Uganda launches new low-cost HIV drug.

The Ugandan government on Sunday launched a cheaper one-pill-a-day drug for HIV treatment, marking an advancement in its fight against the human immunodeficiency virus (HIV).

Cipla Quality Chemical Industries, Ltd, in Uganda is the proud manufacturer of the new drug, a triple cocktail (Efavirenz, Lamivudine and Tenofavir) HIV drugs. The single-dose Trioday treatment, which costs only $13 per month, replaces the cumbersome 12-drug cocktails that used to be the only option for people with the fatal human immunodeficiency virus.

“We are reaching the phase of the end of the HIV epidemic in Uganda and the region. We had never dreamed about this in 30 to 40 years back,” said Ugandan Prime Minister Ruhakana Rugunda, who launched the drug on behalf of President Yoweri Museveni.

Uganda has a large burden of HIV and AIDS: based on UNAIDS estimates, there were 1,500,000 Ugandans living with HIV in 2012 with 1,400,000 being among adults and 100,000 being  children. Women are dis-proportionally affected by the epidemic because only 44% of the adults infected were men. In 2012, there were 140,000 new infections in the country with 86% being among adults while 14% was among newly born babies. Furthermore, 63,000 persons living with HIV (PLHIV) were estimated to have died of AIDS related causes in 2012. 

These statistics imply that 383 Ugandans get infected with HIV on a daily basis, and an additional 173 people die due to AIDS related causes every day. In general, AIDS is one of the major causes of morbidity in the county. According to the 2008 Service Delivery Survey by Uganda Bureau of Statistics, HIV/AIDS accounted for 14% of all visits to the health facilities. 

800 Ugandans trafficked- 2013 report

The love for money and search for a better life has made so many Ugandans willing to go and work a broad fall victims of human trafficking. Uganda is one of the countries in the world that have organized trafficking rings which have lured at least 837 Ugandans into conditions that border on modern-day slavery, a new report shows.

The 2013 report on Trafficking In Persons (TIP) indicates that of that number, 429 were victims of transnational trafficking, while 408 were trafficked internally.

 

Uganda was a destination for at least 20 victims from six countries: Madagascar, Somalia, Rwanda, Burundi, South Sudan and Tanzania.

 

“We can’t tell exactly the percentage of the increase in victims of trafficking because there were no proper record mechanisms of trafficking cases in police in 2012,” said Moses Binoga, the coordinator of the Anti-Human Trafficking Taskforce at the ministry of Internal Affairs. “But what we know is that the number of reported cases increased in 2013 due to increased sensitisation on human trafficking.”

 

Binoga further told The Observer that not all human trafficking reports got by other agencies outside the police were registered as criminal cases, because some victims were uncooperative, while others lacked clear details.

 

“This explains why the statistics given in this TIP report are bound to be higher than the ones given in the police’s Annual Crime Report 2013,” he added.

 

The report found that deception, with promises of employment, care, education and marriage, was a key driver behind much of the trafficking. But force was sometimes used in cases related to human sacrifice.

 

Most transnational victims of trafficking were recruited by individuals and unlicensed companies in Kampala. The majority of the victims left the country disguised, usually by road, through neighbouring countries such as Kenya, Rwanda, and South Sudan.

 

Ugandan officials are scrambling to act on an envoy’s report that more than 600 Ugandan girls are trapped in Malaysian prostitution rings with no easy way out.

 

Advertisements pinned on the walls of shopping malls in Uganda’s capital promise young women a free ticket to a well- paying job in Malaysia as a nanny, maid or bartender. But the advertisements are a trap.

Uganda’s honorary consul in Kuala Lumpur said in a report released last week that up to 10 Ugandans are trafficked to Malaysia daily and that at least three have been killed there in the last two years.

The U.S. Department of State said in its 2011 report that Uganda “does not fully comply with the minimum standards for the elimination of trafficking.

According to the U.S. State Dept Trafficking in Persons Report, June, 2009 ; Uganda is a source and destination country for men, women, and children trafficked for the purposes of forced labor and sexual exploitation.

