KAMPALA – The Alliance of Women Advocating for Change (AWAC), NAFOPHANU and Uganda Nn’edaggala N’obuwangabwaffe on Tuesday launched the Community Actors for HIV Plus – abbreviated as CAHIV PLUS intended to control rates of HIV infection among sex workers across the country.
Since October 2022, CAHIVPlus initiative which will prioritize epidemics and pandemics preparedness, mental health support, HIV/SRHR, and economic resilience has tackled the aftermath effects of the Ebola epidemic and COVID-19 pandemic.
The initiative is driven under the theme: “Community Actors for HIV Plus-Uganda for epidemics and pandemics. Preparedness, mental health and economic resilience.”
Ms. Macklean Kyomya – Executive Director – AWAC noted that back in 2017, they started the Community Health and Livelihood Enhancement Group – CHLEG, to help female sex workers adhere to ARVs and prep but also ensure that there are low or no more HIV infections amongst them.
“During that time, it was challenging because you would mobilize but you couldn’t trace them and yet the project requires you to actually keep them on the service, which became a bit hard for us to keep each other in the loop. So when we started this CHLEG, we requested each other that if you choose to travel, communicate, but also stock your drugs.”
Many times, Kyomya says their clients were complaining of transport to go for refills and food because the drugs were making them dizzy but also hungrier.
This, she says triggered them to start with the saving component.
“And indeed, we started saving and our nature of saving was you save every month, and at the end of the year you share the savings, but also in that process, it was agreeable among ourselves, that if I have a personal problem, maybe it’s school fees, the child is sick or rent, you can borrow a loan at a very low interest.”
As time went on, Kyomya says many of them had used the savings to invest in housing, pay school fees for their children among others and as an institution, they had managed to save around 600 million Uganda shillings.
“This year, with the savings that we had reserved for two years as an institution, we also managed to secure a piece of land of 24 acres in Luwero.”
From here, she noted that they want to set up a hub of holistic transformation integrated with different socio-economic structures, mental health, women’s spaces, children’s safe spaces, and administration block.
On the other hand, she said that when the Ebola broke out in Mubende and Kassanda – learning from the COVID experience, they expected a lockdown but all their members were thriving.
With help from UNAIDS, she said they have implemented a number of community interventions.
Going forward after realizing the number of sex workers who are affected by Ebola, and going through a lot of trauma, “we thought how about if we could actually do the CAHIV community actors for HIV plus to support the community-led monitoring – CLM with very minimal resources.”
“So this is how the two link to one another,” she explained.
Some of the female sex workers shared their experiences, noting that CHLEG has helped them, especially in hard times of outbreaks but also in catering for themselves like rent and school fees payment for their children.
They also revealed that they have been encouraged to take their HIV medication and also provided with psychosocial support.
“If one of us gets a problem, we are able to help her out,” one of them said, adding that many of them developed themselves with credit access from their Group.
They asked the government to provide them with funds like the PDM their Group “because some of us are aging but we can as well do business.”
Ms. Sarah Nakku from the United Nations Programme on HIV and AIDS – UNAIDS Uganda commended AWAC, noting that when it comes to addressing HIV, the principle is using communities as a backbone.
“So we think that the approach of using communities to address pandemics and epidemics that erupt most especially like the time we had COVID-19, but also during Ebola, it is the basis for us to manage epidemics and also pandemics in a short period of time than concentrating on the medical approach alone.”
“We did realize that with Ebola when communities of traditional healers, communities of sex workers, people living with HIV, but also survivors of Ebola came on board to tell people how they can face stigma and discrimination at the same time how they can continue accessing health care services amidst the lockdowns, we saw the country managing Ebola in the duration of only four months,” she added.
She noted that much as medical workers do a lot, they have to be accompanied by strong community engagement to achieve the intended goals.
Nakku revealed that in the past millennium development goals, HIV as a strategy was the only one that was achieved to a tune of 70% yet most millennium development goals were not attained even at a level of 50%.
“We believe what AWAChas launched today together with their partners will not only help in terms of sustaining community responses but also help in terms of identifying emergencies and pandemics at a very quick schedule at a fast period of time.”
She also commended AWAC on the CHLEG model as a sustainable mechanism of empowering communities economically.
“We know that these circles once the communities are motivated with economic empowerment with circles in that particular form then they are in a position to address pandemics with reduced resources.”
This, she said also enables sustainability, keeping in mind that donors come and go.
Nakku attributed the high HIV preference among sex workers to the increased poverty levels among sex workers – noting that the approach of using economic empowerment is generally ideal because it helps in terms of breaking the cycle of sex work in the country.
Ms. Mary Borgman— U.S. President’s Emergency Plan for AIDS Relief – PEPFAR decried the impacts of stigma and discrimination that need to continue to be addressed to ensure that everyone feels at home in their communities.
“So the strategy to complement current systems, such as we heard about complementing, the community-led monitoring initiative, supported through PEPFAR and UNAIDS and in collaboration with communities is really essential.”
“Again, with stigma and discrimination – the financial constraints are highlighted as contributing factors,” she warned.
Representing Dr. Nelson Musoba, the Uganda AIDS Commission boss, Dr. Daniel Byamukama warned the policemen who harass, beat, steal money and even arrest sex workers, noting that “Uganda is big enough for us all.”
“They do it in their personal capacity, not representing the government.”
He commended AWAC for always coordinating sex workers and sensitizing them on HIV prevention, noting that the national HIV response emphasizes the involvement of all communities – from planning, coordination and implementation.
Dr. Byamukama, however, noted that despite all the work done, there is very little improvement in HIV reduction among sex workers.
“Yes, we are not as bad as we used to be 15 years ago but when it comes to HIV infections, we aren’t getting better.”