In-depth: In the wake of the LRA: HIV in Uganda and Sudan

UGANDA: Lack of rural health services keeps HIV-positive IDPs in camps

Photo: Manoocher Deghati/IRIN
Not everyone is ready to go home
KITGUM, 29 August 2007 (IRIN In-Depth) - After attacks by the rebel Lord's Resistance Army in northern Uganda tailed off last year, the government said it would begin closing the camps housing more than one million people displaced by the 21-year conflict. But, despite continued calm, only a trickle of people has returned home.

In the Acholi region, hardest hit by the war, the estimated 21,000 people who have left the camps have mainly gone to satellite settlements between the main camps and their homes because they are afraid that the fighting will start again, and that there will be land mines in their villages. They also know they will be far from services like those in the camps.

"I want to go home, but I cannot," Maureen Auma*, an HIV-positive single mother of three, told IRIN/PlusNews. "I fall sick so often and the health centre would be too far away to walk when I'm weak."

Auma is not yet on antiretroviral (ARV) medication, but receives Septrin, an antibiotic, from the health centre that serves the Palabek-Kal camp for internally displaced persons (IDPs). If she were on ARVs, which help prolong life, she would have to travel 40km from Palabek-Kal to the main government hospital in Kitgum town for her medicine; it would be an even longer journey if she were living at home.

HIV services in northern Uganda are generally limited to hospitals and large health centres, but the government says it intends decentralising services to make life easier for returning IDPs.

"Ideally, what we would like is to see is services like PMTCT [prevention of mother-to-child transmission] and ARV provision being handled by the smaller health centres, which are closer to the people. Unfortunately, it is a very expensive undertaking, and donors have not been very willing to partner with us in this area," said Thomas Ojok, the focal point for HIV in Kitgum district.

"We don't want people to stay in the camps, but we [do] want them to remain on their medication, so if they feel that they can go home and maintain their regimens, they should go ... otherwise they need to stay around town until they can access the services closer to home."

Preparing for mass returns

The UN and non-governmental organisations (NGOs) are also preparing for returning IDPs. "We have a plan to scale up paediatric ART [antiretroviral therapy] through PMTCT but, even now, when people are in the camps, we have a problem of follow-up," said Rufina Oloa, a United Nations Children's Fund (UNICEF) project officer for HIV in Kitgum.

"So we are now starting to use more community-based follow-up, using community volunteers on bicycles rather than larger NGOs that don't really reach everyone."

The Association of Volunteers for International Service (AVSI), an Italian NGO that is the main PMTCT service provider in the region, is working with the government to build health centres equipped to provide antenatal services and PMTCT.

Apart from uncertainty about healthcare in their home villages, HIV-positive IDPs are also afraid to leave the support they get from being around other people living with the same problem.

"Every week I meet with a group and we discuss our difficulties and exchange ideas," Auma said. "We can talk to NGOs as a group and get help, but on my own I don't know what will happen."

Organisations that support such groups are encouraging people to return to their rural areas. Ketty Opoka, the founder of Meeting Point, a local NGO providing community support and care, acknowledged the need for the district health department to strengthen its services, but said this should not stop people from returning to their villages.

"We have opened a new office in Palabek-Kal, and are opening one at the new satellite camp near there - Ogili - where people are able to meet as they do in Kitgum town and get the support they need," she said.

"People should start to move and start cultivating their land instead of sitting around waiting for handouts. We are also encouraging them to form new groups when they go home; that way, information about HIV is also taken to the grass roots," she added.

The consensus among humanitarian workers in the region is that there needs to be a minimum level of health, education, clean water sources and safety available to the IDPs before they can start returning in large numbers.

See new indepth: In the wake of the LRA: HIV in Uganda and Sudan


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