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Winning the war against Aids

HEALTH

Winning the war against Aids

Uganda was one of the countries in East Africa that had been devastated by the Aids epidemic that raged across the continent from the 1990s onwards. Aids is still a major health problem in Africa but a sustained campaign and significant cultural changes have seen a dramatic drop in infections. Uganda, reports Epajjar Ojulu, is winning the war against the dreaded disease.

For a long time after the Human Immunodeficiency Virus (HIV) hit Uganda in the early 1980s, being diagnosed with HIV/AIDS was tantamount to being handed a death warrant. At the time, no one knew anything about the disease.

What everyone knew was the disease emaciated its victims to skeletons. For this reason it was baptised “slim”. In Uganda witchcraft is usually blamed for any mysterious or unknown calamity and HIV was no exception. For a long time the population lived in despondency and despair.

Today there is optimism among Ugandans that what was once an intractable disease, which has tormented them for four decades, is facing defeat.

Health minister Dr Jane Ruth Aceng says the multi-sectoral and multipronged approach against the virus has not only reduced the infection rate from a whopping 27% in 1990 to 6.5% in 2017, it has also handed a lifeline to the 1.3m Ugandans carrying the virus, who for long believed they were as good as dead.

Today, they know they can live normal lives like any other person. The minister says that over 90% of the people carrying the virus have access to anti-retroviral drugs, the modern therapy, which stops the HIV virus from multiplying.

The country has come a long way in the fight against HIV/Aids. At the time the disease first struck, Uganda had just emerged from the 1979 war that routed the notorious dictator Idi Amin from power. The Amin regime had ravaged the country, including its healthcare infrastructure.

The HIV entry point and epicentre was the south-western region, from neighbouring Tanzania and not far away, the Democratic Republic of Congo, where according to Science magazine, the virus is suspected to have made its entry into humans from chimpanzees. Science has documented a man who died of AIDS, the acquired immunodeficiency syndrome’s symptoms, in DRC’s capital, Kinshasa, way back in 1959.

The man widely believed to be the first victim of the then-mysterious disease in Uganda, Gideon Kivumbi, was a prominent trader who used to ferry merchandise from the Lake Victoria ports of Kisumu in Kenya and Mwanza in Tanzania to Uganda.

However, when he fell victim to the new disease, it was widely believed that he had been bewitched by fellow traders in Tanzania for refusing to pay for goods. This is because Ugandans living near the Tanzanian border have for a long time believed that their neighbours across the border are experts in witchcraft.

Kivumbi’s three wives also later succumbed to the virus. Within a few months there were other victims in the area, triggering an exodus, especially of widows whose husbands had died of the virus, away from the region to other parts of the country, ostensibly to escape from the witchcraft.

While there, they married, remarried or got involved in sexual relations that led to further spread of the disease. By the late 1980s, HIV/Aids had become a pandemic in the country.

Because it was blamed on witchcraft, Aids victims were shunned. The only surviving daughter of Kivumbi, Moulencia Nasonko narrated her ordeal to a local daily: “We were shunned by even close relatives and the rest of the community at the time we needed them most.”

Cultural sensitivities

HIV/Aids has been one of the most intractable diseases, not only in Uganda and Africa but globally.  According to the World Health Organisation, over 35m people had died of HIV-related causes by 2017. Another 43m are living with the virus. In Uganda, 1.5m people have died of HIV-related causes since 1982, according to the Ministry of Health.

According to Science, a team led by the Paris-based Pasteur Institute virologist Luc Antoine Montagnier discovered the HIV virus and published the findings in the journal in May 1983. This was the first time that HIV was given an identity and it paved the way for research on therapy.

Montagnier’s findings showed that HIV was unlike any known viruses and antibiotics were ineffective in treating the victims because the virus integrates itself into the genes of the T-cells responsible for protecting the body from infection. According to Science, HIV not only integrates itself into the genetic structure of the host cell but it also multiplies fast, destroying the Cluster of Differentiation (CD4) cells also known as Thymus cells (T-cells), responsible for protecting the body against infection.

The discovery of the genetic makeup of HIV has led scientists to find ways of stopping it from destroying CD4 cells.

Unlike other epidemics, dealing with HIV in Uganda has been deeply influenced by the social, cultural and economic situation of the country. The implementation of the ABC policy (on abstinence, being faithful and using condoms) has faced social and cultural resistance.

Since HIV is transmitted through sex it has, for example, been a Herculean task for healthcare workers to promote condoms and to advocate how they should be used. Ugandans have from time immemorial talked about sex in metaphors or by use of imagery and symbolism, which leave no doubt about the meaning of the message but avoid indicating the sexual organs by name.

Example for the rest of Africa

However, the gravity and threat of the virus to society has forced healthcare workers to discard the cultural norms. This explains the success of the free distribution of 20m condoms in 2017. Another 70 million were imported and sold by the private sector.

Indeed, it is this open door policy which has been the hallmark of Uganda’s success in the war against HIV/Aids, with the mass media awash with messages on how to avoid the virus.

The country has also registered hundreds of non-governmental organisations to supplement efforts by the Ministry of Health. Religious organisations, usually conservative and reticent on sexual matters, have also followed suit in urging their followers to fight the virus. For example, it is mandatory to have an HIV test before one is married in a church or mosque.

The country has won accolades worldwide for its success in fighting the virus. Dr Alan Bernstein, formerly Executive Director of the Global HIV Vaccines Enterprise, has said Uganda’s achievements in the fight against the virus are “world class”.

In Africa, Uganda is number one in the fight against the virus, ahead of Cameroon. Indeed, health officials from other African countries such as Zambia, Malawi and Kenya, among others, have been to Uganda to learn from its experience.

Uganda has demonstrated that its experience of preventing HIV infection, and treating and taking care of those infected, is invaluable to the handling of future epidemics in Africa and the rest of the world. NA

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