Ugandan children are trafficked within the country for forced labor in the fishing, agricultural, and domestic service sectors, as well as for commercial sexual exploitation; they are also trafficked to other East African and European countries for the same purposes.

Karamojong women and children are sold as slaves in cattle markets or by intermediaries and are subsequently forced into domestic servitude, sexual exploitation, cattle herding, and begging.

Human trafficking of Ugandan children for the forcible removal of body parts reportedly is widespread; so-called witchdoctors seek various body parts of live victims for traditional medical concoctions commonly purchased to heal illness, foster economic advancement, or hurt enemies.

Exploitation

The highest number of complaints registered in cases of transnational trafficking included labour exploitation, mostly in the form of domestic work and sexual exploitation through forced prostitution in the Middle East and South East Asian countries.

 

Other forms of exploitation included human sacrifice, child marriage, removal of body organs for sale, and worker conditions similar to slavery.

 

According to the report, Ugandans were trafficked mostly to Kuwait (98), Syria (83), DRC (72), Malaysia (43), India (35), UAE (15), Turkey (13), Kenya (11), Qatar (10), South Sudan (10), Thailand (08), Saudi Arabia (04), Oman (03), Iraq (03), China (02), South Africa (02), Germany (02), USA (02), Rwanda (02), Czech Republic (01), Lebanon (01), UK (01), the Netherlands (02), and Switzerland(01).

 

At least 250 suspects were arrested over human trafficking-related cases last year. Of these, 56 were taken to court and two suspects were convicted of promoting human trafficking, the report says.

 

Over 77 cases of human trafficking are still before the Director of Public Prosecutions (DPP) for legal advice and over 44 cases were dismissed due to loss of interest by the victims.

MINISTRY OF HEALTH STATEMENT ON MARBURG

The Ministry of Health would like to inform the general public that there is a confirmed case of Marburg in the country.

 This initial case follows laboratory tests done at the Uganda Virus Research Institute (UVRI) on September 30th 2014 which confirmed that one person, a health worker, had died of the viral hemorrhagic fever.

The index case is a 30-year-old male Radiographer, who originally was working in Mpigi Health Centre IV, Mpigi Town Council but had been recruited by Mengo Hospital two month ago as a Radiographer. He started feeling unwell on September 17th while at Mengo Hospital and travelled back to Mpigi HCIV on September 18th to seek treatment since he felt more comfortable with a facility that he had worked with for a long time.

He was treated at Mpigi Health Center IV but when his condition worsened, he was transferred back to Mengo Hospital where he was admitted on September 23rd. He presented with Headache, Epistaxis, abdominal pain, vomiting blood and diarrhea. His condition deteriorated on September 27th and a Viral Haemorraghic fever was suspected. Blood samples were removed for further analysis on September 28th; unfortunately he died on the same day. His body was taken to Munkunyu 1 Village, Munkunyu Sub-county, Kasese district for burial.

Preliminary reports also show that his brother, one of the contacts so far listed has developed signs. He has been quarantined and isolated for further monitoring. Samples have been taken from him and are being tested at the Uganda Virus Research Institute. The public will be informed of his status. Altogether 80 contacts have been listed from Mengo, Mpigi and Kasese for follow up.

Marburg Viral Haemorraghic fever is a fatal illness caused by the Marburg virus which belongs to the filoviridae family together with the Ebola virus. The incubation period ranges from 2 to 21 days while the Case fatality rates vary from 24% to 88%. Fruit bats of the Pteropodidae family are considered to be the natural hosts of Marburg virus. The Marburg virus is transmitted to people from the fruit bats and spreads among humans through human-to-human transmission by
direct contact with wounds and body fluids like blood, saliva, vomitus, stool and urine of an infected person.

A person suffering from Marburg presents with sudden onset of high fever with any of the following;
1. Headache
2. Vomiting blood
3. Joint and muscle pains
4. Bleeding through the body openings, i.e. eyes, nose, gums, ears, anus and the skin.

There is no specific antiviral treatment or vaccine available; patients are usually given supportive treatment.

The Ministry of Health is undertaking the following measures to control the spread of the disease;

• Yesterday, a team of epidemiologists and surveillance officers were sent to Mpigi Health Center IV, Mengo Hospital and to Kasese district to investigate the case and list all people who got into contact with the dead.

