Key Populations (KP) in Uganda Come of Age and Ask the Right HIV Prevention Questions as They Navigate Optimal Outcome paths

One working in the HIV Prevention & Care Service Delivery in Uganda, will easily note that the CSOs involved experience a milestone disparity as they sprint toward the UNAIDS 95:95:95 goal.

Imagine there are two sprinters asked to race forward to the finish line. One has their hands tied and the other is free.  It would be preposterous to expect a victory from the one with the hands tied. 

KP-Led Organizations in Uganda face cumbersome barriers which they need to go over to be effective. The major question raised by funders is how to maintain ARVs medication to ensure optimal viral suppression in Persons Living With HIV. But, for KP-Led organizations this goal is arrived at after asking vulnerability and susceptibility-related questions.

A qualitative analysis of reports from 44 KP-led organizations was done. The aim was to find the underlying subjective characteristics linked to achieving HIV Prevention optimal outcomes.

The exercise revealed interesting findings. The readiness to roll out effective HIV Prevention activities hinges on facilitation for organization development. KP-led organizations served beneficiaries with the goal of availing opportunities for access to ARV service providers. There are navigation paths which needed to be addressed as well. These are further divided into the proximate and distal parts with underlying subjective causes and processes (factors).

The proximate causes were defined as actionable attributes of availability and use e.g., presence and taking of the medication. The proximate processes involved time and task oriented activities e.g., time for taking prescription, actual taking of a prescription, availability of food or water necessary for beneficial drug action.

At the distal part were structural and environmental factors e.g., no immediate threats or barriers to one’s taking medication, price, political conditions, social status, stigma, discrimination, harassment, availability of health facilities to ensure refills and regular supply of medicines before stocks run out.

Beneficiaries of KP-led organizations in Uganda, have the following characteristics: unstable housing, have difficulties paying for transport to go to clinics for regular check-ups or refills. The likelihood of facing stigma and discrimination in their domicile communities and at other points of call is so high. These conditions combine into what are known as a Vulnerability and Susceptibility Chain (VASC). VASC in turn opens ways for poor or no possibility to negotiate for safer sex, a possibility for abused partners in a relationship to remain silent about abuses, high likelihood of HIV transmission, poor ARV-adherence and subsequent lack of viral suppression.

But, what can be done to address VASC? 

There are three compelling answers.

The first was to allow KP-led organizations to establish viable groups. These should be facilitated to go through organization development trainings. This in turn would improve their readiness to become effective HIV Prevention actors. It would create a durable prevention culture enabling access to HIV Testing, put those with positive diagnosis on ARVs and ensure those on ARVs adhere so that they experience viral suppression over time. There are added advantages in being part of support groups. It means that people who choose to form, join and maintain viable groups, enjoy many advantages. The advantages range from companionship, building self-esteem, assurance of stable housing, affinity to caring for others and motivation to commit to ARV adherence for those with positive diagnosis. This in turn addresses what is known as Generalized Anxiety Disorder (GAD) known to be faced by PLHIV who are not cared for or who fail to seek care services. This too is associated with lower rates of HIV treatment, adherence to treatment and very poor or no viral suppression, according to Benjamin Ryan (2019) in an article titled “A High Proportion of People with HIV Suffer from Anxiety,”

The second was to enroll in Clinical Trial Programmes that are available in the country. This increases opportunities for regular monitoring and evaluation by well trained and qualified health workers.

The third was to embrace new health technologies that increase opportunities for avoiding breaks in taking ARVs e.g., for vulnerable women and girls. One such example is the vaginal ring. In an article by Roxy de Villiers (2019) titled “The quest for the (vaginal) ring,” the “a vaginal ring inserted monthly could reduce women’s risk of contracting HIV, it is a long-acting form of treatment that HIV-negative women can take before being exposed to HIV to reduce their chances of contracting the virus.”

The above three suggestions combine as opportunities for KP-led organizations in Uganda to promote the taking ARVs as prescribed both easier said and done.

