THE HIV PREVENTION RESEARCH COALITION NEWSLETTER

(August to December 2020) GREETINGS!! Welcome to this issue of our newsletter.

This newsle�er documents the HIV preven�on work of various advocates (individuals and ins�- tu�ons) both in Uganda and in other countries. In this issue, among other stories, we bring you an update on the Medi- cally Assisted Therapy (MAT) program in Uganda and recogni�on of the vari- ous individuals and ins�tu�ons that have contributed greatly to the HIV/AIDS fight in Uganda over the decades. We hope you will find the articles resourceful. Please read on and enjoy!

UGANDA NETWORK OF AIDS SERVICE ORGANISATIONS (UNASO)

11 Introduction of are medically managed to get off the MEDICALLY drugs and to reduce risky behaviors. The ASSISTED THERAPY (MAT) Government of Uganda has acknowledged Program in Uganda, seen the existence of injecting drug use and as a beacon of hope to the this has led to the inclusion of MAT (Buprenorphine and naloxone) to the communities. Uganda’s Essential Medical Supplies list. Uganda started offering Medically Assisted Therapy (MAT) to people who inject with drugs at Butabika National Referral Hospital on 14th September 2020. With the introduction of Medically Assisted Therapy (MAT) in , the pilot district is now seen as a beacon of hope to communities that have been left behind for far too long. Currently we (UHRN) have screened 150 clients for MAT and 33 clients have been successfully By enrolled on treatment. Stanley Nsubuga

ganda has seen increasing numbers of people who use drugs (PWUD) with recent estimates at approximately U45,000 (UHRN programs data, 2019). As a result of increase in drug use and risks associated with use of drugs, interventions to reduce the harms associated with injection drug use and drug related sexual risk are just beginning to be developed and implemented in Uganda. The MAT site established at Butabika National Referral Hospital The UNAIDS fast-track plan calls for rapid acceleration of HIV treatment and Under the Medically Assisted Therapy prevention services by high HIV burdened program, UHRN is responsible for countries such as Uganda and this is to be creating demand at the community level, achieved through roll out of comprehensive mobilizing clients for MAT, providing HIV combination prevention services that patient education, providing patient include Medically Assisted Therapy (MAT) screening and initial preparation, referral for people who inject drugs and leaving no and linkage of eligible MAT clients, and one behind. supporting continuation of psychosocial support services once referred from the Uganda Harm Reduction Network (UHRN) MAT clinic. continues to advocate for a responsive treatment which encompasses the 9 “We are now confident that MAT essential harm reduction interventions will change our lives and those of including Medically Assisted Therapy for our peers” UHRN peer educator people grappling with opioid dependence. voice UHRN is also advocating for inclusion of harm reduction interventions in the We hope that with the introduction and national polices and guidelines. set up a Medically Assisted Therapy (MAT) center to provide drug treatment services People who inject with drugs (PWID) for PWID, it will reduce criminality and

