TASO Gulu Care Centre is devising strategies to deliver medication to minimize stigma. Photos by Simon Wokorach
By Eden Mic and Simon Wokorach
Gulu: Stigma is still affecting adherence to antiretroviral drugs by persons living with HIV in Acholi sub-region.
The Centers for Disease Control (CDC) defines stigma as negative attitudes and beliefs about people with HIV and prejudicially labels them as part of a socially unacceptable group.
According to the CDC, stigma affects the emotional and mental well-being of people living with HIV as they develop a negative self-image and fear of being judged. This results in self-stigma, subsequently, leading to feelings of shame, despair, and fear of disclosing status, getting tested, and seeking treatment.
Easy access to Antiretrovirals (ARVs) has improved the lives of persons living with HIV/AIDS because it has made the infection manageable with adherence to the drugs. However, stigma has been identified as one of the reasons clients abandon or miss medication doses.
Walter Okema, the Center Program Manager at TASO Gulu said, because of stigma, 300 of the 8,959 people who are living with HIV have abandoned treatment between January and March 2024.
Okema said out of the 300 who abandoned treatment, only 160 have been traced and enrolled back, something he said is challenging in the fight against new infections.
Mary Atim, a peer counselor at TASO, noted that while the level of drug compliance amongst adults continues to improve, drug adherence in children remains low because of stigma.
Atim revealed that the center has 650 children on treatment but most of them stay with their grandparents or guardians who do not want to be seen collecting ARVs.
“Many of those children are with their grandparents or guardians who don’t want to be seen collecting drugs. Sometimes they come at night but most times they are busy with their businesses,” Atim said.
In 2022, Uganda developed a stigma and discrimination guideline stipulating the major causes of stigma in the community and how to address each cause.
Victor Rwengabo, the mid-month Zonal Coordinator for Uganda AIDS Commission, revealed that ART enrolment in the sub-region remains low at only 78% against the country’s enrolment of 90%, yet ARVs are now at every Health Center III.
Rwengabo stressed that the stigma and discrimination guideline highlights the activities and priority actions to fight stigma, and urged stakeholders and implementers as they implement to use it as they carry out their activities.
He revealed that as one of the ways to streamline HIV and AIDS stigma, the UAC has disseminated the guidelines to the community and the districts and other stakeholders such as district, cultural, religious, and community leaders.
“As we hope as they do their action plans, they will include activities that specifically target stigma,” Rwengabo said.
In 2017, President Yoweri Museveni launched the Presidential Fast Track Initiative to end AIDS as a public health threat by 2030. This made Uganda the first country in sub-Saharan Africa to domesticate the UN General Assembly resolution adopted in 2016.
Rwengabo said since stigma is one of the issues of focus under the UN General Assembly Resolution, all stakeholders must work hard to ensure the goal is achieved.
“Without ending stigma and discrimination against HIV/AIDS, then we will not talk about ending Aids by 2030,” he said.
Rwengabo said setting up clinics offering HIV/AIDS services within the health centers and hospitals in as one of the factors contributing to stigma.
“We still look at this as a specialized service and we think people on ARVs should receive more care, yet it is a bit unfortunate. Some people may fear going to that section where they pick the drugs from,” Rwengabo said, adding “If it was like any other drug like for malaria maybe I could walk in, go to the pharmacy and they give me my treatment.”
Using home deliveries to avoid stigma
Rwengabo advised those who are eligible for ARVs but have not yet enrolled to use differentiated service delivery models, such as community drug distribution points, to evade stigma.
“We have drugs that we have placed in pharmacies so that if you fear coming to the health center, then you can go to a certain pharmacy in town that we tell you, you go and just sign for the drugs,” Rwengabo said.
Okema, the TASO Gulu Center Program Manager, explained that 85 community drug distribution points have been established since 2010, to bring services closer to people afraid of stigma.
Okema on drug distribution points
“If we put all those who are positive on treatments, we shall have new zero infections by 2030, but we can’t talk about HIV-free generation without fighting stigma,” Okema said.
The HIV prevalence in Acholi is high at 7.4% against the national prevalence of 5.3%. In Uganda, an estimated 1.4 million people are living with HIV and 1.2 million are on treatment, according to the Ministry of Health Annual estimates for 2021.
