A PAPER ON; EMPOWERMENT LEARNING STRATEGIES ON HIV/AIDS PREVENTION: THE CASE OF UGANDA
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1 The Republic of Uganda A PAPER ON; EMPOWERMENT LEARNING STRATEGIES ON HIV/AIDS PREVENTION: THE CASE OF UGANDA By Hon: Bakoko Bakoru Zoë Minister of Gender, Labour and Social Development in The Republic of Uganda A paper presented at an International Seminar / Workshop on: Learning and Empowerment: Key Issues in strategies for HIV/AIDS prevention held in Chiangmai, Thailand, March 1-5, Organised by UNESCO in collaboration with the UNESCO office Bangkok, Regional Bureau for Education and the University of Chiangmai, Thailand
2 1. Introduction: This paper discusses the issue of empowerment learning strategies on HIV/AIDS prevention. In my attempt to present this paper, I wish to highlight the AIDS situation in Uganda and my government s policy on AIDS. Therefore, I will try to show how my country has implemented this policy that now show higher levels of empowering the people infected and affected by the HIV/AIDS pandemic. My main argument is that the country s leadership beginning with H.E Yoweri Kaguta Museveni; the President of the Republic of Uganda took an early lead up today in empowering the people of Uganda with knowledge about HIV/AIDS pandemic. 2.0 HIV/AIDS SITUATION IN UGANDA 2.1 History of HIV/AIDS in Uganda The first AIDS cases were reported in Uganda in 1983 among lakeside traders in Rakai District. In 1987 the National AIDS Control Programme was established under the Ministry of Health and Uganda AIDS commission as a separate entity. At that time, there were already many HIV/AIDS cases in the capital city of Kampala and in Masaka and Rakai districts. By mid 1991, an estimated 1.5 million Ugandans, (or about 9% of the general population and 20% of the sexually active population had HIV infection). By early 1994, there were over 43,000 AIDS cases reported to the National AIDS Control Programme, which estimates that this figure represents only one-sixth of the actual number of cases (TASO, 1995). 2
3 The AIDS epidemic has spread to all districts of the country; however prevalence of HIV varies widely from region to region. Infection rates are as low as 2% of sexually active adults in districts like Moyo in Northwestern Uganda. Meanwhile, rates are highest in Kampala and other urban centres and in some southwestern districts. The male-female ratio among those infected with HIV is about 1:1, with a mean age of 30 years for women and 34 years for men. In the year old age group, there are six times more infected females than males. Whereas, data from sentinel surveillance show that the prevalence of HIV infection among women attending antenatal clinic ranges from 5% in some rural areas, it is about 29% in certain urban areas. Rural areas have become vulnerable targets for the spread of HIV infection (UAC, 2003). As a result prevalence has gone down from 30% in the early 1990 to 6.1% by There is increased awareness (about 90%). Stigma is going down therefore the epidemic is under control 2.2 The Multi-Sectoral AIDS Control Strategy: According to the Uganda AIDS Commission, the impact of the HIV/AIDS epidemic in Uganda has gone beyond the health status of the people. The Government decided to adopt a multisectoral AIDS control strategy. The Multi-Sectoral AIDS Control Strategy requires all sectors of society to be actively involved in the fight against HIV infection and care of the people affected, either directly or indirectly. The strategy addresses all aspects of HIV infection, which have influence on its control as well as its social and economic outcome. 3
4 Aim of the Strategy: The ultimate aim of the strategy is to stop the spread of HIV infection and to provide care and support to those affected socially or physically by the epidemic. By initiating a process of behaviour change for sexual activities safe from HIV transmission and promote medical, social and cultural practices safe from HIV transmission dangers. For example, provision of protective materials to midwives and birth attendants, modification of circumcision practices using a single unsterilized blade during ritual circumcision ceremonies, etc. Promoting effective management of the consequences of the epidemic. Broad areas: AIDS control priority activities have been developed within six broad areas for the Multi-Sector Strategy. Stopping the spread of HIV infection through interventions to alter present risk factors related to locally relevant modes of transmission: sexual intercourse, blood and blood products, mother to child; Mitigate the adverse health and socio-economic impact of HIV/AIDS epidemic by promoting research and interventions to cope with national HIV/AIDS related impacts, to reduce social and economic consequences at community level and to improve care for people with HIV and / or AIDS; Contribute to international efforts in the development of a cure for and vaccine against HIV/AIDS through prioritizing national, research and training needs, and establishing the administrative capacity to monitor ethical, technical and prioritization aspects of research. 4
5 Strengthen the national capacity to respond to the HIV/AIDS epidemic through improved national and sectoral planning, strengthened national institutional capacities for AIDS control training and research, better implementation of interventions, bolstered community coping, and mobilization of human and financial resources nationally and internationally;(vi) Establish a national information base in Uganda on HIV/AIDS by improving data gathering and information access. Activity areas for the strategy Prevention of HIV infection through: Information, Education and Communication (IEC) Health education (related to the health sector) Condoms (supply, distribution, usage, cost and all the attending moral and social issues) through a process of quiet promotion to targeted populations Early diagnosis and treatment of sexually transmitted diseases and their control through follow-up with partner notifications and health education Safe medical practices (including traditional medical practices) Coping with the consequences of HIV and AIDS through: Community-based patient care, which provides a family environment for the patient as a complement to institutional care. Community-based care of orphans in preference to institutional orphanages Macro level planning Review of legal and social issues on, for example: orphans, widows, inheritance, marriage and remarriages. Research to cover the area of: Social, economic and behavioural aspects of HIV/AIDS 5
