Though the rate of HIV/Aids in Liberia is lower than other places in Africa, at just 2-5%, fourteen years of only recently-ended civil war means that outreach, treatment and prevention work has had a late start. Many fear that the epidemic will explode in post-conflict Liberia, as people regain freedom of movement and the economy recovers. A small group of dedicated people have banded together and formed the Light Association to fight the spread of HIV/Aids. The president of the Light Association Joe-Joe Baysah, the first man to publicly declare his HIV status in Liberia, describes the work he is doing there.

This book wasn’t on my original African Reading Challenge list, and I wrote this review for PlusNews, but, there was one thing I wanted to discuss here that didn’t really fit with that review.

First, a bit from my review:

In a new book, Genocide by Denial: How Profiteering from HIV/AIDS Killed Millions, Dr Peter Mugyenyi tells the story of the AIDS epidemic in Uganda from its frontlines: hospitals, orphanages, graveyards, witch doctors’ homes – everywhere but from a drug supply cupboard.

Mugyenyi was one of the founders of Uganda’s Joint Clinical Research Centre for HIV/AIDS (JCRC), which pioneered the provision of life-prolonging antiretroviral (ARV) drug treatment in Uganda in the mid-1990s.

The book is a personal account of “throw[ing] a bucket of water into the towering inferno” of Uganda’s HIV epidemic at a time when the country could do little more than look on as its people died slow and preventable deaths.

After doing his medical training in the United Kingdom, Mugyenyi returned to Uganda to find a mounting death toll from AIDS. Every day he watched parents burying their children and children burying parents. The drugs that could save his patients’ lives were available, if they could only afford them. “The vast majority of my patients died not just of AIDS but of poverty,” he writes.

The vast majority of my patients died not just of AIDS but of poverty

In the early 1990s the first generation of protease inhibitors [anti-HIV drugs designed to suppress virus replication] cost US$14,000 per year per patient, at a time when most Ugandans earned less than a dollar a day.

Mugyenyi had to turn away thousands of patients, including some of his own relatives, because the life-saving medication was so prohibitively expensive; neither his relatives nor his many other patients could understand why, if there were drugs for their condition, they could not get them.

In his narrative about Uganda’s battle for affordable AIDS drugs, Mugyenyi recalls details that are almost unimaginable in today’s world of $10-a-month ARVs: how at the height of the epidemic people started planning funerals as soon as their relatives began coughing; and how Kampala’s ubiquitous pork eateries gained popularity as people sought to avoid the weight loss associated with ‘slim’ disease [a local euphemism for HIV/AIDS].
MORE…..

What I wanted to add, I will quote directly from the book, about the combination of two topics I write about too often: orphans and misguided attempts at aid.

Setup: well meaning aid workers trawl the slums looking for AIDS orphans to help, many of whom are staying with relatives and extended family members. The aid workers provide blankets, school fees, and other assistance to the orphans – just the orphans.

What these well meaning benefactors did not immediately realize were the dire circumstances endured by all children in the home. They all lived and shared the same miserable conditions. The added burden of orphans in their destitute family had made their dire situation much more miserable. All the children spent nights huddled together trying without success to keep warm in the dilapidated dwelling as they all had no blankets. Reportedly only two of the children were now going to school… It does not take much imagination to visualize what the atmosphere in the shanty home must have been like after the departure of the naive donors.

See more of my PlusNews reporting:

Using mobile phones to fight AIDS
Marriage, the new frontier in HIV prevention
Dating is so hectic, I put a personal ad in the paper
Overcrowded Prisons heighten TB risk
The government is only looking after straight people
Change brings new risk for the Karamojong

(The list goes on and on – a good portion of the PlusNews reporting from Uganda comes from the Scarlett Lion laptop.)

(And yes, the red background behind the book cover pictured above is indeed my dining room table.)

Awhile back, I wrote about how I was doing a story that involved newspaper personal ads.

The story proved much harder to report than I had expected. My idea was to speak with people who were living with HIV about finding partners through the personals. Every week, I culled the adverts and sent emails and text messages to people who identified as HIV positive in their ads.