2 petty crimes in geographies where MAT will be implemented, provide an avenue Uganda Commemorates for diversion of petty offenders from the criminal justice system and reduce the cost World AIDS Day of incarceration since it is a cheaper option for rehabilitation. 2020 In this journey, MAT being a new intervention in the country, we need; 1. A high level of engagement of law enforcers and other stakeholders to create an enabling environment for PWID service delivery. This has a big role in violence prevention and response services which are key to increasing access to MAT services, and they should use a humane approach while dealing with MAT clients. “MAT clients are reformed people or in the ganda has made significant progress process of reforming and need support in in fighting the HIV epidemic over the their journey to recovery, they do not need Ulast 3 decades. According to the Uganda to be arrested for taking drugs, and rather Population-based HIV Impact Assessment should be referred and supported to access (UPHIA 2016), the HIV epidemic is coming MAT treatment” under control in Uganda. HIV prevalence Wamala Twaibu, Executive Director UHRN was at 6.0% in 2016 down from 7.3% in 2011. Inspite of this progress, the HIV and 2. Based on the principle of ‘nothing for AIDS epidemic remains a major public us without us’ – the drug user’s involvement health threat in Uganda with an estimated at all HIV/drug use programs is essential. 1.4 million people living with HIV, 53,000 Meaningful and effective participation of new HIV cases registered annually, and an drug users should be promoted and ensured estimated 21,000 Ugandans having died at all levels since they are best able to of AIDS-related illnesses (UNAIDS 2019). know what approaches and interventions Women and young women in particular will work in their own community. are disproportionately affected and this In conclusion, we call upon every duty is threatening the attainment of the bearer and development partner to Sustainable Development Goals. augment the existing efforts by starting, maintaining and increasing specific On December 1st 2020, Uganda interventions that will effectively prevent commemorated World AIDS Day. The HIV transmission among PWIDs and assist Global World AIDS Day 2020 theme was in the treatment, care and support of PWID Global solidarity, shared responsibility. living with HIV/AIDS. COVID-19 has demonstrated that, during a pandemic, no one is safe until everyone Special thanks to the Ministry of Health is safe. Uganda in responding to COVID- in Uganda for their active participation 19 and the effects that it is imposing on and support throughout this process. the national response to HIV and AIDS We appreciate the Medically Assisted tailored the theme for 2020 to: National Therapy taskforce members who include: solidarity and a shared responsibility MAUL, CDC, IDI, UNAIDS, Butabika Referral towards ending AIDS. Hospital and Uganda Police. Among others, speakers called for Stanley is the Advocacy and increased national and global solidarity in Communications Officer at Uganda the commitment to end AIDS as a public Harm Reduction Network (UHRN) health threat by 2030.

3 ...... Leaders on the HIV AIDS frontli/ne

Edited and updated by the late Philly Lutaaya, Christine Kaleeba Prof. Francis Miiro, Dr. Sam Okware, An article by Elvis Basudde, a Beatrice Were New Vision Reporter, added and Dr. Noerine Kaleeba. to The New Vision Website as Others are Dr. Mariam Duggan, global HIV response but were part of the World AIDS Day Dr. Elly Katabira, never included on the original Supplement on 5th December Dr. Anthony Lwegaba, list of 22. 2011 02:44 PM Prof. Can. Gideon Byamugisha, There are a number of persons Dr Stephen Watiti, who have played a key role in Prof. Nelson Sewankambo, the HIV/AIDS response but could s Uganda plans to mark Dr. Cathy Watson, not all fit on this list; therefore, World AIDS Day 2020, it is late Dr. Lucille Teasdale, the list is not exhaustive. that time of year when we Dr. Kihumuro Apuuli, Some of these heroes include: Areflect on the journey thus far and late Bishop Misairi Kawuma and Lillian Mworeko, in particular recognize the efforts of Major Rubaramira Ruranga. Jane Mwirimubi, those who have sacrificed selflessly Others include Dr. Elvis Basudde Aloysius Matovu Joy, in the national response to HIV/ Kyeyune, Moses Supercharger Nsubuga, AIDS. Prof. Peter Mugyenyi, Johnson Masiko, Ms. Milly Katana and Hon. Dr. Joshua Musinguzi, Uganda’s record over the past Beatrice Were Sarah Nakku, decades as a global leader in the Dr. Nelson Musoba, fight against HIV is undisputable. Institutions that were hailed Dr. Karusa Kiragu, Uganda has come a long way in include the US government, Sylvia Nakasi, fighting this pandemic and behind Rakai Health Science Elizabeth Mushabe, this success are several individuals Programme, Mildmay Centre, Bharam Namanya, and organizations that have played the AIDS Information Centre, Betty Kwagala, unprecedented and selfless roles Uganda Blood Transmission Flavia Kyomukama, in different aspects against the Services, the STD/AIDS Control Florence Buluba, disease. In 2010, Parliament Programme, the Uganda AIDS Dorothy Namutamba, commended 22 individuals and Commission and Kitovu Mobile Dora Musinguzi, organizations for their contribution Clinic. Margret Happy, to the fight against HIV/AIDS. Stella Kentutsi, As World AIDS Day 2020 draws Fred Barongo, closer, we bring you these leaders Since August 2020, with the Sam Ochen, here again. recommendation from Civil Jacquelyne Alesi, Society advocates, UNASO has Bridgette Diana Ndagire, They include, been recognizing additional Peace Baguma, President and his heroes that have had a significant Prossy Namakula, wife Janet, contribution to the national and Prof. Francis Miiro,

