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The effects of open border on HIV/AIDS and TB patients in Madi

(Last Updated On: 13 October 2023)

West Nile I As a target is set and advice is passed to people living with HIV/AIDS and those without it to know their statuses – including those enrolled on ARVs, in Madi, West Nile sub-region– it is yet hard to register impressive success because of the uncontrolled movements of refugees and flourishing businesses like night clubs that attract different types of people.

West Madi or what is also called a sub-region consists of more than four districts and shares a common border with South Sudan in the North-South.

Its neighbor, South Sudan has been engulfed in conflict and many of its citizens have sought refuge in Uganda. However, frequent movements of the refugees in and out through open border points, traders, and truck drivers have contributed to a surge in HIV/AIDS cases in the bordering areas.

With the current conflict that has extended to Kajio-Keji County of Central Equatorial State, health facilities have been destroyed; positive people can’t have access to ARVs and those who have enrolled for medication while in settlements when they get back (to South Sudan) can’t continue accessing medication – hence affecting their viral load suppression.

Logoba Health Center III in Moyo district is located less than 30km away from Jale, South Sudan. The facility is currently treating 30 HIV/AIDS patients from refugee settlement camps including others from neighbouring villages of Kajio-Keji county of South Sudan. Unfortunately, two patients who belonged to the South Sudan National Army died from the virus, according to health authorities from Logoba Health Center III.

Fuchoo Idraku Rose, the in-charge of the ART/TB Clinic at Logoba Health III said in 2017 the facility had 37 positive people living with the virus but at the onset of the 2016 conflict in South Sudan, the number of patients stood at 157.

She attributed the increase to open borders, the influx of refugees and the presence of Logoba military barracks in the sub-county as key drivers towards an increase in cases. Fuchoo further noted that through community dialogue they were able to recover lost patients, do tests, and enrol new ones and sensitize the public.

Data obtained from Logoba Health Centre III indicates that out of the 151 active positive people, 97 are females, and 52 males out of which 5 are adolescents. There are 3 children below the age of 0-5.

She equally noted that through regular monitoring and attending to antennal care services, seven (7) out of 97 pregnant women gave birth to negative babies. Two who are pregnant are still under supervision, while the 7 lactating mothers have their first and second PCR results of both the kids and mothers negative.

Antennal care services (ANC) is one key component in Preventing mother-to-child transmission (MTCT) among positive and non-positive people and it helps prevent the unborn from contracting infections from the mother right from the first trimester till delivery.

Despite its importance in scaling down the HIV/AIDS and TB surge, Fuchoo stated that some pregnant and lactating mothers dodge going for antennal services.

“We have never had a birth in this facility to a positive child. Only we have one mother who delivered the child in one of the villages without coming for ANC support and the mother had not been taking her ARV drugs. She got lost for a good period and we had been searching for her and when we found her, that’s how we managed to test all her two children and all results turned out positive,” Fuchoo added.

The statistics further showed that out of 157 active patients, 151 (93%) have viral load suppressed, 6 non-suppressed in both adolescents and adults and 1 child.

Logoba Health Centre III currently has a total of 173 patients comprising refugees and host communities with 156 on medication. Two deaths from South Sudanese and none from Uganda were recorded in the recent past.

Some of the challenges both TB and HIV/AIDS patients in Moyo sub-county, Moyo district go through include stigma, gender-based violence and poor feeding.

Fuchoo explained that the large number of patients visiting the health facility has resulted in congestion, affecting schedules and compromising their privacy. She also said the high number of visits has affected the uptake and intake of ARVs and access to other health reproductive services in the sub-county.

She further noted one reason for the increase in the virus cases in the sub-county is because partners fear testing for HIV/AIDS and those who find they are positive stay away from treatment and keep infecting others.

The health in charge also urged the local population to embrace testing, abstinence, and preventive measures like the use of condoms and encouraging positive people to marry one another to reduce stigma and spread of the virus. She went on to say that regular taking of Antiretroviral Drugs (ARVs) helps reduce viral load among the positives.

“If you take your drugs very well, you end up causing zero infections to your partner and those who are marrying without testing are making a very big offence. So, people should not fear coming out for their treatment and testing both married couples and those dating.

“And assuming you have a partner and later after marrying you realise your partner (wife) or husband is taking ARV whom will you blame?” she asked.

Antiretrovirals are drugs administered to HIV-positive patients and when patients adhere it helps reduce the rate at which the virus multiplies in the human body.

Poor feeding and resistance to medication are some of the challenges encountered by TB and HIV patients. Health experts in the sub-region say patients dodge taking the drugs as a result of hunger. This is because of the impact caused by the drugs on the patient’s body.

After carrying out a survey, Fuchoo said they found that many of the positive patients were malnourished which contributed to too many patients dropping off the treatment line.