I received few replies. And some people bothered to reply only to tell me never to contact them again. One woman replied, but then wouldn’t meet me. One woman set a meeting time with me and didn’t show. Another man replied but really only seemed interested in dating me. Another person met me only to complain about how someone had found his email address in the New Vision and subsequently conned him out of several hundred dollars.

Needless to say, I spent a lot of time trying to report this story, and a very small amount of time actually reporting it. The result is here. One of my only successful interviews was with this lady, who was thoughtful and funny – I could have spoken with her for hours. About six pages of single spaced typed notes were whittled down to this 600 word story.

It would have been great if I could have talked to a bunch of people and gotten multiple perspectives, written a really interesting feature that showed a real trend emerging, but as it is, I had a few sodas with a very nice lady.

Joanna: “Dating is hectic, so I put a personal ad in the paper”

KAMPALA, Joanna*, 25, an HIV-positive schoolteacher who lives in the Ugandan capital, Kampala, decided to take a chance on love by putting a personal advertisement in the newspaper. She spoke to IRIN/PlusNews before her first date with a man who responded.

“I’ve only dated one person who doesn’t have HIV. It’s kind of hectic, because you don’t know your future or how it’s going to be. You’re not ready to pass on the infection to this other person. That’s why I put up my ad in the Meeting Point section of the New Vision [a national daily].

I just wanted to see, would it work? Does it work? But then … I opened my e-mail and there were a lot of e-mails from guys – maybe 20.

I’m going on a date this Sunday. We’re not so sure what we’re going to do – I don’t like sitting down when I’m meeting a person for the first time, so maybe we’ll go somewhere or do something. Somewhere with an activity, not just to talk and eat.

What I liked about him is that when we talk, he treats you like a person. The others were interested in ‘How do you look?’ and I don’t want a person who is interested in how I look, but in my character. We have talked on the phone for three weeks now. He works upcountry – he’s an administrator with some NGO [non-governmental organisation] dealing with HIV.

I hope he’ll be like the kind of person I imagined on the phone; someone who is fun, not someone who has sadness or is into depression. Some people go on and on about their status and that kind of thing – they haven’t gotten over it. I hope he shows some character; I want someone who is free to be himself.

I’m scared, I really want it to work out, but what if it doesn’t? What if we get there and we can’t talk? What if we communicate so much on the phone but then there’s nothing in person?

READ MORE…

Moses Kajenda may not have eaten lunch because of me. When I entered his ward with the supervising doctor at the medical facility of Luzira Prison, Uganda’s biggest penitentiary situated in a Kampala suburb, the sick inmates were eating lunch. Each had a bowl of posho, a flour and water based staple, and a bowl of the broth of bean soup without beans.

The doctor led me over to Kajenda’s bed, neatly made, with pink sheets folded over a dark green and black blanket. I was reporting on the co-infection of Tuberculosis and HIV/AIDS in the prison system, and Kajenda had both viruses. The doctor told me a bit about his medical condition – on first line TB drugs and now ARVs, while before he only took Septrin, a prophylaxis antibiotic. He was doing better here, eating more, not subject to hard labor as he had been at the upcountry facility where he’d previously been serving time.

Kajenda, gaunt and stiff, folded his hands, one over another, and spoke with his eyes to the floor. He answered the doctor, who translated, only looking at me fleetingly from time to time.

The other inmates in the ward sat quietly on their beds, eating their lunch. I was worried about Kajenda’s lunch as soon as we started speaking, and sure enough, an attendant came and took away his food. At first it seemed like the food was just placed on a surface at the front of the room, but by the time we had finished speaking, all the others’ plates had been cleared.

I asked the doctor if he would still get his lunch. Oh yes, yes, the doctor reassured me, and spouted off a list of extra rations prisoners in the medical facility receive – soya, greens grown in the yard behind the facility, and tomatoes and onions from the central prison system.

I asked when they receive this food, since I certainly didn’t see anyone with a tomato or greens. The doctor assured me it’s every other day, or every couple of days, just not today.

As we started to leave the ward, it didn’t seem the attendant was bringing Kajenda his unfinished meal. I voiced my concerns again, but the doctor said, “No, this one will eat, he is just a slow eater, he will finish his food later.”

