“When I first heard that I had HIV, I was so scared and a lot of questions were running in my mind. In the whole family, I was the only one who had it,” narrates Emmanuel Ilaborot Otim, who now serves as the Young Adolescent Peer Supporter (YAPS) for TASO Soroti regional office.
Otim says that he was diagnosed HIV positive in 2005, when he was 9 years old. He recalls that he got the ‘sad’ news a year after the death of his mother in Katakwi district.
“I was so sickly and when my grandmother was told at the hospital that I was tested HIV positive, I saw the way she froze and I felt like something was not right with me. Every village mate of mine who heard the news about my status feared to get close to me, including my own family members,” recalls Otim.
Otim tells Aica that at one point he almost lost his to what seemed to have been too much of stigma due to the feeling of isolation from the rest of the community.
It was at that time (end of year 2005) when he was taken in by TASO Uganda and enrolled on ART care. While at TASO, he got a new home full of hope for a future.
Mr Peter Okiira, the Public Relations Officer for TASO Soroti says that Otim is a face of many other youths who have suffered the consequences of stigma.
“If you want to know of any success story about fighting stigma, just talk to Emmanuel,” said Mr Okiira at the time of interview.
Okiira added that TASO has supported a number of young people living who are tested positive to understand their new status of living.
“We have not only supported children or youths, there is a number of even the elderly who test at later stage and it is not simple for such a person to just accept the new status, so we do a lot,” he added.
This year, Uganda joined the rest of the world to fight against cases of stigma from increasing, such that the many young people like Otim, adults and elderly live a normal life with less distractions, like any other person.
25% Adults in Teso Report Stigma Cases
There are still high cases of stigma among adolescents in the sub region that comprises of the 11 districts [Soroti, Katakwi, Kumi, Kaberemaido, Amuria, Serere, Ngora, Pallisa, Bukedea, Kapelebyong and Kalaki] and four districts of Karamoja [Abim, Kotido, Moroto, Amudat, Napak], and different interventions have been put in place to try to reduce.
Dr Baker Bakashaba, the Regional Project Manager for TASO Soroti says that the organization, with support from the Ministry of Health has engaged on continuous sensitization of the young people living with HIV through the YAPS.
“We have engaged a team of young peer supporters that we have trained and equipped with necessary communication skills,” explains Bakashaba.
Dr. Bakashaba adds that there are positive results of response from the YAPS strategy of communicating with addolescents. According to him, there are reduced cases of the youths dodging medication because they feel energized when s/he receives counseling from a fellow youth.
The Ministry has considered recruiting the Young Adolescents and Peer Supporters to help bridge gaps for the risk factors for the new infections in the different young groups of Uganda’s population and set out to address them.
As YAPS, Otim explains to Aica some of the reasons on ground as to why young people living with HIV still feel left out.
“No body is happy to hear unexpected news. The depression here is self-geared,” explains Otim.
According to him, a number of young people he has interacted with live a life of regrets after getting the results. He said that adults within the age brackets of 20- 24 are the most affected since the acquire the disease through engagements in acts such as unprotected sex.
“It is worse with those who got it [HIV] through unfortunate circumstances like rape,” narrates Otim.
This is the most common issue that has continuously upgraded the phase of stigma in the sub region. Otim says that he has interacted with a number of young people who have feared or delayed to and get medicine because of fear of the way they are perceived in the community where they live.
In his position as a YAPS, he said that has got reports from several health facilities adolescents, including young mothers living with HIV has abscond to receiving ARVs simply because the health facilities are located in open spaces where anybody can see ‘them’ picking the tabs.
“Some of these young men and women who are sexually active are even hiding medicines from their spouses.”
This is one of the salient issues revolving around the adolescents living with HIV in Teso.
According to Otim, most them negligently follow prescriptions of the doctor. He said that the laxity in swallowing the ARVs or septrine at the prescribed times has led to a lot of challenges, one of it is failure to suppress the Viral load.
“I have talked to most of them who have faced a knock-down and they tell me that they swallow their ARVs only when they feel weak or sick, which is very dangerous.