To retain, and attract more patients reduce stigma and improve the nutrition status of the patients in Moyo sub-county, under the leadership of Fuchoo Rose, the formation of farming groups was made. They are now growing vegetables like dodo, eggplants, cabbage and tomatoes.

Since the formation of this group in 2018, the number has grown steadily from 10 to over 35 members with different enterprises after receiving funding of over shs4.8 million (1,000 Euros) from Rice West Nile-Uganda which currently operates as revolving funds.

In 2020, each positive living person saved shs5, 000 weekly and shs200, 000 was realized in the same year.

Lagoba HC3

According to the 2020 statistics from the Uganda Bureau of Statistics, Logoba sub-county has a population of 28,000 of which over 150 are positive. To scale down the infection rate and enrol more patients on treatment, Fuchoo said they are embarking on community sensitization, cross-border monitoring, testing and the use of expert clients.

She added that through the use of expert clients, they can cover wider areas and deliver ARVs for patients up to home and this has eventually reduced stigma. She equally noted that expert clients have helped supply drugs to Jale, Sira Jale, Lotoba, Wudu Town and other deep remote villages of Kajio-Keji County of Central Equatorial State in South Sudan.

Through cross-border monitoring between South Sudan and Uganda, both expert clients and health workers sometimes deliver drugs or restock the Afijo-Jale border and water points where clients come and pick up drugs for three months on agreed dates.

One way of screening positive HIV partners is through the Assisted Notification Partner Testing (APN) where health experts trace contacts of affected patients and in Logoba village, Fuchoo said they were able to screen 50% of the victims.

After screening and someone is found positive, he or she is enrolled for treatment and those who report as a result of exposure to the virus are advised to take Pre-Exposure Prophylaxis (PreEP) for HIV prevention.

Kajio-Keji County is one of the administrative units of the Central Equatorial State in South Sudan. Before the 2015-16 conflict, it had more than fifty health facilities and one civil hospital that had easy access to the management of HIV/AIDS cases.

As of today, the County has only 11 health centres, 14 primary healthcare units and one functional hospital serving over 200,000 citizens.

According to Anthony Akuga Lokiden, the acting medical director of Kajo-Keji County Health Department, the County has 230 HIV/AIDS patients including those with TB and already enrolled on treatment.

He stated that some of the challenges the department is facing include limited funding from partners, insecurity in some parts of the County, limited human resources and inadequate ARVs in most health facilities.

“We highly welcome any partner who can give a helping hand and support us in Kajo-Keji so that we can together easily rehabilitate the destroyed facilities because our target is to reach up to 75% if there is adequate support from all corners,” said Akuga.

He further noted that positive people have to walk for about 30km, all day from South Sudan to the bordering health centres either in Moyo or Yumbi districts in Uganda to access ARVs.

Others he said come to Uganda for reproductive health services despite the operational ART Unit established at Kajo-Kejio Civil Hospital.

Despite the challenges, he said the County health department has embarked on community sensitization through the use of radio talk shows, and active clients to share their testimonies to encourage others to go for testing and reduce the spread of the virus.

Though the exact figures of moralities could not be confirmed as a result of vandalized records from the department, Akuga said in the past they have registered five deaths, anticipating an increase in cases of HIV/AIDS.

Mawadria Geoffrey, the Moyo District HIV/AIDS focal point person revealed during a one-day meeting organized by Moyo district health department in partnership with NAFOPHANU stated that most pregnant women in the district who tested HIV positive have started taking their ARVs.

He stated that the 12-month retention for patients who remained on ART for the last 1 year between Jan-March stood at 94%, and April-June at 92%. However, with a slight drop of 2%, it is an indicator that the district is not doing well, noting that at least 97% of the positive persons are routinely screened for TB and HIV/AIDS.

According to data obtained from Moyo health department, 67% of their children are none suppressed with 33% suppressed in Eira Health Centre in Moyo sub-county. 50% in Dufile Health Center are none suppressed and only one child in Eremi Health Centre whose viral load is suppressed out of the children aged 20 and above.

Also in Moyo sub-county where Moyo Mission Health Centre IV is situated, it has two children whose viral load is suppressed and five are none suppressed – this is below the national target of 95%. However, Lefori and Logoba Health Center IIIs are on the course of achieving 100% viral load suppression.

In Adjumani district, one of the districts hosting refugees, the district HIV/AIDS Control Program Manager, Inyani Mane Dolorence, said in 2022, the district had set an HIV indicator of 95%.

95% of the people living with HIV in the community should be identified and know their status, 95% newly diagnosed should be initiated on treatment (ARVs) and those on treatment should be able to continue with their ARVs as required until they become virally suppressed.

