Uganda: HIV specific laws will make us losers NOT winners.

23 04 2014

I have lived with HIV for the last 29 years. My wife is HIV negative. We have 4 children. When I married her, she was aware of my HIV status, Major Rubaramira Rulanga a member of parliament gave his testimony at during a civil society lobby meeting with MPs.

Statistics show that only 35% of Uganda’s general population have tested and received their HIV results. Majority of the people who know their HIV status are women.

In November 2013, President Museveni publicly tested for HIV in a symbolic exercise to encourage Ugandans to know their HIV status.

Meanwhile the members of parliament have some sort of alternative to the president’s initiative. They want to make HIV testing mandatory and at the same time criminalize the transmission of HIV from one person to another.

These legislators are who serve on the Committee on Health believe that enacting the HIV/AIDS Prevention and Control Bill 2010 into law could help address the current HIV/AIDS epidemic in Uganda.

In the 80s and 90s many African countries did not want to talk about HIV because they feared that their tourism industry would be affected. President Museveni and Minister Ruhakana Rugunda were among the first Africans to say, look, we have a problem (of HIV) and we need to address it.

Since then, Uganda has pioneered numerous interventions such as “if you are going to do it, go with a condom.” This is the ABC approach, which was made here in Uganda and it has been a backbone to the HIV fight since the 80s. Through these kinds of interventions, Uganda managed to reverse HIV/AIDS prevalence from a staggering 18.5% in the early 90s to 6.7% in 2002/03. Uganda became internationally recognized as one of the global leaders on HIV prevention and management.

However, a 2011 survey by the Ministry of Health shows that HIV prevalence has increased – from 6.4% in 2005 to 7.3% in 2011. This places Uganda in the same league as Angola and Mozambique, the only three African countries where HIV prevalence is increasing. HIV is one of the leading causes of death in Uganda.

Now I understand that the members of the Committee on Health are probably frustrated but after reading the content of the HIV/AIDS Prevention and Control Bill, I am certain that they are backsliding. Instead of looking for ways to manage the epidemic, the legislators are seeking to criminalize HIV and this bill has a bunch of contentious clauses.

Clause 41 of the bill criminalizes the “intentional transmission” of HIV to another person.

Human rights activists highly criticize Clause 41. They say that it would be difficult if not impossible to establish to court, who was infected first between two partners for the purpose of prosecution.

In Uganda we don’t have the technology to show/ prove that this particular person infected you. According to the Chairman of the Uganda AIDS Commission, technology will not show this because the virus is continuously changing. Members of parliament are aware of this but they still want to pass the bill in anticipation that technology is changing – maybe one day we will have the technology to prove.

A regulation requiring that a pregnant mother and her spouse be tested for HIV to reduce or prevent mother to child transmission is on the verge of failing, Men started dodging antenatal visits many years ago because of fear of being tested for HIV. We have seen overwhelming reports from Eastern Uganda where men hire boda boda drivers to escort their pregnant wives to health centers for fear of being tested. In fact, we have also heard stories where men steal their wives’ ARVs!

“If I know that knowing my HIV status can be used against me in a court of law, why would I test voluntarily?” Dora Kiconco the Director of UGANET said at a meeting with legislators. If this bill is passed into law, people will shun services such as voluntary (HIV) testing because as long as you don’t know your HIV status, you cannot be convicted under this law.

I can talk about the contentious clauses in the bill until the cows come home. If you asked me, the legislators missed the key aspects. They forgot that they legislate for the people and that to effectively manage the HIV epidemic, we need resources. Government of Uganda contributes only 19% to HIV/AIDS programs, the rest of the funds come from donors. This means that HIV is among the least of our government’s priorities.

Members of parliament must know that many their constituencies find themselves in an under privileged position. People need information. At some point, people thought that if you shared a plate, basin or fork with a person who is HIV positive, you could get infected. This was all wrong information. But the government of Uganda intervened very quickly and raised awareness to an extent that even a child understands how HIV is transmitted.

There is complacency among the people but also among the duty bearers. Treat people, educate people – this could help reduce new infections. It has worked very well in the past. Government has stopped doing some of the things it used to do. Over the years we have seen HIV awareness fade away in thin air especially among the young people.

What if HIV Prevention and Control Bill became HIV Prevention and Management Bill? This could help us prevent new infections and manage the patients by extending treatment and support.

“At one point we had reached the point where the whole world knew that we were taking the lead in fighting HIV. In countries where criminalization has not been done, the progress is very visible.” Noerine Kaleeba founder TASO Uganda

It is proven beyond doubt that if we use the right strategies, Uganda can come reclaim its reputation as one of the world leaders in HIV prevention and management.

In 2011 25,000 babies were born with HIV, last year this number reduced to 8,000 thanks to the PMTCT (prevention of mother to child transmission) intervention. Increased numbers of people going on treatment – about 60% of HIV patients are on treatment. We are making progress.

A recent BBC news story by Catherine Byaruhanga shows “Ugandans selling bogus HIV certificates”. This news story shows a young lady buying HIV negative results after confessing that she is HIV positive. She is buying these results so she can get a job. She is looking for means of survival. What would she rather do?

Now, I totally agree that people who carelessly or even intentionally transmit HIV should be prosecuted. We just have to figure out the right way to do it. Legal experts say thatSection 171 of the Penal Code Act criminalizes intentional transmission of disease (including HIV) and that if there is need, the penal code act can be amended to specifically include HIV.

My opinion is, we should NOT focus on controlling HIV but rather how to manage it. HIV is a challenge but, lets NOT criminalize and stigmatize people when we don’t have a proper framework to manage the process.

Even though the HIV Prevention and Control Bill is relevant, its enforcement remains very questionable. This law will have many loopholes – like many other laws in Uganda. Some people will trickle through the net and the problem will remain.

Did you know that we have the “enguli act” in Uganda? The act criminalizes local brew. What happens today is instead of convicting these people (drunkards); police ends up drinking the exhibit at some point.

Through some of the meetings I have attended between the members of parliament and human rights activists, I have learned that even though some of the MPs use their emotion to defend some of these contentious issues, they are also human, willing to learn and make people friendly legislations.

Only an HIV positive person would know how hard it is to go for a test, to disclose their status and to go for the services.” Lillian Mworeko, Director ICWEA

According to public health experts, the entry point of HIV care is through testing. Lets encourage people to continue test without giving them the impression that knowing their HIV status could be used against them. Lets make sure that HIV services and programs are available, accessible and of acceptable quality for all.

If we are going to criminalize HIV, are we going to improve on the conditions in the retention centers? We are definitely going to have to expand those jails. This is money we could invest in treatment, raising awareness of the epidemic and providing support to the health workers.

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