According to prisoners, they eat only once a day. Food is needed to properly absorb ARVs, and regular caloric intake to give the body strength to fight TB. I thought about saying something more, or about waiting until I saw Kajenda receive his lunch. But I decided against this. Maybe that would just make it worse for him later today, or tomorrow and the tomorrow after that. I couldn’t anticipate what kind of effect my intervention would have.

Walking out of the room with the doctor, who was on his way to lunch, I wondered whether Kajenda would eat lunch.

Probably not.

Perhaps, speaking to him about TB in the prison is important enough to interrupt him temporarily. Maybe it will make health officials more aware of the overstretched facilities and resources at Luzira and that would be advantageous to the inmates in the long run.

But it certainly wouldn’t be advantageous to Kajenda. I couldn’t have told the doctor, no, let’s come back later and let him eat. The doctor was busy and I was taking up his time. And my presence in the ward was sanctioned – by the commissioner of prisons, the officer in charge of this part of the prison, every one of the dozen or so guards who checked my permission letter and ID, the officer in charge of the medical facility, and this doctor, in charge of this ward. Probably twenty or so people in all had agreed to my presence and played some role in me getting from my flat in Kampala to this ward in Luzira.

I always tell people, before I interview them, that it’s up to them whether they speak to me, and if they do, which questions they answer. I said that to Kajenda, but just like I didn’t set the terms with the doctor, Kajenda didn’t set the terms with me.

And so, because of me, Kajenda probably never ate lunch. Or anything that day.



Most of the time, when I take photos, someone will ask me for money in exchange for their image. Journalists aren’t really supposed to do this, but tourists can and do, and that creates an expectation. I tell people, I can’t give you any money, but I’ll take your picture and tell your story and maybe someone will know about this situation and about you, and maybe something will be different.

Lately, those words have felt hollow. I take a lot of pictures, and not a lot of things change. And something changing at some point in the future doesn’t pay school fees today.

But, there’s been a lot of response to the AP story about Stephen and the quarry in Kireka. The Nairobi bureau chief of AP called me the other day and said she’ll probably want Katy and me to do a follow up story. Additionally, the AP has had so many letters saying people wanted to do something that she asked me where she should direct them.

I’ve also gotten several emails, not to mention comments on this blog, about the topic. So, here are a few places you can look into if you want to do something.

• If you’re in Uganda, one of the women in the community who acts as a local leader is named Milly and can be reached via her mobile, which I won’t put here, but if you’d like her contacts, leave a comment or send me an email.
• Meeting Point International works with HIV positive women in the quarry, and they are supported by AVSI.

Mainly, though, I would like to emphasize that though Stephen’s story is sad and heartbreaking, right next to him on a pile of rocks is another kid who is also sad and heartbreaking. This is one of the fundamental problems of both aid work and journalism – every time there’s one kid like this, there’s a dozen. Or a hundred. Or a thousand.

I honestly think that while Stephen deserves help of course, something structural must change and it’s more important to funnel resources to that end. The Refugee Law Project had done a lot of advocacy work around the issue of IDPs in Kampala, and in terms of helping the community rather than an individual, they would be the way to go.

I’m attending the HIV Implementers Conference this week. It’s a whole bunch of PEPFAR officials in town for a few days.

A few facts about the conference, compared to facts about ARVs:

1,500 people attending the conference
$22 for lunch

$33,000 for lunch. In Kampala, you can get a nice local lunch for about Ush 3,000 ($1.50). The conference goes from Wednesday to Saturday, so that’s 4 lunch sessions, for a total of $132,000.

$15 Generic ARVs for one month

Therefore, if all these delegates forgo their pricey lunch, 8,800 people could be on ARVs for a month, or 733 people for a year.

Insecurity affecting HIV funding in Karamoja

KOTIDO, 3 June 2008 (PlusNews) – Frances Otim, living in Kotido, an urban centre in Uganda’s northeastern Karamoja region, doesn’t use condoms because he doesn’t know how, and doesn’t use a mosquito net because the one he has is ripped.

For most adults, malaria isn’t life threatening, but for people living with HIV, acute malaria causes a spike in viral load – the amount of the virus present in the body. This in turn heightens a sexual partner’s risk of contracting the virus. “I had malaria last week,” Otim, who is HIV-positive, told IRIN/PlusNews at the Church of Uganda Health Centre in Kotido.