• So far, a total of 80 people who got into contact with the initial confirmed case have been identified and isolated as a precautionary measure and for follow up for any signs and symptoms within the 21 days incubation period. These include 38 health workers from Mengo Hospital, including his brother and 22 health workers from Mpigi Health Center IV and 20 people from Kasese district. They are currently being monitored by a team of epidemiologists from the Ministry of Health.

• Arrangements have been put in place to transport all suspect cases to the National Isolation Facility in Entebbe should they occur. The facility is already stocked with the necessary infection control materials and other supplies to handle any incoming patients.

• Arrangements have also been made at Mengo Hospital to isolate any suspect with symptoms. Health workers have been asked to effect all infection control measures.

• Preparations are underway to train all health workers at Mengo Hospital and Mpigi Health Center IV on infection control starting tomorrow 6/10/2014 at 9.00am

• Government working with partners and specifically Medicens San Frontiers (MSF) are in the process of revamping the isolation facility at Mulago National Referral Hospital under the leadership of Kampala Capital City Authority in readiness and the facility will be ready in three days time.

• MSF is also mobilizing additional resources to assist with infection control and case management at all the isolation facilities that have been set up.

• The World Health Organization (WHO) is providing technical assistance and logistical support (PPE’s) to all the affected facilities.

• In Kasese, a team has been dispatched to work with the district official and Kagando Hospital to trace for any other suspects.

• Personal Protective Equipments (PPE’s) and other supplies have been mobilized and sent to Mengo and Mpigi health center IV and Kagando HCIV.

• National Medical Stores will supply additional infection control materials to Mengo Hospital and Mpigi HCIV by tomorrow morning.

 The Ministry of Health however informs the general Public that Mengo Hospital is safe and all measures have been taken to ensure that there is no further spread of infection. Patients are encouraged to continue to receive services from there.

 Ministry of Health urges the general public to observe the following protective measures;
• Report any suspected patient to a nearby health unit

• Avoid direct contact with body fluids of a person presenting with bleeding tendencies or symptoms of Marburg.

 The Ministry of Health once again calls upon the public to remain calm and be on alert amidst this epidemic. All suspect cases can be reported on the Ministry hotline on +256750996034.

Hon. Elioda Tumwesigye
Minister of State for General Duties &
Holding the Portfolio of Minister for Health

Uganda holds the 7th Joint Annual HIV/AIDS Review

The Uganda AIDS Commission (UAC) organised the Joint Annual HIV&AIDS Review which took place on 11^th and 12^th September at Imperial Royale hotel in Kampala. The UAC head, Dr. Christine Ondoa said that participants should identify priorities for a new National HIV&AIDS Strategic Plan for the next five years and reflect on the national response to the HIV epidemic.


Former Minister of Health Dr. Rukutana Rugunda, US Ambassador Scott DeLisi being welcomed by UAC Head Dr. Christine Ondoa. Photo by Namirimu Esther

“This year’s theme is, “Getting to Zero, My Responsibility,” she said.

She also noted that the 7^th Joint Annual AIDS Review will be used to assess the performance of HIV/AIDS programs and policies in Uganda since 2011.

The US ambassador Scott DeLisi recognised the ongoing partnership between the HIV&AIDS Development Partners including Ireland, the UK, Denmark, and Sweden, the United Nations agencies, the United States, the government and the people of Uganda.

 US Ambassador to Uganda Scott DeLisi and Former Minister of Health Dr. Rukutana Rugunda at the 7th Joint Annual Review held at Imperial Royale in Kampala. Photo by Namirimu Esther.

 

“Together we have made great strides towards a healthier future for the citizens of this country and in the past two years we have had some notable and noteworthy successes in pursuit of our goal of an AIDS-free generation,” he added.

Ambassador DeLisi said that the government of the United States alone has invested over $2.6billion dollars- that is almost seven trillion Ugandan shillings- to fight HIV over the past decade.

“Today some 600,000 HIV-positive Ugandans live healthy and productive lives because the people of the United States support their antiretroviral therapy (ART).

