In the Fight against HIV during the Corona Lockdown
Executive Director Kuraish Mubiru stepped up during the Covid-19 lockdown in Uganda and supported HIV-positive people by delivering much-needed medication.
Languages: more than 50 spoken languages; English and Swahili are the official languages
Population: approx. 43 million
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This month, we had the pleasure to conduct an interview with the inspiring Kuraish Mubiru, Executive Director of the organization Uganda Young Positives (UYP). The NGO was established in 2003 with the goal to coordinate and mobilize young people living with HIV in Uganda. Aiming at increasing prevention, care and support services, UYP improves the quality of life for young people living with HIV, while at the same time contributing to a reduction in HIV prevalence. Nowadays, UYP counts more than 60.000 members all around the country.
While the impact of the Covid-19 pandemic can be felt throughout the whole world, people living with HIV in Uganda were hit particularly harshly. Measures against the virus included a complete lockdown, not sparring public transport – a measure that virtually cut off access to HIV medication. Kuraish Mubiru from UYP was one of the first to realize this tremendous implication and stepped up to support HIV-positive people by delivering much-needed HIV treatment and providing food supplies.
Mr. Mubiru’s Career at UYP
Having started his career as a volunteer at Uganda Young Positives 8 years ago, Kuraish Mubiru quickly realized his passion about advocacy and speaking up for vulnerable or speechless individuals. Being HIV-positive himself, he has always demonstrated a great understanding of the community’s needs. This fact, together with his dedication and effectiveness in the service delivery, allowed him to quickly climb up the organizational hierarchy. Finally, in January 2018, he was nominated as UYP’s Executive Director, a position he is carrying out with great enthusiasm until today.
Lockdown measures in Uganda and Mr. Mubiru’s response
On March 18th this year, Uganda’s president Yoweri Museveni first addressed the nation regarding measures to fight Covid-19 which, among others, included the closing of schools, places of worships and other public gatherings. In the same week, he additionally announced the cessation of public and private transport. This event gravely affected people living with HIV because they were unable to move to the health facilities to receive their daily treatment of ARTs.
ART – antiretroviral therapy:
Can suppress the viral load, allow the individual’s immune system to regain strength and prevent onward HIV-transmission. If ART is taken every day as prescribed, the amount of HIV in the blood can become undetectable which allows an HIV-infected person to lead a long and healthy life without risk of transmitting the virus, not even during intercourse.
If you don’t reach out to the authorities, we are going to have new HIV infections on the rise during the lockdown
Running out of options to sustain their livelihoods, affected individuals started calling the employees at UYP. This was the moment when Mr. Mubiru felt the need to step up to support his colleagues: “If you don’t get out of your comfort zone and reach out to the authorities, perhaps we are going to have new [HIV] infections on the rise during the lockdown.” He wrote to the ministry of health through the Infectious Diseases Institute to ask for a movement sticker, which would allow him to deliver medication from the health facilities to the young persons living with HIV. After having explained his cause, fortunately, the sticker was given over, and he could start the delivery. From that day on, he provided more than 300 young persons in the Kampala region with their medication: “I spent almost 12 hours of my day driving hundreds and thousands of kilometers during this kind of work that I was doing.”
Food supply challenges during the lockdown
However, receiving HIV medication was not the only challenge people living with HIV were facing during the lockdown. Most of his beneficiaries were living on a hand to mouth basis. Therefore, the lockdown made it impossible for them to leave the house for work which implied that they were unable to obtain food. Again, Mr. Mubiru took action, and together with The Global Fund1 he managed to provide the most vulnerable people of the community with food in addition to medication.
Stigma and discrimination on the rise
Another issue gaining leverage during the Covid-19 crisis was the fear due to stigmatization. Many young people had not yet disclosed their HIV-status to their families and friends because of the considerable level of stigma and discrimination that persists in the communities, partially due to a lack of knowledge about HIV. Being locked up at home, made it difficult for Mr. Mubiru’s beneficiaries to receive and take their medication without others to know about it and therefore increased psychological stress. Not least, Kuraish Mubiru stands up against this form of stigmatization: “I believe we can build a society that is more caring, […] a society that is less stigmatizing and discriminatory.”