6 Biomedical investigations (including traditional drugs) Drug and vaccine trials It can be observed that all sectors are provided with technical and financial resources to design and implement HIV/AIDS initiatives. For example, TASO, which was established in 1987 to provide support and care to people living with AIDS, does counseling, medical care, social support. Meanwhile AIDS Information Centre (AIC) was established in 1997 to provide HIV testing services. Also Nsamizi Training Institute of social development under my ministry which produces Community Development workers at the grassroots (community) Levels has integrated AIDS education into its curricula. These are kind of requirement for all the Institutions or organizations the requirement in Uganda. 3.0 Relevance of Uganda s Approach to Empowerment Learning in HIV/AIDS Prevention 3.1 Successful experiences & practices: The country has realized many experiences and practices. For example, giving each sector the role and responsibility of designing and implementing the multi-sectoral strategy in their own perspective. Others are helping clients to cope with the diseases, and openly sharing sero-status experience through music, dance and drama have been vary successful experiences in Uganda. Everywhere these experiences are the order of the day. 3.2 Approaches: 6
7 The best approaches used to achieve the above experiences are namely; Community participation especially through bottom-up planning of AIDS activities. Decentralization policy that encourages Local Councils participation to generate full support by political leadership at all levels. Resource mobilization from especially external donors. Counseling including pre-hiv anti-body test stage, post-test preventive counseling, ongoing care and support that trickle down to the family. Medical care prevention and treatment and treatment of opportumistic infections and STDs. Home-based care to provide medical and counseling services to very ill patients at their homes. Social support at all centres to help people with HIV/AIDS cope with the disease. Material assistance such as foodstuffs to the needy. Child support in terms of scholastic materials, school uniforms and counseling in HIV/AIDS prevention, care and career guidance. By ,000 children were being supported. Child survival project since 2001 benefits children who had dropped out of school by training in practical skills for self reliance. The AIDS challenge youth club since May 1991 was founded by children whose parents or relatives were living /died of AIDS to provide support and care against trauma. Advocacy and mobilization to increase sensitivity and influence attitudes of all those in responsible positions nationally and internationally. 7
8 Training centre for capacity buildings of its staff TASO resource centre meets the information need of TASO in terms of library, videotape, telephone, fax, and information search. Effecting monitoring and evaluation especially from the 1990 and establishment of management information systems in different agencies. Voluntary Counseling and Testing (VCT) is a comprehensive HIV preventive programme. Anonymity and protection of confidentiality, which are critical to ensure public trust and demand for VCT. Effective counseling that offers a client centered approach with good rapport between the counselor and the counselee based on trust. Major Principles In Practice: In Uganda the most prominent principles in AIDS work are that:- Learning by doing AIDS is a multi-faceted problem and has to be addressed by all sectors Adopting the philosophy of positive living Voluntary counseling and testing being a part of a comprehensive HIV prevention programme These principles have effectively guided AIDS work in Uganda 3.4 Areas of learning: 8
9 There are a number of areas of learning that are emphasized for the clients some of these are namely. Community participation Community driven Behaviour change communication rather than just sensitization Care for the infected Prevention of further spread by the infected Prevention of infection by the anonymous. These learning areas are not just basic, but fundamental in prevention empowerment learning /activities 3.5. Evidence of Empowerment: Through AIDS work, the evidence of this empowerment is in terms of clients Being able to identify their own needs. Being able to design initiatives to address problems affecting them- making self - assessment. Being able to compose drama groups of people living with HIV/AIDS. Being able to manage income -generating activities to earn a living Prevention Capacities: Because of the levels of empowerment realized, clients are able to prevent the spread of HIV/AIDS through the following ways:- Practice of safer sex by condom use. Seeking early treatment Utilizing VCT 9
10 Making use of negotiation skills Promoting the philosophy of positive living. 3.7 Networking: Uganda as a country is a member in different networks; for example, regional networks on AIDS for BCC, local agencies are members of different networks such as Uganda National AIDS society organization. From these networks members benefit a lot. For example Lessons are shared from best practices Sharing information materials Accessing resource personnel Forming coalition to address issues affecting people living with AIDS 4. Evaluation /Conclusion: Uganda s experience in AIDS work has been commendable. For example, the level of awareness about AIDS has increased and care and support services are made available to people living with AIDS right up to the community level A lot remains to be done, for example, documenting best practices is very important. To do this the Mulitisectoral strategy has to be strengthened in all AIDS related agencies. Equally important is extending AIDS services to the rural communities for as people move back to these areas they increase the spread of HIV/AIDS. Further more, all clients are not able to access antiretroviral treatment. This is currently the main concern among many people, both the infected and affected alike. Government is making every effort to avail antiretroviral 10
11 treatment to all those in need. Therefore, the main recommendation of my paper is as follows:- As the fight against HIV/AIDS is not over-all sectors at all levels should be more actively involved in AIDS work As the cure for HIV/AIDS is still not known, there is need to continue empowering people with knowledge on the prevention of HIV/AIDS these are the directions that Uganda is ready to put more effort to fight the spread of HIV/AIDS epidemic. 11
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