The Love Where One Leaves The Beauty of A Woman And Settles For A Fellow Man

Dear Parliamentarian;

In this letter to you, I attempt to highlight or trace:

1. What compels us to denounce homosexuality
2. The people behind denunciation of homosexuality
3. The rationale behind the denunciation
4. Where outlawing homosexuality gets it wrong
5. The ideology of homosexuality
6. The biology of homosexuality
7. The theology of homosexuality
8. Homosexuality is not the pressing matter Ugandan Parliament makes it to be

And please, stop using the term "homosexuals" or "homosexuality." That is oxymoronic. It is also equivalent to tying someone up and expect them to carry water at the same time. Or eating your cake and expecting to have it at the same time.

The people you are dealing with are called: neurodivergent gender diverse persons.

This letter is about the love where one leaves the beauty of a woman and settles for a fellow man. 

It is also about the love where one leaves the man and settles for a fellow woman.

In Uganda, the term "homosexuality" which is less understood, is heard bundled about with much frequency lately. Mostly, from the media and by Parliamentarians. 

It has become a cue for stoking conversations at household level, kitchen tables, market squares, community barazas, talking heads and Ugandan Parliament. Rather than deliberate on the Anti-Homosexuality Bill, ensure that communities become spaces where individuals can participate in learning entrepreneurship skills, eradicatE poverty, HIV and conserve the environment. Uganda has the youngest population below 30 years old in the entire world. They need social development deliberations and policies.

The media houses have a field day, the dailies are scooped so fast off the streets once an attention grabbing headline “Alleged Homosexuality Behind The Closure of A Conference” is grandiosely emblazoned. Homosexuality commands higher listenership, readership and phone-ins, once it is the central talking point at various FM radios.

The Religious-Parliamentary Determinism Of Homosexuality:

Two or three renowned Pastors have short answers to this normativity. “Satanic,” says one. “Sodomites,”  remarks the other. “Devils,” adds yet another.

The Hon. Dr. Nsaba Buturo, MP of Bufumbira East, is preparing to retable the Anti-Homosexuality Bill. The MP has taken leave from the Ugandan Parliament to create time for himself to mobilize numbers to support the Bill. As well, he expects to compose ditties on the one hand and articles that spell out in concrete narratives the criminal extent of Homosexuality. He accuses the United Nations of a surreptitious mission to impose acceptance of homosexuality on sovereign countries.

Hon. Dr. Nsaba Buturo is an accomplished Political Scientist, who holds several degrees: Bachelor of Arts in Political Science and Public administration, from Makerere University; postgraduate Diploma in Developmental Administration; a Master of Arts in Developmental Administration from the University of Birmingham in the United Kingdom, which he followed up with the degree of Doctor of Philosophy in the same field at Birmingham.

He is popular with the Pentecostal Church and when he was appointed Minister, it was seen as a contribution of the Pentecostal Church in a homogeneous government led by President Yoweri Kaguta Museveni. He had the right resume. From 1977 until 1986, he served as a District Commissioner in the Ministry of Local Government under Milton Obote (II) and Okello Lutwa’s government.  When the NRM overthrew Okello Lutwa, Dr. Nsaba Buturo emigrated to the United Kingdom, where he served as a Development Manager, from 1989 until 1995. He returned to Uganda in 1999, and was appointed Director of Planning & Monitoring for the Uganda AIDS Commission, serving until 2001. In 2001, he joined politics and was elected to the Ugandan Parliament, to represent Bufumbira East, a county of Kisoro District. From 2001 to 2006, he served as the State Minister for Information & Broadcasting. He was re-elected in 2006 and retained as State Minister for Information in the cabinet reshuffle of 13 January 2005. In a subsequent cabinet reshuffle in June 2006, he was appointed State Minister for Ethics in the Office of the Vice President. In March 2011, he lost his parliamentary seat and resigned from the cabinet. However, he later on regained the seat and he is presently the MP. 

Uganda has several talking heads on Homosexuality. It pulls in revenue for TV and Radio Shows.  One was heard saying before the camera: “when it comes to homosexuals, I am strong, firm, determined. We shall not allow exhibiting, recruiting and canvassing.”