44 Tezra Lutaaya, When the victim leaves, they are Kenneth Mwehonge, “WHY IS IT HARD taking control and threatening Salome Atim, the abusive partner’s power, Richard Sserunkuuma, FOR A WOMAN TO which could cause the abusive Dr. Piero Corti of Lacor Hospital partner to retaliate in very in , LEAVE AN ABUSIVE destructive ways. There are Dr. Eddie Mwebesa, many reasons why people stay Dr. Adeodata Kekitiinwa, in abusive relationships including Dr. Pontiano Kaleebu, RELATIONSHIP?” but not limited to. Dr. Raymond Byarugaba, Prof. Elly Katabira, Believing Abuse is Normal: A Dr. Erioda Tumwesigye, person may not know what a Dr. Barbara Mukasa, healthy relationship looks like, Prof. Wabwire Mangeni, perhaps from growing up in an Mr. Peter Kitonsa Ssebanja, environment where abuse was Richard Wamimbi, common. David Kabiswa, Anthony Wasswa, Fear of Being Outed: If someone Joyce Kadowe, is in an LGBTQ relationship and Elizabeth Ongom, has not yet come out to everyone, Sam Wangalwa, their partner may threaten to Benjamin Twefeho, reveal this secret. Stephen Muhindo, By Esther Sarah Kutta, Mabel Komugisha Shame: It’s often difficult for Juma Ojwang, someone to admit that they’ve Cox Sempebwa, n relation to the story run by been abused. They may also Dr. Donna Kabatesi, the New Vision about a health worry that their friends and Rashid Mugerwa, Worker, Viola Kakai 32, (RIP) who family will judge them. Prof John Rwomushana, Ihad been working with IHK at the Late Bishop Misaeri Kawuma, time of her death, hacked to death Low Self Esteem: When an Sophia Monica Mukasa, by an axe in the presence of her 3 abusive partner constantly puts Reverend Sam Ruteyikara, infant children, we often wonder someone down and blames them Andrew Youmbe, why a woman wouldn’t just leave for the abuse, it can be easy Hon. Salaam Musumba an abusive relationship. They don’t for the victim to believe those Emily Katarikawe understand that leaving can be statements and think that the more complicated than it seems. abuse is their fault. and Dr. Lydia Mungerera among Leaving a toxic relationship others. or marriage is often the most Love: So often, the victim feels dangerous time for a victim of love for their abusive partner. We wish to use this opportunity abuse, because abuse is about They may have children with to extend endless gratitude power and control. them and want to maintain their and appreciation to these champions and all those who may not have been mentioned here for their efforts, zeal and passion in fighting to realize an end to AIDS. You are unforgettable heroes.

Christine is the Project Coordinator, Children, WUID & AGYW at Alliance of Women Advocating for Change (AWAC)

