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BRIEF BACKGROUND
SAS Foundation located at Bugolobi, Kampala was founded in 2004 as a
Non-governmental Organization, an affiliate to SAS clinics and Hospital with the desire to join other stakeholders to fight against the HIV prevalence and to break it down to zero through Immunization By Education Strategy (IBES).
The SAS Foundation Objectives are to:-
- Reduce the prevalence of HIV disease
- Establish institutions geared towards fighting and reducing the HIV epidemic
- Engage in programmes, projects and activities designed to reduce the increase of HIV
- Provide counseling services especially to families and groups infected and affected by HIV
- Co-operate with government and non-governmental organization with similar objectives.
The SAS Foundation provides quality medical service to the community and over two hundred clients have registered with the organization.
The stakeholder’s workshop
On 5th November, SAS foundation held the first stakeholders workshop intended to present the new model code named Immunization By Education Strategy (IBES) The Theme of the conference was “Eradication of HIV.” One hundred and sixty participants from various organizations within and outside Kampala attended the workshop. Imminent personalities presented papers on the merit and demerit of IBES from the Educational, Social, Legal and medical perspectives.
Presentation of IBES by Rev. Obed Rubaiza
Rev Rubaiza, in his presentation on IBES subject matter, argued that origins of HIV are mysterious, regardless of the origin, its current existence in clusters means that it has building blocks. The population with in the clusters fell flat on its face because it had no resistance against HIV virus.
The ABC was applied but it didn’t penetrate clusters well, hence the stagnation in prevalence over the past years.
The introduction of IBES and discipleship program increases resistance of surrounding population, they find and break clusters. The IBES emphasizes on the introduction would raise the level of resistance at advent of adolescence. A daily dose of HIV resistance information, incorporated in the daily lessons would increase resistance in the children on becoming Adults.
Appropriate information should be given to appropriate age group to empower the young to resist the disease.
He advocated for the training in NTC/ PTCs to adopt HIV as an examinable subject and training teachers in mentorship skills to enable them to provide proper counseling ad guidance to children. National mandatory HIV testing to locate and break new clusters was advanced.
The Educationalist Perspective of IBES
This perspective was presented by Dr. K. Mirembe, a senior Lecturer at Makerere University, who defended her line Ministry in the fight against HIV. Mirembe said that besides HIV being medical epidemic, it is also a social disease. She said that the ministry of Education has designed an HIV syllabus to be taught in schools; especially the primary schools, thru PIASY.
The implementation of sex education as a means of fighting HIV is has been put in place; soon it will be made compulsory in all schools in the country. In this way, HIV would be incorporated in all subjects; the curriculum has been designed so that it is talked about.
The ministry hopes to carry out the informal curriculum where peer led activities are encourage, through which values, skills knowledge is attained. It is negotiable and children own it. They plan their activities with teachers; it is cooperative and participatory in nature which offers opportunities for the curriculum and research for Behavioural habits which relate to sex counseling are to be provided to children with psychological needs. However, the challenge of ministry of Education is how to communicate in the language that is relevant to a particular group.
The Social Science Perspective of IBES by Ms Irene Kisakye
During the 1980s, a lot of information was disseminated by government and non governmental organizations, despite the information about HIV; the corresponding behavioural change has not been realized. As a result, life skills education was introduced which calls for a number of appropriate activities suitable for young people.
Kisakye called upon various stakeholders to build supportive structures around the young person, with parents, church, mosque, schools targeting the young person to get HIV information and devise methodologies that will answers the “how” questions. We need to influence the curriculum which encompasses and harmonizes both the pupils and teachers who have different backgrounds. Packaging and repackaging of HIV education is needed in order to develop changed behaviour in the Children. Kisakye challenged educators and all those involved in HIV sensitization to be more innovative instead of getting stark to the traditional approach of drama, sports etc.
Regular counseling to those with and without HIV, young people sometimes send a lot of confusing statements; in order to win their hearts, we need to identify with them and use other strategies that will produce Behavioural change. Young people are best agents of delaying sex and teachers against HIV/ AIDS.
Kisakya is convinced that the senior women are not the best counselors in school because of their high handed manner in disciplining children. She recommends that schools should be empowered to run their own HIV programmes. Bridging the gap between parent and children and to making the young people part of the planning programmes would make them understand their role as stake holders to.
The Legal perspective on IBES by Mr.Akich Okola
In his presentation Akich Okola, a former deputy Legal Chief in Kenya’s attorney General’s Chambers, raised many legal questions about the implementation of IBES.
Akich’s concern centered on the rights of the HIV victims. He counseled that we should make sure that whatever is done does not violates the rights of the individuals. The problem of HIV /AIDS has raised a lot of legal issues which we must guard against. In his presentation, the following questions were raised.
Whether there was any law in place to protect people from the recommended mandatory testing?