The other was heard saying: “this time, we are sure there will be no technicalities to stop this Act from going through. We shall have the 2/3 quorum to pass the law.”

The Anti-Homosexuality Act, 2014 (sponsored by MP David Bahati of Ndorwa West, was  annulled) stipulated:

“it is aggravated homosexuality for an HIV+ve same sex person to engage in sexual intercourse  with another of the same sex. The penalty is life imprisonment.”

“it is aggravated homosexuality for a same sex person to engage in sexual intercourse with a minor of the same sex. The penalty is life imprisonment.”

“it is aggravated homosexuality for a same sex person to engage in sexual intercourse with another same sex persons of consenting age. The penalty is 7 years in prison.”

In Outlawing Same-Sex Marriage, Uganda misses many points:

It demonizes the three parameters of normativity: identity, expression and self determination. The excuses are an overused cookie-cutter, inured to a public that has been denied the reasons entrenching tolerance. 

The public is denied erudition that unpacks identity, expression and self-determination. There is a tendency of painting a picture of an evil lurking in the dark, planning, devising and cunningly luring innocents into homosexuality. This is a fallacy. 

Homosexuality is now marketed as a vote-puller for many Parliamentarians. It fills the vacuum and expectation that comes with outlining manifestos that matter. 

Homosexuality is a readily available red herring, political enthusiasts dangle, to provoke ire, stoke high adrenaline parade chants, rowdy processions, unruly rallies and destructive backlash. At the end of the processions, parades and rallies, the voters are ready to get in lines, fill up ballot boxes and not question what exactly the manifesto was stipulating!

It turns out that those pushing for the Anti-Homosexuality are a breed of a certain age bracket or membership club. It is  a cohort-generation at the risk of base-rate neglect. Presently, there are more youths coming out as non-conforming, intersex, gay or lesbian in Uganda. Times are changing. Even the market  is changing. The global market is wider and accessible via internet. Laws falsely recalling draconian anachronisms such as “Homosexuality is Un African,” only serve to lock us into toxic hegemonic heterosexual traditional inequities. The Anti-Homosexuality Act is an adjunct to laws abusing privacy. Privacy, intellectual property, decency, dignity and sense of fulfillment go hand in hand. Once abused, it will in turn drive or scare away investment and Pariahize Uganda. 

The Anti-Homosexuality Act, is a likely excuse to get into people’s private phones, businesses, bedrooms, patios, beach parties, vacations, outings and homes.

Before Outlawing Same-Sex Marriage Know This:

Let us unpack the term "Homosexuality!"

Do not bundle up the definition, dismiss it and feel you have done society some good. If you do, this is the reason you will still face the issues again.

What you pontifically term "homosexuality," is actually: gender diversity and neurodivergence speaking to you. Crying out to you for attention. Do not hide your head in the sand please. You are dealing with neurodivergent gender diverse persons.

Not all people who are same-sex loving consummate each other through sexual intercourse, some just hug, others are just platonic partners.

Not all people who are same-sex loving who consummate each other sexually, identify as gay or lesbians.

Some people who engaged in same-sex sexual intercourse did so as a result of consequential interactions such as in prison or institutional settings. Many have since shed off that part of life. Or those who are still undergoing this phase will shed it off in near future of their life-span.

Some same-sex attracted persons are celibate for good (obligate) while others are intermittent (facultative). 

Same-sex attracted persons are dignified human beings deserving respect for their private life. 

Same-sex attracted persons are law abiding and denounce any acts of defilement, rape and non-consensual sex. Like any decent Heterosexual person would denounce any acts of defilement, rape and non-consensual sex. Hell! Even corruption! Don’t you know of some next to you, who enriched themselves with money intended to go to People Living With HIV?

Same-sex persons are intellectuals, engineers, medical doctors, bankers, renters, landladies, landlords, sons and daughters of the soil. They contribute to Uganda’s economy like everyone else.

Same-sex couples are as capable of being faithful, supportive, gain emotional well-being as Heterosexual couples.

