A RESPONSE ANALYSIS OF HIV/AIDS PROGRAMMING ALONG TRANSPORT CORRIDORS IN

July 2009

THE REPUBLIC OF UGANDA ABOUT IOM Established in 1951, the International Organization for Migration (IOM) is the leading agency on issues of migration.

IOM acts with its partners in the international community to: !Assist in meeting the growing operational challenges of migration management. !Advance understanding of migration issues. !Encourage social and economic development through migration. !Uphold the human dignity and well-being of migrants.

IOM is committed to the principle that humane and orderly migration benefits migrants and society. As-of June 2009, IOM comprised 127 Member States and I8 observer states.

FINANCIAL CONTRIBUTORS AND PARTNERS Financial support was provided by the Governments of United Kingdom and the Republic of Ireland through the Joint UN Team on AIDS in Uganda.

AUTHORS This study report was prepared by Dr Bernadette Ssebadduka, John Ssengendo, Agatha Kafuko and Godfrey Kalikabyo.

CORRESPONDENCE For further information please contact: International Organization for Migration (IOM) Uganda Mission | Plot 40 Mackenzie Vale, Kololo | PO BOX 11431 Tel: +256 414 236 622, +256 312 263 210 | Email: [email protected]

COPY RIGHTS All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without the prior written permission of the publisher. A RESPONSE ANALYSIS OF HIV/AIDS PROGRAMMING ALONG TRANSPORT CORRIDORS IN UGANDA

International Organization for Migration (IOM)

July 2009 Contents

Foreword (UAC) 2 Foreword (IOM) 3 Executive Summary 4 Acknowledgments 7 Acronyms 8 Glossary 10

1. INTRODUCTION 12 1.1 The General Situation 12 1.2 HIV and Mobility 12 1.3 HIV Response to MARPS along Transport Corridors 14

2. METHODOLOGY 16

3. STUDY FINDINGS 18 3.1 Regional HIV Programming for MARPS along Transport Corridors 22 3.1.1 The Inter Governmental Authority on Development 22 3.1.2 The Great Lakes Initiative on HIV/AIDS (GLIA) 23

3.2 National HIV Programming for MARPS along Transport Corridors 23 3.2.1 Uganda AIDS Commission 23 3.2.2 Ministry of Works and Transport (MoW&T) 24 3.2.3 Ministry of Health (MoH) 25

3.3 HIV Programming for MARPS along Transport Corridors: Districts along the Northern Corridor 25 3.3.1 Malaba Hot-spot in 25 3.3.2 Naluwerere Hot-spot in District 27 3.3.3 Hot-spot in 29 3.3.4 Ruti Hot-spot in District 31 3.3.5 Hot-spot in District 33

3.4 HIV Programming for MARPS along Transport Corridors: Districts Along the Kampala-Juba route 34 3.4.1 Migyera Hot-spot 34 3.4.2 Karuma Hot-spot 35 3.4.3 Bibia Hot-spot 35 3.4.4 Kampala Hot-spots 37

3.5 Programmming Gaps 42

4. RECOMMENDATIONS 47

5. REFERENCES 50

6. ANNEXES 52

01 | July 2009 Foreword Uganda AIDS Commission

Uganda is widely seen as a success story in fighting HIV/AIDS with a significant decrease in prevalence rates during the 1990s that have stabilized since 2000. The overall burden of HIV/AIDS in Uganda continues to grow, which calls for more evidence-informed and cost-effective programming to further reduce incidence. The need for better coordination and information flow among all those involved in providing these services to improve systematic referral and access to HIV and AIDS services amongst at-risk populations cannot therefore be over emphasized.

Over the last 20 years, Uganda’s response to HIV/AIDS, particularly the actions of the Uganda AIDS Commission have produced an array of information and data. This study however, is the first piece of research to examine the overall HIV/AIDS response at hot-spots along transport corridors. The study provides information on the status of the response in one particular sector that has the potential to significantly impact the HIV epidemic within the entire country, and the region, given the mobility that transport networks create and the particular HIV vulnerabilities associated with mobility.

It is a recognized fact that HIV prevention efforts will not succeed in the long term unless the underlying drivers of the HIV epidemic are effectively addressed. While many of the major barriers are not likely to disappear in the short- term, delaying action will seriously undermine the national and global response to HIV. This study therefore, is important in addressing this gap by providing valuable information to stakeholders who may wish to formulate evidence-informed approaches that are likely to work and make a meaningful contribution in the fight against the spread of the HIV/AIDS pandemic.

Uganda AIDS Commission is pleased to work with IOM and the Ministry of Works and Transport on this project, and we are committed to ensuring that the recommendations from this research will be utilized to inform HIV programming and improve the overall HIV response at hot-spots along the transport corridors of Uganda.

Dr Kihumuro Apuuli Director General | Uganda AIDS Commission

A Response Analysis of HIV/AIDS Programming Along Transport Corridors in Uganda | 02 Foreword International Organization for Migration

According to UNAIDS 2008 estimates, 3.7 million people were living with HIV/AIDS in the three East African states of Uganda, Kenya and Tanzania. While there are many factors that have contributed to the spread of this pandemic, mobility has been identified as a significant driver of new infections in East Africa due to the high-risk environments associated with transport corridors, which often facilitate multiple concurrent sexual partnerships.

This study report documents the findings of a situational analysis of HIV programmes for most-at-risk populations along major transport corridors in Uganda. It represents a follow-up to recommendations of the IOM HIV Hot-Spot Mapping and Situational Analysis along the Kampala-Juba Route (2008), which revealed existing unsafe sexual practices among truck drivers, trucker assistants and female sex workers. Collectively, this research clearly indicates a need to strengthen coordination amongst major actors of HIV in transport programmes, recognizing the mobile nature of target populations and the need for programmatic linkages between sites.

The HIV pandemic remains one of the major socio-economic challenges in Uganda. Our view is that HIV response efforts should give priority to targeting most-at-risk populations to achieve maximum effect with finite resources. This requires well coordinated action by a range of actors operating at different levels to ensure that programmes are differentiated and locally adapted to the relevant economic, social and cultural contexts in which they are implemented.

I sincerely hope that the findings and recommendations of this study will sufficiently inform and inspire stakeholders to move towards concerted action for developing and implementing targeted, effective interventions to address HIV along transport corridors. IOM is committed to working with all stakeholders to promote and support the planning and delivery of these actions on a scale required to achieve the desired results.

IOM wishes to acknowledge and extend its appreciation to the researchers, the Technical Committee, as well as everyone who had an input in the development of this report.

Jeremy R. A. Haslam Chief of Mission | IOM Uganda

03 | July 2009 Executive Summary

This report presents the findings of a situational analysis coordination arrangements; fragmented HIV of HIV programmes for most-at-risk populations along programmes; weak behavioural change interventions; major transport corridors in Uganda. The findings show inadequate health services; unsatisfactory monitoring interesting initiatives as well as a clear need for and evaluation; capacity gaps among critical players; improved targeting at both national and district level. and a need to strengthen public-private partnerships in The objectives of the study were to analyze the current response to MARPs. From the above findings, the HIV programmes; focusing on institutions involved recommendations below are suggested. (“who”), interventions supported or implemented (“what”), and coverage (“where”). The report offers 1. Resource mobilization recommendations based on identified gaps. This study !Under the leadership of the Ugandan AIDS was conducted as a follow-up to recommendations of Commission, IOM and other stakeholders the IOM HIV Hot-Spot Mapping and Situational Analysis should mobilize more funds targeting MARPs along the Kampala-Juba Route, which emphasized the along transport corridors. The UAC Civil Society need to strengthen coordination of actors of HIV in Fund would be one avenue for providing grants transport programmes given the mobile nature of to NGOs to scale-up targeted interventions for target populations, and the need for programmatic example by issuing a Request for proposals linkages between sites. The study findings are intended specifically for MARPs interventions. to sufficiently inform stakeholders in order to move !Build awareness of donors and policy-makers towards taking concerted action for developing on the existing state of the response and targeted interventions addressing HIV along road programming needs through effective transport corridors. The report therefore suggests a advocacy. comprehensive programme framework that can be adapted and taken forward by stakeholders under the 2. Coordination, Partnership-Building and leadership of the Uganda AIDS Commission. Vulnerability Reduction !Strengthen the existing coordination The study methodology included literature review, key mechanisms within local governments for informant interviews, and site visits to selected hot- effective management of the response for spots. Respondents were purposively selected to MARPs; institute coordination mechanisms include local government officials, district health among the civil society organisations and other officials, NGO officials, workers' associations and actors to facilitate efficiency and effectiveness. employers. Towns where a considerable number of !Strengthen coordination structures regionally trucks spend a night while in transit were considered through Regional Economic Communities because these localities normally attract female sex (RECs) like IGAD and EAC, centrally through the workers. UAC, as well as at the district levels in order to facilitate implementation of a comprehensive The study established; a few innovative and successful and harmonized response. programming efforts, limited funding for MARPs HIV !Ensure that stakeholders meet regularly in order programmes especially along transport corridors; weak to align systems, share lessons learned on

A Response Analysis of HIV/AIDS Programming Along Transport Corridors in Uganda | 04 Executive Summary

overcoming challenges, and identify 4. Targeted Behavioural Change programme coverage gaps. !Develop and implement direct interventions that reach MARPs with effective BCC and social !Engage employers in transport, construction, change communication. civil service (customs, immigration, etc.), and !Create a supportive environment for entertainment establishments (bars, lodgings, behavioural change through instituting restaurants) to implement workplace HIV mechanisms that ensure regular access to policies and programmes, including supportive condoms for MARPs and other health and HIV environments for facilitation of access to services and information. services, retention of HIV-positive staff, and de- !Establish national and regional frameworks and stigmatization. toolkits that guide BCC programming partners !Design interventions to reduce vulnerability to HIV through engaging communities residing 5. Integrated Health Services near hot-spots. !Establish a defined health service package !Build partnerships with the private sector clinics targeted to the specific needs of MARPs in hot- and pharmacies to encourage appropriate spots (e.g. open in accessible locations, during treatment (per national guidelines), ensure the evenings, offering services that respond to access to affordable condoms, and refer for the identified needs of truckers, sex workers, HCT, ART and tuberculosis services. and other priority populations. !Scale-up HCT for MARPs in hot-spots, with 3. Harmonized programming for MARPs targeted campaigns that promote regular or !Partners should support and implement a routine counselling and testing. common programme model that meets the !Utilize HCT and adherence counselling for ART needs of MARPs at transport corridor hot-spots and DOTS as an effective vehicle for prevention in a comprehensive and holistic manner. This counselling, through face-to-face counselling, programme should be harmonized in content treatment partner systems, and regular follow- and coordinated nationally (and regionally) up through mobile phone / text messaging. such that actors who are working in !Create a client data management and health geographically separated hot-spots are indeed management information system (HMIS) to working together on a common programmatic allow for smooth service delivery to truckers approach. and FSWs between hot-spots within Uganda and across borders. !Develop HMIS to capture important clinical data such as adherence, resistance, and treatment success rates corridor-wide, with linkages to the central level. !Establish effective referral networks, including marketing of available facilities, direct referral

05 | July 2009 Executive Summary

between facilities within / between hot-spots, BCC, HCT, and condom availability. and with capacity to find client data regardless !Measure the outputs and impact of of location (e.g. using health passport, interventions through surveys and utilization of smartcard, or other technology). HMIS, and integrate these into UNGASS and !Adherence to national guidelines and regional other reporting mechanisms. harmonization for quality and continuity of care !Undertake process evaluations that engage within Uganda and trans-border. stakeholders, service providers, and beneficiaries in order to identify successes and 6. Multisectoral Communication and Advocacy quality constraints. !Market collective efforts of various players !Document effective models for implementing through branding to promote service use. the programme, and share these in regular !Undertake massive and sustained national and coordinating meetings at national and regional regional HCT campaigns together using levels. multiple media channels, and use these to !Implement M&E through national structures reinforce prevention programming and access with regional linkages through RECs. to ART and TB services. !Involve employers, policy-makers, donors, and 8. Capacity building private healthcare providers in demand !Build capacity and offer technical assistance to creation, in promoting workplace policies, and local governments, civil society organisations destigmatization. and the private sector to ensure an effective and !Capture and share effective practices from harmonized response for MARPs. within Uganda and regionally. !Step-up institutional development and capacity building through training and other approaches 7. Monitoring and Evaluation framework and for all the relevant stakeholders. The capacity strategic information building should be a continuous activity and not !Undertake repeat bio-behavioural surveillance a one-off, as is usually the case. surveys (within Uganda and regionally) among !MoW&T capacity to address the HIV needs MARPs to identify baseline HIV prevalence and affecting the transport sector needs more than a behaviours, and to measure collective trends focal point person for HIV. The ministry needs a and impact of implementing partners.. group of specialized and trained officers that !Agree on common indicators for monitoring can facilitate operationalization of sectoral and evaluating HIV and health programming for HIV/AIDS strategic plans. The MoW&T needs to MARPs, including utilization of national train a critical number of HIV resource persons UNGASS indicators and reporting. as compared to simply assigning roles to a few !Regularly identify and address programming selected officers that already have busy job gaps. schedules. The HIV focal persons at both the !Regularly assess the effectiveness, coverage, ministry and district levels should have clear job and intensity of prevention activities, including descriptions.

A Response Analysis of HIV/AIDS Programming Along Transport Corridors in Uganda | 06 Acknowledgment

The authors would like to thank all Government officials from Kampala, Nakasongola, , Amuru, Kasese, Mbarara, Lyantonde, Bugiri and Tororo districts as well as the NGO staff, employers and transport associations that participated in this study for their assistance, support and input into this study. Without your support the fieldwork would have not have been possible.

Particular thanks go to Namulondo Joyce Kadowe of the Uganda AIDS Commission (UAC) and Cypriano Okello of Ministry of Works and Transport (MoW&T). We also wish to acknowledge the valuable input from the Technical Working Group that guided this work.

The financial contribution of the Governments of United Kingdom and the Republic of Ireland through the Joint UN Team on AIDS in Uganda is fully acknowledged.

07 | July 2009 Acronyms

ACDI-VOCA Agricultural Cooperative Development International-Volunteers in Overseas Cooperative Assistance AIC AIDS Information Centre AIDS Acquired Immune Deficiency Syndrome AMREF African Medical and Research Foundation ARVs Antiretroviral drugs ATGWU Amalgamated Transport and General Workers Union BCC Behavioural Change Communication BUNASO Bugiri Network of AIDS Service Organizations CAO Chief Administrative Officer CBOs Community Based Organizations CSO Civil Society Organizations DAC District AIDS Committee DANIDA Danish International Development Agency EAC East African Community FBOs Faith Based Organizations FHI Family Health International FSW Female Sex Worker GLIA Great Lakes Initiative on HIV/AIDS HBC Home Based Care HCT HIV Counselling and Testing HIV Human Immunodeficiency Virus HMIS Health Management Information System IDAAC Integrated Development Activities and AIDS Concern IEC Information Education and Communication IOM International Organization for Migration ICRC International Committee of the Red Cross IRC International Rescue Committee IGAD Intergovernmental Authority on Development MACA Multisectoral Approach to the Control of AIDS M&E Monitoring and Evaluation MAKOCODA Malaba Kyosimba Onaanya Change Development Association MAP Multi-country AIDS programme MARPs Most-at-Risk Populations MoH Ministry of Health

A Response Analysis of HIV/AIDS Programming Along Transport Corridors in Uganda | 08 Acronyms

MoW&T Ministry of Works and Transport NACAES National Committee for AIDS in Emergency Settings NGEN+ National Guidance and Empowerment Network of PLWHA in Uganda NPAP National Priority Action Plan for the National Response to HIV and AIDS 2008/09 - 2009/10 NSP National HIV & AIDS Strategic Plan 2007/8 - 2011/12 OVC Orphans and Vulnerable Children PHC Primary Health Care PICT Provider-initiated Counseling and Testing PLWHAs People Living with HIV/AIDS REC Regional Economic Community ROADS Regional Outreach Addressing HIV and AIDS through Development Strategies STI Sexually Transmitted Infection SW Sex Work TASO The AIDS Support Organization TONASO Tororo Network of AIDS Service Organizations UAC Uganda AIDS Commission UCOBAC Uganda Community Based Action for Children UDHS Uganda Demographic Health Survey UHSBS Uganda HIV/AIDS Sero-Behavioural Survey URA Uganda Revenue Authority URHB Uganda Reproductive Health Bureau USAID United States Agency for International Development USPA Uganda Service Provision Assessment Survey VCT Voluntary Counselling and Testing WHO World Health Organization YEAH Young Empowered and Healthy

09 | July 2009 Glossary

Care and treatment includes increased equitable access to ART; scale-up of HCT services; increased access to prevention and treatment of opportunistic infections including TB; integrated prevention, including nutrition counselling and education, into care approaches; support and expansion of HBC and palliative care, and improvement of referral systems between HBC and health facilities.

