The Bold Decision

 

By Harriet Nakayiza, HIV and Malaria Program Coordinator

 

Rachel is a jolly, ambitious, open-minded young lady from Idinda and a single mom of one. Here at Idinda Health Center II, we are sitting together under the cool shade of a tall tree discussing her journey, her challenges, and how she first got involved with UVP. 

As a young pregnant person, Rachel had to balance pending motherhood, schooling, and family responsibilities, while also navigating social stigma around her pregnancy. In fear of being seen pregnant, Rachel avoided antenatal care, and didn’t consider going for an HIV test to confirm her status before giving birth.

Rachel first met UVP during one of our adolescent reproductive health sessions for youths in 2019. She heard about our programs on the radio and was excited to learn of an upcoming event that she could attend. Despite all of her other responsibilities at home and in the garden, she always made time to attend these sessions and even took a keen interest in leading a few activities!

Through her involvement with UVP, she learned about an upcoming HIV-malaria community outreach event, where we offer testing, treatment, and health referral services. Feeling ready to know her status, Rachel signed up for testing and learned her test results were negative.

“I knew I had to gain [the] confidence to make a bold decision to take the [HIV] test, but the fear in me couldn’t let me do so. But this time ‘round, I had to overcome the fear…”

Rachel feels empowered now that she knows her status. She was scared to find out, but now she’s prepared to take good care of own health, and is eager to support other young people in finding out their own status. There is often a great deal of stigma and fear around HIV in the village, but with Rachel as an ally, we can help reduce these concerns and ensure more youths receive proactive HIV testing. Twekembe! -- working together for a healthier Uganda.

 

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Learn more about UVP on our website and please consider supporting UVP with a monthly gift. We provide year-round programming and education for HIV/AIDS, clean water and sanitation, malaria prevention and treatment, reproductive health services, and fistula repair surgeries.

Under the Moonlight

 By Josephine Asio, Former HIV and Malaria Program Coordinator at UVP

Wilson’s story is being shared with his consent. 

 

Moonlight events bring HIV testing and counseling to community members who cannot attend typical HIV outreach due to work demands. The events get their name because they are conducted in the evening under the light of the moon and held at trading centers to target a population at higher risk of contracting HIV.  

 

Moonlight events, as well as regular HIV/STI counseling events, help to decrease stigma associated with HIV infection. UVP staff educate communities on the options that are available for HIV treatment, and make connections to local facilities where HIV positive individuals can obtain antiretroviral treatments. 

 

Due to the COVID-19 pandemic, the President of Uganda implemented a curfew to encourage citizens to remain indoors and prevent further spread of the virus. The curfew has put a pause on moonlight events. Some people, particularly men, feel more comfortable testing for HIV at moonlight events as they believe the setting is more private. With stigma around HIV infection, a testing event may cause extra anxiety for men and women who want to know their HIV status. 

 

Wilson, a young family man with a wife and four children, admits to UVP staff that he would prefer receiving an HIV test at a moonlight event. With assurance, Wilson realizes that UVP is capable of providing privacy and upholding confidentiality even with day-time HIV testing. Wilson received a test and was happy with the level of privacy upheld by UVP. He looks forward to moonlight events returning so that more of his friends and neighbors can access HIV services that don’t interfere with their work schedules.

 

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Learn about all the ways UVP fights HIV on our website. If you’d like to help men like Wilson, please consider supporting UVP with a monthly gift. In addition to supporting HIV/STI education and testing, UVP provides programs and education for clean water and sanitation, malaria prevention and treatment, reproductive health services, and fistula repair surgeries.

The Brave Month

by Harriet Nakayiza, Program Coordinator

Seated under a cool mango tree at Bugono Health Centre IV, this is where Kasita found out her status. She’s a shy, kind young lady, only 19 years old. She’s also living with HIV.

So many times Kasita had seen and participated in UVP’s sensitizations for HIV, but never sought HIV testing for herself. Since she never felt ill or with a history of sexually transmitted infections, Kasita didn’t think an HIV test was necessary, but she always had a little fear that the test might be positive. This month she was brave.

When she first found out about her status she was frightened and upset. “Usually fear is the beginning of all troubles,” she said. “But with time, we adjust, we seek help, and we live a healthy life.”

