A letter to Janet K. Museveni and Center for Disease Control in Atlanta
GLOBAL HEALTH
I have just completed a valuable experience at a facility called the New Life Medical Center (NLMC) in a remote Northern Uganda District of Kitgum. This center offers HIV related treatment and provides psychosocial support to mothers who are enrolled in the Maternal Child Health’s PMTCT program. This facility belongs to Food for the Hungry - Uganda, an affiliate of FH International, a Christian based international organization. This particular health facility, accredited at health center II, is funded by Blood Water Mission in Tennessee, USA. This facility is quietly transforming lives of persons living with HIV in Kitgum, Pader and Lamwo districts with promises to realize HIV free generation!
The purpose of this letter are threefold: to applaud your endless efforts at fighting HIV and to recognize the investment in both human resource capacity development and provision of relevant logistics for the treatment of HIV such as ARV drugs and others; to inquire from your respective offices whether it is realistic and possible to achieve the dream of engendering HIV free generation in Sub-sahara Africa under its current conditions and; Ito contribute in shaping the global discourse towards consolidating MDG experiences in this region.
A background would suffice. The NLMC is the second most reliable treatment center in Kitgum district after St Joseph’s Hospital, a Catholic establishment. The NLMC is specifically focused on HIV treatment, although it provides general outpatient clinical services. In my stay at this facility, I witnessed 100% HIV negative turnover of Early Diagnosed Infants in the Stewardship study program which enrolled mothers to a PMTCT program when they are within 14 weeks of gestation or under.
The outcome of this treatment convinced me that the WHO Option B+ is a golden bullet for that shared global dream of HIV free generation. I believe that this is a unanimous global position because results from a strict adherence to Option B+ would exceed the 95% target of mothers not transmitting HIV to their unborn foetuses.
The CDC identifies three biomedical conditions under which this dream could be realized; lifelong antiretroviral treatment for persons living with HIV; eliminating mother to child of HIV infection and expanding voluntary medical male circumcision.
While I may agree with the CDC’s position on biomedical management of HIV, this prospect has its limitation in the global health realms. In Sub-Sahara Africa, studies show that Male circumcision can only reduce HIV infection invariantly by close to 60%. My critical analysis estimates that biomedical aspect of HIV care contribute to about 30-40% of the total HIV free generation discourse. The other 60-70% is mediated through psychosocial aspects. A robust combination of the two paradigms, however, has great potentials to yield the highest outcome expectancies.
Biomedical aspect of HIV care are known; counselling and testing; enrolment in ART, male circumcision and accompanying health education. The psychosocial aspect of the treatment is the recognition of the vast arrays of the impacts of social determinants of health on the persons or family living with HIV. This is very crucial aspect of HIV care and yet it attracts disproportionally little funding.
In my work with the NLMC, I found that health literacy/education, income, social support networks, gender (male involvement) and transportation were the major social determinants of health that affected timely uptake of EMTCT services and slows the realization of HIV free generation.
It is at this level that my question becomes relevant. How can we espouse so much hope in a HIV free generation when the children we are delivering HIV free are born into the very same risky social conditions under which their parents are entrapped in - especially in sub-Sahara Africa?
For Northern Uganda, this dream is very far off the mark as yet. For Uganda, where HIV statistics are politicized, the realization of this dream may even be challenging. For instance, studies by Ahaibwe and Kasirye (2013) showed that only 56% of Ugandans have ever used HCT/VCT services and therefore by implication, only half of the Ugandan population is aware of their sero-status. This contradicts the official figure that 1.5 million people are living with HIV. I challenge this position and argue that HIV prevalence in Uganda is about 15% with some regions having prevalence of up to 18% - thanks to antiretorviral medications. Unless we become bold and honest, how can we dream of a HIV free generation? In Uganda's case, honesty and integrity are missing in the HIV free generation discourse.
END
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