Moonlight VCT refers to HIV Counselling and testing carried out at night to the convenience of FSWs, truckers and other mobile populations and other categories of the population that engage in busy work throughout the day like Bankers, boda -boda cyclists and farmers.

Prevention includes a whole range of services intended to curb the further spread of HIV. The services implied under prevention are: accelerating prevention of sexual transmission of HIV targeting vulnerable and most at risk populations; promotion and scale-up of PMTCT; ensuring blood transfusion safety, universal precautions and post- exposure prophylaxis (PEP); controlling sexually transmitted infections and developing appropriate policies and programmatic guidelines for implementation of new HIV preventive technologies proven to be effective.

Social support includes the following services: psychosocial support; formal and informal education; vocational and life skills development and sustainable community and household livelihood and economic empowerment. Others are access to basic social services; appropriate legal, social and community safety nets; sensitization and awareness creation on human rights; protection mechanisms and provision of non-tuition costs and essential requirements to OVC in formal education.

Truckers refer to truck drivers and their assistants. These include individuals who earn a living transporting goods across major transport corridors within the country and across national boundaries.

A Response Analysis of HIV/AIDS Programming Along Transport Corridors in Uganda | 10 Section Guide

INTRODUCTION 12

METHODOLOGY 16

STUDY FINDINGS 18

RECOMMENDATIONS 47

REFERENCES 50

ANNEXES 52 1. Introduction

1.1 THE GENERAL SITUATION body's response to the virus and because of the social The markers of the HIV epidemic remain staggering. implications of mobility on HIV-risk behaviour. Viral Thirty-three million people are living with HIV globally. levels in the blood peak within a month of acquiring HIV, The global epidemic is stabilizing; however, the overall during the acute state of infection. Some studies number of people living with HIV (PLWHAs) has indicate that half of all HIV transmission occurs within increased as a result of the ongoing number of new the first 1-5 months of infection. A likely reason for the infections each year and the beneficial effects of more hyper-epidemics seen in certain population groups and widely available antiretroviral therapy (UNAIDS 20081 ). some Southern African countries is combination of Sub-Saharan Africa remains most heavily affected by acute stage of infection with high levels of multiple HIV, accounting for 67% of all PLWHAs and for 72% of concurrent sexual partnerships (as well as low levels of AIDS deaths in 2007. Sub-Saharan Africa comprises 10% male circumcision). Having several partners at the same of the world's population. Of the 22 million PLWHAs in time increases the likelihood of transmission during the Sub-Saharan region, 17 million live in East and Southern acute stage when viral load is at its highest. The key issue Africa2 . UNAIDS 20083 estimated that by the end of is that population mobility and the risk environments 2007, in the three EAC states, there were 3.7 million associated with transport corridors facilitate people to PLWHAs. have several sexual partners at the same time. Modes of Transmission studies undertaken by UNAIDS, World 1.2 HIV AND MOBILITY Bank, AIDS Commissions, and partners in Kenya4 and Mobility is a potentially significant driver of new Uganda5 reinforce this fact, and this is a reason why infections in East Africa because of the nature of the national strategic frameworks in many countries, as well as the East African Community, include a focus on mobile populations who are most-at-risk of infection including female sex workers and their clients along road and water corridors.

Hot-spots along transport corridors can be visualized as “risk-zones”. They are areas of relative economic prosperity where a number of different categories of people converge for different reasons. These localities comprise not only truckers and female sex workers, but rather a broad cross-section of people whose convergence results in environments that are conducive to engaging in HIV-risk sexual behaviour.

1 The 2008 Report on the global AIDS epidemic from UNAIDS 2 East African Community Integrated Regional Multi-sectoral HIV and AIDS Strategic Plan, 2007- 2011. 3 2008 Report on the global AIDS epidemic, UNAIDS/WHO, July 2008. 4 Kenya MoT Study Team. Modes of Transmission, Epidemiological and HIV Response Synthesis: Inception Report. March 2008. National AIDS Control Council, Kenya. 5 Uganda MoT Study Team. Modes of Transmission Study: Uganda: Inception Report. April 2008. Uganda AIDS Commission.

A Response Analysis of HIV/AIDS Programming Along Transport Corridors in Uganda | 12 Map showing type of female sex worker clients by studies have included informal traders, truckers, school location children and teachers, the military, sex workers, staff in road side bars and restaurants, workers in lodgings, and others. These individuals attest to the fact that the complexity of their lifestyles should be reflected in efforts to fight the HIV pandemic6,7 . HIV is not the primary health concern of MARPs.

In spite of the dangers that HIV poses to truckers, several studies have found that HIV is just one of the many concerns in their lives. Risks of immediate concern are more likely to include potential unemployment, road accidents, and robbery. Health concerns of truckers frequently include malaria, respiratory infections, gastro-intestinal maladies, backaches, STIs, and HIV/AIDS6,8,9. Partly because HIV is not a key concern to those at most risk of infection, HIV risk behaviour remains prevalent along East Africa's highways. Self-reported STI prevalence along Kenyan and Ugandan highways is several times higher than the general population with 15% reported on the Northern Corridor segment from Mombasa to Kampala, and 30% reported on the Kampala-Juba Corridor7,9 . The latter study also found that condom use was inconsistent with both regular and casual partners, resulting in 3,200- 4,148 new primary infections on the Mombasa- Kampala route per year. Condom use and availability was significantly lower in Uganda than in neighbouring A key finding of the IOM study of the Kampala Juba Kenya, and lower in regular than casual clients of sex corridor is that the environments and population workers (64.5% vs. 89%). demographic between different hot-spots varies greatly, with truckers being the minority of clients of sex The relative high number of unprotected sexual acts and workers in most locations, particularly in the north, low availability of condoms indicates inadequate where uniformed services predominate (See map prevention programming and unacceptably low risk above). perception among high-risk groups. In terms of prevention, by increasing condom use in both casual Respondents in a number of transport corridor HIV and regular clients from 78% to 90%, an estimated two-

6 Mapping HIV along the northern Maputo and Nacala transport corridor in Mozambique: IOM, PHAMSA 2006 7 Kriitmaa, K., Ferguson, A., and Irving G. HIV Hot-Spot Mapping along the Kampala-Juba Route. IOM June 2008 8 Carael, E. Long-distance Truck Drivers' Perceptions and Behaviours Towards STI/HIV/TB and Existing Health Services in Selected Truck Stops of the Great Lakes Region: a Situation Assessment. April 2006. IOM Nairobi. 9 Morris, C. and Ferguson, A. Hot Spot Mapping of the Northern Corridor Transport Route-Mombasa to Kampala. University of Nairobi / University of Manitoba Strengthening STD/HIV Control Project. December 2005.

13 | July 2009 thirds of new infections could be averted annually10 . 1.3 HIV RESPONSE TO MARPs ALONG Evidence confirms that there is a higher rate of HIV TRANSPORT CORRIDORS infection in “communities of the mobile”11 . This is mainly Responses need to reach most-at-risk populations in because mobility can encourage high-risk sexual these areas as well as focusing on highway corridor hot- behaviour. Furthermore multi-local social networks spots. create opportunities for sexual networking, including multiple concurrent partnerships which are a key driver The HIV response has seen the EAC registering some of the epidemic in Sub-Saharan Africa. minimal progress in the prevention and control of HIV/AIDS through the use of multisectoral and multi- In an IOM study of the Northern Maputo and Nacala dimensional approaches to planning and managing the transport corridor in Mozambique, truckers report a pandemic12 . The EAC Partner States have many common number of different sexual networking patterns during road transport corridors, with at least five additional their journeys in the form of regular sexual partners at corridors under construction, that attract many workers trucking stops and casual sex at different places. This who interact sexually with communities along roads, behavioural pattern signifies multiple concurrent with exposure to HIV-risk behaviour. partnerships. They reported little or no contact with health services. Mobility causes people to become more Besides the oftentimes long distances between loading difficult to reach, whether for prevention education, sites and destinations, many of the existing roads are in condom provision, HIV counselling and testing, and poor condition, which forces truckers to unnecessarily post-infection treatment and care. The current trend of spend additional nights away from home. It is against expanded trade and improved road infrastructure in this background that the EAC convened regional East Africa poses challenges which require concerted stakeholders in October 2008 to share information response efforts. Road transport is also important in related to HIV and transport corridors. During the light of the intersection with ports, fisheries, rails, and meeting, Partner States recommended the civil servants working at border areas and weighbridges. establishment of regional coordination mechanisms, including a multisectoral partnership on HIV and MARPs in East Africa, involving National AIDS Commissions, other national and regional stakeholders, as well as international collaborating partners13 . It is hoped that such coordination mechanisms would facilitate information sharing, improved coordination, and building of synergies among stakeholders and programmes in order to significantly impact the HIV epidemic.

12 East African Community Integrated Regional Multi-sectoral HIV and AIDS Strategic Plan 2007-2011. 13 Meeting of EAC HIV and AIDS Cross-border Regional Transport Corridor Stakeholders: Report of Meeting. 07-08 October 2008. EAC HQ Arusha, Tanzania. 14 Serwadda et. al., Lancet 1985 10 Morris, C.N., and Ferguson, A.G. Estimation of the sexual transmission of HIV in Kenya and Uganda on the trans-Africa highway: the continuing role for prevention in high risk groups. Sex Transm Infect 82: 36871. October 2006. 11 Lurie, M., Migration and the Spread of HIV in South Africa, (Baltimore, MD: PhD thesis, Johns Hopkins University School of Hygiene and Public Health, 2001).

A Response Analysis of HIV/AIDS Programming Along Transport Corridors in Uganda | 14 In Uganda, HIV/AIDS remains a major socio- Presently, the national response to HIV for MARPs along economic challenge. Since 1982 when the first AIDS transport corridors in Uganda remains fragmented, cases were reported in Uganda14 , HIV rapidly spread uncoordinated, and of insufficient scale and intensity to throughout the country evolving into a severe, mature, stem the epidemic. Although a number of actors and generalized epidemic. The overall burden of support or implement HIV interventions for MARPs HIV/AIDS in Uganda continues to grow, which calls for along transport corridors, it is not clear who is doing more evidence-informed and cost-effective what, where and how. It is imperative to bring national programming to further reduce incidence. partners together in terms of programming to ensure coordination and collaborative strategic planning if we Although it is acknowledged that MARPs along are to meet national priorities. Support to improve transport corridors are among the groups that are most stakeholder coordination, monitoring and evaluation, affected by HIV/AIDS, studies show that truckers and and advocacy is needed for national ownership and other MARPs in Uganda have inadequate access to harmonized programming so that there is significant prevention programmes, VCT, ART, and basic health impact on stemming the epidemic along corridors of services15 . This gap is attributed to poor targeting, mobility. This response analysis is one of the first steps inadequate services and weak coordination. towards improving coordination of HIV for populations in transport corridor risk-zones. This analysis is aimed at Increased targeting and scale-up of coordinated identifying HIV/AIDS interventions and existing interventions that transcend spatial constraints are programming gaps in the hope that the findings will required to prevent new infections associated with contribute to the foundation for scale-up of transport corridors, and to mitigate the impact. This harmonized HIV programming for populations that will have positive implications on the overall epidemic. tend to engage in multiple concurrent sexual The National Strategic Plan (NSP) emphasizes the need partnerships along transport corridors in Uganda and to prioritize HIV interventions for MARPs. A number of East Africa. studies conducted by IOM in Sub-Saharan African countries attest to this fact, including the 2008 HIV Hot- The objectives of the response analysis were to; Spot Mapping and Situational Analysis along the identify existing HIV/AIDS responses or interventions Kampala-Juba Highway16 . The study underscored that targeting MARPs along the transport corridors, and mobility of populations necessitates strengthened specifically, identify the key actors in the response coordination at hot-spot, district, national, and regional (who); take inventory of projects and programmes for levels; consequently, the Joint UN Team on AIDS in MARPs in the transport corridors, their objectives and Uganda through IOM, in partnership with UAC and the achievements (what); establish the reach of the existing Ministry of Works and Transport (MoW&T), have agreed programmes (where); assess the capacities and needs of to facilitate improved coordination of HIV in Transport the agencies involved in the response; and make sector interventions, starting in 2009. recommendations based on identified gaps.

15 Carael, E. Long-distance Truck Drivers' Perceptions and Behaviours Towards STI/HIV/TB and Existing Health Services in Selected Truck Stops of the Great Lakes Region: a Situation Assessment.. April 2006. IOM Nairobi. 16 Kriitmaa, K., Ferguson, A., and Irving G. HIV Hot-Spot Mapping along the Kampala-Juba Route. IOM June 2008

15 | July 2009 2. Methodology

The study methodology consisted of document reviews, the past or ongoing, the challenges of such responses, key informant interviews, and site visits to the selected and the various calls to action in addressing HIV in districts. The study was conducted at the national level transport corridors. Major sources of information were and at districts located along the Northern Corridor World Bank / GLIA, International Transport Workers stretching from Malaba to Katuna, and along the Federation, IOM, and others. Key informant interviews Kampala-Juba Route. From the Northern Corridor, the were held with local government officials, district HIV following towns/districts were included: Malaba in focal persons, district health officers, NGO officials, Tororo District, Naluwerere in ; Lyantonde transport worker associations, and private companies town in Lyantonde District, Ruti in and working within the selected sites. Mpondwe in Kasese. On the Kampala-Juba route, data was collected from Migyera town in Nakasongola Visits to hot-spots were conducted to obtain first hand District, Karuma in and Bibia town in experience on the state of HIV programming in the Amuru, and at various hot-spots in Kampala. districts along the transport corridors and to validate national level information. The sites included in the study, also termed “HIV hot- spots”, were categorized as border post stopovers such Data analysis followed content and thematic as Malaba, Mpondwe and Bibia; long-established approaches. Interview transcripts were generated and stopovers such as Naluwerere, Lyantonde and Ruti; and reviewed to delineate aspects directly relevant to the the emerging stopovers of Migyera and Karuma. response analysis. The identified gaps were considered Kampala is in its own category given its cosmopolitan in making the recommendations. attributes.

Hot-spots were purposively selected to gain a quick impression of institutions (“who”), the nature of services provided to MARPs in terms of prevention, care and treatment, and social support (“what”), as well as coverage (“where”). All public sector departments that are mandated to ensure provision of HIV/AIDS services directly or indirectly to the target group in hot-spots as well as NGOs and CBOs known to be providing HIV/AIDS services to MARPs were included in the study. A list of respondents interviewed is annexed to this report.

