Candongwa is five years old. Orphaned by AIDS, he is also HIV positive. He has no relatives except one young sister in primary school. They are living in the war torn area of Kitgum, in Northern Uganda, theatre of a conflict for the last twenty years between the rebels of the Lord Resistance Army (LRA) and the government. "We met Candongwa one afternoon in his hut, during a home based care visit". Dr. Chiara Pierotti explains. She has been working in Northern Uganda for the last six years, running projects on HIV/AIDS for AVSI, an Italian NGO, working in the country since 1984. "He had a terrible skin rush. He was very weak, sick. And sad. AIDS was already at a quite advanced stage. The only solution would have been to put him on ART. But how? - I was wondering - in a war-torn area, without any adult relative to take care of him". ARV drugs have to be taken twice per day, at the same hour. Side effects are common and need to be monitored carefully and managed immediately. But Dr. Chiara took the risk. Candongwa was enrolled in the ART programme of St Joseph's Hospital where the provision of ART is supported by the Catholic Relief Service (CRS) and the European Union, with technical assistance from AVSI. Today, after one year of treatment, Candongwa is healthy and happy. The treatment is working successfully. gwa was enrolled in the ART programme of St Joseph's Hospital where the provision of ART is supported by the Catholic Relief Service (CRS) and the European Union, with technical assistance from AVSI. Today, after one year of treatment, Candongwa is healthy and happy. The treatment is working successfully.
"Treatment success is blind to race and continent", was declared last August during a presentation on ART at the Toronto XVI International AIDS conference. It was found that adherence to ART is better in African programmes than in North America with 77% and 55% adherence respectively. This is in turn the same result that came out from an abstract submitted by AVSI during the same event, showing good immunological and virological response and a strict adherence to ART in the rural war-torn area of Kitgum, as the case of Candongwa shows clearly.
The number of adult patients on ART in St Joseph's Hospital, after one year and a half of the programme, is 722, while 54 are children. The benefit they are receiving from the programme is quite evident. "Key to adherence, in fact, is not the environment", Dr. Lawrence Ojom, medical superintendent of St Joseph's Hospital, explains. "It is rather the involvement of communities in the follow-up of the patients". One fundamental component of the ART programme is the involvement of two local NGOs (Meeting Point and CHAPS) in the follow up of the patients in the community. Trained caregivers, often on ART themselves, monitor the patients at home. "This component is very important especially here in the North, where over 70% of ART clients are located within the urban areas, thus quite easy to reach", Okiddi Ponziano, CHAPS Director, explains. "What people need here in the North is the companionship of somebody who is taking care of them", Ketty Opoka, Meeting Point coordinator says. "And this is exactly what our caregivers are trying to offer through home visiting to the patients on ART". aregivers are trying to offer through home visiting to the patients on ART".
"It is this component of social cohesion, very strong in Northern Uganda, which allows the treatment to be successful, even in an emergency context", Dr. Ciantia, AVSI Country Representative says. "Quite the opposite, AVSI experience in the HIV/AIDS sector in the country shows clearly that, while conflict is often locally reported to accelerate the spread of HIV, prevalence in conflict-affected regions is similar to rates in other peaceful regions (6.9% in North-Central and North-East compared to 6.7% in peaceful Western and Central). Moreover, an AVSI abstract submitted at Toronto AIDS Conference shows that Internally Displaced Camps (IDP) had rates of pre-test (89% versus 81%), test (91% versus 85%) and post-test (99% versus 93%) higher than those in other centres. Enrolment uptake is higher in conflict-affected (100%) than in peaceful (75%) and estimated PMTCT coverage is similar in conflict-affected (32%) and peaceful regions (31%)". Not only that; another AVSI study demonstrates how IDP children have a higher risk of malnutrition, but reduced risk of HIV-infection with higher HIV prevalence among children living in town than among those displaced (39% versus 20%). Finally, a study carried out in collaboration with the Italian National Institute of Health demonstrates that internally displaced women have a reduced risk of being HIV-1 infected. This is probably due to their reduced mobility and increased access to health education and prevention services, which are often implemented in protected camps. "The relationship between humanitarian crises and HIV/AIDS is ambiguous", was stated during the Pre-conference HIV/AIDS, Conflict and Displacement, organized by UNICEF and UNHCR in Toronto last August and where Dr. Ojom, St Joseph's hospital MS, presented the ART programme in Kitgum. "Emergencies can increase risk factors for HIV transmission, but they can also play a 'protecting' role vis-à-vis HIV infection, limiting population mobility and isolating communities". igher risk of malnutrition, but reduced risk of HIV-infection with higher HIV prevalence among children living in town than among those displaced (39% versus 20%). Finally, a study carried out in collaboration with the Italian National Institute of Health demonstrates that internally displaced women have a reduced risk of being HIV-1 infected. This is probably due to their reduced mobility and increased access to health education and prevention services, which are often implemented in protected camps. "The relationship between humanitarian crises and HIV/AIDS is ambiguous", was stated during the Pre-conference HIV/AIDS, Conflict and Displacement, organized by UNICEF and UNHCR in Toronto last August and where Dr. Ojom, St Joseph's hospital MS, presented the ART programme in Kitgum. "Emergencies can increase risk factors for HIV transmission, but they can also play a 'protecting' role vis-à-vis HIV infection, limiting population mobility and isolating communities".
However, "populations affected by emergencies have been neglected in the provision of essential HIV/AIDS prevention, treatment and care service, in particular in the delivery of ARV drugs". This was noted with concern during an experts' consensus meeting on providing ARVs as part of comprehensive HIV services to populations in emergency settings co-organized by WHO, UNHCR, UNAIDS, MSF and UNICEF and in which AVSI participated . "Although ARV delivery has been shown to be feasible and affordable in low-income settings, a large number of people living in emergency-affected countries do not have access to quality HIV services, including ARVs. "In Kitgum district, the ART coverage is only 32%", Dr. Chiara confirms. "Only 4 sites (12%) out of 34 health facilities in Kitgum district are providing ART (2 hospitals and 2 rural health centres). Paediatric ART is available only in 1 facility and diagnostic facilities are very poor and only in urban areas, with only one CD4 count machine available in St Joseph's Hospital, and few qualified staff able to implement the ART programme". The high-level consensus meeting came to the conclusion that the provision of HIV services is not only feasible, but is an inalienable human right and a public health necessity; and that governments, NGOs and international donors should give due attention to populations in emergency settings with national plans and must integrate HIV/AIDS planning into all stages of humanitarian assistance preparedness and funding schemes. It is a collective responsibility. We owe it to Candongwa. We owe it to the people of Northern Uganda. l, and few qualified staff able to implement the ART programme". The high-level consensus meeting came to the conclusion that the provision of HIV services is not only feasible, but is an inalienable human right and a public health necessity; and that governments, NGOs and international donors should give due attention to populations in emergency settings with national plans and must integrate HIV/AIDS planning into all stages of humanitarian assistance preparedness and funding schemes. It is a collective responsibility. We owe it to Candongwa. We owe it to the people of Northern Uganda.
[ Any views expressed in this article are those of the writer and not of Reuters. ]