55 ...... family. Abusive people can often be #charming, especially at the beginning of a relationship, and the victim may hope that their partner will go back to SHOULD YOU being that person. They may only want the violence to stop, DISCLOSE YOUR not for the relationship to end entirely. HIV STATUS? Cultural/Religious Reasons: Traditional gender roles I am personally tired of supported by someone’s culture all of this and it needs to or religion may influence them stop. There is no reason to stay rather than end the for anyone to suffer in relationship for fear of bringing silence or feel like they shame upon their family. are invisible because of a health condition. Lack of Money/Resources: Financial abuse is common, This is why I decided to and a victim may be financially disclose my status to the dependent on their abusive world. It was not an easy partner. Without money, it can thing to do but the thought seem impossible for them to of living freely as my true leave the relationship. self and stop suffering in silence encouraged me to Disability: When someone disclose, and ever since then is physically dependent on I have never been happier. their abusive partner, they can Disclosure is important in feel that their well-being is the fight against HIV and connected to the relationship. By this is why it is important to This dependency could heavily Shakirah Namwanje empower every person to influence their decision to stay get to a place where they in an abusive relationship. am a survivor of sexual can disclose their status. abuse and a young woman These Obstacles and more living with HIV. Personally, I I think you can all agree offers more insight into the Ibelieve that as young people with me that disclosure reasons why women may not we take certain things can set one free and allows leave an abusive relationship seriously and relationships one to adhere to their until it’s too late. So, for those are one of them. When the medication properly —be it who keep blaming women relationship doesn’t work for prevention or treatment for not having taken that step out it can be absolutely without fear of stigma and please be enlightened. Find devastating. There are many discrimination. It helps you more information on the 16 young people especially to find those that are true days of activism website at women living in shame friends and, hopefully, true https://16dayscampaign.org/ because of their HIV status love because the person and they don’t want the gets to love you for who Esther is the HIV/SRHR world to see them as less you truly are. Disclosure Programs Officer at of who they really are. They allows people in discordant the Uganda Network feel guilty and are constantly relationships to seek blaming themselves for the prevention and treatment of AIDS Service status. approaches that help both Organizations (UNASO) partners stay healthy.

66 ...... However, for disclosure PRIORITIZATION OF MENTAL HEALTH to be successful we— partners, families, friends SHOULD BE CENTRAL IN COVID-19 and communities as well RESPONSE STRATEGY IN UGANDA as governments and civil society organizations—have Shortly after the first to work together to: official COVID-19 case was confirmed in Uganda • Create a safe and non- on 23rd March, 2020, judgmental environment for the Ministry of Health people to feel comfortable requested people who to disclose their HIV status. had travelled back to the country between • Offer youth-friendly 7th and 23rd March to services that include HIV report to district health and sexual and reproductive officials for testing. This health package. indirectly escalated stigma against people who had transborder travel history • Educate communities with – many of whom were information on HIV/AIDS called out on different prevention and treatment. By social and mainstream media platforms. • Offer prevention tools Aidah Babirye The Ministry of Health such as condoms, oral eople around the world prepared in time to pre-exposure prophylaxis are facing increasing fight the pandemic but (PrEP), post-exposure mental health issues overlooked the issue of its prophylaxis (PEP), diagnosis Pduring this COVID-19 effect on the mental health and treatment of sexual pandemic. People at risk of Ugandans. As we think of transmitted infections (STIs), of abuse, employees facing the preventative measures HIV counselling and testing, job uncertainty, children, in place to fight against the etc. marginalised communities pandemic, we should also like sex workers, those think of the aftermath. suffering from chronic Issues of stigmatization, Young women in particular diseases like HIV/AIDS and and discrimination in the are reported to have high most notably, patients who society resulting in mental incidence of HIV compared have just recovered from health disorders haven’t to their male counterparts. COVID-19. been fully addressed by We need to empower young According to the World the government. women and girls so they can Health Organization, one Marginalised communities stay healthy, whether or not person dies every 40 seconds like sex workers are they are ready to disclose from suicide. Every suicide accused of escalating the their status. is a tragedy that has long- spread of COVID-19 in lasting effects on the people Uganda. This is due to their left behind. Mental health contact with truck drivers Shakira is a Programs is the level of psychological crossing different borders. Officer at UNASO and well-being or an absence of However, this has made mental illness. them more susceptible to a 2019 AVAC Advocacy In Uganda today, over 2,350 mental health problems as Fellow people have recovered from a result of discrimination the COVID-19 and about and stigma from the 20.4 Million worldwide. But, community. According have the communities been to Alliance of Women prepared by the government Advocating for Change for the aftershock of the (AWAC) an umbrella of pandemic? grassroot female sex