“We need to teach about condoms,” said Patience Ajok, the centre’s programme coordinator. She would like to do this, as well as a lot of other activities related to HIV prevention and treatment, but is limited by a tiny budget and having very few staff members. “The number of [HIV-positive] clients is increasing, but personnel and funding is not.”

(More…)

Insecurity affecting HIV funding in Karamoja

KOTIDO, 3 June 2008 (PlusNews) – Frances Otim, living in Kotido, an urban centre in Uganda’s northeastern Karamoja region, doesn’t use condoms because he doesn’t know how, and doesn’t use a mosquito net because the one he has is ripped.

For most adults, malaria isn’t life threatening, but for people living with HIV, acute malaria causes a spike in viral load – the amount of the virus present in the body. This in turn heightens a sexual partner’s risk of contracting the virus. “I had malaria last week,” Otim, who is HIV-positive, told IRIN/PlusNews at the Church of Uganda Health Centre in Kotido.

“We need to teach about condoms,” said Patience Ajok, the centre’s programme coordinator. She would like to do this, as well as a lot of other activities related to HIV prevention and treatment, but is limited by a tiny budget and having very few staff members. “The number of [HIV-positive] clients is increasing, but personnel and funding is not.”

(More…)

My material on Karamoja is going up, slowly slowly, so I thought I would put the first two pieces here. More is following, and I’m still hoping to get more done before I post a bunch of pictures and general reflections next week.

Ngeleca Maddalina – “I don’t remember the last time there was meat to eat”

KARAMOJA, The Ik are one of several ethnic communities in Uganda’s northeastern region of Karamoja, near the border with Kenya.

Culturally and linguistically distinct from the rest of Uganda, Karamoja has often been marginalised and lacks the kind of services and infrastructure found in the rest of the country. While most ethnic groups in Uganda are Bantu, the Karamojong are Nilotic – they are taller than most Bantu people, speak a dissimilar language, and still dress in traditional clothes. (More…)

Namoe Aisha: “I’m ready for the medicine, me myself, I’m ready for it”

MATANY, Namoe Aisha, an HIV-positive widow with four children, is currently undergoing treatment for tuberculosis at the Matany Hospital in Moroto district, a remote region of Karamoja in northeastern Uganda. She told IRIN/PlusNews about the difficulties she has encountered since being diagnosed with the virus two years ago.

“When I was still young I went to Soroti [a district in eastern Uganda] for school, and there I married a Musoga [ethnic group in eastern Uganda] man. We had four children. Two years ago he became very ill and he died.

“I was also sick and I went to test and found that I have HIV. My co-wife [her husband's other wife] was also sick with AIDS and she died soon after our husband. She had refused to be admitted to hospital even though she was coughing with blood. (More…)

Many people have criticized a new program in Tanzania that gives people economic rewards when they test negatively for STIs (sexually transmitted infections). Congo Girl calls this “derogatory.”

Yet, one of the many purposes of this program would be to give people money so that they don’t have to have sex for money, or engage in other risky sexual behavior associated with economic gain, a fate far more derogatory, in my opinion, that participating in this program.

(The program has other purposes and aims, but here, I’ll mainly be discussing this one.)

So, here’s the thing, sex, in an African context, is NEVER the kind of glamorous-I’m-wiedling-my-all-powerful-feminitiy-to-make-loads-of-money kind of thing. No Eliot Spitzer Number 9 here. More often than not, “risky sexual behavior” isn’t sex work as an employment category but as a means to put a coin in your pocket. The line between a sex worker and someone who has a sugar daddy is practically nonexistent, as is the line between a sex worker and someone who is hungry.

In a western context, the idea of sex work as a woman’s prerogative is controversial, but valid as a hypothesis. In Africa, it is not. The question that needs to be asked here is, why are women having risky sex? And the answer, always (okay, almost always, like 99.9 percent of the time always), is that they need the money.

They need money to buy food. To pay for shelter. To survive.

If they’re only saying yes to risky sex because of extreme poverty, then it is the poverty that is derogatory and the payout that is empowering.

One interesting comment on Congo Girl’s blog is that this will perpetuate economic inequality between postives and negatives. This is a valid point, as is another point by a reader who asks what happens to someone who is raped. These are things that the researchers should consider.