As Kasita looks to the future, she is confident and hopefully. Her 8 month old beautiful baby girl needs her, and she is committed to taking her antiretroviral therapy (ART) “until the end end of my life” as she would say. 

Kasita also learned a powerful lesson: HIV is not only transmitted to people with multiple partners. This is the type of misinformation that continues to perpetuate stigma for individuals living with HIV. 

Through UVP-led community sensitization, more women like Kasita (and her husband too!) are able to know their status, seek life-saving treatment, and undo harmful myths to live a happy, healthy life.

Kasita's story is being shared with her permission.
You can support young women like Kasita to know their HIV status by supporting UVP's HIV program!

The Power of Relationships

 by Harriet Nakayiza, Program Coordinator

I’m sitting outside of Nawansiinge Health Centre II in the grassy area because the all the seats in the waiting area are occupied. Nurse Betty told me that if I wanted to meet with her, I would have to wait until she had finished serving all the patients. So, I wait.

Nurse Betty is a dedicated government health worker; she arrives to the clinic early and continues to take patients long after most of her colleagues leave for the day. Each health center has targets to reach – a certain number of HIV or malaria tests to conduct each quarter, and it is clear that Betty is committed to reaching those goals. Today, I’m here to introduce UVP to her and request any supplies she can provide. Nawansiinge Health Centre serves UVP’s 2020 villages, so it should be fairly easy to gain her assistance in providing supplies for the upcoming HIV outreach because it will directly benefit her catchment area.

When she finishes with the last patient, I formally introduce UVP’s work to Nurse Betty. She admits that she has not heard of UVP, but seems very interested in our work. We discuss at length our mutual mission of delivering health services in communities that need it most and the challenges of that endeavor: long distances to travel, unmaintained roads, and a lack of funding for such outreaches. Our mutual passion for the work is evident, which is why I was surprised that she didn’t immediately provide supplies – she said she needed to speak to her supervisor. Understandably so, I think to myself.

True to her word, Nurse Betty calls me back the next day to tell me that her supervisor has approved for Nawansiinge Health Centre to work with UVP by providing supplies and health workers to conduct HIV outreaches. Although Nurse Betty was not familiar with UVP’s work, her supervisor was and expressed great interest in working with us. It is this moment that I realize the power of a relationship – UVP works with many health centers in the area, and health workers collaborate frequently. Because of our deep relationships both in villages and health centers, the supervisor at Nawansiinge Health Centre II knew about UVP and trusted us. To us, trust is the highest compliment.

If you, like UVP, think relationships are important, either schedule a call with the Executive Director to chat about UVP happenings or become a monthly donor with UVP so you can build a lasting, sustainable impact in Iganga!

Investing in Teenage Girls #WPD2016

July 11, 2016, marks the 27th annual observance of World Population Day, a day designed by the UN to highlight global population issues. The goal is spread awareness of population-related issues such as family planning, gender equality, poverty, maternal health and human rights. This year’s theme is ‘Investing in Teenage Girls.’  

How does #WPD2016 apply to Uganda?

The Pearl of Africa may triple its population by 2050. It has one of the world’s youngest and most rapidly growing populations, with 78% of the population being younger than 30 years of age and nearly half being younger than 15. Ugandan women have fertility rates of, on average, 6 children each throughout their reproductive periods. On average, 3 out of 10 women have unmet family planning needs -- and the prevalence of these needs are much greater in rural areas. [State of Uganda Population Report, 2014]. Girls and young women (15-24 years old) are disproportionately affected by HIV/AIDS, at rates twice that of men in the same age bracket. Only two-fifths of young adults correctly identify the ways to prevent sexual transmission of HIV.

What can you do?

•   Read more about #WPD2016 at UNFPA.org
•   Check out the WHO factsheet on family planning and contraception
•   Support UVP’s Healthy Villages efforts for Safe Motherhood & Family Planning,  HIV/AIDS, and Obstetric Fistula.  

