NYT Article: "In Uganda, AIDS War is Falling Apart"

Today the New York Times ran an excellent and very sad series of article on the AIDS situation in Uganda and across the world. Read them here:

In Uganda, AIDS War is Falling Apart

http://www.nytimes.com/2010/05/10/world/africa/10aids.html?ref=world

As the Need Grows, the Money for AIDS Runs Far Short

http://www.nytimes.com/2010/05/10/world/africa/10aidsmoney.html

After Long Scientific Search, Still No Cure for AIDS http://www.nytimes.com/2010/05/10/world/africa/10aidsscience.html

Cultural Attitudes and Rumors Are Lasting Obstacles to Safe Sex

http://www.nytimes.com/2010/05/10/world/africa/10aidscondom.html

Below are few quotes from the first article...

Uganda is the first country where major clinics routinely turn people [seeking HIV drugs] away, but it will not be the last. In Kenya next door, grants to keep 200,000 on drugs will expire soon. An American-run program in Mozambique has been told to stop opening clinics. There have been drug shortages in Nigeria and Swaziland. Tanzania and Botswana are trimming treatment slots, according to a report by the medical charity Doctors Without Borders.

…

And, most devastating of all, old-fashioned prevention has flopped. Too few people, particularly in Africa, are using the “ABC” approach pioneered here in Uganda: abstain, be faithful, use condoms.

For every 100 people put on treatment, 250 are newly infected, according to the United Nations’ AIDS-fighting agency, Unaids.

That makes prospects for the future grim. Worldwide, even though two million people with the disease die each year, the total keeps growing because nearly three million adults and children become infected.

Even now, the fight is falling short. Of the 33 million people infected, 14 million are immuno-compromised enough to need drugs now, under the latest World Health Organization guidelines. (W.H.O. guidelines are conservative; if all 33 million were Americans, most clinicians would treat them at once.)

Instead, despite a superhuman effort by donors, fewer than four million are on treatment. Just to meet the minimal W.H.O. guidelines, donations would have to treble instead of going flat.

Uganda is a microcosm of that: 500,000 need treatment, 200,000 are getting it, but each year, an additional 110,000 are infected.

“You cannot mop the floor when the tap is still running on it,” said Dr. David Kihumuro Apuuli, director-general of the Uganda AIDS Commission.

…

“I’m worried we’ll be in a ‘Kampala situation’ in other countries soon,” said Ambassador Eric Goosby, the Obama administration’s new global AIDS coordinator.

“What I see is making me very scared,” agreed Michel Sidibé, executive director of Unaids. Without a change of heart among donors, Mr. Sidibé said, “the whole hope I’ve had for the last 10 years will disappear.”

Donors give about $10 billion a year, while controlling the epidemic would cost $27 billion a year, he estimated.

His predecessor, Dr. Peter Piot, said he had seen optimism soar and then fade.

…

American officials who spoke on the condition of anonymity confirmed the financing freeze.

“The decision was made late in the Bush administration to cap Uganda at $280 million,” one said. “That’s an industrial amount of money.”

United States Embassy officials debated adding $38 million, he said, but cabinet-level Ugandan ministers had been caught stealing from other donors and, though forced to repay the money, were not jailed. The government “hasn’t shown the leadership or commitment to transparency to earn additional funds,” the official added.

Also, he said, Uganda contributes too little. Oil was recently discovered near Lake Albert and the government promised to spend the royalties on roads and electricity, but did not mention AIDS.

“And now the paper says they’re buying Russian jets,” another official added with obvious disgust. Uganda is negotiating for a $300 million squadron of Sukhoi fighter-bombers.

Sanitation Week Stories

We partnered with the District Water Office in March, in order to do sanitation work in all of the Healthy Villages, in celebration of International Sanitation Week. We were meant to specifically focus in Nabitovu - district officials and a team of 50 university students would go there every day to do house-to-house sanitation education and hands-on work. District officials also planned to visit each of our HV villages, however, so that all were participating in "Sanitation Week." We had already arranged "hands-on days" in each of our other villages, this time the district offiicals would come along for the ride. Part of UVP's annual sanitation goals this year include holding these sanitation 'push' campaigns in each of our Healthy Villages.

The Sanitation Days really began on Wednesday. On Tuesday, to get everything organized and ready, Julius had held a hands-on training with 4 of the university students and a bunch of the VHT members. He went over how to make a tippy-tap, a plate stand, etc. He also helped the VHT members come up with an action plan - for the rest of the week (Wed - Sat), all sanitation workers would divide into 6 groups. Each group would be lead by a VHT member (or perhaps 2), and a UVP or District individual (or perhaps 2), and have around 8 or 9 university students. Over the course of the week, we worked with these teams to ensure that each team was constructing tippy taps that was up to standard, and UVP staff used our bicycles to travel from home to home checking in on the teams. We also provided lunch to the university students, to allow them to put in a full day's work.

