Selina Akello sits in a clearing between the mud huts in her village. ”I will tell you anything,” she says. An older man passes within earshot, but she does not falter. This conversation would have been impossible a few years ago; Akello has the disease that used to be called ”slim” because people wasted away. Now it is called HIV/Aids.
”Once in a while I get scared for the future,” she says. ”Then I pray to the Lord to help me to live longer and I always make sure I take my tablets.”
A few years ago, HIV was cutting through a generation of health workers, farmers, teachers and parents. Few would speak about it, let alone be tested. But Uganda, where Akello lives, has been at the forefront of a roll-out of low-cost Aids drugs, subsidised by the Global Fund to Fight Aids, Tuberculosis and Malaria, the United States government and other donors.
Figures released this week by the United Nations Joint Programme on HIV/Aids show that 22,5-million people in sub-Saharan Africa have the virus in their bloodstream, of whom 1,34-million are receiving treatment — 28% of those who need it immediately. Those who look after themselves may not need the drugs for 10 years after infection.
The improved care has turned HIV from a taboo subject to something people can discuss and try to prevent.
Akello is not yet on antiretroviral (ARV) drugs to suppress the virus, but is taking Septrin, or co-trimoxazole — an antibiotic that wards off infections deadly to those with damaged immune systems. She is only receiving care after travelling 32km to Soroti town, where the Ugandan charity The Aids Support Organisation (Taso) recently opened.
But support and treatment are slow to reach rural areas such as Katine, where Akello lives. Nobody knows how many people have HIV there. The health centre at Tiriri often runs out of test kits, which means staff cannot even save babies from infection. A dose of drugs to the woman before birth and the baby afterwards cuts the risk of transmission, but in Katine health workers do not know which pregnant women have HIV.
Once patients are on ARVs they must take them for life and the virus in their bloodstream may become resistant to them. Akello knows she will not live a full span and people rely on her. Her baby died, but she is bringing up her sister’s children, aged eight, 10 and 16, because she has a small business, making the local hooch, and her sister has nothing.
She worries about the children. ”I try to plan for them,” she says. ”They help me when I am a bit weak with the business, but sometimes it is so hectic that I get pains in my chest and my back.”
She was tested after realising during a meeting held by Taso in Katine that she had put herself at risk. After her husband left her, she had relationships with more than one man. She tries to warn people in Katine, chatting with the women at the well. Some listen, she says, but many do not believe she has HIV because she does not look ill.
Angela Alelo (30) found out in May that she and her three-year-old daughter Sarah Muyama were HIV-positive. Her partner had been tested first because he was clearly ill and losing weight.
Alelo has three children, aged 16, 10 and six, from her first marriage. She left that because she was beaten. Her family paid back the dowry and at 27 she set up house with a respected police officer called Edward Wamboka. Sarah was born soon after. She is not angry with her husband, who she thinks was HIV-positive when they met. ”There is no way I can blame him,” she says. ”Many people now fall sick. It has happened.”
Both were put on ARVs and Wamboka (45) is back at work. The child does not yet need ARVs and is being given Septrin. But they know the drugs only prolong life for a while in Africa. ”We are worried because of the children. There will be nobody to care for them,” she says.
Part of this tragedy was preventable. Alelo should have been tested during her antenatal care. Tiriri health centre participates in programmes for the prevention of mother-to-child transmission that are supposed to be sweeping across Africa with the drugs — but not when the HIV test kits have run out, and it has never had ARVs to dispense.
But it is not only about drugs, says Dr Godfrey Egwau, acting medical superintendent at Soroti hospital. ”It is about the way you look after yourself. If somebody is involved in farming and is less and less able to work, gradually it erodes your economic style. You may not be able to feed yourself properly or transport yourself from A to B.”
Taso thinks many people in Katine need help, beyond its 217 registered clients who have journeyed to Soroti town. Most people can only get to Soroti if they walk or get hold of a bike.
Government policy is for every level-four health centre such as Tiriri to offer ARVs. Dr Simon Oluka, the only doctor in the 25Ã‚Â 000-strong Katine sub-county area, would like to begin an ARV programme at Tiriri, but says: ”If we are not able to sustain mere test kits, how are we to sustain ARVs?” — Guardian Unlimited Ã‚