A Cross-border initiative for expanded access and increased uptake of comprehensive and integrated HIV/AIDs services, among the south Sudanese refugees and Host Communities in West Nile region and Kiryandogo District of Uganda. It aims at contributing to improvement of quality of life of persons infected and affected by HIV/AIDS. Its key deliverables are: accelerated and easy access to prevention, care and treatment; increased demand and usage of HIV/AIDs services by different categories of targeted persons; reduced Stigma and discrimination; ICT enabled tools deployed for multi-flow of real time information to increase follow-up, adherence, confidentiality and improved coordination; strengthened community/ health facilities linkages and a robust monitoring and evaluation system.
The problems to address among the refugees and the host communities in West Nile include; poor health seeking behaviour, poor treatment adherence among HIV/AIDs positive persons, weak follow up, stigma and discrimination, limited health and social services. This has been coupled with weak coordination of the West Nile region HIV/AIDs structures and delivery systems.
The major causes include; Socio-cultural and economic barriers, War and displacement, brutal treatment resulting in rape and trauma. The growth of trading centres adjacent to refugee settlement camps has led to an influx of different groups of people such as business men and truck drivers. Risky behaviours such as alcoholism and prostitution have led to an increase in new infections. The Limited capacity of the West Nile region to respond to the crisis of refugees is further complicated by the lack of viral load suppression services in district hospitals of Arua, Yumbe, Moyo and Adjumani. Inadequate laboratory services in all the health centres and long distances involved with inefficient transport system has severely affected referrals. The dropout rate of HIV/AIDs patients under care and treatment reported in Bidibidi refugees Settlement is about 20%. The infrastructural deficit has led to a lack of facilities for testing and shortage of test kits, drug stock-outs, Low staffing levels in health facilities, insufficient and delayed food supplies to the refugees and inadequate accommodation for teachers and health workers.
AFLI has interests in the West Nile region and Kiryandogo District particularly in the south Sudanese refugee settlement camps and adjacent host communities, because of the high prevalence rates of HIV/AIDs and the risk of it spreading to dangerous levels, thereby devaluing all current efforts and investments in life saving. According to the UNHCR (2017) reports, the population of Sudanese refugees in Uganda has reached 800,000 and still increasing. In an earlier assessment conducted by AFLI (April 2017), Bidibidi refugee settlement alone has 272,168 refugees. Out of 10,000(4% of the camp population) refugees tested, 3.4% (340) were found to be positive and were enrolled for treatment. With a 20% drop out rate, it means that there are high absolute numbers of people that can potentially be a source for further infections. Given the already limited number of organisations offering HIV/AIDs services in camps and host communities, the ramifications could be catastrophic if comprehensive HIV/AIDs programming is not implemented.
The Service delivery short comings that AFLI will address include:
existing service delivery in health facility based acre and treatment, lack of Information, Education and Communication (IEC) materials in the main local languages of the host communities and refugee dialects; limited psychosocial support to Persons Living with HIV/AIDs (PLHIV), Orphans and Vulnerable Children (OVCs); limited support towards comprehensive HIV/AIDs care by partners; unacceptability to use male and female condoms and weak distribution; limited adoption of male circumcision, lack of HCT and SMC implementation partners ; limited TB/HIV Collaborative interventions; shortage of drugs for opportunistic diseases services; weak programming for nutrition for PLHIV, stigma and discrimination and community home-based/palliative care.