A RESPONSE ANALYSIS OF HIV/AIDS PROGRAMMING ALONG TRANSPORT CORRIDORS IN UGANDA 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 Kampala 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 Tororo District 25 3.3.2 Naluwerere Hot-spot in Bugiri District 27 3.3.3 Lyantonde Hot-spot in Lyantonde District 29 3.3.4 Ruti Hot-spot in Mbarara District 31 3.3.5 Mpondwe Hot-spot in Kasese 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