Access to HIV/AIDS services improving in war-torn north

Over 90 percent of the displaced population in the northern Ugandan district of Pader live in overcrowded camps, relying on handouts from relief agencies for their survival, where the problem of HIV/AIDS can't always be given priority. "The condition of life here is very bad - there is violence inside and outside the camp," said Aurelie Desmouliere, who works for the international medical charity, Médecins Sans Frontières (MSF), in Patongo camp in Pader. "Reports of sexual violence are rampant, while HIV/AIDS programmes are inadequate, which is not helped by the gap we have for medical workers." For almost twenty years northern Uganda has been racked by a brutal conflict between the government and the rebels of the Lord's Resistance Army (LRA), which has forced around two million people into about 200 camps for internally displaced persons (IDPs) scattered across the region. LIVING ON THE EDGE Rampant insecurity in the north has made it the country's most underdeveloped region: its inhabitants live in constant fear of LRA attacks; the rebels routinely mutilate and torture civilians, and have abducted an estimated 25,000 children for use as soldiers, sexual slaves and domestic workers. People are also unable to access good quality healthcare services, education, water or food; they have no proper sanitation system, and waterborne diseases such as cholera are a chronic problem; entire families live in tiny, one-roomed mud huts where there is no privacy. "Conditions in northern Uganda are totally unacceptable and intolerable," said Jan Egeland, the UN Emergency Relief Coordinator, when he recently visited Pader's camps. "This situation has to change because people have to live a better life and have a better future." A 2005 survey by Uganda's health ministry and its partners revealed that an estimated 1,000 displaced people in the north died every week, more than 90 percent of them from disease, with malaria and HIV/AIDS the top self-reported causes of death. Sexual exploitation of displaced women and children is common in the camps: another survey by the government and the UN in 2005 found that around 60 percent of women in the largest camp in Gulu district had experienced some form of sexual and domestic violence. "The [HIV] infection rate in this part of the country might be the highest - tests we have carried out at the antenatal clinic show an infection rate of between 14 and 15 percent," Dr Bach Cameron, head of the MSF-run health centre at Patongo, told a visiting UN team led by Egeland. Uganda's national HIV prevalence rate is 6.4 percent, but in the northern region it is over nine percent. Despite the seriousness of the epidemic, the displaced populations have little access to life-saving HIV/AIDS prevention, care and support services. INSECURITY HAMPERING SERVICE PROVISION None of the few relief agencies working in Pader district specialise in HIV/AIDS. According to some, because of the emergency nature of their work, they were unwilling to begin providing antiretroviral (ARV) services only to abandon them in mid-stream due to rebel attacks. "When you start, you have to be able to follow up as we did in Arua [a district less affected by the war in northwestern Uganda], where we have 7,000 people receiving counselling, while 2,000 are on ARVs," Desmouliere noted. However, she said MSF planned to start voluntary counselling and testing (VCT) services at Patongo, and would start providing free ARVs to patients once the security situation ensured that they could sustain the service. "People living with HIV/AIDS have limited access to quality services here because of the fact that they are living in camps where insecurity is rampant, where it is not easy for humanitarian services," said Dr John Ntambi, a relief worker in the district of Kitgum. "It is clear, when you look at the number of people supposed to receive antiretroviral therapy, the proportion is really low compared to elsewhere in the country." In the districts worst affected by the war - Gulu, Kitgum and Pader, collectively known as Acholiland - displaced children bear the brunt of the humanitarian crisis. Exposed to sexual abuse and abduction, they have little education or health services they can turn to in the resultant trauma and disease. "The problem is big for them [children], compared to those in the rest of the country. The main factor in the north is that most people are living in IDP camps and they have lost all the sociocultural upbringing a society offers," Ntambi pointed out. "We have child mothers here, and there is lack of access to services, lack of access to information, and this has compounded the whole problem." Unlike Pader, in Kitgum several NGOs offer VCT services and treatment for opportunistic infections, and some even provide ARVs. Ntambi added that HIV/AIDS programmes in northern Uganda had started receiving valuable funding and there were efforts to improve access to treatment. NEW EMERGENCY PROGRAMME Elizabeth Madraa, who heads the Ministry of Health's AIDS Control Programme, conceded that the war in northern Uganda had adversely affected health infrastructure, but said since there was relative peace in some areas, the government had embarked on programmes to expedite efforts to revitalise the health system. "We are in a programme to roll out comprehensive care at the village level. We have recently had training for nursing counsellors - so much money has been put in the area to help re-activate services," she said. Dr Sam Okware, director of medical services in the Ministry of Health, said the new emergency programme aimed to scale up access to health services. "The programme has a number of players, including UNICEF [UN Children's Fund], WHO [UN World Health Organisation], UNFPA [UN Population Fund] and others," he said. "We want to double access to medical services in the region within the next six months." A US $11.8 million project, coordinated by UNICEF, plans to increase access to ARVs, expand prevention methods such as condom distribution, and provide counselling for psychosocial trauma. Okware said northern Uganda would also have priority access to drugs from the national medical stores. Shannon Strothen, the UNICEF official in charge of northern Uganda, commented: "By the middle of the year we want to see services being delivered to every area, and by the end of the year we would like to see some tangible results."