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No boundaries - HIV in Karamoja

Kraal leaders discussing HIV and AIDS, Karamoja

“Lives are changed by a disease that knows no age, gender, social standing or political affiliation. The only way it can be fought is from a united front, with one supporting the other.” Wendy

That is what the Irish Aid funded programme on Strengthening the Capacity of Local Governments and Civil Society in HIV Prevention in Karamoja (SCALAP-K), is out to build. Uganda has a decentralized form of governance and it is through these systems of governance that the programme is implemented, with the leadership carrying the flag right from the grassroots to national level.

At the grassroots level, Sub-County AIDS Committees (SAC) were set up as a channel of communication about HIV/AIDS. The members that sit on this committee represent a cross-section of the communities.

Ngoleriet Sub-county in Napak district, Karamoja region is one area with such a set-up. Karamoja region is a unique place with its wealth of cultural and traditional practices. Widow inheritance and courtship rape are cultural practices that were initially cherished but are now scorned since they are an avenue through which HIV can be spread. As an elder put it,

“We cherish our cultural practices but, we had to stop them. I consulted my fellow elders and we agreed to discourage our sons from courtship rape. Instead, we are now encouraging them to identify a girl and have her tested first.” Joseph Lowal, elder, Nawokotelei village.

Stigma towards the people living with HIV is still high among the communities. With the help of Voluntary Health Teams, some of whom sit on the SAC, information is shared with different people in order to teach them about HIV/AIDS and reduce stigma.

How better to share information than to take it to the people in their homes and places of work! The Karamojong are traditional cattle-keepers so, they practice pastoralism. During the dry spell which last between 3 – 6 months, the young men in-charge of herding the animals lead them away from home, in search of pasture. Thousands of heads of cattle are kept together in shelters known as kraals. 

Among the young men that go to the kraals is a group that was trained and equipped with information about HIV/AIDS. Kraal Peer Educators, as they are referred to, were former peace ambassadors. Now that peace has returned to the region, they have taken up the health issue.

Thirty year old Paul Achia, a Kraal Peer Educator from Nawaikorot A Village, in Napak district says,

“We were told it is us to rescue ourselves from the disease. We have survived the guns, let us also rescue ourselves since this disease knows no age or gender. Taking care of oneself is the best medicine for HIV”.

The people living with HIV/AIDS have formed support groups in order to fight stigma (discrimination) towards HIV positive people. This is still prevalent among the communities, with some HIV positive people being ridiculed and asked to live apart from the rest of the family. Ikinyoma PHA group with 30 members is one such support group.

Pascal Naker, a 46 year old wife and mother of 5, has lived through this. She got married in 1989 as a first wife to a Primary School teacher and lives in Kangole Trading Centre. From 1999, Pascal’s husband used to fall sick a lot, with different opportunistic diseases like tuberculosis and herpes-zoster.  She never suspected anything serious until 2007 when her husband was hospitalized in a neighboring district. Around this time, her co-wife abandoned them and she was left to nurse their husband alone.

During her stay at her husband’s bedside, the doctors treating him asked her to get tested for HIV. This was the first test she was doing since 1999 when she gave birth to her youngest child. It was also around the time when her husband also started falling sick. She was found to be HIV positive and she also learnt that, her husband knew his status since 1999 when he first fell sick. She asked to be transferred to a health centre near home where she began receiving ARVs and her husband continued with his.

“My husband was afraid of telling me the truth about his health status because he was afraid that I would walk away and he would have no one to take care of him. He was also afraid of our extended family and community’s reaction”. Pascal says.

A neighbour at home used to taunt them about their status and advocated for their being lynched or sent away from the community. Ironically, on one of Pascal’s visits to the clinic, she found this neighbor there. She too had contracted the disease! The taunting and stigma from the community reduced because, everybody realized that it could be any of them walking in Pascal’s shoes.

“Like Philly Lutaaya said, today it’s me, tomorrow it’s someone else. The support group has also been very good since we now move around as a group so, the people do not abuse us anymore.” says Pascal.

In Tooekitela village, Nawaikorot B sub-county, Napak district, is 60-year old James Lowat. Married to two wives with six children, he found out that he is HIV positive in 2003. His first wife, to whom he was married for over 25 years and had four children, tested negative. Through mutual consent, they agreed not to live together in order to protect her. In 2010, he married a second wife with whom he has 2 children. During her second pregnancy, she tested HIV positive and received medical attention that enabled her to give birth to an HIV free baby, now aged 2 years. Much as James is receiving ARVs from a nearby hospital, his wife has refused to use the life-saving drugs and has instead chosen to drown her challenges in locally brewed alcohol.

Given that James is 60 years of age, he is also benefitting from the Irish Aid and DFID funded Social Protection programme, which targets elders over 60 years of age.

“We receive $10 per month and with that money, I am able to buy soap, scholastic materials for my son and supplement on the diet at home to include more proteins”.

Irish Aid funded HIV interventions in Karamoja are implemented by partners TASO and AMICAALL who contribute to ensuring that the HIV prevalence in the regions drops from 5.3% where it currently is to 3.5% where it was, 8 years back.