The jury is still out on whether or not this will work. I’ll be curious, along with a lot of other people, to see what happens. One thing that I worry about is the fact that women are paid out every six months: this may not be frequent enough to cover the daily grind. It’s a lot of money, as much as the annual income of most participants, but I fear the long wait in between payouts might cause participants to engage in risky behavior to cover costs in the immediate present.

But this is a concern with the program design, not the program concept. The design will be tweaked over time as the researchers figure out what does and doesn’t work.

The concept, however, is far from derogatory in my opinion. One comment on Congo Girl’s blog says that this program makes her “uncomfortable.”

The only thing that makes me uncomfortable is the thought of women having sex for the cost of a plate of beans and posho. If this program can reduce that kind of occurrence, then the commenter should handle her discomfort while the program participant is eating.

New stories I’ve written for PlusNews.

Hard labor for HIV-positive IDPs in Kampala
KIREKA, 1 May 2008 (PlusNews) – Melia Alanyo, 46, left northern Uganda for the capital city, Kampala, in the late 1980s when the rebel Lord’s Resistance Army (LRA) started abducting, attacking and killing people in her village.

She has spent the last 20 years in Kireka, a low-income suburb on the city’s outskirts, collecting and breaking rocks into chips at a local quarry. For every 20-litre jerry can she fills, she earns 100 Ugandan shillings (US$0.06). On a good day, when she is feeling strong and can take the sun beating down on her back as she chips away at the rocks, she takes home about 1,000 Ugandan shillings (US$0.60). (MORE…)

Hear Our Voices: I tell everyone I’m HIV positive
KIREKA, Carmela Acen fled her home in northern Uganda when the rebel Lord’s Resistance Army (LRA) began its insurgency campaign in 1986. She told IRIN/PlusNews about her life in Kireka, a poor township in the capital, Kampala.

“I couldn’t stay longer in Kitgum [district in northern Uganda]. Two uncles and two relatives were killed. I couldn’t stay in my village, Lukung.

“I went to Kampala and stayed with a sister in Kibuli [suburb of Kampala], and then moved to Kireka. I am caring for 28 children left behind by my brothers and sisters and in-laws. Most of the parents have died of AIDS, one of cholera and the others in the war. (MORE…)

I admit that I haven’t followed the US Presidential race as closely as I might have were I still living in the USA, but this is a salient example of why it so acutely affects things in Africa. And a salient example of why McCain is an idiot who doesn’t deserve to run a country.

The following is from the NYT Political Blog (though all emphasis is mine):

A transcript of the encounter follows. (Weaver is John Weaver, his senior adviser, and Brian is Mr. Jones, his press secretary):

Reporter: “Should U.S. taxpayer money go to places like Africa to fund contraception to prevent AIDS?”

Mr. McCain: “Well I think it’s a combination. The guy I really respect on this is Dr. Coburn. He believes – and I was just reading the thing he wrote– that you should do what you can to encourage abstinence where there is going to be sexual activity. Where that doesn’t succeed, than he thinks that we should employ contraceptives as well. But I agree with him that the first priority is on abstinence. I look to people like Dr. Coburn. I’m not very wise on it.”

(Mr. McCain turns to take a question on Iraq, but a moment later looks back to the reporter who asked him about AIDS.)

Mr. McCain: “I haven’t thought about it. Before I give you an answer, let me think about. Let me think about it a little bit because I never got a question about it before. I don’t know if I would use taxpayers’ money for it.”

Q: “What about grants for sex education in the United States? Should they include instructions about using contraceptives? Or should it be Bush’s policy, which is just abstinence?”

Mr. McCain: (Long pause) “Ahhh. I think I support the president’s policy.”

Q: “So no contraception, no counseling on contraception. Just abstinence. Do you think contraceptives help stop the spread of HIV?”

Mr. McCain: (Long pause) “You’ve stumped me.”

Q: “I mean, I think you’d probably agree it probably does help stop it?”

Mr. McCain: (Laughs) “Are we on the Straight Talk express? I’m not informed enough on it. Let me find out. You know, I’m sure I’ve taken a position on it on the past. I have to find out what my position was. Brian, would you find out what my position is on contraception – I’m sure I’m opposed to government spending on it, I’m sure I support the president’s policies on it.”