An HIV/AIDS-free life and marriage

Muzamiru Ngobi is 27 years old and resides in Nakamini (a 2011 Healthy Village) where UVP has just conducted an HIV outreach. He was able to attend and get tested for HIV/AIDS after getting education and group counseling by the nurse and counselor. When asked why he wanted to get tested for HIV/AIDS, he had this to say: "I am planning to get married in August this year and we have tested for HIV as a couple once since our relationship started. Today I have come alone for testing because she is out of the village but I will share my results with her and move with her to Namalemba health center for another round of HIV/AIDS testing so that we are able to live an HIV/AIDS free life and marriage." 

This was the first HIV/AIDS outreach day of 2013.  It was a success with over 150 community members coming for counselling and testing- many testing together with their partners or other family members.   

HIV and UVP: Healthy Village Teams work to combat HIV in Iganga

By Gwendolyn Wernersbach 

HIV rates in sub Saharan African remain a major public health concern globally.  Uganda in particular is considered by many to be among the world's earliest and most compelling national success stories when it comes to combating the spread of HIV.  In recent years, Uganda experienced a decline in HIV prevalence, however, new reports show that the HIV prevalence rate has increased slightly, and that women are disproportionately affected compared to men.    

The HIV prevalence rate in Iganga is estimated to be higher than the national average by about eight percent.  Rural populations are most affected, as access to HIV testing, counseling and treatment are more difficult to come by in remote areas.  According to the Ugandan Ministry of Health, 85% of the population of Uganda does not know their HIV status, which demonstrates the impact and importance of these services.  Access to HIV counseling and testing is compounded by the fact that AIDS-related stigma and discrimination remains the single most important barrier when it comes to behavior change and public action. 

The Uganda Village Project (UVP) is helping to combat rates of HIV in rural areas of the Iganga district by providing HIV counseling and testing services through our Healthy Villages Team program.  The Village Health Teams work with local partners, including St. Mary’s, to conduct culturally appropriate outreach activities to educate communities about basic HIV prevention methods, and often incorporate dance, drama and music performances in to their messaging.  Additionally, UVP is actively involved with distributing condoms in collaboration with partner NGOs, and also administers voluntary HIV testing for villagers as a way to eliminate fear, stigma, or costs associated with travel to a clinic. 

Meet our friend Naigaga Sarah of the Nabitovu village.  Naigaga Sarah is a 34-year old mother of three children, and a proud member of the UVP Nabitovu Village Health team.  She is pictured below holding her youngest child as she waits to speak with the counselor about her results following a routine HIV test. 

Naigaga Sarah comes from a polygamous marriage, she is wife number three and the youngest wife in the home.  "We all came to test today," she said smiling.

"Since Uganda Village Project came into the village, my co-wives, my husband and myself have been testing for HIV at least once and sometimes twice every year.  As a Village Health Team member I encourage others to come for testing and mobilize the village for the HIV education sessions as well. I am happy for the opportunity Uganda Village Project and their donors have given us, by bringing testing right to the village level.  They test at the health centre as well, but it is far and walking there can sometimes be tiresome, therefore bringing testing to us is good and we are grateful."

In 2011, 1,421 HIV tests were administered in nine villages.  So far this year, as of July 2012, 1,623 HIV tests have been administered in eleven villages.  For those that test positive, they are referred to The AIDS Support Organization (TASO), their closest health center, or Iganga district hospital for follow up care and treatment.    

In these ways and many more, UVP is helping to reverse the trend of HIV in Iganga district.  We can only continue to do this important work through your help, generosity and support.  Learn more about how you can make a difference by supporting UVP’s HIV prevention efforts in Iganga here.   

Gwen is passionate about global public health and humanitarian relief efforts, both domestically and internationally. She has worked in the areas of HIV prevention, refugee health, nutrition, fitness, water and sanitation projects, and public health emergency preparedness. Gwen has served as a Peace Corps Volunteer in Lesotho, and holds an MPH from Emory University in Atlanta. She currently works with the American Red Cross and serves on the board as a Member At Large for UVP. 

Alumni Profile: Kate Cerwensky, Program Associate at the Boston University PMTCT Integration Program and former UVPer

Kate Cerwensky is a 27-year-old public health professional and UVP alumna. She currently lives and works in Zambia for the Boston University PMTCT Integration Program and the Zambia Center for Applied Health and Research and Development. She travels on the side as much as she can.

