieved.
On the second 95%, the country is at 90% and might be on truck in the next 5 years to achieve the 95%. To do so, Uganda Aids Commission and Ministry of Health is partnering with cultural institutions, faith-based institutions and engage the leaders with information because some members of the population believe in such leaders and will trust the information coming from their leaders. Mr. Musoba mentioned leaders such as the Kabaka of Buganda and Omukama of Tooro. He also mentioned the use of media to disseminate information.
He also mentioned that during the Lockdowns due to COVID 19, there was disruption in terms of movement, resulting into disrupted access to antenatal care by some expectant mothers because at one time one had to get permission from a government official to move to health facilities. This also resulted into limited access to ART and there was also a reduction to Antiviral enrolment, diagnosis of Tuberculosis and a reduction is HIV testing.
Question and Answer session with Dr. Musoba:
a) What is being done to reduce the HIV prevalence rate among sex workers?
b) What is being done to address stigma especially with laws that penalise people living with HIV and infecting others without disclosing their status and such laws seem to increase the stigma.
c) What is happening with the Global Fund and if Uganda was still accessing the Fund money?
d)Why VHTs have been put on hold in some communities yet they were very effective?
e) If UAC has a figure on the number of people affected as a result of Covid 19 by COVID?
f) About the 95%, 95%, 95% goals, how does UAC conduct its statistics to come up with the figures they do end up with?
g) Teenage pregnancy and the high risks of HIV with every pregnancy. What is the supposed impact of teenage pregnancy on the 5.4% rate? What is the projection in relation to the impact of COVID 19?
H) The issue of stock out of ARVs and of testing kits even when there was money. What UAC is doing about it?
i) Concern over the high prevalence rate in illegal communities like LGBTQI, sex workers in the fight against HIV spread and stopping Aids and stigmatization. What is being to address such challenges in such communities?
J) Concerns over some testing kits not working in some scenarios and DIDs, what is being done to address the matter.?
K) What should be done about the people who are not going to test, especially men who don’t go with their pregnant partners for antenatal care? One participant shared a story of how some expectant mothers hire Boda-boda riders who take them to the hospital to pause as their spouses when these women go for antenatal care in hospital were its compulsory for expectant mother to go with their spouses.
Dr. Musoba responses to questions:
a) For specific groups with high HIV prevalence rate such as sex workers, the Ministry of Health and partners have put in place strategies for key populations such as designed programs to reach such population. He gave an example of health workers distributing condoms in the night and carrying out HIV testing programs in the night, targeting sex workers because of the nature of their work (sex workers) which happens in the night and they rest during day time. He also mentioned that for those in uniforms, UAC and Ministry of Health and partners don’t wait for the men and women in uniforms to come to them, they go the them (men and women in uniform) and test them from their places of work and sometimes residence.
b) With the issue of stigmatization Dr.Musoba talked about the HIV control Act 2014 where an individual can take the other to court if they did not disclose their HIV status to another when they engaged in a sexual act without protection spreading HIV to the other partner. He mentioned the have been question to revise the Act as one way of eliminating stigmatization. He also mentioned the massive engagement of police and members of the judicial system on the implications of implementation of such laws.
c) On the Global Fund question, he said since 2005 Uganda is one of the beneficiary countries of the Global Fund and that in the past 3 years the country has received $ USD 6 million dollars in the fights against HIV/ Aids, TB and malaria. He added that the country has moved on from the 2005 Global fund scandal.
d) About the VHTs structure at different levels, he acknowledging the challenge of financing and hoped government will address the issue by improving the financing of VHTs so people can get access to information and services.
e) He also emphasised the need to employ councillors in health centres for better information delivery. He acknowledged that most time the counseling is provided by professional health workers such as doctors and nurses who are always in the rush and don’t have the adequate time to provide people who seek information from them because they have a long line of many patients to serve.
f) On the issue of statistics and data gathering he mentioned that the Ministry of Health has one of the best data collecting systems in Africa. He gave an example of a midwife who delivers in a health center and fills the report of this delivery which is then sent to the district level where its uploaded to the national data. He added that the system is validated and the figures are credible. He also noted that with the help of the Uganda Virus Institute, the Ministry of health is able to tell when one acquired the HIV virus, the month and year etc. This he said can help tell about the number of HIV new infections in
relation to the COVID 19.
g) Regarding the issue of the Aids Trust Fund- Dr. Musoba noted that it was one of the most innovative mechanism adopted for money mobilization dedicated to HIV testing, counseling and treatment, but it’s not been implemented yet because of various reasons and technicalities involved. He said it was projected that 2% of the money would be taxed on drinks, such as alcohol, soda etc to get the fund. This would collect about 2-3 million dollars a year which was below budget, and yet the budget for the fund would need to be big. The donors were another challenge. An account should also be created by the Ministry of Health in partnership with the ministry of Finance.
h) He also noted that in Uganda we don’t see much of prominent people sharing their HIV positive stories which would be very helpful because it would amplify the voices in the fight against HIV.
i) He also noted that regarding the prevalence rate of HIV women where more at risk of acquiring the virus than men but it’s the men who die more of Aids than women because of their bad health seeking behavior resulting into not testing and enrolling on treatment.