We should accept in our midst, support those who are neurodivergent gender diverse persons. Stop using the term "homosexuals" or "homosexuality."

The Nature-Nurture Determinism Of Homosexuality (same sex sexuality):

The basis of neurodivergent gender diverse persons:

It is now politically correct to say same-sex or same-gender or neurodivergent gender diverse persons and not homosexuals. When one says “homosexuals,” they assume three things;

a) They assume that homosexuals are not human beings and they are aliens who must have come from other planets.

b) They assume it is okay to correct the anomalies before them, hence the arbitrary physical assault, healing by touching, dehumanizing therapies, healing by raping, extrajudicial arrests, denial of association, talk about them in a very degrading manner possible.

c) They assume that homosexuals are “sex” maniacs incapable of anything else but orgies, bars and lifestyles rooted in debauchery. 

d) They dismiss the fact that these are human beings they are talking about. All human beings are self-recognizing, self-affirming, self-preserving and enjoy agency and autonomy.

The politically correct same-sex/gender descriptor assumes a dignified whole person and affirms their right to life, happiness, liberty and freedoms. This is in turn based on breakthrough science into normativity and life span science.

Humans develop through a combination of nature (stressors for selectivity) and nurture (stressors for cognitive accomplishments) with both permeating each other equally.

The genes are autonomous self driving small robots with specific instructions on how, for instance, a single hair strand will be woven for instance. Nature further provides say, food-based nutrients used as a source of building blocks for the hair.  But, your hands must reach the food, your legs must transport you where the food is, the environment must be such that one can be able to move about. Nature-nurture for you!

The body has autonomous hormones that awash our blood stream with chemicals giving specific instructions on when or where a single hair strand will be woven for instance. It is also up to nurture to provide say, opportunities for you to sense changes in whether. This triggers your innate capacity to thermoregulate. Again, nature-nurture for you!

What ?

To create relations, requires a willingness to associate, trust, groom, bond and be accountable. Humans are self perceiving, self-recognising, self preserving and self determining. They acquire skills to recognize satisfaction. In other words, humans are capable of cognitive accomplishments such as what their body types are, gender other than that assigned at birth is, shared experiences of neurodivergent gender diverse persons, body shapes and who they prefer to associate with. 

In going on about preserving who they are, they select what works for them and what does not. They improvise and adapt.  They are capable of selectivity. They manipulate their environment to live a more fulfilled life. This is what makes people decide to emigrate from their countries of birth. it is what makes humans capable of self evaluation and enjoy decision making. This is also called the power of affordance. Affordance,  is the opportunity for interaction with what is perceived depends on sensory awareness, immediate motivation, current development, and past experience. Humans draw from within their desires and past lessons to inform themselves on how they can benefit or contribute to their own self actualization and transcendence.  

According to life span scientists, it is on this primer, that a disinhibition to create relations, a willingness to associate, trust, grooming, bonding and accountability are nurtured. This is what builds movements, numbers, associations, minorities and majorities. Some scientists refer to these as cohorts. There! It is a group thing.

Why ?

Personality, culture and convention come into play to make humans embody norms, values and beliefs. But, these very elements also produce diversity and behove all of us to embrace  the raw materials of inclusivity. There is need to think beyond dimorphic normativity. According to scientists, a wide range of sexuality, orientation and gender filters are what make us a humanity. All in all, we are our own legacy. In other words, we rely so much on what we go through over a lifetime internally and externally to affirm who we are (Erikson). 

Conventional and culture aligns with normativity (this could be hetero, same sex or pan sexual). Normativity can be affirmed or remain fluid as a result of the accumulated legacy inventoried by one. As they continue to develop, humans go through explainable stages. But these stages are in lock step. The stages are, the age-stage and hierarchy of needs: 

The age-stage stage (theory)

• Identity versus Role confusion (a combination of identity, values and traditions) This is when humans figure out the four types of identity (sexual/gender, vocational/work, religious/spiritual, and political/ethic). This may enable one set a path to attain a certain identity and it may not necessarily be what the majority except. In some cases, due to pressure from, say parents, a child may agree to do something the parents ask without questioning them ( a stage called foreclosure). Or, the parents may give this child a time-out, allowing the child to find out who she or he really is ( a stage called moratorium).

