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Yale University

Publication Date

Spring 2008

Program Name

Uganda: Development Studies

Abstract

Since its emergence in the early 1980s, HIV/AIDS has come to infect 33.2 million people world wide, over two thirds of whom (68%) reside in sub-Saharan Africai. While great strides have been taken in terms of global awareness, research, treatment and care accessibility, the epidemic remains severe and many of those infected, especially those in sub-Saharan African nations, face the continued challenges of stigma and discrimination, limited medical resources, insufficient care, insurmountable costs and great distances to treatment area. When the individual case of Uganda is examined, it is encouraging to note that HIV prevalence has declined significantly since the early 1990s (now approaching a stabilized prevalence of approximately 7.1%ii) and that government and NGO support for persons living with HIV/AIDS (PLWHA) continues to grow. However, a stabilized HIV occurrence in conjunction with a rapidly increasing population equates to more new infections every year and a growing population of HIV positives nationwide. One area of Uganda that is experiencing high incidences of HIV infection, but has received little support is the Teso region, which is comprised of Amuria, Kaberamaido, Katakwi, Kumi and Soroti districts. HIV/AIDS care and support in this region is complicated by a variety of political, social and geographical complexities. The area has experienced over thirty years of continuous civil conflict stemming from on-going cattle rustling by Karimajong warriors, local militia activities and, more recently, attacks by the Lord’s Resistance Army (LRA). During the course of these conflicts, almost 500,000 people have been relocated into internally displaced peoples (IDP) camps, where vulnerability to contracting HIV is significantly increased. The implementation of education, prevention, treatment and care services is difficult due to continued insecurity (despite some resettlement successes), inaccessibility and the huge client volume needing not only medical attention, but also counseling and sustainable livelihood activities. In addition to these challenges, this area has experienced widespread flooding during the past nine months, which has lead to widespread crop failure, property destruction, malnourishment and even further displacement. The objective of this practicum period was to observe the practices of The AIDS Support Organization (TASO), which is the oldest, indigenous HIV/AIDS comprehensive care program in Uganda, and to identify the specific challenges and needs of this area as it continues in a post-complex emergency state. Throughout this period a variety of research methodologies were employed. Observations of the counseling, medical and projects departments in their operations both at the center and in outreach settings provided the majority of the data. This was supplemented by a series of interviews and focus group discussions with TASO clients, staff and number of key informants about the area. Interviews and other data collecting activities were limited by actual volunteer work, such as administrative assistance with reports and presentations, distribution of drugs and foodstuffs, filing clerk work and laboratory tasks, including blood draws, HIV tests and record keeping. This period provided invaluable insights not only into the operations of TASO but also into the challenges of implementing HIV/AIDS care in an ongoing conflict setting, with continued complexities of remote, displaced populations and widespread natural disasters. Although many factors were uncovered that are driving the epidemic in this area and prevent proper treatment and care, the most significant include widespread polygamous practices leading to multiple sexual partners, the lifestyles of many IDPs make them vulnerable for contracting HIV, the general lack of income for proper nutrition, medical treatment and transportation to care centers, and social attitudes such as widespread despair as well as continued stigma and discrimination against PLWHA. Due to the wide spread poverty in this area and lack of funds for transportation to treatment centers, there is a huge need for continued and expanded outreach care especially to IDPs and those who continue to be affected by cattle raids and the recent floods. At this point staff and resources are completely exhausted though more outreach programs are required and there are great demands for TASO services including counseling and medical treatment as well as need sustainable livelihood activities and community groups. There is a lack collaboration with local partners, which has weakened the area’s referral system and in some cases has caused a duplication of services. Although TASO has achieved a great deal in the face of these challenges, the Soroti program itself would benefit from a variety of minor organizational changes that could eliminate inefficient uses of time and resources and allow more clients to be reached.

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