Whether we have to test the whole population or certain percentage of the population to get our objectives?
He also questioned the benefit of a test requirement before one can get marriage license
Should there be a requirement that every patient to be operated must be tested
Should there be a notification by Doctors who are about to operate on a patient that they have taken HIV test? All the above have impact on human rights. Cultural practices such as polygamous marriages contribute to spread of HIV.
He lamented the absence of a legal framework in Uganda to deal with these issues, and called upon the state to put such laws in place. He said, there is need to have a legal frame work to deal with such glaring issues that pertain to human life.
The Medical prespective on IBES by Dr.Andrew Kambugu
Dr Kambugu, the head of clinical Department Makerere medical school, and a researcher in infectious diseases such as HIV, presented the genesis and epidemiology of HIV as outlined:
- Brief Biology of HIV
- How HIV presents
- How HIV is spread
- IBES Medical perspective and their implications
HIV BIOLOGY
Dr Kambugu warned participants that retrovirus integrates into the body, and that the infection is for life. People Living with HIV (PLWH) even with drugs remain infected and can infect others. HIV is difficult to eradicate medically.
Implications
Majorities of infected people look normal and do not know they are infected. A lot of transmission occurs unknowingly.
How HIV is Spread
- Mainly Hetero sexual in Africa
Risk factors
Sexually transmitted infections (STIs)
Vulnerable groups
Role of circumcision
Social context
- Mother to child transmissions MTCT
During pregnancy
At birth
During breast feeding
Implications
HIV is a Behavioural / social issue. In order to protect children we have to start with their parent. Early detection in those who don’t have symptoms is a strategy that is utilized to limit HIV transmission.
HIV Treatment and Implications
What is special about HIV treatment?
Treatment is for life. PLWHA on Antiretroviral drugs need to take 95% of their medication for it to work.
Implications
- Though treatment prolongs and improves quality of life, it is not the answer.
- Treatment is difficult and costly!
IBES Medical Perspective
- Medical issues related to HIV occur late and there is need for early intervention which IBES suggests.
- HIV is a multi sectional issue
- IBES needs to take account of MTCT.
- Health workers need to use every opportunity to reach out to individuals.
Workshops on the Presented Perspectives
EDUCATION
To target all children at all levels through information dissemination and the methods through which this can be done are:-
Family;
Engage family head to break the silence in homes to enable children open up.
Drama/Dance;
In schools, church, committees, HIV messages can be put across in form of skits,
songs, etc
Message Dissemination;
ABC should be reinforced by re-packaged messages for different age groups and by consistent and repetitive dissemination of these messages in schools, churches, bill boards, etc
Involvement of Ministry of Health;
New policy such as establishing a counselor in all schools.
Training teachers in HIV/AIDS and Sex education.
Involve HIV/ AIDS in the curriculum but not making it examinable.
Seminars/Workshops;
Constant reminder of the Public about HIV/AIDS through workshops and seminars across the whole country and targeting different work groups.
Video shows;
Can be organized in communities, schools, and social clubs in the different language easily understood by the target groups.
Work place policy;
HIV/AIDS work place policy should be strengthened to avoid stigma/ discrimination through training work place managers and leaders to develop acceptable policies.
Children out of School;
Street children should be targeted and counseled on risks, changes in the ministry of Education, Labour Gender and Social development.
MEDICAL
To target children with education campaign. Develop a habit of visiting health workers even when not sick.
It is up to the client to choose which health worker to go to in terms of gender sensitivity.
The attitude of health workers towards disabled patient should change.
Integrate mandatory testing with Immunization.
Using patients themselves, the community, and health workers as disciples and mentors.
Encourage the use of child friendly materials in dissemination of information.
SOCIAL
Information transfer has to be done at an appropriate time and place. Parents, teachers and parents should be involved in the fight of HIV.
HIV awareness, education should be a continuous process. The teachers should be empowered to handle the children.
Family counseling, mentorship and discipleship should be accepted in the community.
Life skills should be taught to the children.
Condom use should be discouraged for children.
LEGAL
There is need to have a legal framework in place in discrimination at work place, schools and at home.
The law should be implemented to prevent more fiction in adults.
Mandatory test should be done at homes for children and should be kept confidentially as at school it can’t be reduced.
Children should be involved in every activity possible without discrimination.
The right for marriage, polygamy and under age marriage should not be allowed.
Closing Remarks
The chair person thanked all the participants for attending despite the bad weather and for contributing positively to the noble cause.
She however noted that legal angles view lot of fear about children, mandatory testing and how to handle the results.
Young people have their views which need to be addressed
Repetitive education through Immunization should be encouraged and even to reach out to the street children.
She also encouraged health workers to come in at an early level and parents should pay casual visits to them.
SAS Foundation is already working towards the eradication of HIV through IBES.
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