UGANDA: Change brings new risk for the Karimojong
KOTIDO, 16 June 2008 (PlusNews) - Karamoja, in the northeastern corner of Uganda, is a remote and highly traditional society where the writ of successive governments has had only limited impact.
The Karimojong, fierce and nomadic cattle herders, had managed to hold onto a way of life that seemed to basically ignore the rest of society. But times are beginning to change as more and more Karimojong move to towns to trade with strangers.
As many as 2,000 traders from all over Uganda - and even districts in neighbouring Kenya - gather in Kotido, one of Karamoja's larger towns, every Wednesday to buy and sell cattle.
"There are Congolese here, and people from Lira [a town in northern Uganda] or Mbale [a town in Eastern Uganda], and UPDF [the national army, the Uganda People's Defence Forces, which is carrying out a disarmament exercise in the area] as well," said Patience Ajok, the programme director at the Church of Uganda Medical Centre in Kotido town.
Karamoja, once so insular, had the lowest rate of HIV/AIDS prevalence in Uganda – about 0.5 percent in the 1990s when the rest of the country had a prevalence rate in double digits. Today, the prevalence is 4.5 percent - which is lower than the national average of 6.4 percent - but voluntary counselling and testing centres in urban areas are registering rates of over 20 percent.
"In the manyattas [clusters of huts where extended family units live in rural areas] the HIV infection rate is low but it is high in urban areas - very high," Ajok said.
The Karimojong are one of the few communities in Uganda that still maintain a traditional lifestyle, revolving around the manyattas, cattle, and moving their herds in tune with the rain and green pastures.
 In the manyattas [where extended families live in rural areas] the HIV infection rate is low but it is high in urban areas - very high | But recent flooding, followed by a drought, has made for two bad harvests and wide-spread hunger. Food scarcity is driving people out of the rural areas and into towns where they have easier access to food aid distributions.
And as more people migrate to urban areas in Karamoja, there is an increased risk of contracting HIV.
"Our warriors move to town and leave the village," Margaret Alepar Achila, the Member of Parliament for Kotido, told IRIN/PlusNews. "So they are staying in urban areas and they don't go back to the manyatta."
"Much of the time they are marketing their cows in town," she added. "There is a lot of socialisation; they drink tortor [a local alcoholic brew]."
In town, where the Church of Uganda does as many as six outreaches per month that provide voluntary counselling and testing, 70 to 90 people will attend each session and Ajok guesses that usually about 10 to 15 are found to be carrying the virus.
"The number of people [infected with HIV] is increasing daily," she said.
Missed opportunities
Despite this, Karamoja has not benefited from the HIV programmes available in the rest of the country. Unstable for years due to cattle raids that have become increasingly deadly with the introduction of modern weapons, Karamoja has largely missed out on government health and development initiatives, and little has been done to inform the people about HIV. The few health facilities that exist are ill-equipped to deal with HIV testing, treatment and care.
Many in Karamoja still attribute HIV to witchcraft, while others accept it as part of the natural order of things – everyone has to die at some point, they say. Stigma is high, and women who lose husbands and children to HIV are often expelled from their villages.
In the towns, the government and a number of NGOs are belatedly starting to raise awareness about the pandemic. A recent visit from the minister of health has raised hopes that the region may finally be on the country's HIV/AIDS agenda.
According to Ajok, things are slowly changing. "In 2005 there was stigma," she said. "In 2006 it was better, and in 2007, people were seeing their neighbours receive services and grow stronger and they want services too."
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