Q: “But you would agree that condoms do stop the spread of sexually transmitted diseases. Would you say: ‘No, we’re not going to distribute them,’ knowing that?”

Mr. McCain: (Twelve-second pause) “Get me Coburn’s thing, ask Weaver to get me Coburn’s paper that he just gave me in the last couple of days. I’ve never gotten into these issues before.”

This went on for a few more moments until a reporter from the Chicago Tribune broke in and asked Mr. McCain about the weight of a pig that he saw at the Iowa State Fair last year.

I don’t know what’s wrong with me sometimes. I spend the majority of my life as cynical as can be, but when I see these little kids groups performing at various conferences I’m covering, I just tear up.

Watoto is actually a musically talented group, but they’re a little too polished for me to be really affected (and the picture of the bazungu pastors on the front of their webpage seems a little off to me). But today, at the Uganda Aids Conference, these fifteen little kids in yellow tshirts with overalls on sang “Lean on Me,” and one of their own creation called “I am special,” and I just melted. Maybe it’s the maternal instinct catalyzed by off key singing. Or more likely my desire to find something redeeming about Speke Munyonyo.

Then Glibert Bukenya, the Vice President of Uganda, walked in and tear evoking singing came to an end, to be replaced by the Ugandan National Anthem. It’s not that the anthem isn’t touching, but I need more than nationalism to make me shed a tear.

Bukenya proceeded to make a speech in which he ad libbed a reference to his speech writer, then he told HIV/AIDS researchers to not complicate their research when presenting it to the government.

Maybe we should have researchers train children to sing about circumcision and home-based health care? That could bring a tear to my eye.

IRIN and PlusNews don’t use bylines, but yes indeed, this is my work. A lot of the time I do work to finish it and invoice for it, but this is a story that I’m pretty happy with. Oh, and if you read my previous post about the taxi to Jinja, this article explains why I spent two hours going to Jinja, two hours on the way back, for a one and a half hour interview – ie, nearly four out of six hours in transit.

KAMULI, 17 March 2008 (PlusNews) – Admitting to being HIV-positive is a difficult task for anyone, but David Balubenze was faced with some special challenges as the pastor of Deliverance Church Nankandulo, in Kamuli, about 100 kilometers from the capital, Kampala.

READ MORE…

I’m filing left and right, so I won’t put the full text of the stories here, just some links to my work (PlusNews doesn’t use bylines, but if you check the page, the Uganda stories are mostly ones I’ve written.)

Women shoulder AIDS burden

Home-based HIV treatment extends lives

Africa worst affected by shortage of health workers

I’m filing left and right, so I won’t put the full text of the stories here, just some links to my work (PlusNews doesn’t use bylines, but if you check the page, the Uganda stories are mostly ones I’ve written.)

Women shoulder AIDS burden

Home-based HIV treatment extends lives

Africa worst affected by shortage of health workers

KAMPALA, 4 March 2008 (PlusNews) – Much excitement greeted the opening of Quality Chemicals in 2007, the first manufacturer of antiretroviral (ARV) medication in East Africa, but six months later the production lines are still idle.

The spacious factory, which cost about US$38 million and covers roughly 1,115 square metres, can produce around two million ARV tablets in an eight-hour shift, but the National Drug Authority (NDA) of Uganda has not yet granted it a license to produce the life-prolonging pills.

A long inspection process required for licensing and manufacturing the drugs has caused the delay, but factory officials expect it to be granted in the very near future.

Quality Chemicals managing director Emmanuel Katongole said the cost of their ARVs would be significantly lower than the $15 per month the government paid for imported generics; he also anticipated orders from the ministries of health in neighbouring Kenya, Rwanda and Tanzania.

Uncertain market

But until the factory gets the go-ahead from the UN World Health Organisation (WHO), and ARVs from Quality Chemicals are added to its list of recommended drugs after a WHO-NDA joint inspection, neither governments nor non-governmental organisations (NGOs) will buy.

“There is an understanding that if Quality Chemicals produces commodities of international standards, approved by the WHO at a competitive price, then the Ministry of Health will procure,” said Kenya Mugisha, director of clinical and community health services for the Ministry of Health. “But they must meet general manufacturing practices.”

