Men in the north slow to respond to AIDS message

Awareness of the AIDS pandemic is generally high in northern Uganda, but the message has not hit home with some men, who are still too afraid of the stigma against the disease to seek treatment.

According to Robert Ochola, coordinator of HIV/AIDS activities at Kitgum's St Joseph's Hospital, the social fabric of the Acholi people - the ethnic group worst affected by the 20-year war in Uganda's northern region - has broken down almost entirely, relegating men to waiting for handouts from relief agencies.

The war has forced an estimated two million people into camps for the internally displaced, drastically altering their lives and roles in their communities.

A walk around Akwang camp for the internally displaced in Kitgum district, home to around 16,000 people, reveals several makeshift taverns crammed mostly with men, even in the early hours of the day, drinking potent local brews and playing cards.

Boredom and excessive alcohol consumption, compounded by the feeling that the war and their subsequent encampment have emasculated them, often led to risky sexual behaviour. Ochola and other health workers said sleeping with many women was one of the few ways the men had left to exert their masculinity.

Charles Odong, who works with Meeting Point, a local nongovernmental organisation, said women made up about two-thirds of their patients and were generally more willing to volunteer to be tested for HIV.

A counsellor attached to the AIDS clinic at St Joseph's, Beatrice Opira, confirmed that far more women volunteered for HIV testing than men. "Men still seem to be greatly affected by stigma, and do not want to be seen openly going for testing," she said.

The upshot of this reluctance to discover their HIV status was that men rarely sought treatment, and died from AIDS-related complications much earlier than women.

At a recent meeting of people living with the virus in Kitgum town, most of the 12 women present were widowed and all were on life-prolonging antiretroviral (ARV) medication, but not a single man attended.

"I discovered I was HIV-positive last year when I got very ill," said Lucy Lalam (not her real name), in her early twenties. "My husband knows my status but has refused to go for testing - he keeps putting it off and I'm worried he will get sick and die soon if he doesn't get treated."

Sylvia Ocan says her husband abandoned her and their two children, and married another woman when he found out she was HIV-positive, accusing her of having been unfaithful. He died about a year later, never having been tested.

At a meeting for people living with HIV in Akwang camp, Patrick Onen was the only man. He said very few were willing to come out publicly with their status, as they felt admitting it would make them "less of men".

"Out of 178 registered members of our group, 'Kati Woko' ['come out' in the local Acholi language], only 36 are men," he said. "There is little interest among them even to learn about AIDS - when we try to hold information sessions they tell us they know everything about it, but then you see them drinking and having many women."

The clinic at Akwang actively promotes HIV testing among men, but testing kits are only available at the antenatal care clinic. A mobile counselling and testing unit from St Joseph's, meant to visit the camp every two weeks, had not come in two months, Onen said.

Although condoms distributed by volunteers are freely available, people have to sign for them, which many men are unwilling to do.

Francis Achirei, a community health worker at the clinic, said if men were expected to protect themselves from contracting the virus, test for HIV and seek treatment, the entire process needed to be much more male-friendly.

"The men have to travel to St Joseph's if they want to be tested," he said. "If they had easily available and confidential testing here [in Akwang], they may be more encouraged to come for testing."

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