He also noted that in 2013 alone, PEPFAR support gave over 88,000 HIV-positive pregnant women the chance to give birth to HIV-free children.

L-R: US Ambassador to Uganda Scott DeLisi, Former minister of Health Dr. Rukutana Rugunda, Uganda AIDS Commission Chairman, Professor Vinand Nantulya and Dr. Christine Ondoa. Photo by Namirimu Esther.

 

The Chairperson of UNASO, Dr. Raymond Byaruhanga said that Civil Society Organisations (CSOs)  have participated in the midterm review of the National HIV Strategic Plan, been represented on National Prevention Committee, we are members of the Country Coordinating Mechanism (CCM) for Global Fund and other working groups both at national and district levels.

He praised the Government of Uganda for continuing to demonstrate its commitment to the national fight against HIV/AIDS through various ways, for example on 31^st July; President Yoweri Museveni signed the HIV and Control Bill into a Law.

L-R: Executive Director of TASO, Dr. Christine Nabiryo, Commissioner Ministry of Health Dr. Alex Opio and Dr.Donna Kabatesi of Center for Disease Control Uganda. Photo by Namirimu Esther.

 

“Even though it has some unacceptable clauses, this law has positive provisions like a nationwide fund for HIV care, and outlaws discrimination against HIV-positive individuals in workplace and schools,” he added.

 

He recommended that the CSOs role in all thematic areas of the new National Strategic Plan (NSP) be articulated to ensure systematic programming, capacity building as well as monitoring and evaluation of the CSOs contribution to the national response.

According to the World Health Organisation (WHO), leadership and governance involves “ensuring strategic policy frameworks exist and are combined with effective oversight, coalition building, regulation, attention to system-design and accountability”.

 

The Executive Director of Uganda AIDS Commission Dr. Raymond Namanya presenting a statement on behalf of the CSOs. Photo by Namirimu Esther

“The current status of leadership and management of the response at all levels is weak. The national and decentralized partnership structures as of now cannot be evaluated as very effective to facilitate smooth communication and coordination,” he added.

He also said that contradictory messages have been sent out on the emerging interventions, resulting in inaction on new evidence. As a result, the response is becoming disjointed to the extent that key offices are not even aware of national priorities.

Dr. Byaruhanga recommended that the revised NSP should clearly define the roles of different stakeholders, including UAC, Ministry of Health (MOH), CSOs, Local Governments, Political leadership among others.

 

He noted that although many citizens have keen interest to carry out program and budget monitoring and evaluation as well as demanding accountability from the duty bearers, it is clear that they are not adequately empowered to do so with appropriate information and techniques.

 “We recommend that community scorecard mechanism be institutionalized. This model facilitates participation, accountability and transparency among service users, providers and decision-makers and gives citizens an opportunity to appraise the quality of services to increase duty bearers’ responsiveness to their needs,” he noted.

Health workers, AIDS Development Partners, CSO representatives, representatives from embassies, representatives from government and media present at the 7th Joint Annual AIDS Review held at Imperial Royale on 11th-12th September. Photo by Namirimu Esther

 

Uganda AIDS Accountability Scorecard Launched

The Uganda AIDS Accountability Scorecard, the first of its kind in the country was launched on Wednesday April 30th by the Uganda Network of AIDS Service Organisations (UNASO) at Hotel Africana, in Kampala.

The Uganda AIDS Accountability Score card which was produced by the Uganda Network of AIDS Services Organisations (UNASO) with support of United Nations Development Programme(UNDP) rates the degree to which the Government of Uganda is fulfilling its commitment to respond to the AIDS epidemic.

Presenting the findings of the Scorecard, the Executive Director of UNASO, Mr. Bharam Namanya, said that the study shows that anti-retroviral therapy (ART) for both adults and children was performing well as well as tuberculosis (TB) treatment.

He said that the number of Ugandans accessing Anti-Retroviral treatment increased from 329,060 (57 per) to 577,000 (76.5 per cent) between September 2011 and September 2013.

“Findings also reveal that the majority of respondents are happy with the performance of other interventions; Prevention of Mother to Child Transmission (PMTCT), HIV Counseling and Testing (HCT), and Safe Male Circumcision (SMC).”