In 2022, the district managed to identify 73% of the first 95% of the people targeted a figure of 332 out of 454. They managed to initiate 332 on care and treatment and 91% were virally suppressed.

Out of those they identified (73%), 269 were nationals aged 25-49, the greatest population infected by HIV and the number mostly affected were women at 102.

In terms of sub-counties, the highly burdened Adjumani district includes Adjumani Town Council with 108 newly identified cases followed by Itirihwa with 32, Pakele 31, Dzaipi 25, Ciforo 21, Adropi 17, Ukusijoni 16, Ofua 8, Pacara 7 and Arinyapi 3. The least is Pakele Town Council with 01 infection making a total of 269 cases among the nationals.

The rates of infections at the refugees’ settlement are 28 in Dzaipi, Pakele 27, and Ukusijoni 8. Itirihwa, Ciforo, Ofua and Pacara did not record any cases of infections in 2022.

Preliminary information released by UNFPA in 2022 indicates that the HIV/AIDS prevalence reduced to 2.6% and this was attributed to some interventions undertaken in the fight against the spread of the Covid-19 pandemic.

“The refugees who are on treatment in Uganda once they cross to South Sudan, we are not sure of whether they take their drugs though some say they get their drugs from Nimule Hospital at the border or Juba Teaching Hospital among other health facilities. When they come back and retested, it indicates that they still have a high number of virus in the blood meaning that they have not been taking their drugs resulting in transmission of HIV,” said Mane.

Despite the challenges, now the district is prioritizing how to achieve the triple 95%, first by the identification of the first 95% of people living with HIV in the community through targeted HIV testing where a person can be screened or tested for HIV, identifying hotspot areas where HIV is on increase and also spotting key population who indulge themselves in risky behaviours that can lead them into getting the disease. They target commercial sex workers, long-distance truck drivers and the fishing communities along the River Nile, among others.

In the second 95%, they are initiating patients on treatment and strengthening health workers’ capacities to offer the best counselling services so that when a PLHIV seek services they can accept to take ARV willingly and continue taking it until they are suppressed, offering psycho-social support, and stigma fight, among others.

The last intervention of 95% is viral suppression backed by the initiation of treatment where the person can be virally suppressed by offering psycho-social support services by bringing or involving the PLHIV.

“We also use the district indicator intervention like the structure of PLHIV at the sub-county levels, the executive for the district and the young positives or the adolescents’ peer-support to ensure that there is support among them to achieve the triple 95% in the district. All these are some of the set strategies that we are now using to curb infections,” he emphasized.

Currently Adjumani district has a teenage pregnancy rate of about 14% and PLHIV attending to antenatal care services is at 96%. In 2022, 38 out of 42 positive people are already initiated on treatment.

According to Mane, Adjumani is on track to achieve the triple 95% because, in the first 95%, the district registered 73%. In the second target, they achieved more than 4%.

In 2022, Adjumani district registered 651 TB cases among the nationals who were enrolled on treatment. 236 are aged 25-49. 182 adults aged 50 years and above represented 28%, and 165 children below 15 years stood at 25%. Those aged 15-24 were 68 at 10%.

Chandiru Hadija Juma, 21, is HIV positive and was elected Miss Youth Positive (Miss Y Plus) Northern region under UNEPA. She is also the coordinator for the Forum of Young People Living with HIV/AIDS under Moyo AIDs Heroes Association.

She narrated that many young positive people have no good caretakers; an issue she revealed is contributing a lot to the loss of young girls who skip drugs for months.

She equally noted that as a result of stigma, many young people who are positive fear showing up in public, adding that once a positive person has reached a stage of skipping medication as a result of stigma it becomes very challenging because that person has to be taken to the second line of treatment yet the first line of treatment is better.

As Moyo AIDs Heroes Association, she said they are now focusing on how to improve patients’ well-being in schools and the community because once a child with HIV is stigmatized, the child will easily end up not following his/her medication on time or completely.

According to Chandiru, most of the young positive people are being taken care of by their grandmothers or old people, citing her as an example, adding that dealing with young adolescents is tricky or hard in terms of guidance and counselling.

Moyo

In 2012, the Forum of Young People Living with HIV/AIDS under Moyo AIDs Heroes Association had 25 young members, unfortunately, two of them died. Besides, there are still others who have yet to come out to test or disclose their statuses.

“So for this case, our target is never to give up but rather see that this forum comes back on board to stand, be well known and fight for the young positives,” said Chandiru.

In Moyo district, the new infection rate among adolescent girls, young mothers and elderly women is twice that of adolescent boys since the children are so exposed to sexual activities. She attributed it to the inventions of social media where teenagers watch pornographic movies and want to try.

Okuga Isaac, 45, is a resident of Logoba village, Moyo sub-county. He contracted the virus in 2019 and for the last 9 years, he has been taking his ARV drugs promptly.