Presentation by Dr. Steven Watiti, a renown HIV activist
He started by talking about his journey as a person living with HIV and how he started engaging with the media, particularly the New Vison print Newspaper where he had conversations with the editors on writing about living with HIV. At first the editors where not enthusiastic, with one worrying that his experience would stigmatize people, but later his proposal was accepted to write for the New Vision newspaper, but he had to craft his stories in a way that wouldn’t scare people but rather have positive massages. When he started publishing a column with the NewVision newspaper, he started getting
calls from within Uganda and outside Uganda. Some of the callers doubted his HIV status and wondered if he was being paid for making his status public
Uganda statistics show that there has been an increase of people living with HIV in the country from 1.2 in 2010 to 1.4 million in 2020 as a result of improved access to testing, care and treatment. He explained the increase in number is happening because more Ugandans are living with HIV are on ARVs treatment collecting the medicine from about 1000 ART centers across the country.
He however noted that not all individuals on treatment are suppressing the virus because they do not adhere to treatment. He also noted that every day 104 people get infected with HIV, mainly through unprotected sex because those living with HIV are not on treatment and some who are not treatment are not
adhering.
He gave an account of when his CD4 was so low and his immune system was compromised. He explained that the CD4 count measures the damage done on one’s system. He mentioned that at the time when his CD4 count was low, between 1999 and 2000, he’d had Tuberculosis, cancer and meningitis. He says he started improving when he was put on treatment. He added that when people are tested and those who test positive are started on treatment and
adhere to the treatment, government hopes to achieve zero new infections, zero Aids related deaths and zero stigmatization.
He noted that if we did as planned in 2030, we could not have 22000 people dying every year, translating into about 60 dying of Aids related deaths every day . He noted that if we help the people who test positive to swallow their medicine, they will not die of Aids and will not be able to transmit the virus. Taking medicine every day, the same time helps one from dying of Aids.
He shared his journey of taking ARVs, from when he would take 16 tablets a day, which was a terrible experience and would make him vomit. To
access the medicine, he would pay 500$ when his salary was 300$ per month. Now he takes one table a day, a combination of ARVs, which has made it easy to adhere. He also mentioned of the Antiviral injection trials that are ongoing in the country where an individual would need to be injected once every 6 months.
Dr. Watiti also said that 80% of the money for HIV testing and treatment is donor money. He called upon government to invest in one pill a day treatment. He also mentioned that most of the new infections in the country are among adolescent girls and young women. He shared a story of a young woman who is HIV positive and his adhering to her treatment. Her husband is HIV negative, so when she is given her medication, she removed the labels from her drugs and throws them and her card away because she doesn’t want her husband to know her HIV status. He also shared another story of a high-profile person in Uganda who called him about his dying brother who has Aids and was being admitted in one of the expensive private hospitals, the brother had been on and off medication for two years. The hospital had done several tests, but not his CD4 count which was a very important test. The hospital did the patient
a disadvantage.
He noted that discrimination enacted stigma, adding that stigma sometimes comes in a mockery way. He talked about his experience where some people told him that they loved him but discouraged him from remarrying after the death of his wife because they though he was going to die soon. But he married anyway and he has been living with his wife for 17 years. He emphasized that stigma promotes misconceptions and half-truths. He also noted that self-
discrimination exists and it’s the worst because it makes people live in shame and hiding etc.
Question and Answer session with Dr. Watiti:
a) One participant raised concerns over the contested figures of male circumcision in Uganda and wanted Dr. Watiti to clarify on the matter.
b) Also, another participant wanted to understand why there is a common public statement of people preferring to get HIV than cancer.
c) An explanation on why some people test HIV positive, never start treatment and don’t get sick for several years.
d) If Uganda can achieve its goal of ending Aids by 2030 if only 55% of men test for HIV?
e) What can be done for high profile hospitals to provide adequate management and treatment of HIV positive patients who have Aids.
f) How easily accessible is PEP to communities? ( A story of a young girl who had sex with a man known to be HIV positive by the community and when she went to a government health facility to access PEP on weekend she was asked for money by a (health worker) So the concern was on the issue of corruption and the role it played in accessing PEP.
Dr. Watiti responses below:
a) On the issue of people who test negative but are not on treatment and don’t develop any health complications, Dr. Watiti explained that HIV is a lengthy virus. Its slow in some people, but they eventually develop symptoms. This could take years, up to 20 in some people depending on their immune system because they are slow progressors. But it also depends on the subtype of the virus a person has acquired. He however noted that such a person can still spread the virus to others. He emphasized that treatment is very key to managing and ending Aids.
b) On the issue of contested male circumcision reports, he noted that some statistics might have been inaccurate and that some of the reported cases might have been hoax.
c) He talked about his thoughts of changing from an HIV activist to a Cancer activist because less attention is given to cancer activism compared to HIV.
d) He also noted that getting a vaccine for HIV has proven to be a challenge because the virus changes variants. He encouraged Ugandans and journalists to follow research going on around the world to develop HIV vaccines.
e) He also noted that we need to provide pastors with adequate information to eliminate HIV stigmatization and also testing. He mentioned that 30% of his classmates at the medical school died of Aids.
f) On the issue of teenage pregnancy, he only hoped that those sleeping with the girls and were HIV positive were on treatment and were adhering and did not transmit the virus to girls.
g) On the issue of high-profile hospitals mismanaging patients with Aids, he hoped that the health practitioners referred to them to health centers such as Mild May which would offer better management and treatment.
h) Regarding PEP accessibility he encouraged people to have contacts of doctors they trust, who would advice on where to access PEP. He explained PEP as meaning taking drugs to prevent the HIV virus from spreading. He said he know people in many Ugandan districts who could help on that.
Conclusion.
The breakfast meeting was well appreciated by participants and they agreed that there is a lot to be done if as a country we are to end Aids by 2030.
Compiled by Nakisanze Segawa.