I believe we can build a society that is less stigmatizing and discriminatory.
Financial hurdles for UYP
This whole situation did not only challenge people living with HIV – also the service provision itself confronted Kuraish Mubiru and his NGO with substantial obstacles. Since the pandemic stroke unexpectedly, UYP had not budgeted for the medication delivery which has subjected the organization to financial barriers. At the onset of his initiative, Mr. Mubiru had to use up his own savings to fuel the car he uses for delivery. After his savings came to an end, he mobilized financial support from UNAIDS2 as well as from friends and other NGOs and actors of the Ugandan civil society. A WhatsApp group was created with more than 165 members, all HIV-related activists, enabling Mr. Mubiru to present his work and gain support from further organizations like TASO3 and UGANET4.
Challenges during the medication delivery
Besides financial barriers to surmount, Mr. Mubiru faced numerous hurdles along the way, including long distance travels to homes and health facilities via an impaired road network, entailing several car breakdowns. Occasionally, he was retained by traffic controls, scrutinizing his possession of the movement sticker since he was not considered an essential medical worker. This often made him drive home past the curfew hours (7pm). Yet, none of these obstacles could discourage him from delivering the medication and livelihood support because he knew how much his community relied on him. “When I offered that service to them, they literally welcomed it and saw me as their savior because they were totally out of options.”
Withdrawal of lockdown measures but increased traffic fares
Lately, some of the confinement measures have been lifted: notably, public and private transport are allowed to move again. However, traffic fares have skyrocketed since the lockdown which impedes ordinary citizens of Kampala to use public transportation. Therefore, Mr. Mubiru continues his effort to deliver HIV medication and livelihood support. He reckons that “Covid-19 has opened our eyes that there should be a direct mechanism to support people living with HIV to be able to live meaningful lives but also, to be able to sustain their long-life treatment.”
Covid-19 has opened our eyes that there should be a direct mechanism to support people living with HIV to sustain their long-life treatment
Even though Covid-19 has marked tremendous detriments for people living with HIV in Uganda, it has led to an increased solidarity among the stakeholders and has demonstrated the need for collaboration in the fight against HIV: “I think the solidarity, especially among civil society organizations, networks of PLHIV5 has increased, but also from the public side, the government realized now how important it is to establish relationships and direct partnerships with entities like ours.” Mr. Mubiru’s effort is just one example of many engaged actors that have stepped up during the current Covid-19 crisis. His leadership, tireless effort, and sense of solidarity towards fellow brothers and sisters in need is what enables communities like his to sustain themselves in such extraordinary times of crisis. To conclude with his words: “Covid-19 will end, our fight shall continue. And therefore, to all the stakeholders in the HIV response: I want to assure you that nothing on earth is going to intimidate us and nothing will be there to stop us.”
Since HIV/AIDS was first recognized in Uganda in 1983, the country took an open stance towards the virus pandemic and was among the first African countries to install a National Committee for Prevention of AIDS (NCPA) and a national AIDS Control Program (ACP). Despite financial and technical support from the WHO, several mobilization campaigns and disseminated HIV prevention messages, Uganda became one of the countries worst hit by HIV/AIDS in the 1990s.
Yet, much has happened since then: the Ugandan Ministry of Health, together with The AIDS Support Organization (TASO), assumed an active role in the prevention of the pandemic, established a national blood transfusion service, an STD (Sexually Transmitted Disease) control program as well as confidential counseling and testing services. Moreover, transparent reporting on the status of the pandemic as well as guidelines for its prevention and research on HIV transmission, survival and disease progression have amplified local knowledge about the virus.