Literature review focused on HIV and transport corridors programming, mainly in Sub-Saharan Africa. The team reviewed programmatic responses to HIV targeting MARPs along transport corridors whether in

A Response Analysis of HIV/AIDS Programming Along Transport Corridors in Uganda | 16 Map showing active hot-spots in Uganda as of December 2008

KABOKO Oraba Bibia

Atiak

Vurra GULU ARUA Gulu AMURU

Legend NEBBI Goli Hot-spot visited Karuma Hot-spot

Bweyale Water bodies MASINDI

Transport Route Namulu

NAKAPIRIPIRIT

Migyera BUKWO NAKASONGOLA Saum

Ntoroko

BUNDIBUGYO IGANGA TORORO Idudi BUGIRI Malaba JINJA Tororo Cement Jinja Pier Busia KAMPALA Naluwerere Arua Park BUSIA Mbuya Lugazi KASESE Port Bell MPIGI Mpondwe Buwama

MASAKA Lukaya LYANTONDE

Lyantonde MBARARA Ruti

Ishasha

NTUNGAMO KANUNGU Mutukula Rubare Mirama Hills KABALE

Bunagana Katuna

17 | July 2009 3. Study Findings

This chapter presents the findings of the situational the hot-spots visited by NSP prevention priority areas. analysis. Begining with an overall summary of findings in accordance to the thematic areas of the current NSP, In general, the prevention interventions were distorted followed by a detailed description of “who does what towards sketchy IEC/BCC, condom distribution and in where” in the HIV response and finally the programming rare cases, HCT. There was a clear lack of interventions gaps identified. that could offer life skills education for youth at hot-spot communities, BCC technical capacity for HIV service SUMMARY FINDINGS providers, couple counselling, IEC/BCC for PLWHAs HIV Prevention among MARPs etc. It is worth noting that two of the The study findings indicate an effort on the part of local priority areas, that is, universal precautions and PEP; and governments, NGOs and CBOs to implement developing appropriate policies and programmatic prevention interventions that target MARPs. The guidelines for implementation of new HIV preventive prevention interventions were analyzed according to technologies proven to be effective require action at the the five priority areas associated with prevention in the central level. A response in this direction would expect NSP, namely, accelerating prevention of sexual access points for sexual violence victims among MARPs transmission of HIV targeting vulnerable and most at and MMC services and information targeting MARPs. By risk populations; promotion and scale-up of PMTCT; the time of collecting data for this study, specific actions ensuring blood transfusion safety, universal precautions for MARPs in this direction were absent. and PEP; controlling sexually transmitted infections; and developing appropriate policies and programmatic More specifically among the interventions observed, guidelines for implementation of new HIV preventive local governments in partnership with some CSOs were technologies proven to be effective. Table 1 provides a involved in promotion and distribution of male summary of the available prevention interventions at condoms through existing health facilities, community

Table 1: Availability of Prevention interventions by NSP prevention priorities at the hot-spots

Site/District No. of visited Accelerating prevention Preventive Intervention by Priority Area (PIPA) Implementers of sexual transmission of HIV PIPA 1 PIPA 2 PIPA 3 PIPA 4 PIPA 5

Malaba/ Tororo 3 X IEC/BCC, Condom distribution Naluwerere/ Bugiri 4 X IEC/BCC and HCT X Lyantonde 3 Ruti/ Mbarara 3 X EC/BCC, Condom distribution Mpondwe/ Kasese 1 Migyera/ Nakasongola 7 X EC/BCC, Condom distribution Karuma/ Masindi 6 X EC/BCC, Condom distribution & HCT X

Key PIPA - Preventive Intervention by Priority Area PIPA 1 - Promotion and scale-up of PMTCT PIPA 4 - STIs control PIPA 2 - Ensuring blood transfusion safety PIPA 5 - Developing appropriate policies and programmatic guidelines for PIPA 3 - Universal precautions and PEP implementation of new effective prevention technologies

A Response Analysis of HIV/AIDS Programming Along Transport Corridors in Uganda | 18 based distributors and non-traditional outlets such as reduce the high risk sexual behaviour among these bars and lodges. Whereas there are efforts to distribute population groups and to control the spread of HIV. condoms through non-traditional channels to make them available at locations that are frequented by The response analysis identified a gap in provision of MARPs, there is overwhelming evidence to show that PMTCT services to MARPs along transport corridors. By condoms are not easily accessible to MARPs. A study by 2006, 45 percent of health facilities at the level of HC III IOM that was conducted concurrently with this and above were involved in the provision of PMTCT response analysis17 , found that truckers and FSWs have services. The response analysis however shows that difficulty accessing condoms especially during the there is no provision for MARPs in the hot-spots that night, leading to unwanted unprotected sex. The were visited in the study. PMTCT services were existing condom distribution mechanisms do not reportedly available at public health facilities in the guarantee a continuous condom supply to MARPs. districts visited. These services are provided at static sites, where the general public is expected to access Provision of IEC and BCC was one of the most common them. However, there was no effort to directly target ongoing interventions identified. The existing IEC and mobilize MARPs to access these services at the interventions are mostly generic in nature and do not existing health facilities. The existing HIV projects contain messages to respond to the specific needs of targeting MARPs lack targeted communication for MARPs. In the IOM KAP study only 27 and 38 percent of PMTCT despite the numbers of girls and women and the FSWs and truckers respectively thought that the IEC their partners as well as communities involved. messages they had heard were meant for their audience18 . In some of the hot-spots like Bugiri, there An IOM study19 shows adequate technical capacity of was a Community Voices project that specifically most health facilities to diagnose and treat STIs; targeted and focused on the unique information needs however the regular supply of commodities for STI case of truckers. However, a difficulty in mobilising and management is questionable. This study did not explore reaching the truckers was reported to be a main the details of services offered at health facilities constraint to this initiative. Local governments frequented by MARPs and so cannot comment on occasionally utilised events such as the World AIDS Day integration of HCT into management of STI patients. It is (WAD) to hold campaigns that focus on the need for worth noting that there are few clinics that offer SRH behaviour change among FSWs. These WAD efforts like services specifically targeting MARPs at hot-spots; the most others currently targeting MARPs are short-term study identified only one initiative in Bugiri district, in nature, not sustained and are characterised by lack of where a private sector health facility (URHB) provided follow up support for the target population. Whereas services to FSWs with support from the Irish NGO, Goal some local governments and CSOs are involved in Uganda. IEC/BCC interventions, there is no harmonised HIV/AIDS communication campaign to address the Care and Treatment unique needs of the mobile populations and their Within the care and treatment thematic area, the associated sexual networks at the hot-spots. The Ugandan government seeks to improve the quality of analysis observes that IEC and BCC for MARPs in the life of PLWHAs by mitigating the health effects of HIV hot-spots, is grossly inadequate, ad hoc and is unlikely through increase access to ART, HCT, treatment of to yield the sustained behaviour change necessary to opportunistic infections, Home Based Care (HBC) and

17 IOM (2009) HIV Knowledge, Attitudes and Practices of Truckers and Female Sex Workers Along Major Transport Corridors in Uganda 18 IOM, 2009, ibid 19 Kriitmaa, K., Ferguson, A., and Irving G. HIV Hot-Spot Mapping along the Kampala-Juba Route. IOM June 2008

19 | July 2009 palliative care. Overall findings are summarized in Table mobilization by their peers as well as the Moonlight VCT 2 below. that was carried out in the night. These services were however available in less than half of the hot-spots There is a marked increase in the availability of ART in visited. Local governments and NGO partners reported Uganda, given that 57 percent of health facilities at the outreach services to fishing communities, FSW and level of HC IV and above were providing ART services in truckers at hot-spots in the districts of Malaba, Bugiri, 200620 . Although these services were reported to be Mbarara, Kampala and Karuma. HCT services to MARPs available within the districts visited, this response were not reported in Lyantonde, Kasese and Amuru. analysis established a few initiatives specifically targeting MARPs in hot-spots for ART services. MARPs- This response analysis found scattered efforts by NGOs targeted treatment was observed in Bugiri/Naluwerere, operating in the various hot-spots to offer HBC to where a private health facility, URHB, provided MARPs. For example in Malaba, TONASO was providing treatment to FSWs. In Masindi/Karuma, NGEN+ a local care to PLHWA, with an interest in targeting former NGO constructed a clinic that was reported to FSWs. HBC services are provided through collaboration specifically target FSWs and other MARPs with HIV between CSOs and communities. Community services. Clinics offering ART were also offering volunteers are trained as peer educators and carers of prophylaxis and treatment of opportunistic infections. MARPs for HBC services. They were involved in In a project that had ended shortly before this response provision of basic care to PLWHA in their homesteads. In analysis, Lyantonde district had identified one service Masindi/Karuma, TASO was engaged in palliative care provider at the district hospital that FSWs would contact and HBC for the general population; if such in case they needed HIV services. This is a positive interventions like TASO Masindi are linked with the FSW innovation that could be replicated at other hot-spots. network, then FSWs could be reached in the process of serving the general population. HCT services were available for MARPs at static sites as well as through mobile outreaches. Service providers The study found that some CSO had trained and had devised means of reaching the MARPs through instituted community referral systems through the use

Table 2: Availability of care and treatment services for MARPs in hot-spots along transport routes

Site/District Implementors ART HTC TOI IT HBC PC RS Visited

Malaba/Tororo 3 X X X Naluwerere/Bugiri 4 X X X Lyantonde/ Lyantonde 3 Ruti/ Mbarara 3 Mpondwe/ Kasese 1 Migyera/ Nakasongola 7 Karuma/ Masindi 6 X X Bibia/Amuru 7 Arua Park, Mbuya, 7 X X X Nalukolongo/Kampala

Key: ART - Anti-retroviral Therapy, HCT - HIV Counselling and Testing, TOI - Treatment of Opportunistic Infections, IT - Integrated Treatment, HBC - Home Based Care, PC - Palliative care, RS - Referral systems

20 UAC (2007) National HIV/AIDS Strategic Plan: Moving Towards Universal Access, 2007/8-2011/12

A Response Analysis of HIV/AIDS Programming Along Transport Corridors in Uganda | 20 of volunteers. These were responsible for Generating Activities (IGA) for FSWs. It is We have trained PLWHA in identifying PLWHA in their communities, worth noting the need to establish IGAs but we have not been mobilizing them and providing them success stories, if any, in offering able to equip them or give with referrals to nearby health facilities alternative income generating options to them the minimum capital for HIV services. This was observed in sex work. to start their business. So Malaba/Tororo, Naluwerere/Bugiri, in the need to survive, Karuma/Masindi and in Ruti/Mbarara. In Tororo, it was reported that FSWs had some of the women who The effectiveness of the community been trained in alternative IGA as a are trying to escape sex referral systems was hampered by the means of persuading them to abandon work may find themselves reliance on unpaid volunteers and sex work. These interventions however reverting to it, even with unfavourable service provision in the have not proved effective, as they failed their known HIV status.” public health units. Reports indicated to address the priority needs of the FSWs. TONASO, Malaba that FSW and truckers sometimes failed Proper needs assessments were not to access services after they have been conducted prior to the livelihoods referred, due to long waiting hours and training and the nature and content of institutional deficiencies like drug stock training was determined by the service outs. providers. The service providers did not provide capital to enable FSWs use new Social Support skills and knowledge acquired to make a There is limited service provision for living. MARPs along transport corridors in regards to social support. Of all the hot- It was also established that some spots visited, only Malaba, Naluwerere organizations that have attempted to and Migyera had organizations that design interventions for MARPs tended contributed to social support for FSWs- to focus on the MARPs alone without namely WAYS and TONASO. There are a holistically considering their social few attempts to provide Income networks such as families. This affected

Identified Best Practice: Working with MARPs in Malaba a case of MAKOCODA

The response analysis identified a best practice that could be replicated in programmes that target MARPs. The Malaba Low Income Women Cluster/Malaba Kyosimba Onaanya Community Development Association (MAKOCODA) started as an informal association of sex workers in Malaba in 1999. The association is currently working with FHI/ROADS project to mobilise sex workers against HIV/AIDS. MAKOCODA is involved in condom distribution among sex workers and their clients, mobilization of MARPs for HCT services, and provision of referrals. To avoid stigma associated with sex work, the association members are operationally referred to as low income women. Working with existing associations of MARPs provides an avenue for ease of mobilisation and builds confidence and trust towards service providers. It also makes it possible to easily understand their unique needs and respond appropriately.

21 | July 2009 “We have learned that the effectiveness of the interventions. For mitigation programmes for cross-border there is need to design example, those organizations that were and mobile populations, refugees, IDPs, interventions for children supporting FSWs observed that failure to returnees, and surrounding host as we think about the support the FSWs' children was a threat communities in selected sites in the IGAD adults. There was an to project success. Member States; and to enable the oversight when we were scaling-up of this approach and the planning and we thought 3.1 REGIONAL HIV sustainability of the provision of services of only the adult PROGRAMMING FOR MARPs to these populations, by strengthening population. But these ALONG TRANSPORT IGAD and establishing a common adults are men and CORRIDORS approach to support these populations women who have children, within the IGAD member countries. who also have HIV/AIDS. You cannot give support to IRAPP's main components centre on; the parent and isolate the support to refugees, IDPs, returnees, child.” surrounding host communities, and TONASO, Tororo cross-border and mobile populations; cross-border collaboration on the health “We learned in our FSW sector response to HIV/AIDS; and project project in Kawempe that management, coordination, capacity- we cannot achieve success building, and M&E. UNHCR is one of the if we do not have main implementing partners for the interventions for children. 3.1.1 The Inter Governmental support to refugees, IDPs, and host How can you treat the Authority on Development communities throughout the region. mother yet the child is sick The Inter Governmental Authority on Other components are implemented by at home. And yet these Development (IGAD) in Eastern Africa selected NGOs in the respective Member FSW tell us the primary was created in 1996 and comprises seven States. reason they are in this member states. IGAD's mission is to assist business is to feed their and compliment the efforts of the The project started in 2007 and by the children and take care of member states to achieve through end of 2008, had successfully set up them.” increased cooperation: food security and structures and operational frameworks. RHU, Pretest interview environmental protection, promotion The programme works within the existing and maintenance of peace and security HIV/AIDS strategies and programmes in and humanitarian affairs, and economic the respective member states. In cooperation and integration. In terms of Uganda, the current operational sites are HIV programming, the IGAD Regional Busia hot-spot and Kyaka 2 IDP camp in HIV and AIDS Partnership Program . The planned activities at (IRAPP) is a four-year programme funded the hot-spots include prevention services by the World Bank to address among as well as care and treatment including other things, HIV issues among the sub- referral as stipulated in the NSP. regional cross-border and mobile populations. The objectives of IRAPP are: IRAPP being a regional project focuses on to improve access to HIV/AIDS harmonizing protocols and supporting prevention, care, treatment, and HIV service delivery across the borders.