In the end, it was an incredible, amazing success! On Friday, I went to the meeting place, knowing that I would find somebody working nearby, and indeed I did: I found Edward, one of the VHT members. He was wandering around with a bunch of Jerry-Cans over his shoulder and a bundle of wire, and he agreed to take me over to Julius's team. On the way from Kasokoso's (the meeting place), we passed house after active house - the entire village had come alive with sanitation work! It was incredible. Houses were being "smeared" (this apparently keeps fleas away), tippy-taps were everywhere, wood was being cut for plate stands and latrines and trash pits were being dug... two individuals stopped us, as we walked the 2 or so minutes to Julius's team, in order to ask Edward about getting a tippy-tap, or wire, or string, or something like that. Edward told me that the whole village was like this - "people did not go to their gardens today," he said. "They have been working since morning, just doing sanitation."

It was truly amazing. It seemed like the university students, district people and UVP staff, had somehow become a critical mass, and ignited a fire of action in the village that was now continuing without us. Everyone is working! Everyone suddenly wants their house to be as excellent as their neighbor's! It is truly inspiring to see.
-- Leah Bevis, Healthy Villages Coordinator

Malawi and Uganda Consider HIV Status Bill

This link describes a bill being considered in Malawi, but Uganda is actually considering passing the same law. 

http://news.bbc.co.uk/2/hi/africa/8607365.stm

If passed, the law would make it illegal for a person who knows they are HIV-positive to infect another individual.  The article above mostly focuses on the problems this would pose to sex industry workers - and there's certainly a healthy industry in Uganda who could complain of the same. 

A few months ago, however, a friend pointed out to me an even bigger problem with such a law. (She was referring in our case to Uganda, not Malawi.)  Making it illegal to knowingly pass on HIV essentially makes it dangerous to know that you have HIV.  Not knowing is safer - if you pass it on, you can't get convicted, because you had no idea!  This provides a disincentive for testing, which is the only true way to know if you are HIV-positive.  

Imagine, for instance, that two married people living in a village are HIV-positive.  The woman (lets call her Isa), suspects that her husband (Nsoni) has AIDs, and has passed on HIV to herself.  Isa figures that Nsoni probably contracted HIV in the years after their marriage - perhaps through mere cheating, or perhaps through another wife.  Isa wants to test herself for HIV.  After all, she's still having children by Nsoni, and if she's HIV-positive she wants to take the proper precautions to avoid mother-to-child transmission.  However, to the best of Isa's knowledge, Nsoni has never been tested himself.  So this mean that if she tests herself, she'll be the first one to know that she is HIV positive.  This would allow Nsoni, in the coming years, to prosecute her for knowingly passing along HIV to him - never mind that he's almost certainly the one who had it first, because now it can't be proved either way.  But it would be clear that Isa was the only first one who knew about it (for sure), and especially if she didn't volunteer the results of the test to Nsoni right away, she might be liable under the law. 

I don't claim to be an expert on this sort of HIV related policy, but this was the story that my friend explained to me, in our conversation months ago.  And I think its a worrying one. 

Reproductive Health News from Iganga

Interesting article from AllAfrica.com - Iganga District in the news.

Iganga Stores Full of Contraceptives

Comments from UVP staff or locals?

Fundraising Month Begins in 1 Week

In just one week, Fundraising Month for Uganda Village Project will begin!
This is a time of year when we work our hardest to raise funds in order to be able to bring safe water to villages, give scholarships to orphans, improve nutrition and sanitation for rural families, and all the many important programs that will change lives in the Iganga District for the rest of the year.

Would you like to join us? It's easy! Anyone can help!
- Visit our brand new Fundraising and Media Center where you can download brochures, posters, and a manual full of fundraising ideas and tips
- Stay tuned- we'll be posting weekly updates to this blog on the progress made towards our goals, successful fundraising stories, ideas, and more
- If you'd like to stay updated on what other friends and UVP members are doing for Fundraising Month, check our Twitter feed, join our Facebook Cause, or be sure that you are on the mailing list for our newsletter.

Landslide in Eastern Uganda

contributed by Jeyandini Fernando

This past weekend in New York City, the rains were deemed torrential and caused much damage to the suburban communities around the metropolitan area. Flights were cancelled, school children kept safe at home, and rescue crews worked to clean up the damage. Two days later, the sun is shining and we are all back to the daily routines that were on hold from the weather. Earlier this month, heavy rains caused brutal landslides in the Bududa region of Uganda. Except, 2 weeks later, everything is not back to normal.

Around 200,000 people live in the most affected area surrounding Mount Elgon; about 300 are expected to be dead. The locals, now “rescue workers,” are struggling to recover bodies under five, and sometimes ten, meters (16-32 feet) of mud. Entire villages have been renamed cemeteries. An estimation of when the mud can be cleaned up is impossible since the downpours continue in the rainy season. As the victims fall deeper, any hope of a proper burial or last rites disappears.