Uganda Village Project (UVP): Tell us about your involvement with the Uganda Village Project – when were you involve and in what capacity?

Kate Cerwensky (KC): I served as the Safe Water and Sanitation Project Coordinator for UVP during the summer of 2008. We were based in rural Kalalu Parish in Iganga. My team of five was tasked to promote WaterGuard, a water-chlorination product developed by the CDC. We also coordinated two side projects: 1) establish a relationship between the community and partner organizations to build five shallow wells within our parish, and 2) mobilize the community for mass distribution of insecticide treated nets.

From 2008-2009 I served as UVP's publicity chair on the executive board. I helped to create promotional materials, including orientation and project area manuals, as well as pursued and established relationships with external partners.

UVP: What was your biggest challenge working in Iganga? How did you deal with it?

KC: The biggest challenge, but the most fun as it turned out, was learning how to live like your rural community. My team had the most rural placement, and therefore we did not have electricity, running water, indoor plumbing, washing machines, air conditioning, etc. It was quite the learning experience, and extremely humbling. We dealt with it as a team - took turns fetching water from the borehole, handwashing our own clothes, etc. Most of all we learned from the community, which helped gain their trust.

UVP: What is your favorite memory about your time in Uganda?

KC: Too many. It could have been coming home after a really hard day in the field to no fewer than 30 children between the ages of few months and 10 years waiting for us in our front yard excitedly. It could have been the shallow well commissioning ceremony (the "ribbon cutting" celebration) after the construction of one of the community wells, with all of the singing and dancing. It could have been the morning I left my village - I was so sad to leave, and one by one my community members gave me a last token of appreciation - an orange, an egg, maize, sugarcane, a live chicken... etc. My bags were already bursting and then I had to find places for 40 random food items, which was incredibly touching. Or maybe it was white water rafting the Nile with the other volunteers :-)

UVP: How has UVP shaped your career today and what you aspire to do in the future?

KC: UVP solidified my desire to get my Masters in Public Health (International Health and Epidemiology). I always knew I was keen for international work, but wasn't sure exactly what that was until my time in Uganda. Since Uganda, I have worked in rural Kenya, and now have been living in urban Zambia, providing technical support and program implementation and evaluation services. I am extremely happy with where I am now, and can see myself staying in Zambia for years to come, growing with my current organization.

UVP: Tell us more about your work - what are you working on and who are you working with?

KC: I currently live in Lusaka, Zambia, and have been working for Boston University's Center for Global Health and Development's local affiliate - the Zambia Center for Applied Health Research and Development (ZCAHRD) - since January 2011. The Boston University Center for Global Health and Development (CGHD, previously CIHD) has been engaged by the U.S. CDC Global AIDS Program/Zambia to provide technical, logistical and limited financial support for the provision of prevention of mother to child transmission (PMTCT) services to eight District Health Management Teams (DHMTs) in Southern Province, Zambia, through the Boston University PMTCT Integration Program (BUPIP).

UVP: What are the goals of the Boston University PMTCT Integration Program?

KC: BUPIP has two interrelated, overall goals, 1) to make prevention of mother to child transmission (PMTCT) services accessible and affordable to women in 80% of the urban and rural areas of the covered districts in Southern Province; and 2) to enable the rapid scale-up of early infant diagnosis (EID) services in the same areas (MOH 2010 testing target for exposed infants was 80%). These goals are being accomplished by continuing our support of the Government of Zambia (GoZ) (Southern Province) in scaling up quality PMTCT services within maternal and child health programs in accordance with the national PMTCT and EID Strategic Objectives.

Secondary essential goals are 1) to provide quality palliative care to HIV-affected children; 2) to implement innovative approaches to reach hard-to-access rural populations through the use of community workers (Trained Traditional Birth Attendants (tTBAs), Community Health Workers (CHWs), and PMTCT Lay Counselors); and 3) to develop effective community networks for increasing awareness and program participation.

UVP: What has your role been at the organization?

Personally, I am a Program Associate for the greater BUPIP, but within the organization sector, I serve as Program Coordinator for our Antiretroviral Therapy in Antenatal Care (ART/ANC) Program Evaluation.