A Response Analysis of HIV/AIDS Programming Along Transport Corridors in Uganda | 22 Rapid assessment was concluded in Busia to assess the 3.2 NATIONAL HIV PROGRAMMING FOR MARPs volume of HIV risk, plan service delivery and to consult ALONG TRANSPORT CORRIDORS the local government on collaborative implementation of the project. IGAD is seeking to find innovative ways of 3.2.1 Uganda AIDS Commission offering services beyond the static health facilities and is UAC was established in 1992, with the primary goal of eager to strengthen use of strategic information to providing oversight and coordinating the multisectoral guide programming improvement. response to HIV/AIDS. UAC has the mandate to coordinate MARPs. Presently UAC has focal persons 3.1.2 The Great Lakes Initiative on HIV/AIDS (GLIA) delegated to coordinate regional and national HIV The Great Lakes Initiative on HIV/AIDS (GLIA) is a responses among migrant populations namely the regional body comprising of six countries, namely GLIA, IGAD and NACAES. UAC has developed a Burundi, Democratic Republic of Congo, Kenya, mechanism for self coordinating entities, which Rwanda, Uganda, and Tanzania. The GLIA HIV constitute the partnership committee (local NGOs and programme focuses mainly on migrants and mobile CBOs, International NGOs, AIDS Development Partners populations, the group of MARPs that are rarely (ADP), line ministries, decentralized response, youth, targeted. Presently, GLIA activities cover parts of the parliament, research and academia, PLWHA, faith based Mombasa-Nairobi highway, KampalaKigali transport organizations and media, arts and culture). route, and Bujumbura-Bukavu transport route. In Uganda, operation areas are Naluwerere in Bugiri UAC developed the NSP which highlights different District, Mbuya in Kampala, and Katuna in Kabale MARPs as priority groups for HIV interventions. Within district. GLIA's work is coordinated primarily though the the current NPAP; the budgetary provision to GLIA secretariat in Kigali, which then works through the implement HIV prevention strategies targeting MARPs National AIDS Commissions. In Uganda, the UAC is approximately three million American Dollars and for supports ATGWU to implement in collaboration with targeted services to high-risk groups is five and half MoW&T. In addition, GLIA has supported capacity million American Dollars over two years (2008/2009- building of NAFOPHANU. In terms of the response, GLIA 2009/2010). It is not clear though, how much of this has a three-year project, though until now, it has made funding will be committed to MARPs in HIV high-risk achievements with preparatory work to establish zones along transport corridors. Much as it is services delivery at moderation rooms in Katuna, acknowledged that the NPAP could not have listed all Naluwerere and Mbuya. The key challenges are priorities, it is worth noting that truckers do not feature ensuring regular condom availability at the recently among the special groups (MARPs) budget. established moderation centres and the limited capacity of implementing partners; moreover there is The increased prominence of MARPs arising from the not enough funding for systems strengthening. findings of MOT study and the Kampala-Juba hot-spot mapping, present opportunities for justified investments to MARPs in high-risk zones along transport corridors.

In terms of the national response among other players, the MoW&T policy exists and directs all road- construction contractors to incorporate HIV prevention activities into their work plans.

23 | July 2009 Additionally, a few CSOs are providing services to 3.2.2 Ministry Of Works and Transport (MoW&T) MARPs especially the sex workers. However, the In 2007, the MoW&T developed a five-year HIV/AIDS commonly provided services are VCT and condom strategic plan (2007/2008-2011/2012) for HIV distribution. At the regional level, IGAD and GLIA are prevention, control and mainstreaming. The goal of the investing in MARPs along transport corridors within strategic plan is to control and prevent HIV/AIDS in the Uganda and within the East African and Horn of Africa work place and enhance health and productivity of the regions. GLIA's a five-year (2008-2012) regional workers to ultimately contribute to effective sectoral HIV/AIDS strategy initiative has a budget of 63, 330,874 performance. The objectives of the plan seek to serve American Dollars of which 13% (equivalent to four population categories, namely; the MoW&T staff, 8,037,000) is committed to HIV interventions targeting MoW&T contractors, communities interacting with mobile populations. MoW&T project workers and transport stakeholders along the Northern Corridor. Planned activities focus on The key challenges UAC faces in improving the HIV HIV education, promotion of safer sex, promotion of response to MARPs along transport corridors include positive living, VCT and STI treatment services, inadequate information on the magnitude of the HIV promotion of care and support among the target problem among the population group in question, population categories. Specific mention of high-risk difficulties in programming HIV services for mobile populations along transport corridors is missing MARPs given that the existing HIV/AIDS services are throughout the strategic plan. mostly facility based. Extra resources would help to offer services that are convenient to MARPs in high-risk MoW&T acknowledges need to target MARPs along zones along transport corridors. Service providers and transport corridors however, they draw attention to the programme managers need specialized knowledge on need to build the skills for delivering HIV services and how to reach mobile populations, developing models information to the target group citing its mobile nature and approaches of targeting MARPS would help as the main challenge. Other challenges include address this. Additionally, there is a need to develop a inadequacy of HIV information at some of the monitoring mechanism which would facilitate ongoing workplaces, incomprehensive HIV policy, HIV statistics collection of information on MARPs and therefore specific to the transport sector and funds to implement provide evidence upon which to design interventions the actions of its current strategic plan. It is thought that and allocate resources. Overall resource tracking for the above challenges could be addressed through funding HIV programming for MARPs is not advocacy with top management within the Ministry. comprehensive. UAC does not have a mechanism to generate information on budgets of partners who have In terms of coordinating the HIV response within the interventions for MARPs. ADPs especially IOM and transport sector, MoW&T has a coordination structure UNFPA are helping to generate information on MARPs. though it needs strengthening. A focal point officer works with a team of representatives from each MoW&T department to coordinate HIV/AIDS activities at the Ministry level.

At the district level, the MoW&T collaborates with the HIV/AIDS focal persons and transport companies where applicable to implement HIV/AIDS. MoW&T does not have a coordination budget line, only for implementation of HIV activities given the funding

A Response Analysis of HIV/AIDS Programming Along Transport Corridors in Uganda | 24 constraints and the fact that HIV/AIDS is not a core the ministry is certain that they can help speed up the activity in MoW&T. scale-up of HIV services to MARPs because of existing resource like health facilities across Uganda and health In addition, the current structure in the Ministry of communication expertise among others advantages. Works and transport does not provide for the HIV/AIDS focal officer. HIV/AIDS assignments are in addition to 3.3 HIV PROGRAMMING FOR MARPs ALONG the focal officer's core duties, moreover there is no TRANSPORT CORRIDORS: DISTRICTS ALONG facilitation to perform HIV duties such as a salary THE NORTHERN CORRIDOR increment for the appointed officer and the HIV office lacks stationery, communication equipment and well- 3.3.1 Malaba Hot-spot in Tororo District maintained computers to perform HIV office work. Malaba is a town in Tororo District, on the Uganda - Kenya border situated along the Northern Corridor 3.2.3 Ministry of Health (MoH) which stretches from the Port of Mombasa to Katuna on The Ministry of Health provides the policy guidance and the Uganda-Rwanda border. Like the nearby town of standards for health services and facilitates delivery of Busia, Malaba is an important border crossing town that health services nationwide. The MoH acknowledges has a very high transitory population. Below is a that existing HIV programmes for MARPs along description of the response to HIV along the corridor by transport corridors and MARPs in general, are stakeholders in Tororo District and in particular Malaba inadequate in quality and quantity. town.

Currently the MoH works with partners to address MARPs HIV needs and has established networks with UAC, GLIA, EAC, ECSA, IGAD, PSI/pace, IOM and UHMG in this regard. Additionally, the Ministry's successes in targeting MARPs include participating in studies that have provided strategic information, developing comprehensive IEC/BCC materials such as film shows for fishing communities, which mainly focus on STI prevention and treatment as well as establishing an inventory on which MARPs are receiving HIV services. MoH has programmes that reach MARPs at places where they frequently congregate; one such programme targets sex workers at their workplaces. MoH programmes that target MARPs have not been The Tororo District Local Government has been evaluated which makes it difficult to assess their impact instrumental in HIV prevention in the district. Using on the HIV response. Primary Health Care (PHC) funds, and support from development partners including USAID and WHO, the The ministry notes as programming challenges the district holds regular film van outreaches in Malaba difficulty in delivering HIV services and following-up town. The District Health Office collaborates with the mobile populations in absence of a well-developed district Works Department in the provision of IEC on coordination network as well as the limited IEC/BCC HIV/AIDS to populations along the corridor, including activities that are culturally appropriate for the various truckers. Whereas the District Health Office focuses on MARPs populations. However with adequate support, HIV prevention among truckers, FSWs and the general

25 | July 2009 population in Malaba town, the Works department group; Malaba Women Orphanage Support, and Apia focuses on road construction workers and the Women's Group. The CBO had trained 89 peer communities surrounding road construction routes educators and 30 peer counsellors by December 2008, mainly because the Works Department is responsible and continues to facilitate volunteers who participate in for maintaining the feeder road network while the drama shows. The shows are an avenue for highways remain the responsibility of the MoW&T disseminating HIV prevention information and through the Uganda National Roads Authority (UNRA). encouraging positive behavioural change.

The district local government is at the forefront of MAKOCODA also distributes condoms through 15 providing HIV counselling and testing services to strategic outlets (bars and lodges). The selected bars MARPs and dispensing condoms through lodge and bar and lodges have become popular among FSWs and owners. Occasionally the district conducts Moonlight truckers in Malaba town. In addition, MAKOCODA is HCT in partnership with CSOs like ATGWU and the involved in the mobilization of FSWs and their clients for Tororo Network of AIDS Service Organizations the project moonlight VCT. Volunteers help to refer (TONASO). FSWs for treatment at Malaba HC III. MAKOCODA equips women that have quit sex work with income Malaba HC III, located within Malaba town provides generating skills and knowledge and provides low treatment for opportunistic infections and ART to the income women with loans to enable them to engage in general population. This centre does not target services gainful employment activities. for MARPs. The Tororo Network of AIDS Service Organizations A good number of CSOs provide HIV/AIDS services for The Tororo Network of AIDS Service Organizations FSWs and truckers at Malaba. These include: FHI, (TONASO) is a NGO which brings together all CSO TONASO, and MAKOCODA. CSOs in the hot-spot carry actors who target HIV and AIDS within Tororo. It is out HIV sensitization outreach, distribute IEC materials implementing a project referred to as the “PLWHA and train peer counsellors among the FSWs and Cluster Project” in Malaba. The overall goal of the project truckers. is to expand access to clinical and non-clinical services for people living with HIV and AIDS (PLWHA); reduce The Malaba Kyosimba Onaanya Community stigma and discrimination in the community; and Development Association promote prevention among HIV positives. The Malaba Kyosimba Onaanya Community Development Association (MAKOCODA) is a CBO that To facilitate access to treatment services for PLWHA, was formed in 1999, as an association of FSWs to protect TONASO created networks of community volunteers their interests. With financial support from FHI-ROADS who provide home-based care to PLWHAs and refer for (USAID), the association is involved in HIV prevention HIV services. It was however observed that the activities among FSWs, Truckers, bar and lodge effectiveness of the referral services is limited by the low attendants and the community members. This CBO is staffing levels and regular stock-out of testing kits in the currently implementing a project targeting FSWs local government health centres where referrals are referred to as “Prevention of HIV among Low Income made. In the area of social support, TONASO is involved Women of Malaba”21 . The project is implemented in in training PLWHAs, including FSWs and youth, on partnership with other CBOs, namely Malaba Women's Gender Based Violence (GBV) and income generating Effort to Eliminate Poverty; Akolodongo Women's activities. The major challenge to the sustainability of

21 The term “low-income women” was coined to avoid the stigmatization that accompanies sex work.

A Response Analysis of HIV/AIDS Programming Along Transport Corridors in Uganda | 26 TONASO's social support activities is the 20 lodges and 18 bars in Naluwerere. “We have the responsibility lack of funding to provide start-up capital Drug use and alcohol abuse are common of mobilizing our truckers for beneficiaries' income generating among the FSWs. and giving them activities. information on HIV/AIDS. Naluwerere town is located only two We are committed and do the best that we can do. The Amalgamated Transport Workers kilometres from Bugiri General Hospital. However, the challenge is Union The town has a government aided HC II that we are also not well The Amalgamated Transport Workers (Naluwerere), two private clinics, and five trained in mobilizing and Union (ATGWU) is a transport workers' private drug shops. The responses sensitizing these truckers.” union providing HIV prevention services contained here are a description of the Site Coordinator, to truckers in Malaba, Naluwerere and epidemic by different actors. ATGWU in Malaba Katuna along the Northern Corridor and in in West Nile. ATWGU Bugiri District Administration did not “The district is not directly provides the following services: have any specific interventions for sex targeting the MARPs as a information on HIV and STI prevention, workers and clients in 2008/2009. category due to resource distribution of condoms, and referrals to Although the district officials recognize constraints, though we agencies providing HCT and ART. The the higher risk of truckers and FSWs to acknowledge that the main challenge to ATGWU is the acquire and transmit HIV infection, the presence of MARPs poses inadequate community mobilization annual work plan does not have any high risks to HIV skills as reflected by the Site Coordinator targeted interventions as reflected by the transmission in the in Malaba. HIV/AIDS Focal person. district.” HIV/AIDS Focal Person, 3.3.2 Naluwerere Hot-spot in Bugiri Regular HIV services are provided to the Bugiri District District general public through the static clinics Naluwerere is located in Bugiri Town and outreach, including HCT, PMTCT, and Council. It has an estimated population of condom distribution. Because of the 22,000 people comprising diverse ethnic close proximity to Bugiri Hospital, it is groups including: the Basoga, Samia, assumed that the population in Japhadhola, Baganda and immigrants Naluwerere access HCT and PMTCT from from other East African Countries. the hospital. This assumption cannot be Naluwerere Town sprung to importance made of sex workers and their clients in the 1970s and has remained a major though. This is particularly of concern for truck stop-over for decades. It is truckers who need to access services at estimated that over 100 trucks stop by night and are unlikely to stay more than a Naluwerere every night. The truck couple hundred metres from their population has attracted a high number vehicles. On a few occasions, the Bugiri of FSWs to the town. The town has a District Health Office has implemented considerable number of part-time FSWs targeted prevention activities. For that engage in gainful work during the example, it was observed that in 2006, day and in sex work at night. The majority district celebrations for the World AIDS of the population derives their livelihood Day were held in Naluwerere and from small business and illicit trade which specifically targeted the FSWs. In is thriving here. There are approximately addition, health units sometimes

27 | July 2009 “MARPs in the district are conduct VCT outreaches for FSWs and patients must wait longer at the health accessing ARVs through fisher folk. The district Works facility which affects demand for and the hospital. Only that you Department requires all contractors to adherence to treatment. The long waiting do not say that this service include HIV prevention interventions in time is among the reasons HIV services at is for a prostitute. Our their bids, and the district officials follow health facilities are not convenient to thinking is that these up actual implementation of the same by mobile populations, especially truckers. services are for the the contractors working on the district general population. We do feeder roads. It was, however, observed Several CSOs are involved in HIV not discriminate.” that HIV interventions among prevention activities in Naluwerere. At HIV/AIDS Focal Person, contractors remain weak mainly due to the time of the study, several of the CSOs Bugiri District inadequately skilled HIV programming were not implementing any activities staff. citing either lack or inadequacy of “We have a radio talk funding. CSOs interviewed included show every Tuesday. On Bugiri Network for AIDS Service this talk show, we focus on Organizations (BUNASO), Integrated issues like cross- Development and AIDS Concern (IDAAC), generational sex and Uganda Community Based Association commercial sex. The show for Children (UCOBAC), GOAL Bugiri, is broadcast in the local Community Voices, and Uganda language. We have tried Reproductive Health Bureau (URHB). to use the show to Below is a summary description of the promote the ABC+ services provided by each of the CSOs strategy and to encourage interviewed. commercial sex workers to test for HIV.” Bugiri Network for AIDS Service Information officer, Organizations BUNASO The Bugiri Network for AIDS Service Organizations (BUNASO) is an umbrella HIV/AIDS treatment is provided through organization, which brings together the public health care system. Bugiri CSOs within the district. The network Hospital, located 2 Kilometres from does not implement specific HIV projects Naluwerere town, provides ART, for most-at-risk populations near the treatment of opportunistic infections and transport corridor, but does host a weekly Septrine prophylaxis. HIV care and radio show on HIV/AIDS. treatment is available to the general population, but there is no specific effort BUNASO holds meetings on a monthly to reach out to sex workers and mobile basis attended by organizations populations that need ART but may not implementing HIV/AIDS interventions in be able to access it. This understanding is the district. The meetings could be used reflected by the HIV/AIDS focal person. as an avenue to improve coordination of targeted interventions in transport The district health units are understaffed corridor hot-spots in collaboration with yet receive many patients. As a result, the local government.