77 workers’ organisations in upon testing. On 24th May, literature on how to deal Uganda, mental health 2020 the Ministry of Health with mental health issues problems intensified among reported that 25 truck drivers should be made accessible female sex workers during had disappeared into the to each and every Ugandan this COVID19 pandemic. The community after they had so that people receive organisation together with tested positive at Elegu and help in a familiar and non- its partners availed female Malaba border posts. This put stigmatized setting. The sex workers with a toll-free both the individuals and the trained health officials line – AWAC Malaika Toll community at risk. placed by the government Free line 0800333177 - as must know how to recognize a strategy to address the Government should be at signs and symptoms early increasing issues of mental the forefront of fighting and assist people in getting health problems among stigma and discrimination appropriate help. Sex Workers. This toll-free of COVID-19 patients by The Ministry of Health line provides the caller with embracing and receiving should also provide mobile psychosocial support in form back recovered patients in or online counselors of counselling, access of the community. Government and psychiatrists to HIV treatment, sexual and should lead by example. With offer psychological and reproductive health services government publicly engaging psychosocial support to and addresses issues of the recovered COVID-19 people. Since most people gender-based violence in the patients in national activities, are in self-isolation, having Sex Workers’ community. more people will be willing to someone professional to This is inadequate because get treatment upon testing talk to during this pandemic non-profit organisations, like positive for the disease. This could solve unforeseen AWAC, are run by donations kind of approach is a form mental issues. and so their funding cannot of psychosocial support that address all problems like will clearly address issues of While government is putting mental health faced by stigmatization of COVID-19 different measures in place these people and so call for patients and recovered to fight COVID-19, it should government interventions. patients. also prepare for its bearing on the masses which include On 23rd April, 2020 the The government should also mental health disorders New Vision newspaper put in place systems and so as to prevent health reported that in Kalangala measures to address issues of conditions from escalating district community members mental health during and after and keep more Ugandans refused to receive a the COVID-19 pandemic. We out of the hospital. discharged patient, Charles need to ensure that mental Lwanga Banya who had then health services are available The writer is the recovered from coronavirus to people bringing prevention Administration and disease even after testing and early intervention to sub Communications Officer negative twice. The district county levels closer to people. at Alliance of Women chairperson Willy Lugoloobi Advocating for Change said that about 400 members Government programs and (AWAC) of the community wanted him to stay away from the village for another 21 days to ascertain that he had recovered from COVID-19. This clearly detailed the extent to which communities haven’t been prepared to receive recovered COVID19 patients. Similarly, Ugandans have not been individually prepared by the Ministry of Health on how to handle positive results of COVID-19

