Paul extends a hand in greeting as he is introduced in a shaded room in Moroto hospital in northeastern Uganda.
He is wearing a striking short-sleeved baby blue shirt dotted with small white crucifixes.
Even though he has put on a little weight since being treated for HIV, Paul is a slight man and the shirt hangs loose on his thin frame. His facial expressions give nothing away as his story is told. Paul’s wife ran away after he tested positive for HIV. Before she left she killed the child they had together. It was an “act of mercy”, the translator says, so as not to leave it with its father to suffer.
Though stigma surrounding HIV/Aids has lessened greatly in other parts of Uganda, a combination of a lack of education, cultural practices and extreme poverty make matters more challenging in rural Karamoja, the poorest and least developed part of the country.
Kalisto follows Paul into the room. He once lived with his six children and his wife, but after he tested positive for HIV she left, taking the children with her. Now he lives alone in isolation because his neighbours won’t come near him for fear of contracting the virus.
Karamoja is isolated from the rest of the country due to difficult dirt tracks; the harsh heat exhausts the landscape and occasional flooding makes food production incredibly difficult. This results in high rates of unemployment and poor nutrition. Whereas Kampala is crowded, Karamoja is sparse.
There are long distances broken only by occasional straw-roofed huts on the drive to Moroto – the town in Karamoja where one of the region's largest hospitals is based, as are many NGOs. Few visitors travel here unless embarking on a safari. In Karamoja, 88 per cent live in poverty compared to the national average of 31% per cent. On top of extreme poverty and malnutrition, the greatest of Karamoja's problems is HIV transmission.
Increasing HIV rates
Charles, a programme co-ordinator with a Ugandan-founded action group, the Aids Support Organisation (Taso), explains that the situation is deteriorating rather than improving, with a staggering increase in HIV prevalence rates in recent years.
“In the eastern region of Uganda, where Karamoja is, it stands at 5.3 per cent. In 2011 according to the Ugandan Aids Indicator survey it was 3.5 per cent,” he says.
Traditional cultural values hold sway in the northeast, a land of nomadic people. Public uptake for condoms, which prevent the transfer of the virus, has been low. When a man dies the clan considers it right that his brother inherits his wife. This is one of the key ways in which the virus is spread, according to experts.
Catherine takes a seat in the HIV clinic in Moroto hospital alongside her one-year-old son Patrick. During her pregnancy Catherine was given medication to prevent the transfer of the virus to Patrick and so he is HIV negative. However, there are other issues. Catherine is HIV positive and her husband is not. They never use condoms nor do they have any intention of doing so.
“So you see the problem?” the translator sighs after she has left.
“The perception is negative. Condoms are a very new component to Karamojongs,” Charles says. He explains that efforts are ongoing to educate Karamoja’s population about the health benefits of condom usage as well as their role in family planning.
In Karamoja, difficulties remain not only in preventing the virus but also in treating it. Cultural practices and a distrust of modern medicine means that some are reluctant to take medication, often opting for local witchdoctors instead of trained medics. Traditional healers’ advice often includes the abandonment of antiretroviral therapy, the treatment that prevents the onset of Aids, and the use of traditional medicine in its place.
There are other problems. People, being nomadic in nature, travel to where they can find grass for their animals. This makes it very difficult for follow-up care or to be sure that people are taking drugs. In response, Taso has set up a chain of local community workers, many of whom are HIV positive themselves, to try to keep tabs on people to help them.
In the capital Kampala, the situation is different due to circumstance and a higher level of education. Though stigma still exists, it does so alongside defiance. There is a definite refusal to accept the role of the pariah and a determination not to be defined by a HIV-positive status.
Robinnah sits back in her chair in her home in the centre of Kampala. The grandmother of eight found out she was positive years ago, after the death of her husband. Since then she has become an active member of a local HIV-positive women’s group.
“Most times it is we who stigmatise ourselves first; we just feel that you can be in society” she says. “I have been able to do so many things that even people who are not positive haven’t done. So I don’t see why I would complain.”
A young man called Herman angrily relates how being HIV positive caused him problems. He is an avid footballer and his teammates refused to share cups or kits with him, ultimately telling him to leave.
“I want to show my family I am positive and I can do something. I can do that job which a negative person can do,” he says.
In Kampala the virus is gradually having less of an impact on individuals’ lives – 26-year-old Chris is studying for a masters and dismissed the idea of HIV having heavily affected his life.
“I accept exactly what I am and then once you accept exactly what you are you have to live normally,” he says. “So for people who have not accepted exactly what they are, they are the ones who actually find life difficult.”
Second article in a series of three. Tomorrow: The threat posed by complacency in the fight in Uganda against HIV/Aids
This article was supported by a grant from the Simon Cumbers Media Fund Student Scheme