An estimated 300,000 Ugandans need the life-prolonging medication. About 50,000 of the 106,000 people receiving ARVs in Uganda are supported by the President’s Emergency Plan for AIDS Relief (PEPFAR), a worldwide initiative by the US government to combat the spread of HIV/AIDS; most of the rest obtain their ARVs via the US-based Global Fund to Fight AIDS, Tuberculosis and Malaria, in conjunction with Uganda’s Ministry of Health.

PEPFAR has strict procurement regulations and procedures that must be followed before its money can be spent on ARVs from Quality Chemicals, including an inspection by the US Food and Drug Administration (FDA), a regulatory body.

“There’s no reason why it shouldn’t happen, it’s a question of making it happen,” said Permilla Bartlett, the PEPFAR coordinator in Uganda. There is no FDA inspection planned in the near future, and even after an FDA inspection, “procurement has to follow certain regulations”. PEPFAR already has procurement partners, so it may be difficult for Quality Chemicals to become a supplier.

Quality Chemicals will also produce the anti-malaria medication, Lumartem, which contains artemisinin and lumefantrine but is significantly cheaper than Coartem, the WHO-recommended first-line brand containing the same ingredients.

“Nairobi called, I have to go,” I say to David, very often these days.

Sometimes, I feel like an entire city in Kenya owns me. And I guess they kind of do. When “Nairobi Calls,” it is someone from AP asking me to go somewhere, usually about twenty minutes after they call, or someone from my brand-spanking-new position at PlusNews, where they seem to have a previously unheard of appetite for HIV news. All HIV all the time.

It’s great – I’ve never been so busy and my days at Daily Monitor are finally numbered (and yes, yes they do still owe me a lot of money per contract, but no, no I don’t think they will ever actually pay me). I won’t miss the pig-pen o’ journalists also known as a news desk, with 40 people queuing for one phone, but I do miss the more leisurely pace, the time to blog, the time to respond to emails.

So yes, yes this is really an excuse disguised as a blog post. An excuse for not blogging more, and for not writing back to you, dear friends. Sorry, Nairobi called.

Reuters AlertNet link to my story
(but more pictures if you read it here…)

The gate of Mityana Prison, an hour east of Kampala, is guarded by a single khaki-clad officer with a rifle. As prisons go, it’s not large, housing just 107 inmates.

Zaini Kizire, 28, is one of two HIV-positive prisoners here. Sitting with a group of female inmates, all wearing beige smocks, untailored except for sleeves, she folds her body into the smallest space possible on the concrete floor.

Asked what they know about AIDS, no one replies. Then Kizire says: “First, you get tested, then retested, then they do a CD4 count, then you take two tabs, one white and one yellow.”

Her understanding of HIV/AIDS isn’t technical or epidemiological, but Kizire is one of the few prisoners with even a basic grasp of how the disease works.

In one of the men’s cells, measuring five by five meters (16 by 16 feet) and holding about 20 inmates, an older man says AIDS is a disease that affects the young and the aged, that you catch it through sex or sharing sharp objects like razors, and there wasn’t a cure.

Another prisoner, wearing a faded Nokia t-shirt, spoke up after a few minutes: “AIDS is a biological weapon. The only solution is that the physicians who manufactured it be kind and find medicine.”

In the next cell, similarly small and with just as little natural light, it was the inmates who asked the questions. “If someone has not been tested, what should he do?” asked one. “If I have the disease and my wife has it as well, will our child have it?”

Kizire and the other HIV-positive inmate make a trip to a local hospital once a month to collect their anti-retroviral drugs (ARVs), as upcountry prisons have no health facilities. The hospital is 1.5 km (1 mile) away and the prison has no form of transportation for the inmates. She fears the day when she’s too ill to walk.

LIVING ON ARVS

In Luzira Prison on the outskirts of Kampala, the situation is different. Luzira houses 25 percent of Uganda’s 27,000 prisoners, and at least 300 are HIV-positive, although most inmates have not been tested.

Here there is a medical centre, Murchison Bay, within the prison compound that distributes ARVs and the prophylaxis Septrin (which helps prevent opportunistic infections, though it isn’t always effective.).

