The AFRican

By Frankie Edozien

KAMPALA, Uganda

With so many people infected by the HIV virus here, it was inevitable that a sizable number of couples would have negative partners. Keeping those partners virus free has led one organization to try a novel approach — having a social club for such couples. The Discordant Couples club is run by The AIDS Service Organization (TASO), Uganda’s longtime HIV support network. They meet quarterly and share experiences and have counseling sprinkled into their sessions. “It is a big challenge,” said TASO spokeswoman Anne Kaddumukasa.

“Many of them do share that their spouses get tired of using condoms and sometimes if it is the woman, because culturally the woman has less power over sexual related issues, sometimes we may not have enough power to convince the spouse to put on a condom,” she added. Since TASO began the club, it has grown to over 100 couples. About half of the patients in TASO’s Kampala center qualify as discordant couples. Indeed, many women have found out they are infected and their husbands continued as before, until the women actually fell sick, as was the case of Zam Nakawooya, a schoolteacher.

The married mother found out she was HIV positive in 1993, but it was not until her second child was born and she fell sick years later that her husband got tested. “We took our blood and found out I was positive and he was negative. So he wondered ‘how did it come? I’ve stayed with my wife almost 10 years; how can it be like that?’ That doctor said it usually happens and we call those people, discordant couples.”

At Kampala’s leading HIV clinic, the Infectious Disease Institute, head of clinical services explained that HIV has touched the entire nation. “In Uganda any family, has lost someone or a friend to HIV, in that sense it is easy to deal with stigma. Everyone is affected,” said Andrew Kambuga. “The national prevalence stands at 6.4 percent that represents a triumph. So before this, HIV prevalence was between 12 and 15 percent in the late 90s.” The doctor estimated that now there could be 150,000 new infections annually so novel approaches are welcome and needed. The nation’s population is 27.6 million.

“We realized that we really needed to support these people, because many of them have children, many of them have been living together for over 10, 15 years, and encouraging them to separate will not help because they need to bring up these children,” Kaddumukasa added.

Speakers are brought in often and blame is severely discouraged. Part of the club’s mission is to have members have a life free from blame, free from judgment and a sexual life that includes proper condom use all the time. Very few members who are negative have been infected in the five years of the club. “We keep checking them but it’s very insignificant. So that means they are using condoms. We also assure them that ‘you may not remain negative all your life if you continue to expose yourself to the infection. You can sero-convert and become positive,” she added.

This report is supported by the Project for International Health Journalism Fellowship Program as part of the Henry J. Kaiser Family Foundation’s Media Fellowships Program.

Images Courtesy of www.tasouganda.org and http://www.idi.ac.ug

By FRANKIE EDOZIEN

New York Amsterdam News

Nov 27-Dec 3, 2008

 KAMPALA - Nathaniel Okeji looks out from the balcony to the gargantuan Mulago Hospital across the dirt road and shakes his head in awe.

On this spring day, the Nigerian military doctor is on a break from the intensive lectures he and 22 other African doctors are receiving from Uganda’s Infectious Diseases Institute (IDI).

As the cacophony of dialects hum around him, Okeji a pediatrician marveled at how Ugandan doctors successfully test newborns for HIV, the virus that causes AIDS.

In his home country, he has to wait until the infants are at least 18 months old.

“I’m very impressed with what I’m seeing here,” Okeji says. He’s been making the rounds with IDI doctors for the past three weeks.

“We are going to bring an entirely new face to HIV management in Nigeria, especially among the military. The standard here is exactly almost what I’ve been seeing going abroad the in the UK or USA. As far as I’m concerned, the USA is now here in Uganda.”

Along with Okeji, the Nigerian government has dispatched eight other doctors to this inconspicuous single-story Ugandan clinic, nestled in the hills that surround Kampala.

Since opening in 2004, this state-of-the-art facility has become the go-to institution African countries trying to effectively manage HIV treatment, as well as others looking to learn what works in developing nations.

The institute is dwarfed in size by its neighbor, Mulago Hospital, Uganda’s national hospital.

Mulago’s expansive grounds and blue and white walls are familiar to some moviegoers, as scenes form “The Last King of Scotland” were shot there.

IDI is showing consistently that premium care can be given even without having investments in numerous brick-and-mortar structures. Its patients, called friends, are regaining their foothold in society after being pulled from certain death.

Other African nations have taken note of Uganda’s success in bringing a sizable chunk of its population back from the brink of death and looked to its successful roadmap to treating millions infected with HIV.

For Patrick Makelele, one of two Zambian doctors who came for the IDI training program, a need to learn to successfully managing patients on antiretroviral therapies brought him to Kampala.

“My expectation is to update my skills in ART management, get the latest [information] . . . basically to learn from the huge experience of Uganda,” says Makelele, who is employed to support Zambia public health ministry.

Andrew Kambugu, 35, the institute’s head of clinical services, says training in the management of malaria, the continent’s other great scourge, is also offered to doctors. And he says dividends are already being paid in the region.

“The outlook for this institute is to be a regional institute serving [all of] Africa, not just Uganda. One of the initial stimuli for the development of this institute was to have a program that would impact beyond Uganda.”

So far, 28 African countries have sent close to 2,000 medical professionals there to be trained. Skills are then passed on to doctors and nurses who could not be there.

IDI has set up an on-call center manned by two pharmacists daily to take calls and emails from doctors and nurses from across the continent whom they’ve trained.

“A doctor might call and say ‘I started my patient on these three drugs and he’s come back later and his body has broken out in a rash. His eyes are swollen and red. What could be the cause?’” explains Rabinah Lukwago.