• Intimacy versus isolation (humans seek intimacy, collaboration, reciprocating connections with one another). Humans devote time to one another. This turns out to form decisions for intimate relationships whether hetero, same-sex/gender or pan-sexual.

• Generativity versus stagnation (humans achieve generativity through care, engage in mentorship, teaching and helping others). This is extended to next generations through advocacy, standing in for those who are stigmatized, care, creativity and sacrifice.  This may determine why we have people strongly normed as hetero, same-sex/gender or pan-sexual.

• Integrity versus despair (the goal to combat prejudice and helping all humanity is wired in many and is so motivating). Humans are connected to the histories, cultures and desires to be who they truly are. So, some people may be drawn to each other by these motives. The desire to care, to be compassionate to the stigmatized, the suffering attracts a big section of people. Why don’t you rather legislate on what will bring about socio-economic-political contexts for equitable development.

The hierarchy of needs theory gives further illumination on the commonality of humans and what motivates people to address or express how their needs are to be addressed (Maslow):

1. There are physiology needs such as need to satisfy hunger and thirst.
2. There is a safety need, satisfied by a sense of organization, predictability, safety, stability and security.
3. The love and belonging need, means that humans desire to love and be loved; belong and be accepted; need to avoid loneliness and alienation.
4. Humans crave success and esteem. There is a a need for self-esteem, achievement, competence and independence; recognition and respect from one another. 
5. There is a need to live up to one’s fullest and unique potential. This is called self-actualization.
6. Then comes a sense of higher achievement and supreme feeling called self transcendence.

The personality Traits (these ones are the reasons behind the choices we make. It is why we achieve ecological niches. It is why we select vocations, mates, locations to stay and adventure):

1. Openness: The ability to be imaginative, curious,  creative and open to new experiences
2. Conscientiousness: The ability to be organized, deliberate, conforming and self disciplined
3. Extroversion: The degree at which one is outgoing, assertive and active
4. Agreeableness: The state of being kind, helpful, easy-going, generous
5. Neuroticism: The state of being anxious, moody, self-punishing and critical.

How ?

There is a capacity for  being self driven, self-imposing, self-recalling, self -checking and tolerance. Two important notions come to mind here. Allostatic load and affordance.

Allostatic load is the total combined burden of physiological stresses (power to advocate, ability to withstand burn-out or trauma, fear, anxiety, pain and a higher blood pressure) that an individual lives with.  This contributes to affirmation and the desire to lead the life people are comfortable with.

Affordance, on the other hand, is the opportunity for perception and interaction that a person can retrieve, access by drawing from experiences, learned lessons, places and objects. People look back into their history of attachment. There are preattachment (birth to 6 weeks), attachment in the making (6 weeks to 8 months), classic secure attachment (8-2 years), attachment as affirmation (2-6 years), mutual attachment (6-12 years), new attachment figures (12-18 years), attachment recalibrated (18 years) stages that provide accumulated experiences. This is what brings about the commonly agreed upon or uncommon phenomena. What the scientists call universals and outliers or majorities and minorities. This is the basis of uniqueness that abounds in humanity. One cannot claim to revere humanity but dismiss uniqueness.

When ?

We are our biological-hormonal-genetic-social raw materials. Our bodies grow at different paces, because our body parts don’t all grow at the same pace. For instance, our brain, grows at a different rates (neurological development). The limbic/amygdala system responsible for fear and excitement matures before the prefrontal cortex, where planning ahead , emotional regulation, and impulse control occur. Adolescence is responsible for much of who we become as adults. During adolescence instinctual and emotional areas develop earlier before analytic and reflective ones do. This is a time when one is exposed to novelty, excitement, adventure, relish high-stimulation experiences, high-adrenaline situations or bending gender norms. Adolescence is a time of discovery, arousal, stress and sensory bombardment. It is also a time, when one gets to know about their sexuality, orientation, gender and identity.  This is a time when a boy will  or not pierce the ears,  “throw or not throw like a girl” or “walk or not walk like a girl,” if you get the drift.  A girl will “prefer female or male assigned sports,” be or not to be a “tomboy,” cut off all hair or have or not ambiguous hairstyles. To hell with socio-cultural dictates. Awareness undergoes priming during adolescence due to what is known as adolescent thinking from age 10 years to 19 years. This is a time of brain maturation, intense conversations, schooling, challenges and increased independence. Adolescents begin to differentiate between focusing on one’s self to turning toward an abstract world. This is so due to two aspects: cognitive growth and puberty. 