A Response Analysis of HIV/AIDS Programming Along Transport Corridors in Uganda | 28 Uganda Reproductive Health Bureau (URHB) Integrated Development Activities and AIDS By December 2008, URHB was implementing a project Concern (IDAAC) entitled “VCT, Syndromic Management of STIs and Integrated Development Activities and AIDS Concern Promotion of Support Groups”, funded by GOAL Bugiri. (IDAAC) Bugiri is a local NGO that was established in One of the objectives of the project is to reduce the risk 1991. Since 2007, the organization has been of HIV transmission among a target population of 660 implementing HIV prevention programmes in female sex workers. UHRB has identified and trained Naluwerere town, Mutuuba and Sigulu Islands, and resource persons among the FSWs who act as a linkage Budhaya and Buhemba Landing sites. The organization with the target community. These resource persons has little experience working with most-at-risk provide information to FSWs about the availability and populations, and currently targets the general access to HIV services at URHB and other providers like population. BUNASO, Naluwerere HC II and Bugiri Hospital. To avoid stigmatization, the services are not provided exclusively GOAL Bugiri to FSWs; URHB uses an identification code for FSWs who GOAL Bugiri is a branch of GOAL Uganda. The seek services. On the initial visit, FSWs pay a nominal fee organization is not involved in direct service delivery, of Uganda Shillings 1,000 and thereafter services are but plays a key role of providing financial and technical provided free of charge. FSWs receive VCT, treatment of support to local NGOs and CBOs addressing HIV/AIDS opportunistic infections and STIs. The main gap in this within Bugiri District. The organization works with sub innovative project is how to reach the FSW sexual grantees that implement HIV prevention activities partners with STI treatment as well as promoting among FSWs and fisher folk. The agencies supported by consistent condom use in both transactional and non- GOAL Bugiri include BUNASO, which is funded to host a transactional sex, among both FSW and their sexual weekly HIV prevention radio programme, and UHRB, partners. which provides VCT and STI treatment for FSWs. Under care and treatment interventions, GOAL Bugiri provides Energy Institute of Uganda-Community Voices IDAAC and Sigulu Women's Awareness Organization Since 2006, Energy Institute of Uganda has been with training and financial resources for delivery of supporting Community Voices, an NGO operating in home-based care programmes. GOAL Bugiri regularly Naluwerere town. Community Voices has recruited carries out capacity assessment of its sub grantees and volunteers who work as magnet theatre resource provides training based on the needs identified. persons, peer educators and peer counsellors. The primary target of Community Voices is truckers. Truckers 3.3.3 Lyantonde Hot-spot in Lyantonde District are sensitized on HIV/AIDS through volunteers who also Lyantonde town is the seat of Lyantonde District, and is distribute leaflets on HIV prevention and refer to health located midway along the -Mbarara highway. It facilities for VCT and care and support. has been an important transit town for decades, long before the area gained district status in August 2006. The services of the NGO are however limited to The district has five sub-counties and has an estimated sensitization on HIV. Referral systems are weak and population of 78,000. The major tribes are Banyankole, clients are referred to public health facilities which they Bakiga, Barundi, Rwandese and Baganda. The do not find convenient due to long waiting hours, low predominant economic activity is bar, lodges, and levels of staffing and regular stock out of drugs. restaurant management businesses followed by the Similarly, volunteers are not facilitated to mobilize selling of cattle and cattle by-products. The district is truckers and were reportedly de-motivated. located within the cattle corridor and therefore has many migrant cattle keepers who move to and from the

29 | July 2009 “MoW&T is simply telling district in search of pasture. They travel MARPs in Lyantonde are the boda-boda us to undertake HIV from as far as Kachera in cyclists, wheel barrow pushers, bar activities at the district and Katonga in Ssembabule District. attendants, and taxi drivers. The district without providing showed a willingness to address HIV in additional funds to that The location of Lyantonde town makes it transport, though frustrated by meager effect. Here on the ground, convenient for servicing trucks and as funds, as depicted in the quote. how do you tell a politician rest for the truckers. On average, more that I will not construct than 50 trucks park overnight in Two CSOs in Lyantonde district were feeder road X, because I Lyantonde. The truckers develop social visited namely: NGEN+ and AMICAAL. need to divert the money links with the local community, including Both CSOs had been implementing into HIV sensitization?” as clients of sex workers. FSWs travel outreach to FSWs but at the time of the District Engineer, from distant districts in pursuit of visit these activities had stalled. Lyantonde District truckers. NGOs and the Lyantonde AMICAAL was until recently District Administration have mounted a implementing an HIV/AIDS at workplace “The incoming FSWs have concerted response to HIV/AIDS among programme targeting bars and not been exposed to HIV FSWs, truckers and road constructors as restaurant owners. This intervention was prevention messages and described by the DHO Mbarara District. suspended due to inadequate funding. are reportedly more Civil Society outreach to MARPs willing to engage in In Lyantonde District Local Government, continues to be sporadic implemented unprotected sex. The the District Health Office carries out only upon securing short-term grants. district lacks funds for evening VCT outreach to bars and continual HIV prevention restaurants. Between May and The commencement of civil works for the efforts among FSWs and November 2008, the District Health Mbarara-Masaka highway, which started the ongoing FSW influx is Office distributed 93,200 pieces of in early 2008, had frustrated HIV not helping.” condoms to lodges and bars through prevention interventions in Lyantonde HIV Focal Person, community outreach. As part of the town. CSOs reported that the Lyantonde District bidding guidelines, the Works construction has attracted large Department in conjunction with the numbers of FSWs, who have immigrated procurement department now requires from other parts of the country and from all contractors to budget for HIV neighbouring countries. This group of prevention activities targeting FSWs has been hostile to HIV prevention construction workers and neighbouring campaigns and is described as more communities. The biggest challenge to willing to engage in unprotected sex. HIV prevention in general and MARPs in With limited funding, this situation is particular is the inadequate funding to eroding past gains in HIV prevention implement outreach activities. among FSWs.

On the whole, the district is not satisfied Reynolds Construction Company (RCC) with what that is being done to prevent was contracted by MoWT and UNRA to HIV among MARPs in Lyantonde town. expand the Masaka-Mbarara highway. However, their future plans centre more The company has started an HIV at the on FSWs not truckers. Other transport workplace programme. The company workers that have been identified as sensitizes construction workers about

A Response Analysis of HIV/AIDS Programming Along Transport Corridors in Uganda | 30 HIV before deployment and at the time Lyantonde and Ntungamo. Common “Consultations start at the when they assemble to receive their ethnic groups are the Nkole, Ganda and, late stage. Partners come wages. The HIV prevention campaigns by Rwandese. The trading centre has one and ask us to endorse fully RCC present a viable opportunity for government-supported HC II, a few developed proposals, improving HIV prevention between sex private clinics and private drug shops. rather than consulting us workers and their sexual partners in There has been no marked response to in conceiving the projects. Lyantonde town. the phenomenon of transactional sex in This is not good Ruti due to the absence of NGOs and consultation.” 3.3.4 Ruti Hot-spot in Mbarara higher level health centres. DHO, Mbarara District District Ruti trading centre is a part of Mbarara In Mbarara District Local Government, Municipality and is located along the the Mbarara District Health Office does Mbarara-Kabale highway. It is located not implement any services directly. The four kilometres from Mbarara town from district jointly implements some activities which it is separated by the Ruti Forest with partners for instance for the World Reserve. Ruti is named after a big tree in AIDS Day. The district also holds joint the town that used to house many planning meetings with HIV partners. The pelicans. Ruti has been a busy town since district signs MoUs with implementing the 1970s and used to act as a partners and reviews their proposals. rehabilitation centre, offering language However the district is dissatisfied with lessons to labour migrants from South the consultation processes, as reflected Western Uganda seeking jobs in Central by the DOH Mbarara District. Uganda. Owing to its location along the highway, it attracted businessmen and There are several CSOs in Mbarara thereafter the truckers. It is one of the district. The team visited Mayanja oldest truck stops along the Kampala- Memorial Hospital Foundation, Mulago- Katuna route. When the trucks started Mbarara Teaching Hospitals Joint AIDS stopping in the town, FSWs followed. Program (MJAP) and Reproductive Because of the truckers, the town Health Uganda. What follows is a developed into a centre for cheaper description of the services provided to merchandise and fuel. Truckers have MARPs by the CSOs. established homes and businesses in Ruti, consequently developing the site into a trading centre.

Ruti has an estimated population of 2,500 persons and approximately 50 FSWs. It has an estimated 10 lodges, 15 bars and a slum called omukalere. On average 40 trucks stop over every night. Truck population has however been on the decrease over the years following the establishment of truck-stops in

31 | July 2009 Mulago - Mbarara Teaching Hospitals Joint AIDS camping approach in Uganda, which it implements in Program (MJAP) the districts of Mbarara, Kiruhura, Isingiro and Ibanda, MJAP is a collaborative undertaking between Mulago and has in the recent past implemented home-based and Mbarara teaching hospitals. Since 2004, MJAP has HIV counselling and testing. been providing routine counselling and testing (RCT) to all its patients and their caregivers in 27 wards in Mulago Under community camping, a team of health workers and in 18 wards in Mbarara teaching hospitals; 6 stays in rural areas for a period of 4-5 days providing HIV regional hospitals and 6 satellite clinics located within counselling and testing, and care and support to the catchment area of the two teaching hospitals. HIV community members. In a period of one year (2008), positive patients are followed up through the family- MMHF applied the community camping strategy to based care (FBC) programme to their homes to counsel 40,298 and test 39,306 people for HIV22 . MMF encourage their family members to test for HIV. Since its records also show that between 2006 and 2007, 19,373 inception in 2004, MJAP has tested 335,518 patients clients were counselled and tested. using the RCT and the FBC approaches (MJAP 2008). In Financial Year (FY) 2007/08, 159,402 patients were tested for HIV. Of these, 97% were tested using the RCT approach in wards and clinics supported by MJAP and 18,678 were tested using the FBC. Although these services are not directed to sex workers and clients per se, and whereas FSWs visiting the hospitals do not disclose their social status, these services are available to the general population [FSWs inclusive]. All patients are tested irrespective of the presenting illness. Follow up of the positive clients (including FSWs) provides the opportunity for HIV counselling and testing to family members; encouraging disclosure and psychosocial support to orphans. Community camping takes HIV services closer to the population and takes into account community norms Mayanja Memorial Hospital Foundation (MMHF) and values. The approach is associated with high MMHF provides an integrated HIV services including: acceptance rates, high turnout and appropriateness for HCT, PMTCT, HIV prevention campaigns, treatment of reaching hard-to-reach populations such as STIs, TB screening, treatment of opportunistic pastoralists. Under community camping, services are infections, provision of Septrine prophylaxis, palliative available to the community both during the day and at care, referrals, peer education, training of health night over the course of one week, to the benefit of workers and couples VCT. MMHF also provides ART mobile groups such as fishermen, truckers23 , and boda- through Mayanja Memorial Hospital (MMH). MMHF is boda cyclists who may not have time to access HIV currently implementing two innovative HIV prevention counselling and testing during the day. Statistics were strategies: community camping and home based HIV not available on the number of sex workers and mobile counselling and testing with care and support. The populations accessing HIV services at MMHF. The foundation is credited for pioneering the community foundation remains a major player in HIV prevention in

22 MMF (2008) http://www.mmhfoundation.org/?link=projects Accessed on 15.01.2009 23 Especially if teams camp close to thehot-spots

A Response Analysis of HIV/AIDS Programming Along Transport Corridors in Uganda | 32 Mbarara, and potentially also for mobile clean water as most residents use “We do not have populations, sex workers and their polluted waters from River Mpondwe. information on the clients. MMHF could play an increasingly Insurgency that is common on the magnitude of their HIV important role if they target mobile mountainous areas has caused needs and therefore have populations by camping at hot-spots congestion in the lowlands. Sexual not responded adequately. such as Ruti and others along the offences and petty theft are common HIV focal person, Kasese Mbarara-Katuna highway. offences with perpetrators sometimes disappearing to the Congolese side to 3.3.5 Mpondwe Hot-spot in Kasese escape prosecution. District In Local Government, Most-at-risk populations are comprised of FSWs and their clients, which include truckers, and labour migrants in Hima Cement Company, Kasese Cobalt Company, Queen Elizabeth National Park, Rwenzori National Park, construction workers, prison farms, Mpondwe Town Council is along the soldiers in the army barracks, and ex- trans-Africa highway connecting Kenya fighters. The district leaders confessed to to the Democratic Republic of Congo and doing little with regard to HIV/AIDS is located 72 kilometres from Kasese prevention, care and treatment or social town. Mpondwe town council was support targeting sex workers and established in July 2008 and has an clients. The district is developing a five- estimated population of 170,000 people, year strategic plan in which they intend to approximately 50 bars and lodges, and target MARPs specifically, but it was not 260 FSWs. The overnight truck load is on obvious which MARPs would take first average 75. The town has a high priority. The existing coordination efforts overnight truck population because the usually involve holding meetings with Congolese authorities do not allow stakeholders but there are no binding or trucks to spend a night on that side of the border; in addition truckers prefer the more decent accommodation on the Ugandan side. The main economic activity is lodging, entertainment, and cross-border trade in fish, cement, produce, cloth, fuel, sugar and timber. Congolese music and alcohol are plenty in Mpondwe. Major tribes are Bakonzo, Batoro and the Congolese. The town has one hospital, Bwera Hospital and two HC IIIs names Kasanga and Nyabirongo. The town suffers from chronic shortage of

33 | July 2009 long-term commitments among stakeholders. The appropriate services to sex workers, truckers and their district notes that one of the reasons they have not families outside Hima. The demand for ART in Kasese is responded adequately is lack of strategic information overwhelming; however, the shortage of logistics limits on HIV MARPs. the number of patients that can be enrolled in ART. In addition, attracting employees to the available HIV In the construction sector, the district has enforced the services is still a challenge as a large proportion of requirement by the MoW&T that road construction employees prefer to seek services outside Hima companies hired to work in the district sensitize casual Cement. Other challenges include limited availability of workers and surrounding communities about HIV. funding for providing psychosocial support to PLWHAs Kasese Town Council has initiated HIV sensitization and meet the expense of sustained BCC interventions. activities with thematic road signs. A description of interventions by private sector actors, follows. 3.4 HIV PROGRAMMING FOR MARPs ALONG TRANSPORT CORRIDORS: DISTRICTS Hima Cement Company Limited ALONG THE KAMPALA JUBA ROUTE Hima Cement Company has a large fleet of trucks, and attracts migrant labourers from across Uganda and Along the Kampala-Juba Route, the study team visited elsewhere. Hima is a cement manufacturing company Migyera, Karuma and Bibia towns. Interviews were held established in the 1970s located in the district. The with selected district officials and civil society company has an elaborate HIV/AIDS programme that organizations as described below: targets all staff. It also carries out outreach activities to neighbouring communities within a radius of 10 3.4.1 Migyera Hot-spot kilometres. Specific interventions for migrant workers Migyera is 146 km from Kampala along the Kampala- started in 2003. HIV prevention interventions include Gulu highway. It is found in Nabiswera Sub-county, Hima community sensitization days, Hima Post-test . Nabiswera Sub-county borders club outreach, Hima Peer educators, and community Lake Kyoga to the east, Ngoma to the west, Wabinyonyi outreach. According to data available, Hima cement to the south and the Kafu River to the north. Migyera through its stand alone clinic and community outreach has a population of approximately 6,000 people and has was able to reach 1,605 people with VCT and 800 people approximately 8 ethnic groups that include, among with ART in 2008. The company works closely with AIC, others, the Baganda, Baruli, Banyankole, Acholi, Alur, MoH and MICROCARE in its HIV/AIDS programming. Banyoro, Langi, and the Banyarwanda.

The Company spent approximately 77,000 USD on HIV programmes for 2008 and has allocated the same for 2009/2010. From its HIV prevention programme, Hima Cement Company Limited has enjoyed a cordial relationship with the community. This is an important case of corporate social responsibility that should be encouraged among companies especially those employing large numbers of migrant workers in transport, mining, and manufacturing.

