Despite the formation of the UPDF district forum, there has been no clear leadership structure at various levels such as division and Headquarters which made the Armed Forces constituency lack proper representation at the national level. Though the UPDF were recipients of the Stephen Lewis Fund from NAFOPHANU, but due to lack of streamlined leadership with no clear systems and structures, the livelihood support project could not benefit the PLHIV in the UPDF as targeted.

 

Consequently, discussions were held in 2008 between the Forum and leaders of UPDF. One such meeting was held on December 5, 2008 to streamline and strategically position UPDF in particular and armed forces generally in the national HIV/AIDS response. The meeting agreed on ensuring better quality of life for UPDF members who are living positively and those of surrounding communities. This was to be done through building the institution’s capacity and framework for supporting members of UPDF and the surrounding communities in coping with HIV/AIDS infection and effects, and promoting behavioral change, acceptance and positive living. An interim committee of the UPDF, guided by NAFOPHANU was put in place.

Basing on the above background, members agreed to do everything possible to streamline leadership at divisional and national level. To this end, visits to UPDF divisions to reorganize and establish PLHIV networks/Post test clubs became paramount as a starting point for a strong and empowered forum. With support from the Partnership Fund of Uganda AIDS Commission, the exercise was embarked on.

The joint UPDF-NAFOPHANU exercise started on May 1, 2009 with Kabamba and Mbarara and was concluded on July 2, 2009 with Military Police and Chieftaincy of Military Intelligence (CMI). In all, 18 divisions and independent units were visited. They included; Kabamba, Mubende, Kakiri, Mbarara, Masaka, Nakasongola, Masindi, Gulu, Pader, Moroto, Mbale, Magamaga, Jinja, Presidential Guard Brigade (PGB), Airforce, Military Police, CMI and Bombo General Army Headquarters.  In each of the visits, focus group discussions were held with a selected team of officers irrespective of status. This involved sharing of what was actually on the ground i.e. activities, challenges, ARV status for officers who are living with HIV, election of committee members and forging a way forward. The mini-situational analysis laid foundation for the action planning exercise that the members had to work on and was later shared in the general meeting at Bombo on 16 July 2009.

Out of the visits, a lot was discovered. The Directorate of HIV/AIDS of the UPDF has done a lot towards sensitisation and provision of services to the officers though generally, stigma levels are quite high. Mubende, Masaka and PGB had already established active Post test clubs while the rest had to be either rejuvenated or started afresh. A number of activities were being conducted across all divisions. They include but not limited to; community mobilization and sensitisation, music, dance and drama, film shows, income generating projects (poultry, piggery, canteen business, revolving savings scheme etc), access to treatment and support such as voluntary counselling and testing (VCT), home based care, condom distribution among others.

A number of challenges were raised in the meetings. They include; trading centres, in and around the barracks are a haven for new infections and re-infections, stigma, especially self-stigma, non-disclosure especially to partners/spouses and supervisors, difficulty in convincing others to test, limited or no sustainable income generating activities, discordance issues, transfers and senior officers make life difficult for HIV+ officers. Other challenges are redundancy/idleness of soldiers’ wives, lack of nutritional support, adherence problems, commitment to soldiery duties, deployment to centres where one cannot access HIV services, lack of OVC specific programmes and limited funds (for transport to pick ARVs , IGAs and running administration). Some of the units such as CMI do not have a single counselor for HIV Counselling and testing (HCT).

The officers and men in all divisions and independent units would like to be more involved in the activities to reach both the infected and affected by HIV. Though they varied from one area to another, the activities include; expanded income generating projects, capacity building in various skills such as peer counseling, life skills, HIV counseling and economic empowerment. Others are community mobilization and sensitisation, care, treatment and support, Music Dance and Dramma, stigma reduction strategies and encouragement of disclosure for officers to access care, treatment and support from where they are deployed.

The officers recommended a number of strategies for increased involvement of all stakeholders but largely starting at division/independent unit level. They are;

• Individual contribution is a key component  to take advantage of
• Leaders to come up with fundable proposals
• Lobby Directorate of HIV/AIDS to design a method for transfers/movements of PLHAs officers that have disclosed to access treatment while encouraging others to disclose
• Establishment of ART centres in all divisions/units
• Measures for disclosure should be applied to avoid the common deployment issues
• Decentralise service delivery for units/divisions that have branches
• Participatory approach in designing programmes
• Inter-networking and exposure/ experience sharing visits
• Capacity building in various skills e.g. life planning skills, peer counselling, positive prevention
• IGA identification, initiation and management
• Target trading/urban centres in and around the barracks
• Encourage couple counselling
• Networks to strategically think of means to generate income for the planned activities
• Transport facilitation for the district forum

Having concluded the exercise, a general meeting for the Post-test clubs networks’ leaders was organized at Bombo on July 16, 2009 to know one another, share the field findings, lay foundation for a sustainable district forum and elect the district forum leadership and BOD member. It was attended by all newly elected/confirmed leaders, UPDF Directory of HIV/AIDS services, NAFOPHANU and Uganda AIDS Commission (UAC).