For cognitive growth to be achieved, one goes through more stages:

1. Personal fable (narcissism), where one feels unique, destined to be great, praised and on top of the world.
2. Invincibility fable, where one believes no harm can come to them and no type of alcohol or drugs can intoxicate them.
3. Imaginary audience, where one believes they are the centre stage and capable of making headlines
4. Formal operational thought, where one finally is able to apply their thoughts outside of nearby reality or stimuli to abstract things. This is a time when one is able to think about life in a future. 

Puberty and nourishment:

We are our hormones. Previously, we have seen that at adolescence we form new attachment figures when but our brains have underdeveloped response inhibition, emotional regulation and organization, we enjoy risky thrills because our limbic grows faster than prefrontal cortex. This is compounded by the hormones that surge into our body at around this time. Note that all changes of puberty depend on nourishment. So, diet deficiencies of iron, calcium, zinc and other minerals should be addressed. Many transformations take place at puberty such as growth in height, growth in size, weight, muscle and organ growth. Sexual maturation follows these growths. The parts that are directly involved in reproduction such as uterus, vagina, penis and testicles increase dramatically and mature in function. The other features that do not affect reproduction directly, mature around this time too. These are shape of body, voice, hair and agility. Linking sexual interest, masculinity or femininity to sexual orientation or interest, must include that fact that it could be a masculinity-femininity, masculinity-masculinity, femininity-femininity or celibate outcome. This is biology and you don’t need legislation for this.

Where ?

Attachment is a lasting emotional bond between persons and it influences relationships throughout life (Grossman et al., 2005). We have seen that not all people are heterosexually normative. Some are neurodivergent gender diverse persons. Some engage in the love where one leaves the beauty of a woman and settles for a fellow man or where one leaves the man and settles with a woman is possible and may not be about sexual intercourse. It may be because of affinity over a similar experience  people went through. It could be as a result of backlash. It could be as a result of realizing similar likes and dislikes. Please do not assume that all same-sex relations are about sexual intercourse. Although some are. Nevertheless, these relationships thrive and survive. Again, rather than deliberate on the Anti-Homosexuality Bill, ensure that communities become spaces where individuals can participate in learning entrepreneurship skills, eradicating poverty, HIV and conserve the environment. Uganda has the youngest population below 30 years old in the entire world. Deliberate on how well to position this beautiful nation to be the fulfilling promise for achieving development goals for them and their loved one. We owe this to the younger generation with the resources we have in our cherished Uganda.

Tom, has  provided Life Span Counselling and Suicide Prevention Support since 1999.

The Goal Is Viral Suppression Among Those Living With HIV In Uganda: Our Story 1999-2019

What are the verbalised and non-verbalised concerns of the Person Living With HIV? What are the verbalised and non-verbalised of the provider? This is what this report seeks to bring to light. We hope it will inform your approach to caring for people living with HIV.

While ARVs have shown positive results by suppressing the HIV virus, the toxicity that comes with it is threatening to demotivate patients. This could be one of the causes of non-optimal ARV adherence and viral suppression. Despite of ARVs being around for over 20 years, we still have untreated people living with HIV, we still have people living with HIV who cannot get full ARV doses, we still have people living with HIV with high viral load. We developed this report as an advocacy tool as well. We wanted to share a perspective whose narrative is not mainstream because other issues take up the agenda. Yet, the issues we raised here make up the bulk of work needed to eradicate AIDS in Uganda. This report concludes that there are four factors  (subjective motives) which are significant in determining viral suppression: 

1.   The time one has taken ARVs; 

2.   Optimal ARV Adherence; 

3.   Provider subjective motives; 

4.   Beneficiary subjective motives. 

These predict the success or failure of viral suppression.