Despite the effort by Hima Cement, it was noted that a Migyera grew into a town in 1981 during the huge gap remains with regard to the delivery of construction of the Kampala-Gulu highway as it was

A Response Analysis of HIV/AIDS Programming Along Transport Corridors in Uganda | 34 used as a camping centre for the construction workers. among FSWs. The Works department is playing an This attracted migrant casual labourers from near and increasingly important role in HIV prevention by far. When the road was completed long-distance sensitizing road construction workers and surrounding truckers maintained the location as a stopover on their communities both on highways, contracted by the way to and from Northern Uganda. Following the MoW&T, and on district roads which are contracted by ascendance to power of the National Resistance the district. In addition, following the directive of the Movement in 1986 and the relative peace that ensued, MoW&T, the districts now requires all bidders for road shops, lodges and restaurants were set up. A health construction to budget for HIV sensitization among facility is located six kilometres from the town at the construction workers and surrounding communities. Sub-county headquarters. The township has an The department further follows-up to make sure estimated 10 private clinics. To date (December 2008), companies comply with the directive. an estimated 120 trucks stop over per night in Migyera. Several NGOs operate in Nakasongola District and at The population of truckers attracts a high number of the Migyera Hot-Spot in particular. These include FSWs who come from as far as Kampala to offer services Nakasongola Jerusalem Medical Centre (NAJMEC), at night and then travel back to Kampala. An estimated Caritas, TASO, Save the Children, Youth Empowerment 50 FSWs reside in Migyera town, and most of these are Against HIV/AIDS (YEAH), African Medical and Research employed as waitresses in lodges and restaurants. The Foundation (AMREF), and Concern World Wide. officials interviewed indicated that the FSWs include Specifically in Migyera, NAJMEC, World Vision and school girls and women in long-term relationships. Caritas are involved in providing HIV services including Below is a description of the response to HIV in HIV prevention outreach in the community, distribution transport programmes by stakeholders in Nakasongola of leaflets and brochures, and supporting peer district and Migyera. educators. The agencies have a strong orientation to mitigating the impact of HIV on households especially orphaned and vulnerable children (OVC) which is commendable. The challenge is that none of these agencies specifically targets sex workers and their clients in their HIV prevention campaigns.

3.4.2 Karuma Hot-spot Karuma is located 248 Kilometres from Kampala along the Kampala-Juba route. It is found in Mutunda Sub- county in Masindi District. It borders the districts of Oyam and Amuru to the north and the River Nile in the east. It has a population of about 700 permanent residents and a huge transit population. Karuma is Nakasongola District Local Government plays a critical comprised of numerous ethnic groups including the role of coordinating agencies involved in HIV/AIDS Lugbara, Congolese, Alur, Langi, Kakwa, Bakiga and prevention, care and support. As a stakeholder in HIV Banyoro. The town is host to a large population of IDPs prevention, the district health office carries out HIV from Northern Uganda, several of whom have found prevention sensitization campaigns, shows HIV livelihoods in Karuma town and are reluctant to return prevention films in the communities (town and rural to their homes even after the relative peace that has areas), and on some occasions distributes condoms ensued.

35 | July 2009 The history of Karuma dates back several decades as a radio spots through the local FM stations. NGEN+ Clinic gathering place for hunters and traders of ivory and specifically targets FSWs offering them HIV prevention rhinoceros horns from Murchison Falls National Park. information, condoms and HIV counselling and testing Karuma sprung to importance in 1963 during the services. construction of the Karuma Bridge when large numbers of people were arrived as casual labourers and sex Masindi Motor Cycle Association workers. Migrants were attracted from Lango, Acholi, The Association sensitizes its members on HIV/AIDS. At Arua, and Western Uganda. each boda-boda stage, there are five boda-boda cyclists working as peer educators to sensitize their colleagues There is little viable economic activity in this area aside about HIV and distribute condoms received from TASO from its importance as a truck stop, where an average of Masindi Branch and the district headquarters. The 60 trucks stop per night. There are about 14 bars located association refers its members to TASO for VCT and ART. mostly along the main road. There is only one public The association lacks funds to sustain and scale-up its health facility, a Health Centre II constructed and named prevention campaigns as well as proposal writing skills. after NGEN+. The clinic was constructed for workers during the construction of the Karuma Pakwach, after 3.4.3 Bibia Hot-spot which it was handed over to the government. Bibia is located in Atiak Sub County, and Transactional sex is very prevalent, with an estimated 60 is 11 km from the Uganda-Southern Sudan Border and FSWs excluding school girls. Below is the response of about 15 km from Nimule, the first trading centre in different stakeholders to the prevention of HIV among Southern Sudan along the Kampala-Juba route. It is most-at-risk populations in Masindi District, with about 450 km from Kampala along the Kampala-Juba particular emphasis on the Karuma hot-spot. Route. Bibia has an estimated population of 9,000 people comprised mainly of four ethnic groups, namely: The Masindi district administration considers road the Madi, Acholi, Baganda and the Sudanese. Bibia grew construction workers and the neighbouring into a town during the construction of the Gulu-Juba communities to be vulnerable to HIV and is therefore road in 1945. To date, the population has grown largely focussing prevention efforts on these population due to the influx of internally displaced persons fleeing groups. Bidding guidelines now require construction war in Northern Uganda and Southern Sudan. Bibia's companies to incorporate a section on HIV prevention, most-at-risk populations include: sex workers, truckers, which is funded within the contract. The district and uniformed personnel. Some IDPs engaging in high- monitors implementation of HIV prevention activities risk behaviour may also be vulnerable. It is estimated during road construction and also holds HIV that between 30 to 50 trucks stop-over in Bibia every coordination meetings to discuss cross-cutting issues night while the number of female sex workers is including prevention among most-at-risk populations estimated at about 250. There are over 20 bars and three in transport corridor risk-zones. large lodges. Some of these sex workers are employed in lodges as waitresses. There is only one public health Several CSOs provide HIV services in Masindi District centre in Bibia town (Bibia HC II) and several private including TASO, DANIDA, NGEN+, ACDI-VOCA and clinics. A summary of the response by stakeholders in Baylor Foundation. TASO provides HCT, palliative care to Bibia town and Amuru District in general, follows. PHAs with no specific services targeting most-at-risk populations in risk-zones near associated with the Amuru District Local Government does not have specific transport corridor. Baylor Foundation is involved in HIV prevention interventions for most-at-risk disseminating HIV information through talk shows and populations in the town. HIV counselling and testing is

A Response Analysis of HIV/AIDS Programming Along Transport Corridors in Uganda | 36 however carried out at Bibia HC II with International Rescue Committee (IRC), “Mobilizing MARPs is difficult because they are support from ICRC. The district also and Feed the Children. NGEN+ always on the move. They carries out VCT, HIV sensitization, constructed a clinic at Olwiyo on Karuma- don't have time to listen to condom distribution and referral Pakwach Road. The NGOs mentioned you. The district uses the services. Truckers do not benefit from above as operating in the district and at radio but the truckers may these services because the centres are Bibia do not target most-at-risk not tune the local radio all not open during the evenings when populations in transport corridor risk- the time and when they transport workers would be able to zones. Priorities are in other areas, stop over, they are always access them. It is not known whether sex including OVC. Until now, the funding drinking.” workers and their other clients are circumstances have not allowed NGOs HIV Focal Person, Amuru accessing the services. This concern is the flexibility to reach MARPs. District espoused in the quote. 3.4.4 Kampala Hot-spots The district carries out sensitization outreach to the general population and also broadcasts radio spots on the local FM stations whose frequency Truckers are not able to access when travel further away from the district. With the little support from UNICEF, ICRC, and Feed the Children, staff from the health centres in the district carry out outreach activities in markets. These activities could be used to reach out to truckers, uniformed service personnel, and FSWs and other MARPs at Arua Park is a busy location situated in the places where they often congregate. the middle of Kampala city; on Johnson It is unknown whether sex workers and Street. The park has a big day-time the majority of their clients, uniformed population of approximately 20,000 services, are being reached with targeted people due in part to a multiplicity of prevention programmes. activities taking place in the area, including but not limited to, small HIV coordination in Bibia and Amuru restaurant, clinics, bars, lodges and petrol district is weak. A few instances of stations among others. On average, more collaboration have been during the than 100 trucks are parked and loaded preparations for the World AIDS Day. This with merchandise every day. Trucks at collaboration has not been followed this hot-spot transport merchandize to through by the district to hold regular Northern Uganda towns of Arua, Koboko stakeholders' meetings. Several NGOs and Yumbe and beyond the Ugandan are involved in HIV prevention, care and border to Southern Sudan. The park is support activities in Amuru District, surrounded by approximately 30 bars including NGEN+, Marie Stopies, Health and 20 lodges, in addition to a few hotels. Alert Uganda, UNICEF, International These surrounding bars and lodges are Committee of the Red Cross (ICRC), reportedly a hub for most of the

37 | July 2009 “Given the resource constraints, commercial sex workers. Most of the over 10 bars and 5 lodges and district HIV interventions focus lodges in Arua Park charge on hourly reportedly has an estimated 50 on programmes for the general basis therefore, only a few truckers commercial sex workers. The nearest population and are not spend whole nights in lodges, resorting public health facility is Kiswa Health specifically targeted to MARPs.” instead to the open park ground and centre IV with a number of private HIV Focal Person, Kampala shop verandas. CSWs are relatively clinics and drug shops. Unlike other District cheap; costing between UGX 5000 and truck stops in Kampala, discussions UGX 20,000. The hot-spot has revealed that HIV outreach prog- “The district is willing to approximately five health facilities, rammes are periodically conducted at undertake interventions for mainly private drug shops. this hot-spot by the MildMay Centre MARPs in transport corridor Uganda. During these outreaches, HIV risk-zones, however the PHC Mbuya Truck Park is located in counselling and testing services, funds are insufficient and we Nakawa Division, along the Kampala- condoms distribution and HIV&AIDS [the district] lack prior Jinja highway. It is the biggest treatment services are provided. experience in implementing overnight stop for heavy trucks and HIV prevention programmes trailers in Kampala. Over 30 trucks park Nalukolongo WFP Park Yard was specific to MARPS.” each night. This truck stop is established in 2002 by the World Food District Health Officer, surrounded by small and medium- Programme (WFP) to accommodate Kampala scale businesses including food kiosks, the growing fleet of WFP trucks and retails shops operated mainly by transporting mainly beans, flour and young women that reportedly to hunger-stricken areas. This exchange sexual services with truckers hot-spot is found in Wankulukuku for a fee. There are approximately 20 opposite Muteesa II Stadium. It is bars and 15 lodges surrounding this located in Rubaga Division approx- truck stop. imately five miles from the city centre. The majority of the truckers are Kenyan However, it was reported that most nationals. On average 30 trucks park truckers prefer to use lodges in over-night in this yard, with the truck Bugolobi and/or Kireka because those volume increasing during agricultural around the truck stop are considered harvesting seasons. The park yard is substandard. So truckers pick SWs surrounded by small densely from this area and move with them to populated towns like Kabuusu, their desired lodging places. The Kabowa, Nalukolongo, Kitebi and lodges nearby Mbuya Park Yard mainly Kibuye. These towns are congested serve truck assistants and their sexual with markets, bars and lodges, mainly clients. Annexed to this Park Yard is operated by youth. 100 bars and 84 Mbuya Park Yard II in Kalerwe zone lodges were estimated in the area located approximately 70 metres away. surrounding the park yard, and these This Park Yard was established in 2003 provide entertainment, food and to accommodate the overflow of trucks accommodation for truckers and other from Mbuya Park Yard and currently an travellers. It was reported that bars and average 25 trucks stay overnight. lodges are the main contact points Mbuya Park Yard II is surrounded by between FSW and their clients. Apart

A Response Analysis of HIV/AIDS Programming Along Transport Corridors in Uganda | 38 from Kitebi Health Centre IV, most of transport corridor risk-zones but is “Addressing HIV issues in the the healthcare facilities are privately- constrained by funding and prog- transport sector requires taking owned clinics and drug shops. ramming capacity issues. an integrated approach. Transport sector strategies In Kampala District Local Government, It was also argued that “inadequate addressing HIV/AIDS need to truckers were easily mentioned by key recognition of the diversity of MARPs in integrate all relevant modes of informants, as MARPs, alongside the transport sector and of their living transport; however this is people living in fishing communities, and working conditions accounts for limited by lack of a coherent commercial sex workers, low-income the programming and coordination policy framework to guide the women, and women heads of gaps”. The result has been ad hoc, actions of the many households. Other MARPs frequently uncoordinated, and sometimes stakeholders targeting different mentioned included transport corridor duplicative interventions targeting at-risk groups and to establish business partners such as bar owners, different at-risk populations. responsibilities.” bar workers, food workers, young girls living in communities around hot-spots The district raised a concern that most and female transient traders. Despite of the previous interventions along “The responsible district the general recognition that truckers transport corridors were largely structures have not been and people living in areas of intense directed towards truckers and facilitated to do this work, thus transport operations are MARPs, nearly commercial sex workers, leaving out affecting a clear articulation of all the key informants were not aware other at-risk populations in the sexual specific roles that different of specific programmes targeting networks of transport corridors such as institutions could play within most-at-risk populations and communities leaving near truck stops, context of transport addressing particular HIV needs at the spouses of MARPs and those engaged interventions in order to raise “hot-spots” in Kampala. Resource in transactional sex that are not easily awareness and promote behavioural change.” constraints were cited as the main identifiable as practising sex workers. reason why HIV/AIDS interventions for Weak HIV programming for MARPs truckers and other MARPs had not was acknowledged. It was felt that; little “Even the little HIV prevention been successfully integrated with other had been done to integrate HIV issues interventions that are being existing district primary health care within the district-transport prog- undertaken by the different programs. rammes. transport companies for their employees are not well The HIV interventions that have been Key informants acknowledged that, documented and are not yet undertaken by the district include building smart partnerships involving integrated into the district distribution of free condoms, outreach transport companies and the district HIV/AIDS plans and programs (not specifically targeting health departments in the planning programmes.” MARPs), distribution of IEC material on and implementation of HIV inter- District Engineer, Kampala HIV prevention. The district also, in ventions for MARPs was critical for the partnership with organizations such as response. This, it was argued, would IDI, MJAP and Baylor, provides HIV ensure informed decision-making prevention, treatment and care through information sharing, and services through district health units. would promote effective interventions The district is willing to undertake HIV through sector-wide communication interventions targeting MARPs in and advocacy.