He noted that some of the challenges HIV patients go through include the side effects of ARV drugs, poor feeding and stigma and these, he said have forced many to dodge the medication.

A father of 3 children, Isaac said all his children are HIV negative and this, he attributed it the regular taking of ARV drugs. Like others, he said the major challenge among HIV/AIDS-positive people is stigma and limited food which has often led to domestic violence within families.

“I don’t forget my medication schedule. I take it every day at my appropriate time. The advantage of this medication is that it reduces the viral load in you, you can’t easily give it to your partner and also be strong enough to work, feed my family and myself,” he explained.

As a casual worker at a construction site alongside farming, he generates income to help meet other basic needs of the family and also to provide a balanced diet and improve his nutritional status.

Since joining the farming group in 2008, his life has never been the same and he can now get vegetables and sell others to meet scholastic materials for his children.

Currently, Moyo sub-county HIV-positive people are implementing a five-year framing project with funding from RICE West Nile International amounting to the tune of shs4 million.

The project aims to equip them with enough food for consumption and for sale but importantly to help improve HIV patients’ health statuses and keep the uptake of ARV drugs, reduce domestic violence among them as a result of limited.

“I feed on greens, fish and a lot of my foodstuff that I eat I don’t purchase from the market but from my kitchen garden and farm. Sometimes people wonder and can’t believe that I’m positive (sick), now I can eat well and be able to pay my children’s fees,” added Isaac.

According to data obtained from the Uganda Bureau of Statistics, in 2017, Moyo district recorded 393 cases of Gender Based Violence across health facilities in the district. However, the number of cases increased to 1,043 after the outbreak of the COVID-19 pandemic.

To minimize cases of GBV, Isaac is urging the government to tailor programs that target positive people, urging that many HIV patients feel stigmatized and discriminated against when it comes to accessing government programs when they are mixed with the rest of other community members.

Mali Michael is the Moyo district education officer who attributed the high rate of infections to sustenance abuse, poor parenting and night discos.

He said to fight HIV/AIDS in the affected areas, there is a need for concerted affords and called upon the LCs and other leaders to look at the issues of alcohol consumption, use of drugs, opium and use of other toxic drugs that are causing people to get excited and move away from normal behaviours.

To reduce the spread of HIV/AIDS, Moyo General Hospital has recruited six of their viral-suppressed patients and 10 more remaining non-suppressed clients who are providing home visits.

Andruvu Toloko Bandasiof Rendike Chiefdom in Moyo sub-county where Eria, Besia and Logoba Health Centers are located said that as cultural institutions their clan leaders are working in partnership with the Local Council One and VHTs to mobilize the community to help reduce the spread of the virus in the sub-county.

“In our local language, we say “nay ru ebe ni nya limi I” meaning “your health is your wealth”. Our major concern is poor parenting and this poor parenting is not only those who are positive but it is a general public problem in our district here.

“People are lazy. So, let’s fight poverty after which our young positive people living in our families will have enough to eat and have suppressed viral load through proper feeding,” he said.

The National Forum for People Living with HIV/AIDs Network in Uganda is an NGO that brings together all the networks of people living with HIV. They are advocating and coordinating for better HIV services in the community across the country, especially the young positives.

With other projects implemented in 136 districts including Moyo through the support of USAID, the aim of the project is to train more young positives to come on board such that they can help reach out to their peers in the community, advocate for adherence and retention among the adolescents in the targeted district.

Graphs

In Moyo, the project is executed with the sole aims of increasing access and adherence to HIV treatment, reducing AIDS-related diseases and promoting positive living among the PLHIV in areas where the project has been ongoing since May 2023 before it ends.

Joselin Mbawadu, the project coordinator for NAFOPHANU said they are looking at building the capacity of the young PLHIV such that they can help in improving retention and promote positive living among members.

“We are applying a peer-to-peer module, positive people, people who have come out and accepted their status and they have testimonies to share with the PLHIV who have issues of adherence and retention. We are also empowering the PLHIV with knowledge and skills of how to manage their treatment and comprehensive household assessment,” explained Mbawadu.

With the help of the project, the ART in charge offers technical support to expert clients on how to assess their nutrition, monitoring the clients daily so that they ensure clients take their drugs on time and at the right doses, including drug storage.

Mbawadu further said the project will help create Young PLHIV structures to improve the coordination of the young positives, have the role of monitoring services among the adolescents in their community, do evidence-based advocacy in the respective districts level where more than 60 YPLHIV have already been trained in treatment, literacy and have attached them to different facilities in West Nile 25, in Acholi 25 and Kampala 20.

By Kei Emmanuel Duku Yona

This story has been produced with the support of the Uganda Network on Law, Ethics and HIV/AIDS (UGANET).

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