Within six pilot sites in Southern Province, we are working with the District Medical Officers and Maternal and Child Health (MCH) nurse in-charges and staff to provide ART in the MCH wards for HIV-positive pregnant mothers during their antenatal care and throughout the infant's period of breastfeeding (up to 18 months). By providing ART services in the MCH wards, rather than referring these pregnant women to separate ART wards on the premises or to even farther ART facilities, there is a more streamlined service. Additionally we are assigning each HIV-positive pregnant mother presenting at first ANC booking their own Lay Counselor (volunteer community health worker, trained in ART adherence, Adult and Pediatric ART, and Opportunistic Infections) to follow up with the mother-infant pair to provide ART adherence counseling and PMTCT support, as well as remind them of existing appointments to help decrease lost to follow up.

Lastly, my team is attempting to introduce new point-of-care testing technology into Zambia to be used within MCH in obtaining CD4 counts and creatinine levels. It is hoped this will create same day ART initiation as the HIV diagnosis (rather than the current 3 week timespan). In short, the pilot's primary objectives are: 1) Increase the amount of HIV+ pregnant women initiating ART, 2) Decrease the time it takes from HIV diagnosis to ART initiation for pregnant women, 3) Improve adherence for daily ARVs for HIV-exposed, breastfeeding infants, and 4) Increase adherence to MCH and EID services for the mother-infant pairs.

UVP: That is great and so exciting. Knowing what you now know from your experiences in both Uganda and Zambia, what advice do you have for future interns/volunteers? What was one thing you wish you knew before volunteering in Iganga?

KC: I would suggest going into it with an open mind - not a top-down imposing mind. Take the time to slow down your own lifestyle to foster relationships with the community. Remember patience and flexibility is key.

Sujal Parikh Social Justice Fellow Cat Kirk in her own words

I am a master’s student from the University of Michigan School of Public Health where I am studying Health Behavior and Health Education. My area of interest is global health with an emphasis on HIV prevention, awareness, and stigma reduction. I became interested in global health as a WorldTeach volunteer in Namibia, where I saw firsthand the devastating toll of HIV/AIDS and have been actively involved in HIV/AIDS advocacy as a chairperson of the World AIDS Week Committee at the University of Michigan. The Sujal Parikh Social Justice Fellowship is an incredible, and necessary, opportunity to gain a better understanding of the health needs of elderly villagers and particularly their perceptions of the impact HIV/AIDS has on their lives. The elderly are a frequently overlooked population in the prevention of HIV/AIDS. And I am hopeful that through researching the needs of the elderly, Uganda Village Project will be better able to meet the health needs of elderly villagers and provide HIV/AIDS prevention programs that will be appropriate for this age group. I am honored to carry out this work with Uganda Village Project in the memory of Sujal Parikh, who was an inspiration in his dedication to global health and social justice.

Cat Kirk is the first person awarded the Sujal Parikh Social Justice Fellowship; she will begin her work involving HIV/AIDS and the elderly this summer. Sujal Parikh was a medical student, AIDS researcher, and tireless advocate for global health and social justice.
Learn more: http://www.ugandavillageproject.org/in-honor-of-sujal/

Inside the Villages: HIV testing in Buwolmera

Forty-five-year-old Monica lives in Buwolmera, one of our Healthy Villages. When her husband heard that UVP would be conducting HIV testing, he declared it a day for “knowing our status.” He said that Monica and her co-wife should ignore tending the garden for the afternoon and instead participate with him in UVP’s HIV and syphilis testing day in the village.
Monica was excited that her husband was supportive and that he had encouraged both of his wives to go for testing. Most of all, she was happy to have the opportunity to know her status. She says the importance of testing is critical especially in a marriage where a husband has multiple wives. That’s because there is an extremely high risk of infection in polygamous settings.
In Uganda, new HIV/AIDS infections are very high among married people. Polygamy has been cited by the Uganda AIDS Commission as the cause of a recent increase in HIV/AIDS rates. Multiple sexual relationships spread infection. Monogamous marriages with extra-marital sexual partners contribute 46% of the new infections.
--by Maureen Nakalinzi

Learn more: http://www.ugandavillageproject.org/what-we-do/healthy-villages/hiv/