Today, about 1.4 million Ugandans are living with HIV, of which 150,000 are children below the age of 15. In Uganda, women are disproportionately affected, making up 60% of HIV positives; however, HIV treatment is higher among women compared to men. Generally, about 89% of Ugandans living with HIV know their status, around 84% are on antiretroviral therapy and 75% of HIV-positive people have suppressed viral loads – though estimates differ by source, and numbers for affected children rank substantially lower. Progress has been made in the number of deaths related to HIV/AIDS which have declined by 58% since 2010, amounting to 23,000 people in 2018. Furthermore, the number of new HIV infections has decreased from 92,000 to 53,000 people per year over the same period. Overall, this results in an HIV prevalence rate of 5.8% among Ugandan adults.
According to the Ugandan Ministry of Health (2020), “HIV&AIDS continues to be a major socio-economic challenge and is among the leading causes of morbidity and mortality.” Considering the fact that the HIV epidemic is spread across the entire population, Executive Director of UNAIDS, Winnie Byanyima, Ugandan herself, urges domestic effort to scale up even further. She addressed the fact that Uganda, like many African countries, “will soon become middle-income economies and therefore will receive less international aid.” An increase in domestic levels of funding, along with a reduction of financial inefficiencies and a strong civil society that can hold the government accountable, are of outmost importance to her.
Uganda’s vibrant civil society encompasses numerous HIV support organizations, including TASO, Uganda Young Positives, MenEngage, Uganda AIDS Orphan Children Foundation and Traditional and Modern Health Practitioners Together against AIDS which share the ambition to fight HIV/AIDS and to ensure a life worth living for all HIV-infected people.
HIV stands for human immunodeficiency virus and weakens a person’s immune system by destroying CD4 (T) cells that defend the body against infections and diseases. If untreated, HIV can ultimately lead to AIDS, the acquired immune deficiency syndrome which is considered the most advanced stage of an HIV infection and entails the development of certain cancers, infections or other severe long-term clinical manifestations.
HIV is transmitted via the exchange of body fluids, including blood, breast milk, vaginal secretions, and semen from infected people, notably during sex or drug taking, or through mother-to-child transmission during pregnancy and delivery. Ordinary day-to-day contact such as shaking hands, sharing personal objects, food and water, hugging or kissing does not cause the transmission of the virus.
There is no cure for HIV – but ART, antiretroviral therapy, can suppress the viral load, allow the individual’s immune system to regain strength and prevent onward transmission. If ART is taken every day as prescribed, the amount of HIV in the blood can become undetectable which allows an HIV-infected person to lead a long and healthy life without risk of transmitting the virus, not even during intercourse. Adherence to ART by pregnant and breastfeeding women living with HIV furthermore prevents HIV transmission to their newborns.
Today, early and constant medication permits an HIV-infected individual to live nearly as long as someone who does not have HIV. Increasing access to HIV prevention, diagnosis and treatment has turned HIV into a manageable chronic health condition.
- The Global Fund to Fight AIDS, Tuberculosis and Malaria is an international financing organization that aims to eradicate the aforementioned diseases.
- UNAIDS is the joint United Nations program on HIV and AIDS and coordinates global action on the HIV/AIDS pandemic.
- TASO stands for The AIDS Support Organization, founded in Uganda in 1987, and is considered a pioneer non-public actor in the HIV and AIDS response in Uganda.
- UGANET, or Uganda Network on Law, Ethics and HIV/AIDS, is an NGO founded in 1995 that provides legal assistance and is committed to fight human rights abuses related to HIV.
- PLHIV stands for People Living with HIV.
- Centers for Disease Control and Prevention: https://www.cdc.gov/hiv/basics/index.html
- MenEngage: http://menengage.org/regions/africa/uganda/
- U.S. Department of Health and Human Services AIDSinfo: https://aidsinfo.nih.gov/understanding-hivaids/fact-sheets/21/51/hiv-treatment–the-basics
- Uganda Young Positives: https://www.ugyoungpositives.org
- Ugandan Ministry of Health: https://www.health.go.ug/programs/aids-control-program/
- UNAIDS Uganda:
- WHO – HIV/AIDS: https://www.who.int/news-room/fact-sheets/detail/hiv-aids
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