Unlike many African prison systems, Uganda’s recognises the threat posed by AIDS. “These walls are temporary,” says Michael Kyomya, the medical superintendent at Murchison Bay. “Prison can be an incubator for infection, and it will spread to the community.”

Though Kyomya and his staff try to serve the vast needs of the prisoners and the community – who also visit Murchison Bay as a referral clinic – he says they are grossly underfunded. Their budget of 130.5 million shillings ($77,000) per annum is about half what a centre their size usually receives.

“The UPS (Ugandan Prison Service) is working hard to scale up provisions of care,” said Megan Rock, protection coordinator for the International Committee of the Red Cross (ICRC) in Uganda. “There’s a lot of good will and mobilization of external partners.” Currently, the ICRC is working in active partnership with the UPS and the health ministry on a joint pilot project to address the problems of malaria, tuberculosis and HIV/AIDS.

Ugandan President Yoweri Museveni was one of the first African leaders to acknowledge the HIV/AIDS pandemic sweeping the continent, and made tackling it a priority. The country’s prevalence has dropped to about 8 percent from around 15 percent in the early 1990s. But critics say rates are on the up again due to the government’s decision to shift emphasis in AIDS education from condoms to abstinence.

Condoms are not available to prisoners, despite acknowledgement from officials that some of the inmates were having sex. “Although (homosexuality) is not culturally accepted, one cannot deny that it is there,” says Mary Caddu, prison commissioner for support services. “If infected prisoners don’t get information, they will infect others through homosexuality.”

Charles Bagenda, a prisoner in charge of AIDS-control activities in Luzira’s Upper Prison maximum security unit, says the ratio of AIDS counsellors to prisoners was one to 160. “Living with HIV in prison is different than outside,” says Bagenda. “People who are incarcerated are alienated from their families, so all the support comes from within the system.”

One of Bagenda’s duties includes running a support group for HIV-positive prisoners called the “Post Test Club,” which meets on Fridays. At a recent meeting, prisoners in yellow uniforms with thin black stripes complained about the scarcity of Septrin and a lack of proper nutrition, blankets, and other supplies.

They also shared practical tips for living on ARVs in prison. “We watch when the Muslims begin to pray to mark time to take our ARVs,” said one prisoner, who declined to give his name. He later added: “The club gives us courage and we don’t worry because you know you are not alone suffering. We get confidence and it gives us a go-ahead to tell our friends about the disease.”

But Zaini Kizire, the HIV-positive female inmate at Mityana Prison, has no such support system. Recalling how it was when she first entered prison, she said: “The other ladies feared me, didn’t want me to touch the cups and plates.”

With her next trial date approaching, she doesn’t know which would be worse – to serve more time with the disease or try to cope in the outside world. At least in prison, the government gives her ARVs once a month.

The New York Times has several interesting stories that talk about the problems of HIV/AIDS support given my global networks.

The first, by a journalist turned public health worker, discusses the correlation between food and ARVS:

Western donors have increased the distribution of antiretroviral drugs in sub-Saharan Africa. But they have done little to make sure that the recipients do not starve to death or have to choose between paying for transportation to the clinic and feeding their children. Studies like this one seek to demonstrate that packaging food aid with H.I.V. drugs or reimbursing patients for travel can actually improve health and save lives.

A second article, with similar themes, focuses on Rwanda:

Matsepang Nyoba, a Lesotho woman with AIDS who was undoubtedly saved by programs funded by the Gates Foundation. However, when she gave birth, her daughter Mankuebe couldn’t breathe and asphyxiated for want of a $35 oxygen tank valve the health center just didn’t have. The Gates Foundation has given $650 million to the Global Fund to fight AIDS, malaria and tuberculosis, but the oxygen valve fell outside the priorities of the fund’s grants to Lesotho.

The first article highlights the problems of food security in families with HIV, and the second, with the distribution of funds to health clinics for HIV.

Both agree, however, that some aid is better than no aid. The Rwanda article states:

If Global Fund resources had not been available, tens of thousands more would be dead from AIDS, and hundreds of thousands would not know their HIV status.

While this is of course true, it seems that many programs are (mis)guided about the way to go about distributing funding and ensuring that ARVs are effectively used.