The Provider subjective motives: Treatment as prevention, management of side effects, follow up of beneficiaries, HIV Testing, ARV Therapy, ARV Adherence and Viral Suppression.

The Beneficiary subjective motives: Identity (sexual/gender, vocational/work, religious/spiritual, political/ethnic values and traditions within a social context), sensibility (sense of worth, esteem, wholeness), mobility (ability to move, associate and relate), intimacy (ability to seek and and be sought after) integrity (ability to maintain or retain bodily function, contribute to community), creativity (ability to innovate, think and execute ideas), connectivity (ability to adopt new habits, initiate and maintain links with people and community) safety and security (awareness that disability is not inability), generativity (ability to mentor and being a role model) and dignity (guaranteed unconditional positive regard) focus of the beneficiaries.

This is where your advocacy work is much needed:

This will increase your advocacy skills. This is what is meant by Strategic HIV/Public Health Planning and Programming.

Join networks which promote social justice, set aside some funds for traveling to attend these meetings.

Create time to engage in advocacy and activities that leverage the quality of HIV Prevention in your catchment area. You can also link up with other organizations involved in HIV Prevention and Care. Do not work in isolation. Also avoid using PEPFAR money to arrange birthday parties, beer parties, workshops in bars and lastly don't use PEPFAR funds to buy private cars, phones and lead luxurious life. You will be prosecuted.

The Advocacy work:   

Nutrition, Light Work And Working Out As Treatment (NLWRx):

We have made frequent visits to the clinics, requested laboratory tests and made sure medications were taken as prescribed. But, at household level, there are issues that arise resulting from toxicity of the medications. We tried our best to provide counseling and home made remedies. These were nutrition/food based remedies, light work and joining support groups. 

But, let us be honest (cut the BS...as Americans say!) we (kindly) need logistical support from the pharmaceuticals that manufactured these drugs. Come out and help us identify, buy, stock and ship foods with higher anti-oxidants to counter the debilitating effects of the virus and ARVs. Help us promote meaningful participation in quality life for all. We have witnessed uplifting experiences when the right foods were taken by those taking ARVs.

Medication and Side Effects: 

The use of multiple drugs that act on different viral targets is known as highly active antiretroviral therapy (HAART). HAART decreases the patient's total burden of HIV, maintains function of the immune system, and prevents opportunistic infections that often lead to death. HAART also prevents the transmission of HIV between serodiscordant same sex and opposite sex partners so long as the HIV-positive partner maintains an undetectable viral load. We take this message seriously.  We seek support to enable us promote management of side effects of ARVs among most of our beneficiaries.

Support your clients living with HIV in order for them to attend clinics regularly because as they continue taking ARVs, they need to be checked for side effects. 

These are some of most reported side effects: Nausea, tiredness, diarrhoea, skin rash, liver toxicity, yellow eyes, light coloured stool, dark urine, poor appetite, pain around abdomen and lower back (tenderness of liver and kidneys), peripheral neuropathy, lipodystrophy, anxiety, mood changes, strange dreams, anaemia, lactic acidosis.

Comprehensive HIV prevention package  including Circumcision:

WHO/UNAIDS recommendations emphasize that male circumcision should be considered an efficacious intervention for HIV prevention in countries and regions with heterosexual epidemics, high HIV and low male circumcision prevalence. When we go out to the communities for our Health Education/outreach services, we talk about comprehensive HIV prevention package which includes: the provision of HIV testing and counseling services; treatment for sexually transmitted infections; the promotion of safer sex practices; the provision of male and female condoms and promotion of their correct and consistent use. Our task of mobilizing for voluntary medical male circumcision (VMMC) for HIV prevention is informed by two objectives. The first is to engage communities in embracing HIV Prevention activities. The second is to cascade activities in UNAIDS 95:95:95. For references please read Male circumcision for HIV prevention (WHO)

Reducing number of sexual partners:

The more sexual partners you have in your lifetime, the more likely you are to have a sex partner who has HIV and whose viral load isn't suppressed or who has another sexually transmitted disease (STD). People who drink and/or use drugs may be more likely to take risks, such as not using protection during sexual activity, when they are drunk or high. This can increase their risk of getting HIV or other STIs.

