#AIDS2011 Thirty years of HIV in Uganda

Hope Clinic Lukuli and more importantly the members of the community we serve have spent an enjoyable day with a reporter from Reuters looking at Uganda's experiences over the past 30 years. The United Nations General Assembly are holding a High Level Meeting in New York in the coming week. Reuters want to hear from the communities about how the reality of HIV has changed.

Policy - Partnerships - People
The success story for Uganda, and also for other countries but at a different pace, has been to develop the policy framework, form the partnerships, and most recently to think about the HIV and AIDS-related needs of the people. The policy framework and specifically the Government of Uganda's acknowledgement of the risk to the population of HIV led to openness, national awareness campaigns and the 'Zero grazing' guidance. That willingness in the late 80s and early 90s of the government to inform its populous was a key start. Consider the countries which only began to publicly speak about a need for action in the past decade - look at the prevalence rates in their populations.

Partnerships and the need to bring together education, health and research within the country and development partners was another key step for Uganda. In the past 10-15 years, the coordination has been improving - family planning sites now offer PMTCT services; most government hospitals provide HIV testing as a routine part of admissions; the Global Fund granted Uganda HIV funding since 2003; US PEPFAR identified Uganda as one of the 15 focus countries with funding since 2004. Meanwhile, the Government and civil society in Uganda was getting on with the awareness work, the information on prevention and accessing services, the actual delivery of care and support and the constant challenge to bring together stocks of ARV and the households that need them. In the majority of instances, a household that does not have the financial capacity to buy ART.

Which brings the conversation to the People. Policy - Partnership - People is about planning the HIV services for the person, whether negative or positive, whether alone or in an affected household. The design of HIV services that is working is where it is client focussed. Removing the Stigma of only finding the services at a site with 'HIV' painted on the walls and logo; reducing the Time away from their smallholder farm or market stall or employment, and bringing the services to the place they already visit for fevers and maternity care; addressing the Inertia through community level information and committed people who will engage and motivate people with accurate information and can share the promise of services for those affected by HIV; reducing the Cost of travel to the HIV service site, the cost of the test, the cost of the mosquito net or water filter to reduce opportunistic infections; lastly address lack of Knowledge, or the wrong information being held. Shaking hands is safe, cleansing rituals and showers don't work as PEP, babies can be born HIV free if the mother is tested and she and baby are treated.

This STICK, acts like the children's game in Africa. The wheel they roll along is the comprehensive HIV services working. The STICK can be good, to keep the services going, or bad and put it into the wheel and it stops - services fail.

Partnerships have led to projects - start it up, staff it anew, buy the equipment, wait for the clients, close the budget, close the service, file the donor report. These are the stigma-rich sites where people don't want to get off the bus, they are not community based, but cluster around already busy government sites, they are narrowly doing testing, another does ART, another does PMTCT. The client is expected to travel from place to place, away from home and their place of employment.

Hope Clinic Lukuli uses the good STICK.
Support to the community and the staff to appreciate why the services are necessary and how they fit into the general health care the clinic provides. Hosting HIV services reduces the stigma, the clinic's people/ patients visit for fevers, reproductive health or child immunisation. Each group provides HCL staff with the chance to calmly talk about HIV and knowing one's status.

Training not just in the specific service of that medic or that grant support but a wider understanding of how the client's feel and the pressures of time and culture that could affect their decisions to visit the clinic. We have clients, like Gaudencia, who know their status, have not had to brand themselves in public with it, and yet are asked for advice and refer and encourage people to the clinic. The training is ongoing, with supportive supervision discussions, encouragement and the reward of a grateful community.

Infrastructure is a great motivator of staff and unpaid volunteers. It means they have the tools of their work and the confidence that when they refer a person to become a patient, the counsellors, the laboratory staff and the drugs will be there. Through being a Government of Uganda accredited ART site, the drugs are funded by local tax collections or the Global Fund or purchased by the Clinton HIV/AIDS Initiative with CHAI being funded by UNITAID. The 'sustainability' that projects crave, is achieved as Hope Clinic Lukuli is now 11 years old, when US funds stopped supporting new HIV positive clients, the Ministry of Health supported Hope Clinic, with these partnerships, to continue to serve. Today over 650 HIV positive clients are supported at Hope Clinic: half of those who receive ART are on MoH/GoU drugs from the non-US partners to Uganda.

Community is essential to ensuring that the design and delivery of HIV services and AIDS-related services is efficient. Clients can access the services near them, priced at a level that removes financial barriers to access. The community relies on the catalyst of friends and information channels that will influence usage, reduce stigma, and steadily bring those who still refuse but are visibly ill into the comprehensive care. Hope Clinic Lukuli thanks Gaudencia, Margaret and Stanley for this work as volunteers.

Knowledge that is accessible, relevant to that community and in the format that promotes its understanding and action is the key. The Policy is macro level, the Partnerships are a bridge through country coordinating mechanisms and partnership framework agreements to match need to funds. The People are the keepers of the knowledge of how they want the services delivered.

The thirty years of AIDS has seen great development of policy, with it being more clearly informed by affected populations. The partnerships have years of experiences to draw from. The current challenge is to get the funds to the last organisations that serve the people. Hope Clinic Lukuli uses Support, Training, Infrastructure, Community Catalysts and Knowledge to design and deliver the comprehensive HIV and AIDS services that Makindye needs. We do it for and with government, our clients benefit from UNITAID, Global Fund, CHAI, national taxes and US PEPFAR resources.

As the world marks #AIDS30 and the UN GA HLM #AIDS2011 meets in June, the civil society organisations that get on with the work should be considered. Advocacy has shaped the Policy, The Global Fund, PEPFAR and innovative financing like UNITAID are funding the Partnerships. The People are the clients to be, the patients on the register, the community they live in and the community-based health providers that they already rely upon for fever management, maternal health and childhood healthcare. We are here, on the ground, with the clients. Where are you?


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