The Power of Peace and Partnership
May 19, 2008, Gulu, Uganda —By Debbie DeVoe
In northern Uganda, a few short years have meant the difference between life and death, especially for those living with HIV.
Incredibly, back in 2004, the lifesaving cocktail of antiretroviral medications was actually available in war-torn Gulu. But the long conflict between government forces and the Lord's Resistance Army rebel movement limited community access to the medications.
"People couldn't travel because on the way they could easily meet rebels," explains Masimo Opiyo, AIDSRelief coordinator for Comboni Samaritans of Gulu, an HIV services provider supported by Catholic Relief Services. "Now people can move freely and come to the hospital. The number of people dying has drastically gone down."
Ongoing negotiations are not only bringing the hope of peace to the entire region, but they are also bringing the promise of longer lives to people living with HIV. Due to improved security, these people can safely access health facilities to take advantage of significantly improved services, including free antiretroviral therapy, other HIV care and treatment services, and community-based support.
From First Test to Last Breath
As the lead agency of the five-partner AIDSRelief consortium, Catholic Relief Services is supporting two key health care providers in Gulu: the Comboni Samaritans of Gulu center and St. Mary's Lacor Hospital. Through funding from the U.S. President's Emergency Plan for AIDS Relief, these two facilities are working in tandem to provide comprehensive care and support for people affected by HIV in the Gulu area.
Area residents who test positive for HIV at the Comboni Samaritans center are referred to St. Mary's Lacor Hospital, just a few miles away, for an initial medical examination. If test results show that a patient's weakened immune system requires antiretroviral treatment, the patient is directed back to Comboni Samaritans of Gulu, this time right down the hall.
Working out of an office at the hospital, Comboni Samaritans staff open a case file and confirm that each patient meets low-income eligibility requirements. All potential antiretroviral clients must then attend a two-day pretreatment class with someone they live with who agrees to be a "treatment supporter." The training teaches participants about the drugs, possible side effects and expected benefits. Each patient then decides if he or she wants to start the regimen, returning to St. Mary's Lacor Hospital for top-quality treatment.
"If you force somebody to start the drugs and the side effects come, there is a high risk of them dropping [the regimen]," Opiyo notes. "But if they decide on their own, they will take the drugs perfectly without any problems."
Adherence to treatment is extremely important. If patients fail to take doses correctly and consistently, their bodies can build resistance to the medications, requiring them to switch to more expensive regimens, which may not be available. To promote strong adherence, the AIDSRelief program also assigns each client a community volunteer who comes every day for the first few weeks to watch the patient take the medications correctly.
Full of Life
The comprehensive care and treatment offered by this powerful AIDSRelief partnership is lifting people up from their deathbeds. Five years ago, Betty Acellam, who moved to Gulu in late 1988 because of the war, couldn't even stand up to get to a clinic. With help from Comboni Samaritans of Gulu and St. Mary's Lacor Hospital, she is now full of life, filling every room she walks into with her bright smile and glowing presence.
"Comboni Samaritans volunteers were taking care of me," Betty says, remembering how sick she was before she began antiretroviral therapy. "They would pay my bills and give me some help like sugar and food. They took me to the hospital when I was bedridden." Much of the money for this help came straight out of volunteers' pockets when needs exceeded the assistance programs could offer.
Alice Bongomin is another of the thousands given a new lease on life by AIDSRelief programs in Uganda—a lease that was unfortunately unavailable to her husband, who died of AIDS a decade earlier. Alice was lucky enough to be one of the hundred people chosen by the government in 2004 to receive drugs at a local hospital. But she was later told she would have to pay $25 a month for the medications. She couldn't afford the cost on the small income she was earning as a local trader.
Comboni Samaritans of Gulu stepped in, helping Alice buy the antiretroviral medications for two months until St. Mary's Lacor Hospital began dispensing the drugs for free through AIDSRelief. Today, Alice is so healthy and grateful that she works up to six days a week as a Comboni Samaritans volunteer, helping others access the same medications that saved her life.
Healing Bodies, Changing Minds
Community outreach is of particular importance in the Gulu region. The considerable transience of Gulu's population due to conflict has led to the highest HIV prevalence rate in Uganda. Some residents in the Gulu area are so poor, they are willing at times to accept rice in return for sex.
To help stem the disease's spread and fight misinformation, Comboni Samaritans of Gulu and St. Mary's Lacor Hospital have undertaken significant community education. Staff even had to convince residents that antiretroviral therapy actually worked. Before the lifesaving medications were widely available in the region, people were buying the expensive drugs, taking them for a month or two, and then going off of them a few months later when they could no longer afford them. This led to drug resistance and, for many people, death.
"At first people thought the drugs killed people," Opiyo notes. "Now they are seeing teachers back to teaching and soldiers back in the army." Even so, few men are seeking treatment, driving the need for additional education.
Ironically, the sustained peace in northern Uganda is bringing a new set of challenges to St. Mary's Lacor Hospital and Comboni Samaritans of Gulu.
"When people were congested in camps, it was easy to [serve] them. But now with peace coming, people are being scattered as they go back to their homes far away," Opiyo explains. "It's making our catchment area so much bigger, but we need to go and give them services." The CRS-supported AIDSRelief programs in Gulu are reaching out through monthly mobile clinics that bring community- and client-support activities to more remote communities, and by opening satellite clinics in surrounding areas.
"When I see someone looking miserable, sometimes I read from their face that this one might be sick. Then I just go and console them," Betty adds. She hasn't fallen sick again since starting antiretroviral therapy. "I give him or her courage, because [HIV] is not the end of somebody."
Debbie DeVoe is CRS' regional information officer in East Africa based in Nairobi. She has visited projects in Ethiopia, Kenya, Sudan, Tanzania and Uganda, including AIDSRelief sites in Gulu.