Memorandum submitted by PROMPT UK
In considering issues for the promotion of management
of patients' health of PLHA, PROMPT is of the opinion that the
important issues are nutrition, hygiene, management of opportunistic
and other infections including STIs, behavioural change and counselling/support.
At the centre of delivering any package is poverty
which often makes it difficult for any patient to access any or
all of the above care and support packages. Some organisations
like Concern Worldwide in western Uganda have included traditional
medicine as an alternative relief therapy in areas where orthodox
medicines are not accessible. This was first proposed by the community
themselves. It is suggested that interventions should build on
what the community already have.
In rural areas, there is very little care and
support in all its forms for PLHA in terms of access to VCT services,
treatment, psycho-social support community care etc.
PROMPT notes with concern that patients do not
follow up to complete their treatment especially for STDs or cases
where partners may not co-operate to have both treated. Outreach
may have to be more intensive and client-oriented and sensitive.
High expectations from patients are still looming
especially in the wake of precedents set by initiating organisations
that were giving free nutrition supplements, free treatment etc.
High costs/poverty are prohibiting access to
appropriate care and support. Many organisations have looked locally
for alternative relief packages such as traditional medicines
etc adding weight to the point that total involvement of the community
through their health committees in identifying what care and support
could be sustainable and their responsibility for PLHAs is very
What people need is advocacy for behavioural
change through community motivation, knowledge and skills acquisition
for the individual. Advocacy and information can best be delivered
by the existing health workers. This may pose a few shortcomings
but is in most cases the only existing structure. What community
health workers need is training. It is also important to develop
the concept of positive living to make it relevant to our community
in light of new scientific and other developments eg regarding
issues around behavioural change.
The linkage between grassroots organisations
and the mainstream researchers and practitioners is seriously
lacking. Grassroots voices are quite silent in these national
and international occasions.
The issue of interference from religious leaders,
local politics etc, in for example promoting condom use and family
planning is also an issue for advocacy work.
The importance of peer education/training/support
and community motivation in promoting behavioural change should
also be promoted.
Creation of basic safe environments for people
to access services is another area of concern. Eg very few public
and private health units in the country have private rooms where
a person could request for examination for STIs or seek family
planning services. They are usually attended to in the open.
Provision of safe environments where people
will confidently and confidentially seek health services is important
in increasing the chances for people to seek the services. Such
privacy is missing in almost all Uganda's health units.
Stigmatisation is still a big stumbling block
despite of the sensitisation done already.
The decentralisation of services to district
level (eg the STIP project in Uganda) is yet in its early stages
and its effectiveness has not been fully assessed in terms of
lesson sharing. However the Uganda Aids Commission is about to
put in place a system which would enable lessons learnt to be
shared. This might be an annual conference bringing together researchers
and users. This has not been happening before.
Learning about the experiences of particular
successful community based initiatives, what has been tried and
what has been proven effective.
These and many others have to be reviewed in
terms of future service provision.
In a recent Situational Health Survey conducted
by PROMPT, Africare and the Mifumi Project in Mifumi village,
a remote rural area in Tororo District, East Uganda, the following
findings on HIV/AIDS was revealed. (See Dr. Okoth, A: Mifumi:
A Situational Health Survey, 2000) Full report available.
KNOWLEDGE & ATTITUDE
TO HIV CONTROL
33 per cent of respondents did not know what
70 per cent of respondents had never received
any education on HIV/AIDS.
96 per cent respondents believed there was no
form of treatment at all for HIV/AIDS.
65 per cent of respondents had no idea at all
how one could tell if s/he had an HIV infection.
50 per cent respondents were not aware that
HIV could be transmitted through breast milk.
54 per cent of respondents, the majority, thought
the best way to help somebody with AIDS was by health education.
This may partly reflect their wish for more knowledge about HIV
33 per cent thought the best way was by provision
of food and only 13 per cent thought medicine was the most helpful.
39 per cent respondents reported ever having
had a sexual transmitted disease (STD) and 18 per cent of them
had practised self medication. This could easily be inadequate,
incorrect and may not involve treatment of the spouse.
99 per cent respondents thought people were
having sex outside marriage without using condoms and an additional
problem in HIV control is that the Jopadhola still practice wife
inheritance from deceased brothers as a cultural norm.
16 Working in partnership with the Mifumi Project,