Representing UAC, Owek. Joyce Namulondo Kadowe gave the background to the HIV/AIDS response in Uganda, successes, challenges and highlighted the role of people living with HIV/AIDS in the struggle against the pandemic. She observed that PLHIVs are no longer seen as recipients BUT  are equal partners in national response, are key actors in controlling epidemic, GIPA principle thrives on PLHIVs, are front liners to advocate for MIPA vs. GIPA, ensure implementation of prevention with positives as stipulated in the National Strategic Plan (NSP), are key in promoting adherence and make effective peer counselors among others. In coordination, PLHIVs are recognised and classified as an entity, constitute a Self Coordinating entity (SCE) within UAC coordination mechanism (PC), are represented on all key structures such as CSF Steering Committee, NSP Development process, AIDS Competence etc. She urged NAFOPHANU to ensure functional district networks, access to Civil Society Fund (CSF) and ensure capacity building of district networks including those in UPDF.

On the side of the UPDF Directorate of HIV/AIDS services, Lt. Col. Mr. Stephen Kusasira began by highlighting that uniformed services are currently enjoying an unenviable position in HIV: happily consorting with fishermen, truck drivers, commercial sex workers under the unholy matrimony of MARPS [Most at Risk Populations] which marriage must be broken using the post test clubs leadership and multiple stakeholders.
The HIV/AIDS program started 1987 and UPDF recognizes HIV/AIDS as one of the security threats. The program transformed overtime from just a component of public health to a fully fledged directorate, implications of which are; resource allocation – both human and monetary and increased expectations from both the leadership and target population while serving the two service arms [Lands and Air force]. The programme scope has prevention, HIV Counselling and Testing (HCT-both static and mobile) and treatment, care and support. The other cross cutting programme components include Policy issues, PMTCT, SGBV, M&E, Lab support, IEC development, School programs and operational research.  There are 12 accredited centres with 5700 people on ART, individual testing -20491 tested in 2008, couple testing, children testing (873 tested in 2008), routine counselling and testing and PMTC testing  with 363 in 2008 alone. Lab equipment has been acquired and personnel trained in a number of skills.

Despite the achievements, the programme has challenges such as  implementers are elastic with high turnover without specific deployment to the Directorate, commercialization of interventions, incomplete task shifting as still heavily reliant on medics, much emPLHIVsis on Care & Treatment both strategic and influenced by national trends/practices, and reliance on inappropriate, non contextualized IEC materials. On HCT, the challenges are; demand outstripping test kit supplies, stock outs, number of tests vis-à-vis number of people tested, limited or no couple testing due to inappropriate national/international definition, difficult to reach spouses, no mandatory spousal HCT or even notification. Children’s testing is rather complicated, counsellors in terms of quality and quantity and the CD4 linkage cannot be accessed by all who need it. Besides, stock outs, ‘stupid’ confidentiality policies, population mobility- clients and service providers, high training costs, limited lab monitoring, and M&E issues such as different reporting areas with diverse requirements/indicators some of which are unrealistic, obsession with numbers from support partners, time consuming as more time reporting than implementing, unfair attribution of outputs and personnel and computerization of all data still limited still dog the directorate

On PLHIV involvement, there is a deliberate program policy to involve PLHIV but PLHIV previously have not strongly shown their relevance. The request was to show openly that PLHIV officers have something to offer, are visible for the programme to embrace them. There is even a draft policy in place: Non deliberate discriminatory, equal opportunities for servicemen regardless of status and unwritten policy and support from top army leadership. UPDF supports officers who are living with HIV/AIDS and encourages prevention for the uninfected. Therefore, HIV is a recognised threat to UPDF and the country at large. The Director concluded by saying that the solution to the problem lies within UPDF not outside, UPDF will embrace everyone with a positive contribution – including post test clubs that shall be judged by outputs not constitution. UPDF shall move along with PLHIVs if can make the journey interesting and less stressful and not be a burden but part of the solution. PLHIVs should not ask for favours but rather earn them and focus on what can be done within  means and what is sustainable before commercializing association since expensive is not necessarily effective. The final plea was: increase trickledown effect of support, ‘Don't serve us meat and eat the biggest portion.’

The Guest of Honour, Major-General Katumba Wamala, Chief of Land Forces, appreciated the work by all stakeholders and pledged support to the now organized networks.

The interim district forum executive was confirmed to lead all post test clubs and Captain Cassette Wamundu elected BOD member representing Armed Forces (UPDF).

 

The plans underway are to incorporate Uganda Police and Prisons in struggle to prevent more infections and promoting access to treatment .The strategies with contacts are already in place.
 
The author is the Programs manager, NAFOPHANU