Mr. Namanya noted that the findings indicate that most health facilities had infrastructure however, they had not had any renovation and required facelift for they were generally characterized by worn out paintings, dust stained louvers, dirt stained and damaged screening meshes, stained and damaged ceilings, damaged doors, cracked walls, non-functional water taps.

The study also highlighted that the general challenges for prevention indicated that stigma is still limiting identified HIV positive clients from accessing treatment and there is shortage of midwives in supported lower level facilities especially among health centres III.

 Mr.. Namanya also added that the findings show that there is lack of comprehensive counseling skills at Antenatal Care, women fear to test for HIV and AIDS and there is scarcity of both female and male condoms; female condoms are not available and there is limited public education about them.

 “Inadequate public education about female condom, and where it is available, it carries confusing messages from multiple implementers,” he added.

 Another challenge is the biting poverty in the community that has been a hindrance to honoring of referrals. Clients are willing to access service in health facilities but they claim not to have transport.



United Nations Development Programme Country Director, Ms Almaz Gebru officially launching the first Uganda AIDS Accountability Scorecard at Hotel Africana, April 30. Looking on are officials from Mildmay, Uganda AIDS Commission and the Uganda Network of AIDS Service Organisations (UNASO). UNDP-Uganda Photo

Uganda AIDS Commission (UAC) Board Chairperson, Professor Vinand Nantulya, described the scorecard as, “an opportunity to improve service delivery and offers a platform for communication between health service users and the service providers. It underscores immediate response and joint decision-making”.

Eight key elements required for an effective national response to AIDS were assessed, namely: Data Collection, Focus on Most-at-Risk Populations, Treatment, Prevention, Coordination, Civil Society, Financing and Human Rights Mainstreaming based on the performance indicators of Uganda’s National HIV and AIDS Strategic Plan 2011/12-2014/15.

Also at the launch, UNASO flagged off a new Accountability Framework for AIDS Service Organisations in Uganda, a tool aimed at helping CSOs to enhance internal accountability, governance and transparency to build capacity to support the HIV and AIDS sector in Uganda.

 An estimated 1.3 million Ugandans aged 15 to 49 are currently living with HIV and prevalence has continued to rise from 6.4 per cent in 2004/2005 to 7.3 per cent in 2011.

UNASO, with a membership of over 2,000 CSOs, provides a platform for advocacy, coordination, networking, capacity building and information sharing among civil society AIDS service organizations (ASOs) to improve on the effectiveness, efficiency and quality of service delivery in Uganda.

More than 3million Ugandans are living with Hepatitis B; Government needs ush46bn to provide vaccines for all citizens

In 2011, the World Health General Assembly declared the 28th day of July every year World Hepatitis Day. However, due to a number of activities that have coincided with this day, Uganda could not join the rest of the World to commemorate this day. 

Uganda is commemorating the World Hepatitis Day today 1st August 2014 at the Mayor's Garden in Adjumani District under the theme "Hepatitis: Think Again." This is in recognition of the high prevalence of hepatitis and the associated deaths the world over.

L-R: Dr Jacinto Amandwa discussing with Dr. Jane Ruth Aceng

This day provides a chance for countries all over the world to learn about the devastating consequences of the disease and join the global partnership to fight it.

"More than 3million Ugandans are living with the deadly Hepatitis B and the worst bit of the situation is that currently the government cannot afford to provide free vaccinations for all Ugandans. The government needs Ush46bn to buy vaccination for everyone."

It further provides a unique opportunity for countries to come together to focus attention on the global threat of Hepatitis and promote actions to control it.

Director General of health services, Uganda Ministry of Health, Dr. Jane Ruth Aceng said that the government of Uganda needs  Ush46bn to provide Hepatitis B vaccination for all citizens.

Dr. Jane Ruth Aceng

"The vaccines are so expensive and the government cannot afford to provide free vaccination for all. Each does costs Ush40,000 ($16us dollars) per person," she added.

Dr. Aceng also warned that it is important that people get the vaccination  because once infected, the vaccine won't help.

