Unedited article published on issue 32 of African Woman (www.afrocanwomanmagazine.net)
AIDS epidemic is bringing a lot of pressure on the health sector which is congested and often unable to offer quality assistance. African Woman interviewed Dr Samuel Guma, a Ugandan HIV/AIDS specialist and director of an clinic for HIV positive patients.
by Claudia Giampietri
How does HIV/AIDS affect the health systems in Sub-Saharan Africa?
The impact of the AIDS epidemic on the health sector has led to an unsustainable rise of the demand for care from HIV positive patients. It is estimated that in Sub-Saharan Africa, people with HIV related diseases occupy more than half of all hospital beds. Besides, research has suggested that on average HIV patients stay in hospital four times longer than others. Thereby, hospitals are struggling to cope, especially in poorer African countries, and people are admitted only in the later stages of the illness, and their chances of recovery are reduced.
The impact is also on the resources to run health services and the human resources. Considering the government expenditure of less than 10$ a year on general health care for every individual, the demands the disease has brought about exceed the amount of money available.
Is the poor quality of the service a direct cause of the HIV/AIDS epidemic?
It is. HIV/AIDS has had a huge negative effect on the human resources. The shortage of healthcare workers is mainly due to excessive workloads, poor salaries, chronic illness and deaths of the workers due to AIDS, as well as migration to richer countries. Besides, the training of health operators is essential to deliver high quality assistance, but because of the few opportunities for comprehensive HIV/AIDS training, unfortunately, most staff lack the skills and knowledge to treat HIV/AIDS patients, and end up providing poor quality work.
Is there a way to decrease the burden of HIV/AIDS on the health system?
In order to decrease the burden of HIV/AIDS on the health system more efforts should be made to encourage all citizens to test for “early” HIV, before they develop any signs or symptoms of AIDS. Early testing will ensure that those found positive are still fairly healthy and can be given appropriate treatment including antiretroviral therapy to ensure that they stay healthy and don’t get severe opportunistic infections. The more healthy the population is, the fewer the incidences of severe illnesses that may require hospital admission.
How can the rural areas be reached effectively?
In many Sub-Saharan countries, community based HIV care programs like the clinic I run – Kawempe Home Care – and many other referral centers that provide comprehensive care manage to reach rural areas. The blossoming synergy between the local clinics and the central hospitals cannot but help decentralising the health system lightening the hospitals’ workload. Furthermore, they are the ideal model of care for people with HIV/AIDS. Research has shown that community programs that provide physical, psychosocial, emotional and spiritual care attain very good treatment outcomes and improved quality of life.
Don’t these smaller clinics also risk congestion?
Yes they do, because if you are providing a good and affordable service to the community, the news spreads like “wild fire” and every one would want to benefit from the services. The problem has to be tackled at the roots with prevention and early testing. The only effective solution to avoid the congestion of the health systems and the provision of poor quality assistance would be a drastic reduction in the number of new HIV infections.
Who are the most vulnerable people?
The most vulnerable people are the poor, uneducated women and girls, who cannot negotiate for safe sex since they depend on the men for their survival.
Moreover, the availability of antiretroviral drugs has also caused some degree of laxity and as such there has been a tendency of many people being involved in risky sexual behaviours, since they know the medicines can help them if they get infected.
What else should be done to curb the number of new HIV/AIDS infections?
HIV prevention remains the single most effective way to combat the epidemic. A recent study by the School of Public health at Makerere University, found that the greatest number of new infections where among married people. This implies that people living together begin having unprotected sex without knowing their partners status, and it also shows that there could be a lot infidelity among married people. The ABC (Abstain, Be faithful, use Condoms) strategy is still helpful, however new HIV prevention messages should target the groups of people at risk, such as those with multiple partners whether causal or long term relationships like marriage or cohabiting.
Sensitisation of the youth on modes of transmission and methods of prevention should certainly be intensified. Young people should be taught and encouraged to get to know the status of their partners before they enter sexual relationships, and should periodically continue being tested as a couple to ensure that new infections are identified early, hence protecting the HIV negative partner.
Medical male circumcision should also be scaled up countrywide, since it reduces the risk of infection in men by 60%, and this indirectly also helps to protect their female partner. Besides, the initiatives on prevention of mother to child transmission (PMTCT) should be intensified to ensure a new generation that is free of HIV.
5 Comments
September 21, 2009 at 4:46 pm
Thanks to ‘African Women’ for bringing ths article, which in a clear and easily understandable way addresses many of the most relevant pieces of information on how we together can help combat this serious disease og HIV/AIDS. There is a role to play for all of us – let us work together for the benifit of all. Thanks also to Dr.Samuel Guma for his clear answers.
It would be very interesting with follow-up articles with people from different levels of society and different ethnic background sharing their experiences with the disease and/or how they have been able to protect themselves and their families from HIV/AIDS or have been able to continue living with the disease. As Dr.Guma stresses the infection within couples is a serious cause of continuing the spread of the disease, therefore I also suggest that discordant couples are interviewed and are given a chance to share their experiences for other to learn from.
Thank you for your good work.
Yours, Margrethe Juncker
September 24, 2009 at 10:50 am
Thank you for another great post.
I look forward to many more entries with high quality info.
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September 29, 2009 at 12:32 pm
…as I am informed about, concerning the point C of the ABC method, the catholic church may be responsible stigmatizing this kind of attitude?
September 29, 2009 at 12:56 pm
In certain contexts it is. But it is also true that the very same church-goers who refuse the use of condoms “because the Church says so” – usually male adults – also seem to be reluctant in abstaining or being faithful, concepts that are also part of what the Church promotes. This attitude leads me to consider utterly and consciously irresponsible the way many people live their sexuality, and the claim “no condoms because the Church says so” is simply a way of hiding a much bigger problem related male-centered societies that leave little room to women to negotiate for safe sex.
September 29, 2009 at 5:43 pm
…I suggest to stay in these “certain contexts” cause otherwise we may run out of the specific concerning arguments …and furthermore “this attitude leads me to consider utterly and consciously” criminal the way the Catholic Church had built this “male-centered societies” …!!!!