I remember the rain when I first got to Uganda. The rattle on the tin roof kept me up all night in fear of the apocalypse. But, during the days, the strings of raindrops that fell at ridiculous speeds looked like waterfalls in our little village. Twenty minutes later, all the green landscapes were showered with drops of dew. The beauty was breathtaking. I can’t imagine the scene now in eastern Uganda.

The dramatic change from two years ago is unimaginable. Experts say that the lack of land on level ground has forced families to move onto and around the mountains. The deforestation of trees and shrubs for agriculture has left the land untethered and free to wash down the mountainside, and at high speeds can sweep away unsuspecting local community members in a heartbeat.

It is in these moments of reminiscing that I realize how large an impact one summer volunteering in Uganda had on my life. That connection lasts forever. Our hearts go out to the Ugandan people of the Bududa region, just 70 miles from Iganga where our office is located.


View Iganga and Bududa Region in a larger map

Women’s Day in Uganda

Monday March 9th was International Women’s Day. Julius and I celebrated it by running a sanitation workshop in Nabitovu Village. Twenty-eight village leaders attended the workshop, mostly Village Health Team (VHT) members and political leaders.

Nabitovu’s Village Health Team is, fittingly enough, run by a woman called Mbasaliki Monica. Mbasaliki is our most active VHT Chair, and because of her the team is probably our most effective VHT team. Even before we planned our current Sanitation Campaigns, Mbasaliki had organized groups of VHT members and political leaders to go around the village checking households for latrines, and educating families about the importance of latrines and sanitation.

Also, almost half the members of the Nabitovu Village Heath Team are women, and I notice increasingly that, during VHT meetings, women speak up almost as much as men. This is rare in Uganda – go to most village meetings and you’ll quickly notice that the women (who sit on mats), barely voice a word of opinion, while the men (who sit on chairs), dominate every discussion.

Then again, the maternal mortality rate in Uganda is still around 550 out of 100,000 live births. For comparison’s sake, the rate is 11 and 8 out of  10,000 in the US and in Sweden, respectively.  This means that 1 in 25 Ugandan women will die of pregnancy-related causes, while only 4800 will do so in the United States.  Uganda has one of the highest rates of Obstetric Fistula in the world, a painful and physically isolating condition caused by prolonged, obstructed labor. In developed countries, obstetric fistula is unheard of – only in the poorest countries are maternal care standards low enough for such a horrific condition to become prevalent.

Gender roles are incredibly stringent in Uganda (and across Sub-Saharan Africa in general). Women are expected to work in the garden, fetch water, cook all meals, keep the compound clean, wash clothes for half a dozen people or more by hand, look after the kids and tend sick family members, and so on. They also have virtually no say in the allocation of family resources – men are perfectly free to spend the proceeds of their wife’s labor drinking, no matter how badly the household may be lacking food, soap, or school tuition money.

Women have arguably benefited under President Museveni. Now, a set number of women must be Members of Parliament. Every village has an elected women’s leader. Universal primary education, and recently universal education up to senior four (grade 10), has certainly boosted female school attendance.

However, many Ugandans believe that “universal education,” poorly funded as it is, has caused educations standards to sink dramatically, and has thus done more harm that good for the country.

One of the saddest facts of female life in Uganda is the prevalence of domestic abuse. Beating one’s wife is frowned upon in most Ugandan cultures, in the same way that being publicly drunk is frowned upon. That is to say, it is unfortunate, and a bit embarrassing, but nothing that can’t be easily overlooked if a man is respectable and hard working in the other areas of his life. I would guess – and I may be wrong here – that it is the very rare wife indeed who has never once suffered the back of her husbands hand, and many women suffer frequent and brutal beatings.

I was reminded of this fact on Women’s Day in Nabitovu, as I sat around with a few Village Health Team members waiting for the workshop to begin. They were handing around a few photographs, shaking the heads and clucking their tongues in deeply disapproving manner. I leaned over to ask what they were looking at. They showed me. In the photographs, all of them, lay a dead woman, tossed into a thicket of grass by the side of a road. The woman looked to have been about 28 or 30, but was so bruised, cut, and blood-stained that it was hard to tell.

She was a villager from Nabitovu, the team told me, beaten to death by her husband four months prior. “Was the man now in jail?” “Yes.” “The poor, poor woman.” “Yes.”

They continued to look over the photographs, shaking their heads and murmuring in Lusoga. I turned my head to avoid accidently glancing at the photographs again. After a few minutes the owner of the photographs gathered them up and put them away, and as the last one was placed out of sight one of the women clapped her hands together, in a typical Ugandan gesture of disgust. “Aah,” she proclaimed, perhaps to me, or perhaps to the group at large. “Domestic violence, you see? That is the life of a woman in Uganda.”

