Tag Archives: Uganda

Heightened HIV risk for people with disabilities

Inaccessible health services for people with disabilities (PWD), combined with social stigma and violence, contribute to high HIV risk – a gap that must be filled if the disabled are not to remain disproportionately vulnerable to HIV/AIDS, say health experts and activists.
“People with disabilities are at increased risk for exposure to HIV infection. HIV, in some cases in itself, can cause disability,” said Jill Hanass-Hancock, a senior researcher at the Health Economics & HIV/AIDS Research Division (HEARD), a South African research institute.

Globally there are an estimated one billion people living with a mental or physical disability, according to the UN World Health Organization. Many live in low- or middle-income countries and have poorer health and little formal education compared to the general population.

“We cannot talk about reducing HIV and its co-morbidities if you exclude this 15 percent of the world’s population,” added Hanass-Hancock, speaking at the AIDS 2014 Conference, hosted by the International AIDS Society in Melbourne on 20-25 July.

Data are scarce; most national HIV monitoring or surveillance programmes do not specifically track incidence among people with disabilities.

An 2014 meta-analysis of data and data from STD testing by STDAware.com from Sub-Saharan African countries showed that PWD are 1.3 times (1.48 for women) more at risk of contracting HIV than people without disabilities.

The 2014 “Gap Report” published by the Joint UN Programme on HIV/AIDS (UNAIDS) listed PWD as one of the key populations “left behind” in the global HIV response.

The no sex myth

Central to the struggle of PWD to gain inclusion in HIV response is breaking down the assumption that they are not sexually active and therefore do not need HIV services.

A 2014 Human Rights Watch (HRW) report on Zambia documented PWD describing how healthcare workers thought of them as “asexual”.

“People with disabilities are people first. They have the same needs and desires when it comes to relationships and being sexually active,” said Rosangela Berman Bheler, senior adviser at the UN Children’s Fund (UNICEF).

Others caution that PWD are at greater HIV risk due to other factors.

“PWD are four times more vulnerable to sexual abuse and violence. This increases their risk for HIV infection,” said Muriel Mac-Seing, HIV/AIDS protection technical adviser of Handicap International.

According to UNAIDS, “vulnerability, combined with a poor understanding and appreciation of their sexual and reproductive health needs, places people with disabilities at higher risk of HIV infection.” A 2012 article in The Lancet showed that people with mental and intellectual disabilities were at particularly high risk of abuse and violence.

Access barriers

Betty Babirye Kwagala, a medical counsellor for The AIDS Support Organization in Uganda, said the root of the heightened risk for people with disabilities can be seen in basic infrastructure.

“Services are not accessible – literally. Many health facilities do not have ramps or doors wide enough to accommodate people in wheelchairs,” said Kwagala who has had a physical disability since a car accident when she was 19. Five years ago she was diagnosed with HIV.

In her work as a medical counsellor, Kwagala has seen first-hand the lack of information and education materials suited for the needs of PWD, and a parallel lack of knowledge among health workers about how to communicate.

“How can a health worker who does not know how to use sign language communicate with someone who is deaf? They usually use gestures. But you cannot use gestures when prescribing medication,” said Kwagala.

Hanass-Hancock acknowledges bridging communication and understanding between health workers and PWD is critical to increasing the uptake of HIV services. But, she warns, such interventions need to take social conditions into consideration.

“People with disabilities often depend on a care-giver. This has a great impact on getting information privately and confidentially,” said Hanass-Hancock, adding that strategies such as SMS outreach and counselling for hearing impaired people, or easy-to-understand picture books for people with intellectual disabilities need to be developed.

Data gap

HRW’s research in Zambia, where one in 10 people has a disability, recommends a “twin-track approach starting with existing healthcare services more accommodating to PWD by simple things like widening doors”. PWD-specific interventions should be developed as well, they argue, and needs for either approach should be supported by improved data.

“We need to disaggregate the data to break it down by disability because all disabilities are different and will require different interventions. Then we can talk about creating tailor-fit services for them,” said Rashmi Chopra, a researcher on disability rights at HRW.

