Insecurity affecting HIV funding in Karamoja

Frances Otim, living in Kotido, an urban centre in Uganda's northeastern Karamoja region, doesn't use condoms because he doesn't know how, and doesn't use a mosquito net because the one he has is ripped.

For most adults, malaria isn't life threatening, but for people living with HIV, acute malaria causes a spike in viral load - the amount of the virus present in the body. This in turn heightens a sexual partner's risk of contracting the virus. "I had malaria last week," Otim, who is HIV-positive, told IRIN/PlusNews at the Church of Uganda Health Centre in Kotido.

"We need to teach about condoms," said Patience Ajok, the centre's programme coordinator. She would like to do this, as well as a lot of other activities related to HIV prevention and treatment, but is limited by a tiny budget and having very few staff members. "The number of [HIV-positive] clients is increasing, but personnel and funding is not."

The Karimojong, the main ethnic group, are a warrior people who have resisted change and clung to tradition; qualities that have been partially credited with keeping HIV infection rates in the area at about 4.5 percent. According to the Ministry of Health, this is relatively low compared to the rest of Uganda, but the rate is also rising faster than in any other region.

Most aid organisations function with only essential personnel on the ground, if at all, because of the region's insecurity - cattle raids on neighbouring communities are common, and increasingly fatal with the introduction of modern arms - while the difficulty of travelling between districts forces non-governmental organisations (NGOs) either to manage their programmes in Karamoja remotely or give the region a wide berth.

Limited capacity

Agencies working in Karamoja tend to view the region as falling into the 'emergency' category, meaning that it is entitled to emergency relief, but not necessarily to development assistance.

Officials at the international aid agency, Oxfam, told IRIN/PlusNews they were hesitant to devote more resources to Karamoja until the region stabilised and the Ugandan government demonstrated political will, and provided support for regional development.

"We can't invest more money because of the limited capacity for absorption; loads of money can go into Karamoja, but if no infrastructure or conducive policy environment is built, then the possibilities are limited," said Savio Carvalho, Oxfam's country programme manager. "There needs to be a framework."

Without such a framework in place, people like Otim will probably not learn about condoms or the dangers of malaria anytime soon.

Dr James Lemukol works at the hospital in Matany, a town in Moroto district, where there were only a few doctors, he said. At Moroto's main hospital, there isn't even one doctor – just a lone dentist.

Mulongo Muchala, nine, has been in the care of an elder sister since their parents died, but can't provide much for her. She used to get medicine, food rations, and other items from the health centre in Kotido, but a recent change in funding has made this difficult.

The International Rescue Committee (IRC), an NGO, was relying on funding from a larger children's NGO to support patients at the centre in Kotido, but the benefactor agency recently decided to redirect their HIV spending to focus primarily on the prevention of mother-to-child HIV transmission in the region.

This means Mulongo is hungry. When IRIN/PlusNews visited the centre, she had not eaten since the previous day. This is especially problematic because the antiretroviral (ARV) medication that she has been on for two years requires her to have a healthy, balanced diet.

The centre has 530 HIV-positive clients and does sensitisation and voluntary counselling and testing for hundreds of people every month, but over the past year only 20 HIV-positive women have given birth at the centre and benefited from the redirected funding.

According to IRC staff, the programme could benefit from becoming broader. "We [and our strategic partner] have common goals, but theirs are more narrow," said Karen Poole, deputy director for programmes at the IRC.

"Anything is better than nothing - and for Karamoja we aren't going to turn down the chance to support people - but in an ideal world we'd be doing a more comprehensive HIV/AIDS programme."

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