Hepatitis C:

We take to the communities the Hepatitis C message. Hepatitis C, is a liver disease caused by the hepatitis C virus (HCV): the virus can cause both acute and chronic hepatitis, ranging in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Hepatitis C is a major cause of liver cancer. The hepatitis C virus is a blood-borne virus: the most common modes of infection are through exposure to small quantities of blood. This may happen through injection drug use, unsafe injection practices, unsafe health care, transfusion of unscreened blood and blood products, and sexual practices that lead to exposure to blood.

Adolescent pregnancy:

Approximately 16 million girls aged 15 to 19 years and 2.5 million girls under 16 years give birth each year in developing regions. Complications during pregnancy and childbirth are the leading cause of death for 15 to 19 year-old girls globally. Every year, some 3.9 million girls aged 15 to 19 years undergo unsafe abortions. Adolescent mothers (ages 10 to 19 years) face higher risks of fistula, eclampsia, puerperal endometritis, and systemic infections than women aged 20 to 24 years.

Mental health of older adults:

Globally, the population is aging rapidly. Between 2015 and 2050, the proportion of the world’s population over 60 years will nearly double, from 12% to 22%. Mental health and well-being are as important in older age as at any other time of life. Mental and neurological disorders among older adults account for 6.6% of the total disability (DALYs) for this age group. Approximately 15% of adults aged 60 and over suffer from a mental disorder.

Housing:

Housing provides opportunities for wellbeing, safety from adverse weather and security of belonging. Housing and the built environment have a profound impact on human health. The housing sector (commercial and residential) is responsible for approximately 19% of global greenhouse gas emissions and approximately one-third of black carbon emissions - a major component of particulate air pollution. Housing conditions also affect health with respect to building siting and land use, choices of construction materials, design features, and ventilation and energy. 

Livelihood:

This is a very important issue we look into and encourage conversations around. A livelihood is a means of making a living. It encompasses people’s capabilities, assets, income and activities required to secure the necessities of life. A livelihood is sustainable when it enables people to cope with and recover from shocks and stresses (such as natural disasters and economic or social upheavals) and enhance their well-being and that of future generations without undermining the natural environment or resource base. Agriculture in Uganda has a wide impact on people’s livelihoods because it is a source of income, it can positively impact the economy and it serves as a source of food. Given its potential, the nation’s government, non-profit organizations and courageous individuals are seeing the value in further investing in agriculture. 

Recreation:

We encourage beneficiaries to find time to recreate. The act of making something for the second time, or refreshment of the mind, body or spirit through play and relaxation is important and shows how motivated one is.

Criminalization Apparatus of Poverty, Sexuality, Gender and HIV: 

Criminalization has hidden fees and burdens to it. We have come to realise that there are undisclosed burdens/expenses that come with living with HIV, poverty and being of a certain gender. Definitely, sexuality is not far away.  One infraction carries the risk of escalating fees, burdens and break in HIV treatment. Criminalization leads to disparities, stigma and discrimination. There are barriers stopping many from knowing their HIV status. Criminalization, might be risky in a country where many HIV-positive people are believed to be unaware of their status. Take the message to all and sundry.

Conclusion:

Taking ARVs, has its complications but the benefits may outweigh them. The longer one has taken ARVs, the more the needs one has to address. Training providers in cultural sensitivity toward understanding the ramifications of HIV Prevention and care, in turn creates a context of readiness, facilitation and compassionate ethos. ARVs have prolonged life however, an appeal goes to the pharmaceutical manufacturers and governments to go a step further and provide contexts for decriminalizing HIV and support for managing ARV side effects.