Lack of information – including about health and HIV – can leave PWD especially vulnerable inhumanitarian emergencies.

The Sphere Standards, which set out best practice in the delivery of humanitarian aid, encourage humanitarian actors to disaggregate data in their assessments, programming, and monitoring and evaluation tools by, among other things, noting if there is a disability involved.

However, Handicap International has critiqued the Sphere recommendation as insufficient to “mainstream a highly heterogeneous group such as [people with disabilities]”, and says recording the type of disability is crucial.

Despite the data gap, campaigners remain hopeful, saying the discussion has advanced from the days when the intersection between HIV and PWD was not even recognized.

“We must not forget that this is a dignity and human rights issue: most countries in the world – including donor countries – have ratified the UN convention on the rights of persons with disabilities (CRPD). It’s time for them to be responsible for their disabled citizens,” said Muriel Mac-Seing, HIV and AIDS protection and technical adviser for Handicap International.

CRPD, which has been ratified by 147 countries, mandates that governments “provide persons with disabilities with the same range, quality and standard of free or affordable health care and programmes as provided to other persons, including in the area of sexual and reproductive health and population-based public health programmes.”
[Courtesy IRIN]

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Draconian Law setback for Uganda’s HIV response

Kampala, 23 December 2013 (IRIN) –
The draconian Anti-Homosexuality Bill passed by Uganda’s parliament on 20 December would deliver a major blow to the response to HIV/AIDS if it was enacted by President Yoweri Museveni, activists have warned.
Those found guilty of homosexual acts can be jailed for up to 14 years under the new law, a sentence that increases to life in “aggravated” cases, such as those committed by an HIV positive person, or those involving minors, the disabled and serious offenders.

Civil society activists fear that high-risk groups such as men who have sex with men (MSM) and sex workers – whose HIV prevalence is 13.7 and 33 percent respectively – will see their already limited access to prevention and treatment further eroded.

Amnesty International called the law “a grave assault on human rights [which] makes a mockery of the Ugandan constitution.

“President Museveni should avoid the trap of scapegoating a vulnerable minority in the interests of short-term political gain,” said Daniel Bekele, Africa director at Human Rights Watch.

“He should recognize that this repugnant bill is of no benefit to Ugandans – that it only serves to jeopardize basic rights – and reject it.”

The United States government has also called for the bill not to be enacted.

Here is a selection of reactions from those working on the front-line of the response to HIV/AIDS:

Pepe Julian Onziema, programme director, Sexual Minorities Uganda (SMUG), a local rights group

“It’s with deep disappointment that I receive the news of the Anti-Homosexuality Bill passing in our Parliament.”

“If the bill is assented to, the Act would spell a major setback for Uganda’s gains against HIV/AIDS as it will compromise doctor-patient confidentiality, which will push affected LGBTI (lesbian, gay, bisexual, transgender and intersex) persons further underground for fear of prosecution.”

Asia Russell, Director of International Policy, Health GAP

“This harmful and blatantly unconstitutional bill will deal a devastating blow to evidence-based efforts to end the AIDS epidemic in Uganda – a country that is almost unique among aast and southern African countries in that it has rising rates of new HIV infections. Why? Because existing criminalization provisions have meant prevention and treatment services aren’t reaching populations like MSM, who have much higher HIV prevalence.”

“Under this new bill, providing those services would now be illegal – we will see new infections continue to rise as populations get excluded further and further from life-saving treatment, prevention, information and support.”

Milly Katana, veteran activist and board members of the Global Fund to Fight HIV, Tuberculosis and Malaria

“Totally disheartening! It is one of those moments where as a country we move one step forward in realizing civil liberties and public health common sense, [then] we take 10 steps back.”

“The little achievements of the Ministry of Health starting to think of making services available to people who are most at risk of contracting HIV are put in total jeopardy. I hope the president, who has announced himself as a champion for HIV prevention by encouraging Ugandans to test for HIV and knowing their status, will see the non-wisdom in this Act and not assent to it.”

Alice Kayongo, Regional Policy and Advocacy Manager, AIDS Healthcare Foundation – Uganda Cares

“The effects of this (bill) will be felt in almost all sectors but most especially in the health sector and particularly for HIV/AIDS where over 80 percent of the AIDS response is funded externally.”

