Study Theme: HIV

The Incurable (?) Disease: Learning more about HIV/AIDS in Uganda.

By: Georgia Parsons, Prisca Nakayenga and Tiffany Zeng

Our study about HIV began when we traveled to Rakai on 9^th, January, 2020. This is the district where the case with HIV was first detected in an area called Kasensero. A lot of research has been carried out in Rakai (Rakai community cohort study) run by the Rakai Health Science Program (RHSP).  During our stay, we learned on the prevalence of HIV; known to have been high and deadly in the past years but with the programs like RHSP, TASO, DREAMS and AHF, HIV has greatly reduced. Such programs have educated communities about HIV testing, safe male circumcision, and safe sex practices. Among those practices, condom use is emphasized and supported. The programs also ensure the presence and use of ART’s for the positive patients.

On Monday, we had the opportunity to meet with Irene, a Uganda CARES team member at Kalisizo Hospital. We spoke with her about the challenges that the hospital face in working to treat HIV positive patients and prevent the transmission of the disease. Uganda CARES is a program created by the AIDS Health Foundation that works with the Uganda ministry of health to supply free antiretroviral therapy drugs (ART) as well as pre-exposure prophylaxis (PREP) and post-exposure prophylaxis (PEP) to members of the community. PREP is offered free of charge to those at higher risk of contracting HIV including men who have sex with me and sex workers. PREP is available to these members of the community until the risk is eliminated from their life and has proven effective in reducing the HIV incidence among these targeted groups.

Irene spoke about ART adherence and the reasons that someone may discontinue the use of this drug. Some reasons brought to our attention by Irene were the “born again” population believing Jesus healed them and the portion of Ugandans whose culture choses alternative medicine over modern medicine. Irene mentioned a slew of other barriers to reaching the target 90% adherence goal.

Lastly, we learned from Irene that mother to child transmission is still posing a large barrier to lowering the incidence of HIV in Uganda. The government has rolled out programs and treatments in hospitals to ensure that mothers do not transmit HIV to their babies. However, it is still very common for women in Uganda to give birth in the home rather than in a hospital. This prevents these mothers from receiving the treatment necessary to prevent mother to child transmission during birth. The most important part of reducing mother to child transmission is ensuring that the percentage of Ugandans who know their HIV status continues to increase. Our meeting with Irene was incredibly informative and helpful in continuing our investigation into how HIV/AIDS impacts the lives of so many in Uganda.

On Tuesday, we headed to where the Rakai Community Cohort Study (RCCS) was conducted. On our way to RCCS, we passed by Friends’ Pub, which was where the founders of Rakai Health Sciences Program (RHSP) first started. RHSP started with humble beginnings, where the founders originally rented out a small room in the back of the pub to conduct their research. After 10 more minutes of driving, we passed by the road that would lead to Kasensero, a village where the first case of HIV was reported.

Once we got to the data collection site, we were given a tour of the different stations available. At the first station, researchers documented census data including marital status, number of children, etc. Participants were given an ID number to maintain anonymity as their information was being recorded and investigated. Additionally, all participants were volunteers and were given a small compensation for their time. In fact, participants of the study have a 90% retention rate, which has helped the success of the study. At the second station, the researchers took blood samples for further investigation, if the participant consented. At the third station, participants were able to receive HIV services and get tested for HIV free of charge. All HIV services provided by RHSP are free for anyone who needs the services. Lastly, there were smaller, individual tents outside that were stationed for follow-up interviews for participants already in the study.

Women and girls are disproportionately affected by HIV/AIDS and was the leading cause of death among women ages 19 to 49 in Sub-Saharan Africa. This can be attributed to the fact that most women and girls simply are not educated about ways to prevent the disease. Women and girls also tend to marry older men who have more resources to support the family. These men tend to have more than one sexual partner and are more likely to be HIV positive. To help combat this, the DREAMS program that Dr. Robert mentioned in his first lecture aims to provide women and girls ages 9 to 49 training in different skills. The skills training program teaches women and girls anything from making clothing, bags, arts and crafts, etc. to empower them to support their children when their husband is not present. Additionally, most of the girls in the program face domestic abuse in their relationships, which is why this program is targeted to those who need it the most.