She also commended the Chairperson LCV of Adjumani district (one of the most affected areas in Uganda) for passing a Bi-law that every home must have a pit latrine.

"Hepatitis A and B are both oral feacal; this means that one can contract the disease after eating food with feacal matter. Vaccines can be found at Ebenezer clinic in Kampala," she added.

Commissioner for Clinical Services in the Ministry of Health, Dr Jacinto Amandwa, said that treatment of this disease is very expensive and one will spend between ush200,000-300,000 on just tests before treatment.

Dr Jacinto Amandwa,

Dr. Amandwa said that Hepatitis B virus can be transmiteed through health care system by needle sticks injuries, sexual transmission, mother to child and blood transfusion.

"You are all aware of the epidemic of Hepatitis E that we are currently battling in the Napak district of Karamoja. This is due to poor sanitation

He also noted that the contribution of poor sanitation to the transmission of Hepatitis E is another concern especially with low latrine cover and lack of clean and safe water in many parts of the country.

   "Most victims panic and start using ARVs immediately but only 30% of the patients need to use that kind of treatment."

300000 girls in Uganda getting pregnant before they are 19

By Guest Writer Naigaga Phiona Fortunate

Why are so many teenagers and young adults still opting for unsafe sex? Why, when there are sex education classes in most schools and constant public health campaigns, are some people having sex without using contraception or only using a form that protects against pregnancy and not STIs?

According to the Uganda Demographic Health survey 2011, about 14 per cent of young women and 16 per cent of young men had their first sexual encounter before the age of 15 while 57 per cent of young women had their first encounter before the age of 18.

More than 300000 girls in Uganda getting pregnant before they are 19, and many opting for abortion.

Early marriage, early initiation of sex and lack of information, are said to be the leading drivers of adolescent pregnancy. According to Dr Wilfred Ochan, the Assistant Country Representative United Nations Population Fund (UNFPA), lack of access to reproductive health information supported with services, has led teenagers into early sex while poverty and cultural practices continue to force girls into early marriages.

Communications Officer of Isis-WICCE Balikudembe Kireju said that the increased poverty levels due to conflict, displacement and abandonment of known means of livelihood as a result made parents begin to look at their girl children as a source of income in form of dowry if they became formally married. If they were on the other hand impregnated, the culprits were to give some gifts to the parents as a form of appeasement.

Birth control methods
The pill
Pros: It does not interrupt sex and can reduce bleeding, period pain, and PMT.

Cons: It does not protect against STIs; can have side effects; and vomiting, diarrhoea, antibiotics, and other drugs can interfere with its effectiveness.

Injectables

Pros: They do not interrupt sex and are good for those who forget to take daily pills.

Cons: Can cause irregular bleeding, do not protect against STIs, and it can take time for fertility to return to normal once you stop taking them.

The coil

Pros: Does not interrupt sex, can stay in for up to 10 years, and works as soon as inserted.

Cons: May cause irregular bleeding, does not protect against STIs, and there is a risk of pelvic infection.

Intrauterine system

Pros: Does not interrupt sex, can stay in for five years, and works as soon as inserted.

Cons: Some medication interferes with its effectiveness, it may cause irregular bleeding, and it does not protect against STIs.

Implants

Pros: Do not interrupt sex, work for up to three, years and may reduce painful periods.

Cons: Do not protect against STIs, and may cause irregular bleeding, no bleeding at all, acne or weight gain.

The patch

Pros: Does not interrupt sex and easy to reverse.

Cons: May be seen on the skin, certain medication can interfere with its effectiveness, and it does not protect against STIs

Diaphragm/cap

Pros: Can be put in any time before sex, can be reused, useful if seeking to avoid hormones.

Cons: Does not protect against STIs and cystitis can be a problem for some users.

Natural fertility tracking methods

Pros: it does not involve chemicals and is free from side effects.

Cons: it requires keeping a daily record, involves avoiding sex at some times during the month and does not protect against STIs.

Condoms

Pros: Widely available, protect against both pregnancy and STIs, and cause no medical side effects.

Cons: Putting them on requires practice and they can be damaged if handled roughly or used with an oil-based lubricant.