“Even with amendments, the proposed law will have an impact on the quality of healthcare and health education to be provided to gay people living with HIV for the fact that treating someone or providing them with HIV related information will be seen as a promotion act, yielding to imprisonment. While there have been indications of forward movement in this country’s AIDS response, we are at risk of losing so much of what we have gained in the recent past.”

“Evidently, with such developments in the political and legal environments, Uganda is miles away from attaining [the UN-backed target of] zero new HIV infections, zero AIDS-related deaths and zero discrimination. It will not be a surprise if Uganda’s prevalence rate stagnates around 7.3 percent in 2017. However, we still have some hope, His Excellency President Yoweri Kaguta Museveni should reject the passing of this bill into law and everything else will fall into place.”

Flavia Kyomukama, director of the Global Coalition on Women and HIV/AIDS in Uganda

“At a time when the country is trying to implement the national HIV prevention strategy that has underscored the sex workers and MSM as key in the reduction of the epidemic, the legislature thinks it’s a waste of time to have these people access services.”

“A mother, a teacher, a health worker, an employer is by obligation expected to report any LGBT within 72 hours of notice and confirmation that someone is LGBT.”

“How do I report my son? As a teacher how do I report my student who comes to me in confidence? And as a health aide how do I abuse the confidence of the patient? All of us are going to be imprisoned.”
“If the proponents of the bill claim homosexuality is a mental disorder, is it logical to [give] life imprisonment? The [logical] approach would be counseling and treatment.”

And here are some reactions from champions of the new legislation:

Simon Lokodo, Uganda’s state minister for ethics and integrity

“This bill is going to cater for the lacuna which has been existing in the current law and legal frameworks in Uganda concerning this unnatural act. Having passed this bill, a lot has been done to protect our children and innocent victims who would be lured into these western cultures and behaviours, which are totally unacceptable to us.”

“The law is going to condemn any recruitment, promotion and financing of the activities related to these malpractices.”

“On the threats from donors and development to withdraw their financial assistance over this bill, we don’t care and are not bothered at all. We prefer to lose that money than our culture and people.”

“We have an obligation as a sovereign state to protect our people against this unnatural act.

Michael Lulume Bayiga, shadow health minister

“I am happy and excited this bill was passed. We are waiting for the president to assent to it in order for it to become a law. I am particularly happy with the provision that bans the promotion of this cult (homosexuality). This provision will ensure this act will doesn’t take root in our country.”

“No health worker asks patients whenever they seek treatment from a health facility about their sexual orientation, unless he/her chooses to do so. For all the years I practiced medicine, I have never known any sexual orientation of my patients. There is no discrimination in the health service provision.”

[Courtesy of IRIN]

Tied to a rope because she is disabled

Tied to a rope because she is disabled

Although she is 14 years of age, *Lisa cannot eat by herself or talk. She does not play with other children either, and needs help with basic activities. Therefore, her parents tie her to a tree because they feel it is the only way to keep her safe.

Lisa, 14, spends her day tied to a tree near her parents’ home in Nateete, Uganda with a rope. The rope is fastened onto her right leg. When she is not tied there, the rope remains. The tree is now known as Lisa’s tree.

This is not another case of the nodding disease. Lisa is deaf and mute. Her parents think tying her to the tree is the best way to manage her. While there, she keeps on moving around it. From time to time, she picks anything on the ground and puts it in her mouth. Her sisters keep on removing leaves and sticks so she has nothing to put in her mouth. But that doesn’t deter her from searching for something else. She tries to go as far as her rope allows her and when she finds nothing, she continues moving around the tree and sits down when tired.

All this she does while making sounds similar to that of a goat bleating.

Perhaps the saddest part in this story is that this slender and tall teenager was not born with any abnormality.

“She was born normal and could talk and hear. But when she was two years old, she got malaria and got a seizure. Since then she lost her sense of hearing, talking and she sees only partially,” her mother *May Nakato, says.