Kambuzi's Fish Pond in Walukuba Village

Samuel Kambuzi is our Walukuba Village Health Team chair, and one of the hardest-working men in Iganga.  A few weeks ago he invited the UVP staff to come see his 'fish pond.' We went, not knowing what to expct. 

 

The pond is incredible - perhaps 30 by 60 feet, and full of fish.  Another lies next to it, not quite finished.  Kambuzi, his brothers and a few village political leaders financed the fish pond jointly, and they plan to share the proceeds.  The initiative is incredibly because they had virtually no guidance, and yet there was the pond, and there were the fish, darting about and eating ground maize as Kambuzi threw it into the water. 

Fish ponds are not an area of UVP specialization, but we had brought along a man who works on village income genation projects for another NGO, JIDDECO.  This man looked over the pond and offered some general advice: water ought to drain from the bottom of thepond, not the top, strings ought to be strung across the pond in rows to prevent birds eating fish.  The man promised to arrange a series of training days, run by another JIDDECO staff person who specializes infish ponds..  JIDDECO would finance the first training, but Kambuzi and his partners would have to pay forthe rest.  Kambuzi agreed - such techincal expertise would surely be worth the cost, as it would raise their profits in the long run.  We feel sure that the venture will be a success, if only because of the incredible committment shown by this groups of village leaders.

District Celebrates "Sanitation Week" in Nabitovu Village

This week, we have a very exciting addition to our sanitation work in the Healthy Villages: the District Water Office is celebrating international “Sanitation Week” in our villages, focusing particularly in Nabitovu Village.  District officials will be helping us out in all of our five “Healthy Villages,” but a HUGE number of university students, studying health and sanitation development courses, are working in Nabitovu Village today (Wendesday), Thursday, Friday, and Saturday.  These students will be working with the LC members and VHT members to do house-to-house outreach, going around and teaching families to construct sanitation measures.  UVP is, as normal, providing subsidized materials for the process, though the District might pitch in for additional materials in a day or so. 

 

Nabitovu Village is huge – it has about 360 households, and because of the way that houses and gardens are laid out, houses are spread apart instead of being clustered together in the middle of the village.  Thus, reaching out to every area of Nabitovu is quite difficult, and having this type of manpower at our disposal (about 50 enthusiastic and educated university students!), is going to allow us to make a greater impact in Nabitovu than we could have ever done on our own – at least, in a week’s time. 

Sanitation work will continue, as stated, until Saturday, and then take a rest on Sunday.  On Monday (World Water Day), the district is sponsoring a "Sanitation Celebration" in Nabitovu.  District officials and Sub-County officials will attend, and the village will put on entertainment in the form of music, dance, and drama.  UVP's second shallow well in Nabitovu will also be commissioned on this day.  UVP staff members will also take this time to address the entire village of Nabitovu (likely a few hundred villages will be gathered), announcing that this day is not the end of sanitation work in Nabitovu, but rather the beginning.  While the district will cease its work on Monday, UVP and the Nabitovu VHT and other leaders will continue to work across the village, helping families to improve on their sanitation standards, and thus improve health and standard of living.  

 

Yesterday, representatives from the University crew met with our Nabitovu VHT and the Nabitovu LC members.  They agreed to divide up into 6 groups, with accompanying villagers for each group, to move around the village helping families build sanitation measures.  The work starts this morning, and I will post another blog at the end of the week, to let everyone know how it goes!!

Sanitation Progress in UVP's "Healthy Villages"

We have now completed all Sanitation Workshops, in all villages.  Overall, the workshops were a wild success.  About 25 – 30 people attended each workshop, day long affairs that were intensive, interactive, and a LOT of fun.  Most attendees were Village Health Team members or LC (political council) leaders, though other leaders and important community members attended.

 

The two thirds of the workshops were mostly informational, and discussion based.  We did certain funny demonstrations too – for instance, having somebody drink supposedly clean water from a bottle, but having secretly dissolved a ton of salt in the water, to demonstrate the idea of invisible germs or other water contaminants. 

 

The last part of the workshop involved making a map of all open defecation sites around the village, and marking houses without latrines, and then coming up with a village action plan to increase latrine coverage and general sanitation.  The action plan part differed for each village, but usually involved groups of LC members and Village Health Team members working in particular “zones” of the village, reaching out to neighbors and teaching them about sanitation.  UVP is subsidizing the cost of a number of basic sanitation-measure materials, such as small jerry-cans (for hand-washing facilities), and nails (for trash pits and plate stands).

 

Now, we are in the process of running “Hands-On Days” in the villages, teaching the workshop attendees to build trash pits, plate stands and hand-washing facilities, and going over the standards of excellent bathing rooms and latrines.