As calm returns to northern Uganda, tens of thousands of people previously living in camps for internally displaced persons (IDP) camps are now in satellite camps mid-way between the IDP camps and their villages. The new camps are less crowded and people can cultivate their land, but the lack of healthcare is problematic.
Night Acayo is one of more than 1,700 people living in Awoo resettlement camp, having spent the past 20 years in Pabbo, the largest IDP camp in Gulu district. She is glad to be in Awoo because she can grow her own food, a welcome change after years of depending on the government and non-governmental organisations (NGOs) for every meal.
However, the move has proved a mixed blessing: Acayo is HIV-positive and now has to walk for hours every month to fetch her antiretroviral (ARV) medication from the health centre in Pabbo.
According to local officials, about 40 percent of the region's IDPs - estimated at more than two million at the height of the war between the rebel Lord's Resistance Army and the government - have left the dangerously congested IDP camps and moved to resettlement camps closer to their original villages.
HIV prevalence in Uganda's northern-central region is just over eight percent, one of the highest in the country. Cissy Musumba, manager of the Gulu office of The AIDS Support Organisation (TASO), a national NGO, told IRIN/PlusNews her organisation had more than 1,800 people on ARVs, about 40 percent of whom have left the main camps for satellites.
Acayo walks six kilometres to Pabbo, queues for a few hours to collect her ARVs from TASO, rests at a relative's home, and then heads back to Awoo. In September she missed her distribution day at Pabbo, but was able to sell millet worth around US$2.50 to pay for transport into town on another day to fetch her medication.
She says she is luckier than her neighbour, Christine Atto, who is registered for ARVs at Lacor Hospital in Gulu town, 36km away. Atto walks for two days in each direction to collect her ARVs every month.
The issue of transport to health centres is much more serious for patients too ill to walk long distances, when adherence to the life-prolonging medication can be threatened. Many patients are also too afraid to make the final move to their villages, which would take them even further away from health centres.
A recent study of adherence to ARVs in northern Uganda, published in the September edition of the AIDS Journal, listed transport as one of the major barriers to adherence in the region; other factors included food security, health infrastructure and human security.
Northern Uganda's rural areas, cut off by the war for more than 20 years, have few health centres, most of which lack staff trained in HIV management. Musumba said TASO was looking into the possibility of home delivery of drugs and home-based healthcare. "We are still marking exactly how it will work out; we are mapping it," she told IRIN/PlusNews.
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