She says that even when Lisa was older, she couldn’t sit like other children of her age. Someone advised them to take her to a traditional doctor who advised that a hole is dug and Lisa sit in it for a couple of hours a day with a blanket wrapped around her to keep her straight so as to strengthen her back. After three months, she could sit and even started walking. However, she still couldn’t see well, and when she walked, she kept on bumping and knocking whatever was in her way. That is when her parents started tying her onto a rope.

Nakato says, “I don’t know how the idea came to me. I was helpless when it occurred to me. It was a better solution because we couldn’t afford to take her to a school for the deaf and dumb which is the ideal and best solution.”

An attempt at getting medical help
The seizure 12 years ago was the start of the family’s trips to hospital. Lisa has since been in and out of the hospital. Sometimes she is put on drip. One time she needed a blood transfusion and once, had to be put on oxygen. Usually, she is discharged after staying in hospital for about a week.

The doctors recommended that she is taken to hospital every month for medication saying it would stop her from eating dirty things which the mother says was done for six months. But the parents say there was no change so the teenager continued to spend the day tied on to the tree which is dangerously near an electric pole.

One day a lady saw the child and told Nakato that what she was doing could get her arrested. Nakato acknowledged that and asked her to help them because they had run out of affordable options.

The lady advised her to take the child to Butabika Mental Health Hospital where other children like Lisa stay.

“When we reached there, I found that the children there are not in the same state as my daughter. Though deaf and dumb, they can play with balls, go for short and long calls without help. They also feed themselves and walk with a sense of direction,” says Nakato.

Unlike them, when Lisa is left to walk, she wanders around like a zombie, moving aimlessly and she usually gets lost. Even when she sees other children playing with objects like a ball, she doesn’t seem to have any interest. She doesn’t join in when urged to or even kick or touch the ball when it is given to her.

She urinates and passes stool on herself. When she is given food, she ends up throwing it all over the place because to feed, she scratches it like chicken wasting the food. So she has to be physically fed. But she drinks by herself without taking the cup off her mouth till it is empty and then she throws the cup.

Lisa was taken to Butabika for three days and was given medication. But she got a seizure one day so her father, decided to take her to Mulago Hospital where they were told to take her whenever she got a seizure.

Necessary evil
Though strange at first, the sight of a child tied on the rope is something the neighbours have gotten used to. Her parents have also made their peace with it. It is like a necessary evil. Nakato, a mother of four explains that she has to work to help her husband with financing the home so she can’t stay at home looking after Lisa.

In fact, when her siblings are at school, her mother locks her up inside the house because there is no one to watch over her. “Thankfully, I work nearby so when I leave in the morning, I go back at 10am to give her breakfast and bathe her. I return at 2pm to feed her and at 4pm Lisa is taken to her tree because then, her siblings are around to watch her.”

Though the family says they don’t have relatives with the disability and the rest of the children are normal, before Lisa, they had a child who was in the same state as their daughter. But unlike Lisa he could play, recognised things and when he walked he seemed to know where he was going. He too was tied to a tree during the day because, according to them, it was an easier way to manage him. Unfortunately, he got a seizure and passed on. When Nakato talks about him, it is with a pain in her voice. It explains the emptiness and helplessness with which she talks about Lisa’s state. “I wish we could afford to take her to a school for the deaf and dumb. I am sure it would help.”

Irene Nenduta, a neighbour tried to get help from African Network for Prevention and Protection of Children against Child Neglect and Abuse (ANPPCAN) but wasn’t able to go far. The officials say they think Lisa needs to be taken to a home for children like her but unfortunately ANPPCAN doesn’t know one such. The established ones require that some money is paid, so they are trying to find sponsorship for her.

Courtesy Saturday Monitor

UGANDA: Yellow Fever Outbreak

Health officials in Uganda have launched a yellow fever vaccination drive in the north where an outbreak of the disease has caused 53 deaths and 224 infections in 10 districts since late 2010.

Almost a million people are expected to be vaccinated in the campaign, launched by Health Minister Richard Nduhura on 23 January.

The outbreak – affecting all age groups – was first reported in Abim district in Karamoja sub-region on 16 November 2010. Cases have been reported from several northern districts.

Read More Here