39 | July 2009 It was further emphasized that an effective response to Amalgamated Transport and General Workers the HIV needs among MARPs in transport corridors Union (ATGWU): requires establishment of robust coordination ATGWU, a member of the Uganda Long Distance and mechanism, reconciling the expectations of Heavy Truck Drivers Association was established in 1974 stakeholders and addressing their differing levels of and has been providing services to MARPs since 1999. commitment and implementation capacity. With financial support from Family Health International (FHI) (through the USAID ROADS Programme) and the Civil Society Organizations in Kampala Great Lakes Initiative on AIDS (GLIA) (through World Bank), the organization provides MARPs with services in AIDS Information Centre: Busia, Malaba, Naluwerere and Katuna. At each location, AIDS Information Centre (AIC) was established in 1990 ATGWU disseminates HIV prevention information to as a pioneer for VCT in Uganda. The organization works MARPs, operates a resource centre where MARPs are in over 30 districts and has 8 regional branches spread mobilized for VCT; and offers referral services to its country-wide. AIC initiated MARPs interventions in clientele. 2007 and provides these services using a variety of approaches including: facility-based, static clinics, Alliance of Mayors and Municipal Leaders on outreach, and home-based approaches. AIC carries out HIV/AIDS in Africa (Uganda Chapter): HIV prevention outreach among MARPs, distributes Alliance of Mayors and Municipal Leaders on HIV/AIDS condoms, carries out targeted VCT among MARPs, (AMICAALL) is a national NGO registered in 2000. particularly FSWs in Kampala. AMICAALL received funding from the Civil Society Fund under Uganda AIDS Commission and is implementing a AIC provides CD4 Count, treatment of opportunistic two year project (2008-2010) entitled: Scaling up of HIV infections, as well as Septrine prophylaxis through its preventions interventions in Urban Local Governments static sites. AIC carries out outreach activities to fishing project. The goal of the project is to reduce the risk of communities including: Gaba, Port Bell in Kampala and HIV infection among vulnerable young population and Kasenyi, and Kigungu and Nakawogo in Entebbe. among high risk groups in urban areas. The project is Available data indicates that AIC provided VCT and HIV being implemented in three urban councils namely: prevention services to: 1,004 fisher folk including 819 Mbale and Mbarara Municipalities and Nakawa Division fishermen and 185 fisherwomen; 2,357 truckers of Kampala City. Under this project, AMICAAL has including 2,295 men and 62 women; 1,862 boda-boda24 trained peer educators and condom distributors, cyclists; and 20,489 Internally Displaced Persons25 (IDPs) distributed condoms to CSWs and their clients and since 2007. AIC acknowledges that its interventions provided mobile VCT targeting high risk groups. among MARPs are still on a small scale and have not Statistics were not readily available on the numbers of been integrated into overall programming. Under its CSWs and truckers who have been reached with new strategic Plan 2008-2013, AIC intends to IEC/BCC campaigns, received condoms and VCT. The strengthen its interventions among MARPs. key challenges reported by AMICAAL are: the stigma

24 Public transport motorcycles 25 Although a vulnerable population overall, data is lacking to indicate that IDPs would in general be considered a most-at-risk group. Further study is warranted. See (1) The Lancet 2007; 369:2140-2141 DOI:10.1016/S0140-6736(07)60991-X Comment Comprehensive response to rape needed in conflict settings Rachel Jewkes a, (2) The Lancet 2007; 369:2187-2195 DOI:10.1016/S0140-6736(07)61015-0 Articles Prevalence of HIV infection in conflict-affected and displaced people in seven sub Saharan African countries: a systematic review Dr Paul B SpiegelMD a , Anne Rygaard BennedsenBSc b, Johanna ClaassMD a, Laurie BrunsMA a, Njogu PattersonMD a, Dieudonne YiwezaMD a and Marian SchilperoordMA a

A Response Analysis of HIV/AIDS Programming Along Transport Corridors in Uganda | 40 faced by CSWs and Truckers which holds them back The goal of the MARPs Network is to prevent and reduce from seeking services, and the mobile nature of truckers STI and HIV transmission among MARPs by 40% by which makes targeting, follow up and service provision 2012. Members within the network hold meetings and difficult. share lessons through exchange visits among other activities. The MARPs Network Secretariat is the STD Reproductive Health Uganda: Clinic at Mulago National Referral Hospital. RHU, formerly Family Planning Association of Uganda (FPAU) was established in Uganda in 1957 to provide Uganda Health Marketing Group: Reproductive Health (RH) services. The organization is UHMG is a private not-for-profit organization implementing MARPs activities along both the Busia to established in 2006. Since 2008, the organization is Katuna (Northern Transport) route and the Kampala- implementing HIV programmes targeting FSWs, Juba route. The MARPs programmes target truckers, truckers and fishing communities. UHMG operates in other transient traders and Commercial Sex Workers. Pakwach Town Council, Nebbi town and Arua Municipal RHU is currently implementing two MARPs projects Council. UHMG implements its programmes through namely: Breaking the Ice Project in Kawempe Division in sub-grantees. Through Advocacy for Social Kampala which has been implemented since 1998. The Development and Environment (ASDE-U), UHMG is project targets CSWs and their clients. Under this supporting the implementation of the “Putting on the project, RHU carries out home visits to CSWs, operates a Brakes'' project aimed at increasing awareness of STIs clinic for treatment of Opportunistic Infections (OIs), and HIV among long-distance truckers and their sex counselling and community based outreaches. The partners; improving access to VCT, and increasing project also operates a drop in centre for CSWs and their availability of condoms. UHMG has trained park yard clients in Mugalu Slum of Kawempe Division. volunteers who distribute condoms and audio tapes carrying prevention messages to truckers and their sex The second project is the Transient Traders Project partners. implemented in Mbarara Municipality targeting: transient traders, CSWs and other low income women. Women and Youth Services (WAYs): Key activities under this project include: information Women and Youth Services (WAYs) is a national Non dissemination on HIV prevention, distribution of Governmental Organisation (NGO) registered in 1993. condoms to CSWs and transit traders as well as training The organization is implementing: The Prevention and of peer educators. RHU's interventions among MARPs Control of HIV/AIDS among CSWs and their clients with are funded by the International Planned Parenthood funding support from AFFORD/UHMG. The Federation (IPPF), Japan Trust Fund, DANIDA and organization has been implementing services for a UNFPA. RHU is a member of the MARPs network. period of only one year (2008). The project interventions are implemented in Migyera town in Nakasongola The MARPs Network: district, Idudi town in and Naluwerere The MARPs Network is a network of organizations town Bugiri district. Under this project, WAYs distributes working with commercial sex workers and their clients condoms to SWs and their clients through bars and such as uniformed service personnel, truckers, brothel owners. The project also supports Saturday fishermen, migrant workers and other mobile behavioural change health clubs where CSWs, their populations in Uganda. In 2007, the STD/AIDS Control clients and peer educators share experiences on HIV Programme at the Ministry of Health (MoH) and MARPs prevention. In addition, WAYs trains CSWs in alternative organizations formed the MARPs Network through a Income Generating Activities (IGAs) like hair dressing. partnership with the Uganda Health Marketing Group. WAYs implements its activities in collaboration with

41 | July 2009 “A private company is profit- local CSOs and is a member of the infections among adults (15-49 years) driven. I pay a driver to do my MARPs Network. in 2008, 46% were among persons work. You can keep an HIV+ reporting multiple partnerships and person for some time as long Private Sector Providers in Kampala their partners, while 10% were among as they are still willing to work CSWs, their clients and partners of but finally as they get weaker, Aponye (U) Ltd. is one of the clients26 . you are forced to terminate transporters that WFP normally uses to their services.” move supplies across Uganda. It is a private company employing about 30 truck drivers and has no HIV “If I came up with a policy on programmes for its employees HIV/AIDS, that means I would because they find it very difficult to be asking people to test for HIV bring them together at once and talk to and declare their status to the them about HIV. No HIV/AIDS at the administration, definitely they workplace policy. An interview with will not accept.” Aponye revealed the challenges to the HIV response in the private sector. Recent epidemiological data on drivers “If we had some arrangement 3.5 PROGRAMMMING GAPS of new infections and a number of requiring us to provide support, transport-specific studies indicates care and treatment for HIV+ Funding for HIV programmes that governments and development employees, it will bring extra targeting MARPs at hot-spots partners (including donors) have not costs to the company. An along transport corridors placed priority funding on drivers of employee can even sue your The human and national development new infections, including addressing company for compensation just tragedy is that 25 years after socio-behavioural and service access in in case you failed to provide identifying truckers, sex workers and HIV “risk-zones” along national and the services that are clearly populations along transport corridors regional transport networks. As a stated in the company policy. in Uganda as drivers of the epidemic, consequence, a tangible HIV response So as you put in place such programming for the most affected is lacking for these population groups. policies, you need to look at the and infected among these populations other side of the “coin”. In the remains largely insignificant. The Related to the above, the 2008 Uganda private sector, these policies limited funding for targeted Modes of Transmission Study (200826 ) cannot work because the entrepreneurs know they will programming in transport corridor revealed that negligible resources had be tying up themselves. I don't risk-zones is partly accounted for by been spent on MARPs during have to put in place policies the lack of prioritization at the policy 2006/2007 and 2007/2008. Of the US$ which I cannot implement.” level despite evidence. HIV 234 million spent on the national HIV General Manager programming priorities must be response, just one-third was spent on Aponye (U) Ltd evidence-informed. The NSP HIV prevention. Data on funds highlights truckers and CSWs among available for MARPs was not available the key population groups at a higher among implementing institutions. It is risk of HIV infection. Of all new HIV therefore not surprising that this

26 Republic of Uganda. Uganda AIDS Commission. 2009. Uganda HIV modes of transmission and Prevention response analysis, Final report

A Response Analysis of HIV/AIDS Programming Along Transport Corridors in Uganda | 42 situational analysis has revealed that coordinated, the focus is on the “We urgently need to improve insufficient funding is available for HIV general population. MARPs in the coordination at the district. prevention, treatment, care, and transport corridor hot-spots are not HIV resources are wasted support programming targeting highlighted as a priority by several because of uncoordinated and MARPs in transport corridor risk-zones. district HIV focal persons interviewed. unsustained HIV interventions. The interviews revealed that MARPs, Respondents cited funding constraints Deputy CAO, Lyantonde though recognized as key drivers of the as the key cause for weak coordination, HIV epidemic, were not a priority however further analysis revealed that intervention area for both Local the coordination problems also stem Governments and most NGOs in the from weak targeting at national and HIV/AIDS response. The few innovative district level as well as collaboration interventions targeting FSWs and their gaps between NGOs and the local clients in truck stops were of small governments. In some districts, little is scale, few and far between, lacked known by local governments about the capacity for effective programming, interventions implemented by CSOs and are generally short-lived due to working within the districts visited. At funding constraints. This is both the national level, there are Kampala- unfortunate for those populations based CSOs claiming presence in the affected and infected, and a clear districts where they are not active and indication of the need for improved therefore no mention of them was targeting towards the socio- made. Such situations are encouraged behavioural drivers of new infections in by weak coordination. Key stake- Uganda. holders in the response find the coordination efforts unsatisfactory, as There is need for practical targeted the Deputy Chief Administrative funding for most-at-risk populations. Officer (CAO) in Lyantonde rightly expressed thus. Coordination Arrangements This study revealed that the national HIV response in transport corridor hot- spots or “risk-zones” is fragmented and uncoordinated both within and between sites. Coordination arrange- ments for targeting programmes towards MARPs in transport corridor risk-zones are weak. The coordination mechanisms at the district level are largely non-functional, for example, local government structures such as Public - private partnerships in the District AIDS Committees (DACs) response to MARPs do not meet regularly, and where they An effective response to MARPs meet there is insufficient focus on requires building effective MARPs. Where the HIV response is partnerships between the public

43 | July 2009 sector, the private not-for-profits (PNFP), and private programme that is harmonized in content and sectors. The public sector provides the policy, coordinated nationally (and regionally) such that actors coordination, M&E, and strategic guidance, the PNFP working in geographically separated hot-spots are sector mobilizes resources for the HIV response, and the indeed working together on a common programmatic private sector is capable of mobilizing both resources approach is evidently missing. and delivering HIV services to FSW and clients in hot- spots. Weak behavioural change interventions There were inadequate BCC interventions targeting Interviews with service providers revealed that in MARPs in the hot-spots visited. Existing IEC and BCC several instances, bar attendants double as FSWs. Such interventions targeted the general population under a situation highlights the current missed opportunity to the abstinence, be faithful, and correct and consistent collaborate with employers and workers in the use of condoms (ABC) approach. Apart from the use of entertainment industry when addressing HIV condoms, the other aspects of the existing prevention prevention among MARPs. Similarly construction strategy do not appeal to the FSWs and clients. Given companies, transport associations and transport their vulnerability to HIV infection, the need for MARP- companies, and civil servants (transport, rails, specific IEC/BCC strategies cannot be over emphasized. immigration, and customs) have not been adequately As indicated in Ferguson and Morris 2006, and other recruited into the HIV response for MARPs at hot-spots. studies, there is an urgent need for improved targeting, At a national level, the Private-Public Sector Partnership reach, and intensity (frequency) of targeted prevention desk in the Ministry of Finance, Planning and Economic programmes in transport corridor hot-spots27 . The study Development currently does not include MARPs in its indeed identified specific behaviours to focus on, with programs. particular emphasis required on consistent condom use between FSW and both casual and regular clients. The Fragmented HIV programming in transport authors went so far at to quantify the number of new corridor hot-spots infections that could be averted on the Northern From the study, it was evident that the national response Corridor through effective behavioural change to HIV for MARPs along transport corridors is of interventions focusing on consistent condom use as insufficient scale and intensity to stem the epidemic nearly two-thirds28 . both within the transport sector and nationally. There is clear lack of a common programme model that meets In spite of this strategic knowledge it appears that the the needs of these highly-affected population groups in continued inadequacy in targeted prevention a comprehensive and holistic manner. Development programmes stems from a wider BCC/social change partners, government and all implementing partners policy and strategic response gap on the part of currently lack a shared programme framework for concerned governmental institutions and development MARPs in transport that offers a comprehensive service partners. Whereas the NSP highlights the need for package of integrated health services, targeted improved targeting towards MARPs, the current NPAP behavioural change, vulnerability reduction and does not prioritize populations engaging in multiple partnership building, multisectoral communication, concurrent partnerships in transport corridor risk- advocacy and policy development, and M&E. A zones.

27 Morris, C.N., and Ferguson, A.G. Hot Spot Mapping of the Northern Corridor Transport Route Mombasa to Kampala. University of Nairobi / University of Manitoba Strengthening STD/HIV Control Project. December 2005. 28 Morris, C.N., and Ferguson, A.G. Estimation of the sexual transmission of HIV in Kenya and Uganda on the trans-Africa highway: the continuing role for prevention in high risk groups. Sex Transm Infect 82: 36871. October 2006.

A Response Analysis of HIV/AIDS Programming Along Transport Corridors in Uganda | 44 Furthermore, there is inadequacy of national (and effective prevention tool and for facilitating access to regional) guidance for implementing partners on how treatment, care, and support. Available evidence to prevent HIV among MARPs. CSOs have been at the indicates that these populations are highly affected and forefront of implementing population-specific infected by HIV, but that voluntary counselling and interventions, largely precisely cross-generation sex testing (VCT) and provider-initiated counselling and and youth-friendly HIV prevention efforts. This is testing (PICT) are unavailable. however not specifically targeted towards or reaching most-at-risk groups. Information on HIV prevention in The absence and weakness of HIV prevention general and population-specific information is interventions targeting FSW and clients along transport disseminated through: television spots, radio jingles, corridors and lack of a communication strategy for leaflets, brochures, billboards and sensitization demand creation, has further marginalized most-at-risk campaigns in institutions of higher learning. Similar can populations from treatment, care, and support. Due to be done for populations engaging in HIV-risk behaviour the stigma attached to sex work, and the mobile nature in transport corridor hot-spots. Throughout this study, of many FSW clients along transport corridors, it the inappropriate effective behavioural change becomes difficult for the MARPs to access most interventions targeting populations in transport government health services. Furthermore, the current corridor risk-zones was evidenced by limited availability national service delivery mechanism is such that of targeted IEC materials at the hot-spots and the patients register with one health facility for ART and TB- limited programmatic success stories from the local DOTS, which monitors their progress and provides re- governments whether past or ongoing. supplies. This system currently hinders access to services and continuity of care for those populations HIV care and treatment services who due to their mobility need to access services in a There is no known minimum service package that is number of locations, both within Uganda and in specific to populations at transport corridor hot-spots, neighbouring countries. either at the regional, national or district level. The existing care and treatment services are accessed mainly through the static public and private health facilities; without adequate information on available services and referrals, populations, particularly mobile groups like truckers, are unlikely to use these facilities. Furthermore, this and other studies have found that services are open at inconvenient locations during inconvenient times of day29,30 .

It was also revealed that FSWs find it stigmatizing to Social Support seek health care from busy and public health facilities, Social support to FSWs and truckers living with albeit those that do obviously do not reveal their HIV/AIDS is significantly weak. Most of the identity. Access to HCT is of special importance to organizations interviewed are involved in HIV MARPs in transport corridor risk-zones, both as an prevention and only two provide social support, namely

29 Carael, E. Long-distance Truck Drivers' Perceptions and Behaviours Towards STI/HIV/TB and Existing Health Services in Selected Truck Stops of the Great Lakes Region: a Situation Assessment.. April 2006. IOM Nairobi. 30 Carael, E. Long-distance Truck Drivers' Perceptions and Behaviours Towards STI/HIV/TB and Existing Health Services in Selected Truck Stops of the Great Lakes Region: a Situation Assessment.. April 2006. IOM Nairobi.