On the other hand, Dr. Bakashaba reveals that in a period of less than a year, the YAPS are registering tremendous positive responses from the young adolescents whom they have spoken to.
66% of Adults Not Suppressed
The Viral Load suppression among adolescents in Teso sub region is still a big challenge. According to a report from TASO Soroti regional office, 66% of the adolescents have their VL not suppressed.
What is Viral Load Suppression?
Antiretroviral [ART] therapy keeps HIV from making copies of itself. When a person living with HIV begins an ART treatment regimen, their viral load drops. For almost everyone who starts taking their HIV medication daily as prescribed, viral load will drop to an undetectable level in six months or less. Continuing to take HIV medications as directed is imperative to stay undetectable.
What does it mean to be durably undetectable?
Dr Baker Bakashaba, the Regional Project Manager for TASO Soroti explains that taking antiretroviral therapy daily as prescribed to suppress HIV levels leads to an “undetectable” status.
According to him, a person is considered to have a “durably undetectable” viral load if their viral load remains undetectable for at least six months after their first undetectable test result.
“It is essential to continue to take every pill every day as directed to maintain an undetectable viral load,” he explains.
Does being durably undetectable mean that the virus has left the body?
Dr. Bakashaba explains that even when viral load is undetectable, HIV is still present in the body.
The virus lies dormant inside a small number of cells in the body called viral reservoirs. When therapy is halted by missing doses, taking a treatment holiday or stopping treatment, the virus emerges and begins to multiply, becoming detectable in the blood again. This newly reproducing virus is infectious.
He still emphasizes that “it is essential to take every pill every day as directed to achieve and maintain a durably undetectable status.”
According to the National Institute of Allergy and Infectious Disease [NIAID], there is effectively no risk of sexual transmission of HIV when the partner living with HIV has achieved an undetectable viral load and then maintained it for at least six months. Most people living with HIV who start taking antiretroviral therapy daily as prescribed achieve an undetectable viral load within one to six months after beginning treatment.
A person’s viral load is considered “durably undetectable” when all viral load test results are undetectable for at least six months after their first undetectable test result. This means that most people will need to be on treatment for 7 to 12 months to have a durably undetectable viral load. It is essential to take every pill every day to maintain durably undetectable status.
What has been done?
The Ministry of Health together with support organizations such as TASO have put a number of strategies to help fight against stigma among adolescents and improve of the results of the Viral Load Suppression in the sub region and country at large.
This is all being done in a move of realizing 90- 90- 90 vision of 2020.
The 90- 90- 90 is an ambitious treatment target that was launched by UNAIDS and other partners. It is aimed at diagnosing 90% of all people living with HIV, provide antiretroviral therapy (ART) for 90% of those diagnosed, and achieve viral suppression for 90% of those treated by 2020.
The District LCV Chairperson for Serere, Joseph Opit Okojo says that his local council administration department of health has held several meetings with the people living with HIV.
According to him, the district has always received support from TASO and other support organizations that enabled the technical teams to reach to the target persons.
“Sometimes when these people see us leaders going on ground and share with them, it gives them the sense of being considered,” says Opit.
The LCV Chairman for Katakwi district, Walter Elakas Okiring applauds the Ministry of Health and other supporting organizations for rendering necessary support for the people living with HIV.
“Some years ago, much of the donations and support used to go the people with disabilities and this category of people was left out. In fact, even the society rejected whoever was diagnosed HIV positive. But today, they are living with other people happily,” says Elakas.
Presidential Initiative to end AIDs as a public health by 2030
In June 2017, the President of Uganda launched the Presidential fast track Initiative to end AIDs as a public health by 2030.
The initiative highlights five areas of focus: Engaging men in HIV prevention to close the gap on new HIV infections especially among adolescent girls and young women, accelerating implementation of test-and-treat to achieve 90:90:90 especially among men, consolidating progress on elimination of mother-to-child transmission of HIV, ensuring financial sustainability for the HIV response, ensuring institutional effectiveness for a well-coordinated multi-sectoral response.