8 Our Star Advocate 4. What field of study are 8. What is your vision for you qualified in? these health areas? I am a Social Worker. My vision is to see universal health access 5. When did you first get involved in advocacy work 9. What are those moments and what motivated/ in your life that have been inspired you? fun/funny/made you I’m a former sex worker, I was laugh, smile, cry, etc inspired by the situations When my team and I that were violating the mobilized fellow sex rights of sex workers. These workers and other key include systemic exclusion, stakeholders and we poor working conditions, donated food items, stigma and discrimination, sanitary supplies and In this issue, we bring you the shrinking female sex worker detergents to Nsambya story and journey of one of the space due to limited resource Babies Home. As sex key advocates in the Uganda envelope and government workers, we spent some health sector, Ms. Macklean restrictions especially by good time with these Kyomya, the Executive the NGO Bureau. Also, the children, washed them, Director at Alliance of Women challenge of increasing played with them and Advocating for Change (AWAC) female minors (below 18 stimulated public debate years) into the sex work as many people started 1. What are your full names? profession/industry which seeing sex workers I am widely known as Macklean led to the conflation of sex as caring mothers, Kyomya work and child trafficking responsible members of inspired me to do something the community, sisters, 2. Did you have a nick-name about the situation. neighbors, wives and while growing up? daughters in society. None that I can remember. 6. What was your first area But this also gave them of advocacy? a renewed sense of 3. Which schools did you go Collective grassroots hope that amidst their to? organizing and movement challenges they can still I went to quite a number of building, sexual rights and contribute to the wellbeing schools. They are: human rights of female sex of vulnerable members of 1. Kigulya Church of Uganda workers. the community. Primary School-Masindi 2. Masindi Public Primary 7. What health areas are you 10. Which players in the School currently advocating for? advocacy world have been 3. Sir Tito Winyi Secondary 1.Sexual reproductive most instrumental in your School Health Commodities advocacy journey? 4. Alliance Model Secondary 2. Gender Based Violence They have been quite a School 3. Health Promotion number, especially at the 5. St. France Senior Secondary 4. Access to medicines beginning of my advocacy School 5. Mental Health journey, the following were 6. Nsamizi Training Institute of 6. Maternal Child Health greatly instrumental: Social Development (MCH) 7. Cavendish University 7. Nutrition

9 1. Human Rights Defenders & Activists/ Dr. Byamukama Daniel and Dr. Matayo Feminists: Baluku. My Mother – Ms. Kyomuhendo Irene, Ms. Hope Chigundu, Ms. Solome Nakawesi, 4. Under Media Ms. Anne Gashumbi, Dr. Adrian Jjuko, Mr. Sudhir Byaruhanga, Mr. Wokulira Kasha Jackline, Victor Mukasa, Frank Geoffrey Mugisha, Pepe Onzima, Marieke Mooji, Ruth Morgani, Dr. Jenny Batler, Ms. Lilian 8. What message do you have for Mworeko, Sarah Mukasa, Kikonyogo young advocates out there? Kivumbi, Ms. Flavia Kyomukama, Ms. 1.Advocacy requires building evidence Kholi Buthelezi, Julius Kagwa, Dr. Miria with a human face and continuous Matembe, Jessica Nhuhe, Ms. Maria consensus building Nasali and Dr. Maggie Kigozi. 2.Advocacy is also teamwork and collective organizing 2. Under Research and Academia: Dr. Sylvia Tamale, Mr. Ali Kigongo, Dr. Stella Nyanzi, Dr. Ben Twinomugisha, We hope you have enjoyed the few Dr. Eric Harper, Zawaddi Nyongo, Ms. minutes into the life of Ms. Macklean Christine Butegwa. Kyomya, this issue’s star advocate. Look out for our next issue to read about 3. Under public Health Specialist; another advocate causing change in Dr. Peter Kyambadde, Dr. Shaban the Uganda health sector. Mugerwa, Mr. Musa Bungudu, Mr. Mukwaya Robert, Dr. Peter Mudiope,

Upcoming events 1. HIV R4P Virtual

HIVR4P fosters interdisciplinary knowledge–exchange on HIV vaccines, microbicides, PrEP, treatment as prevention and biomedical interventions as well as their related social and behavioral implications. The 4th HIV Research for Prevention Conference (HIVR4P // Virtual) will be held between January 27th HIV Research for Prevention is the only and February 4th 2021. For more global scientific conference focused information, visit www.hivr4p.org. exclusively on the challenging and fast- growing field of HIV prevention research.

10 ______UNASO acknowledges contribution from Ministry of Health, AVAC, research institutions and HIV Prevention Coalition members; UNASO, ICWEA, HEPs, AWAC, NTIHC, PCI, PEERU, UNYPA, Stigmaless Uganda/JABASA, The Health Gap, AIC, CEHURD, NAFOPHANU, CEPARD, PCI, TASO, GCOWHIV, HEJNU, IDI, Mama’s Club, NACWOLA, POMU, Reach Out Mbuya, AGHA, RHU and UGANET among others.

COALITION MEMBERS:

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