“We live in a completely interdependent world, which simply means we cannot escape each other. How we respond to AIDS depends, in part, on whether we understand this interdependence. It is not someone else’s problem. This is everybody’s problem.”
Bill Clinton, Former President
In the 20th century, the world was confronted with HIV/AIDS, a deadly pandemic that claimed hundreds of thousands of lives. The virus is said to have entered Uganda through the Southern border amid the 1979 Uganda-Tanzania war. It is conceived that the Tanzanian soldiers locally known as “the Bakombozi” spread the disease-causing virus when they had sexual relations with the locals. The already superstitious nation was a fertile ground for the virus to spread since most people linked it to either witchcraft or curses.
Luckily, the ascension of a new government to power in 1986 after the notably successful NRA Bush war, a robust campaign against the deadly virus was launched. The Abstinence, Faithfulness, and Use of Condoms (ABC Method) was launched by the incumbent Y.K. Museveni. Due to this intense campaign, Uganda was one of the world’s earliest and best success stories in overcoming HIV.
On a sad note, however, the gains achieved in the battle against HIV were gradually lost with persons infected rising from 600,000 in the 1990s to 1.3 million people in the 2000’s. Uganda now has the 10th highest rate of HIV in the world and the East African region with a 6.2% overall prevalence and 7.6% prevalence among women.
The government of Uganda did not give up on its fight and launched more campaigns such as the Prevention Of Mother To Child Transmission (PMTCT), sensitization to end stigma, countrywide distribution of condoms, which have all contained the spread of the deadly virus and it’s prevalence. Research indicated that around 14 million HIV infections among children were prevented between 2010-2015 due to PMTCT.
On 11th March 2020 however, all the gains and challenges that came with the fight against HIV were at the mercy of a new pandemic. Yes, a new boss arrived when Covid-19 was declared a pandemic by the World Health Organization (WHO). The virus, which started in the Chinese city of Wuhan has seen the world change in many drastic ways. The “new normal” birthed nationwide lockdowns with Uganda’s being declared on 18th March 2020.
To a 3rd world country like Uganda, lockdowns have proved to be harder to enforce and made it hard to survive especially for persons who need constant medical attention, such as HIV/AIDS patients. Many can no longer access health services and hence their treatment due to the ban on public and private transport yet health centers and hospitals are very far and serve large areas. For example, some patients have had to trek over 30km to and from their hospitals to pick anti-retroviral therapy.
Important to note is that treatment adherence is tantamount to the reduction of the HIV viral load to undetectable levels while denial of antiretroviral therapy equals to the viral load increases, even when the interruptions have been short term. This can significantly shorten a person’s life and increase the potential to transmit the virus. Therefore, special attention needs to be given to how this anti-retroviral therapy can get to the patients if Uganda is to maintain steady progress in the fight against HIV.
The pains encountered by HIV patients during this lockdown is perfectly summarised by Simon Bukenya’s story. Noting a higher risk for HIV patients with compromised immune systems, health worker Simon Bukenya decided to make ARV home deliveries. He would cycle over 30km to deliver drugs to the patients who would only be a handful due to the strained transport system. The lingering question therefore is, how many patients couldn’t receive the heroic help of Mr. Bukenya? In as much as the Ministry of Health set up a program to allow community health workers to collect the ARV pills for patients who have openly shared their status, this has not been fully helpful since most patients rarely disclose their status for fear of being stigmatised. Therefore, what happens to those who couldn’t access their Anti-retroviral therapy during the 2 months lockdown?
The biggest and most effective method of combating HIV also seems to be at stake. The PMTCT is difficult to enforce since it is supposed to be offered before conception, pregnancy, labour and breastfeeding yet many pregnant women (HIV positive women inclusive) have restored to delivering from home due to the long distances they have to move to access the hospitals. This means that mothers risk passing the virus to their children during birth and when they miss the antiretroviral treatment which prevents the transmission. There has also been a shortage of Lopinavir and Ritonavir for HIV positive children at the National Medical Stores. These pediatric antiretrovirals are expected to have arrived this month.
If the situation continues in its gloomy state, research indicates that should Covid-19 curtail treatment services for 6 months, new infections in children could surge by as much as 104% in Uganda.