Although the scaling up of Antiretroviral Therapy (ART) has restored hope of life, stigma remains a key barrier to the delivery of quality HIV/AIDS services, utilization of the services as well as prevention of further transmission. At a Knowledge Exchange Forum on issues of Policy, Communities and HIV/AIDS in Africa hosted by the Department of Political Science and Public Administration, Makerere University, on 20th June, 2016, Dr Sheila Ndyanabangi, the Principal Medical Officer, Mental Health in the Ministry of Health warned that the focus on ART without appropriate interventions to address stigma and its effects is likely to rob Uganda of its success in the fight against HIV/AIDS. She said there was urgent need to study and establish innovative interventions that are contextually relevant to sustain and increase gains in the HIV/AIDS war, including addressing stigma. “Stigma affects preventive behavior and those infected take on risky behavior in retaliation. It leads to reduced access to care and treatment due to lack of confidentiality. HIV/AIDS services should be integrated into the general health care services as a way of minimizing stigma. Providing accurate and complete information to the public and all health workers regarding transmission, nature and course of HIV is also crucial in the reduction of stigma,” she advised.
Presenting the global statistics on HIV/AIDS, Dr. Vincent Bagambe from the Ministry of Health noted that although the Government of Uganda had registered significant progress in the fight against HIV/AIDS, the prevalence rate had increased with devastating effects on the economy. According the Uganda AIDS Indicator Survey, the current prevalence rate is 7.3%. Like, Dr Ndyanabangi, he attributed the increase to stigma, poverty and inequitable access to health services. He called for increased funding, to among other things, scale up ART to reach 80% coverage with treatment for the MARPs, irrespective of the CD4 count.
Discussing the approaches to service delivery and the implications for public administration, Prof. Tom Lodge from the University of Limerick (Ireland), said the wider risk in the management of HIV/AIDS by States lies in the neglect of prevention work. “Without effective preventive measures, infection rates remain high.”
In his presentation on HIV/AIDS, decentralization and policy slippages, Prof. Ernest Mallya from the University of Dar es Salaam noted that both governments and communities present hurdles to policy implementation. “The hurdles on the part of the government include limited resources to put in place reliable infrastructure, lack of accountability, wavering political will and lack of inclusion in policy and project planning. On the part of the communities, poverty is the main challenge, making community members unable to access facilities and buy critical requirements.”
Health Economist, Dr. Robert Basaza, called for public-private partnership emphasizing that the private sector is crucial in fight against HIV/AIDS. “40% HIV/AIDS services are provided by the private sector. Uganda can no longer afford to pass a policy without involving the private sector. Establishing public-private referral partnerships with the local private health service providers like drug shops, medical clinics, pharmacies and maternity centers is critical in increasing the number of PLHIV who enroll and access care, support and treatment services,” he said.
Addressing participants, Assoc. Prof. Sabiti Makara from the Department of Political Science and Public Administration, Makerere University, underscored the importance of Civil Society Organizations (CSOs) in the fight against HIV. “CSOs have been instrumental in supplementing government efforts by providing care that has built hope and confidence among people living with HIV. People can now freely talk about their status because of the social networks that have been built by CSOs. CSOs have been critical in the area of prevention and are instrumental in informing public policy,” he said.
According to Mr Bharam Namanya, Executive Director, Community Health Alliance Uganda, CSOs have been key in raising awareness and providing research to inform government and community interventions. “They have provided technical legal support to government to develop HIV & pro-health responsive laws and policies and have held government accountable for non-provision of basic health consumables in public health facilities.” He however noted that the influence of donor agendas on CSO work weakens their credibility in the eyes of policymakers.
Dr Chris Mclnerney from the University of Limerick advised that issues of HIV/AIDS need to be mainstreamed in more than one ministry for effective delivery of services.
In his remarks on the HIV/AIDS policies in the public service of Uganda and their implication on human resource management, the Head of Public Service, Mr John Mitala, said several employers were violating the fundamental rights of employees living with HIV/AIDS. He appealed to Human Resource managers to assist the affected employees to continue being productive, noting that HIV/AIDS was the most significant challenge to Uganda’s social and economic progress.
The Forum was coordinated by Assoc. Prof. Sabiti Makara. It was attended by among others government officials from line ministries, representatives from Civil Society Organizations and researchers from four Universities: University of Limerick, University of Dar es Salaam, University of Kwa Zulu Natal and Makerere University under their joint project titled: “Connecting Public Policy, Communities and HIV/AIDS in Africa.”
Details on the Knowledge Exchange Forum at: https://events.mak.ac.ug/events/uganda-knowledge-exchange-forum-issues-p...
See policy briefs and detailed presentations by participants below