45 | July 2009 TONASO and WAYS. MARPs at hot-spots living with HIV behaviours in East Africa, as well as impact of actions on together with their families need access to social stemming the epidemic31 . support services which could include: training in apprenticeships and livelihoods, provision of income Capacity gaps among players generating activities, ongoing counselling, provision of Respondents highlighted the limited personnel with the school fees to children, outreach activities to sexual skills needed to respond to MARPs' HIV issues at policy partners and family members, and workplace HIV level, for example the overwhelmed ministry staff programmes that encourage HCT, destigmatize, and coordinating HIV issues, without out even clear job offer access to peer-support groups. Interventions descriptions. On the other hand, are the capacity gaps in aimed at controlling HIV among MARPs do not MARPs-friendly programming with various currently integrate social support. respondents expressing the challenge of delivering and monitoring services to mobile targets. Monitoring and Evaluation Most of the respondents did not collect information on A number of district and NGO officials highlighted the access to services among MARPs. For example none of inadequacy in human resources with the skills needed the Local Governments had statistics on the number of to offer MARPs-friendly services, pointing out that there FSWs and their partners tested for HIV, receiving were difficulties in designing messages as well as condoms, benefiting from referrals, and being reached mobilizing mobile populations for services. Skills and with behavioural change communication and IEC capacity gaps of health and other workers, within materials etc. This is partly due to the fact that MARPs existing structures to effectively address prevention, have not been a priority for HIV services organizations, treatment, care, and support in these hard-to-reach both public and private alike. The study established that populations were noted. In undertaking BCC and strategic information is not collected on the individual promoting positive prevention, a number of and collective impact of HIV prevention interventions respondents working for NGO/CSO, private sector, and targeting MARPs. Furthermore, as consistently noted by in government indicated the need for improved skills IOM in Uganda and regionally, there is inadequacy of and tools for effectively reaching sex workers and their quantifiable and generalizable data required for clients in HIV hot-spots32 . measuring HIV prevalence (and incidence) and With regards to the MoW&T, it was noted that the capacity to address the HIV needs affecting the transport sector needs more than just a HIV focal point person. The HIV focal person does not even have a clear job description, similar applies to most ministries. A personnel gap was identified in which it was highlighted that the ministry needs a group of specialized and trained officers that can facilitate operationalization of sectoral HIV/AIDS strategic plans. The MoW&T currently assigns roles to a few selected officers that already have busy job schedules, which leaves a clear need to train a critical number of HIV resource persons.

31 Irving, G. HIV and Trasport Corridors in the EAC What Does the Data Say? Presentation to the 1st EAC Multi-Sectoral Stakeholders Meeting on HIV along Cross-border Transport Corridors, Arusha. October 2008. 32 IOM (2009) HIV Knowledge, Attitudes and Practices of Truckers and Female Sex Workers Along Major Transport Corridors in Uganda

A Response Analysis of HIV/AIDS Programming Along Transport Corridors in Uganda | 46 4. Recommendations

1. Resource mobilization !Strengthen coordination structures regionally !Under the leadership of the Ugandan AIDS through RECs, centrally through the UAC, as Commission, IOM and other stakeholders well as at the district levels in order to facilitate should mobilize more funds targeting MARPs implementation of a comprehensive and along transport corridors. The UAC Civil harmonized response. Society Fund would be one avenue for !Ensure that stakeholders meet regularly in providing grants to NGOs to scale-up targeted order to align systems, share lessons learned interventions for example by issuing a Request on overcoming challenges, and identify for proposals specifically for MARPs programme coverage gaps. interventions. !Engage employers in transport, construction, !Build awareness of donors and policy-makers civil service (customs, immigration, etc.), and on the existing state of the response and entertainment establishments (bars, lodgings, programming needs through effective restaurants) to implement workplace HIV advocacy. policies and programmes, including supportive environments for facilitation of 2. Coordination, Partnership-Building and access to services, retention of HIV-positive Vulnerability Reduction staff, and de stigmatization. !Strengthen the existing coordination !Design interventions to reduce vulnerability to mechanisms within local governments for HIV through engaging communities residing effective management of the response for near hot-spots. MARPs; institute coordination mechanisms !Build partnerships with the private sector among the civil society organisations and clinics and pharmacies to encourage other actors to facilitate efficiency and appropriate treatment (per national effectiveness. guidelines), ensure access to affordable condoms, and refer for HCT and tuberculosis services.

3. Harmonized programming for MARPs !Partners should support and implement a common programme model that meets the needs of MARPs at transport corridor hot- spots in a comprehensive and holistic manner. This programme should be harmonized in content and coordinated nationally (and regionally) such that actors who are working in geographically separated hot-spots are indeed working together on a common programmatic approach.

47 | July 2009 4. Targeted Behavioural Change smartcard, or other technology). !Develop and implement direct interventions !Adherence to national guidelines and regional that reach MARPs with effective BCC and social harmonization for quality and continuity of change communication. care within Uganda and trans-border. !Create a supportive environment for behavioural change through instituting 6. Multisectoral Communication and Advocacy mechanisms that ensure regular access to !Market collective efforts of various players condoms for MARPs and other health and HIV through branding to promote service use. services and information. !Undertake massive and sustained national and !Establish national (and regional) frameworks regional HCT campaigns together using and toolkits that guide BCC programming multiple media channels, and use these to partners. reinforce prevention programming and access to ART and TB services. 5. Integrated Health Services !Involve employers, policy-makers, donors, and !Establish a defined health service package private healthcare providers in demand targeted to the specific needs of MARPs in hot- creation, in promoting workplace policies, and spots (e.g. open in accessible locations, during destigmatization. the evenings, offering services that respond to !Capture and share effective practices from the identified needs of truckers, sex workers, within Uganda and regionally. and other priority populations. !Scale-up HCT for MARPs in hot-spots, with targeted campaigns that promote regular or routine counselling and testing. !Utilize HCT and adherence counselling for ART and DOTS as an effective vehicle for prevention counselling, through face-to-face counselling, treatment partner systems, and regular follow-up through mobile phone / text messaging. !Create a client data management and health management information system (HMIS) to allow for smooth service delivery to truckers and FSWs between hot-spots within Uganda and across borders. !Develop HMIS to capture important clinical data such as adherence, resistance, and 7. Monitoring and Evaluation framework and treatment success rates corridor-wide, with strategic information ! linkages to the central level. Undertake repeat bio-behavioural !Establish effective referral networks, including surveillance surveys (within Uganda and marketing of available facilities, direct referral regionally) among MARPs to identify baseline between facilities within / between hot-spots, HIV prevalence and behaviours, and to and with capacity to find client data regardless measure collective trends and impact of of location (e.g. using health passport, implementing partners.

A Response Analysis of HIV/AIDS Programming Along Transport Corridors in Uganda | 48 !Agree on common indicators for monitoring beneficiaries in order to identify successes and and evaluating HIV and health programming quality constraints. for MARPs, including utilization of national !Document effective models for implementing UNGASS indicators (and reporting). the programme, and share these in regular coordinating meetings at national and regional levels. !Implement M&E through national structures with regional linkages through RECs.

8. Capacity building !Build capacity and offer technical assistance to local governments, civil society organisations and the private sector to ensure an effective and harmonized response for MARPs. !Step-up institutional development and capacity building through training and other approaches for all the relevant stakeholders. The capacity building should be a continuous activity and not a one-off, as is usually the case. !MoW&T capacity to address the HIV needs !Regularly identify and address programming affecting the transport sector needs more than gaps. a focal point person for HIV. The ministry !Regularly assess the effectiveness, coverage, needs a group of specialized and trained and intensity of prevention activities, including officers that can facilitate operationalization of BCC, HCT, and condom availability. sectoral HIV/AIDS strategic plans. The !Measure the outputs and impact of MoW&T needs to train a critical number of HIV interventions through surveys and utilization resource persons as compared to simply of HMIS, and integrate these into UNGASS and assigning roles to a few selected officers that other reporting mechanisms. already have busy job schedules. The HIV focal !Undertake process evaluations that engage persons at both the ministry and district levels stakeholders, service providers, and should have clear job descriptions.

49 | July 2009 5. References

Carael, E. Long-distance Truck Drivers' Perceptions and Behaviours Towards STI/HIV/TB and Existing Health Services in Selected Truck Stops of the Great Lakes Region: a Situation Assessment. April 2006. IOM Nairobi

East African Community Integrated Regional Multi-sectoral HIV and AIDS Strategic Plan, 2007- 2011

East African Community. 2008. Proceedings of Stakeholder Meeting, EAC Regional Cross-border Transport Corridor HIV/AIDS responses

East African Community. LVBC. 2008. transport corridor: HIV/AIDS risks and vulnerabilities. A paper presented at the East African Community HIV/AIDS Cross boarder regional transport corridors stakeholders meeting, AICC, Arusha, October 2008

Irving, G. HIV and Transport Corridors in the EAC What Does the Data Say? Presentation to the 1st EAC Multi- Sectoral Stakeholders Meeting on HIV along Cross-border Transport Corridors, Arusha. October 2008

IOM and SIDA. 2006. Responding to HIV and AIDS in the Fisheries Sector in Africa

IOM and UNAIDS. 2005. HIV and mobile workers: A review of risks and programmes among truckers in West Africa. 2005

IOM. 2006. Mapping HIV along the northern Maputo and Nacala transport corridor in Mozambique

Kenya MoT Study Team. Modes of Transmission, Epidemiological and HIV Response Synthesis: Inception Report. March 2008. National AIDS Control Council, Kenya

Kribs- Zaleta et al. 2005. The effect of the HIV/AIDS epidemic on Africa's truck drivers. American Institute of Materials Sciences, page 771-788

Kriitmaa, K., Ferguson, A., and Irving G. HIV Hot-Spot Mapping along the KampalaJuba Route. IOM June 2008

Lurie, M., Migration and the Spread of HIV in South Africa, (Baltimore, MD: PhD thesis, Johns Hopkins University School of Hygiene and Public Health, 2001)

Mapping HIV along the northern Maputo and Nacala transport corridor in Mozambique: IOM, PHAMSA 2006

Meeting of EAC HIV and AIDS Cross-border Regional Transport Corridor Stakeholders: Report of Meeting. 07-08 October 2008. EAC HQ Arusha, Tanzania

A Response Analysis of HIV/AIDS Programming Along Transport Corridors in Uganda | 50 MMHF (2008) http://www.mmhfoundation.org/?link=projects Accessed on 15.01.2009

Morris, C. and Ferguson, A. Hot Spot Mapping of the Northern Corridor Transport Route Mombasa to Kampala. University of Nairobi / University of Manitoba Strengthening STD/HIV Control Project. December 2005

Morris, C.N., and Ferguson, A.G. Estimation of the sexual transmission of HIV in Kenya and Uganda on the trans- Africa highway: the continuing role for prevention in high risk groups. Sex Transm Infect 82: 36871. October 2006.

Mwijuka, B and Kaweesa K.D. 2008. Modes of transmission study, Uganda. Review of financial resources for HIV prevention interventions

Republic of Uganda. MoW&T. Uganda Joint Annual Transport Sector review report, 2007

Republic of Uganda. UBOS. 2004. Uganda HIV Sero-Behavioural Survey 2004-05

Republic of Uganda. Uganda AIDS Commission. 2007. National HIV & AIDS Strategic Plan 2007/8 -2011/12

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51 | July 2009 Annex 1 Technical Working Group Members

1. Namulondo Joyce Kadowe - Chair UAC/NACAES 2. Bernadette Nalumansi Ssebadduka IOM 3. Catherine Barasa UNAIDS 4. Cypriano Okello MoW&T 5. Deo Waiswa Ministry of Local Government 6. Esther Karamagi PACE 7. Geofrey Mujisha MARPs Network 8. Joseph Mulyanga MoW&T 9. Lazarus Ocira Office of the Prime Minister 10. Lillian Tatwebwa UAC/GLIA 11. Mohammed Kasule Ministry of Education and Sports 12. Michael Lukwiya WHO 13. Michael Muyonga Ministry of Health 14. Mugeni Ouma ATGWU 15. Primo Madraa UNFPA 16. Raymond Byaruhanga AIC 17. Saul Onyango UAC 18. Rose Kabugo UAC 19. Rose Nalwadda UAC/IGAD 20. Pauline Ajilong UAC

A Response Analysis of HIV/AIDS Programming Along Transport Corridors in Uganda | 52 Annex 2 List of Study Respondents

Transport Corridor Hot-spot/ District Respondents

Busia-Katuna Route Malaba / Tororo Amalgamated Transport Workers Union (ATGWU) in Tororo Deputy Chief Administrative Officer District Health Educator Family Health International Malaba Malaba Kyosimba Change Development Association Tororo Network of AIDS Service Organizations (TONASO) Uganda National Roads Authority, Tororo

Assistant Engineering Officer Bugiri Network of AIDS Service Organizations (BUNASO) Chief Administrative Officer District Engineer District Health Inspector GOAL Bugiri HIV/AIDS Focal person Integrated Development Activities and AIDS Concern (IDAAC) The Energy Institute UCOBAC Uganda Reproductive Health Bureau

AIDS Control Programme Manager, Ministry of Health Deputy Chief Administrative Officer

Busia-Katuna Route Naluwerere / Bugiri Assistant Engineering Officer Bugiri Network of AIDS Service Organizations (BUNASO) Chief Administrative Officer District Engineer District Health Inspector GOAL Bugiri HIV/AIDS Focal person Integrated Development Activities and AIDS Concern (IDAAC) The Energy Institute UCOBAC Uganda Reproductive Health Bureau

53 | July 2009 Annex 2: List of Study Respondents

Transport Corridor Hot-spot/ District Respondents

Busia-Katuna Route Malaba / Tororo AIDS Control Programme Manager, Ministry of Health Deputy Chief Administrative Officer District Engineer District Health Officer General Secretary, ATGWU HIV Focal person, Kampala HIV Focal Person, Ministry of Works and Transport HIV/AIDS Programme Officer, Uganda Health Marketing Group National Coordinator, Great Lakes Initiative on HIV/AIDS (GLIA) NGEN+ Programmes Director, AIDS Information Centre Programme Manager, Women and Youth Services (WAYS)

Busia-Katuna Route Lyantonde / Lyantonde Coordinator, AMICAAL Deputy Chief Administrative Officer District Engineer HIV Focal Person

Ruti town / Mbarara Chief Administrative Officer District Health Officer HIV/AIDS Focal Person Local Council II Chairperson, Ruti Town

Busia-Katuna Route Mpondwe/ Kasese Deputy CAO District Engineer District Health Educator HIV/AIDS Focal Point Person Mpondwe Community Liaison Officer

A Response Analysis of HIV/AIDS Programming Along Transport Corridors in Uganda | 54 Annex 2: List of Study Respondents

Transport Corridor Hot-spot/ District Respondents

Kampala-Juba Route Migyera / Nakasongola Chairperson, Nakasongola Boda-Boda Association District Engineer District Health Officer District Works Supervisor HIV Focal Person, Nakasongola Nakasongola Jerusalem Medical Club (NAJMEC) Local Council 1 Chairperson Migyera Zone, Migyera Town Vice Chairperson, Nakasongola Boda Boda Association

Kampala-Juba Route Karuma / Masindi Counselling Coordinator, TASO Masindi District Health Officer District Works Supervisor HIV Focal Person Masindi Motorcycles Operators Association

Kampala-Juba Route Amuru / Bibia District Engineer District Health Officer HIV/AIDS Focal person Rural Community Empowerment Association

55 | July 2009 www.iom.int

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