Uganda has a very high percentage of the population that is infected with HIV (15% by most estimates) and where I am in Acholi Land in the north is one of the only places where the rates are still climbing. Most likely it is still a hold over from the war that ended only 8 years ago. The rebels and government soldiers both used rape and sexual violence as tactics of oppression (in addition to capturing child soldiers, capturing women as sex slaves – to give birth to more soldiers, burning villages, and killing anyone they suspected of opposing them).
The government has a big campaign to get every couple tested called “go together, know together”. In theory this is great as if a woman is neg and her husband is pos then without education and counseling she will probably also become positive. So it does make sense that they only want to test couples together. But this is often taken too far when women who either are not married or who’s husband is away will be turned away from the local health center and not tested.
We often have women coming to our clinic after they have been refused testing at the health center. We just had a woman 38 weeks pregnant in this situation. She became pregnant with a man who was going all across the country installing the electric poles (all the way up the country electric poles and wires are stretched but there is no electricity running through them, as with many things here it will happen someday). Anyway, since he was no longer with her they refused to test her. We gave her the test and it was positive. When we get a positive result we send the client with a referral letter to go to the health center for follow up testing, counseling, and medication. Because we wanted to make extra sure this happened, Christine, our amazing Ugandan student went to the health center with the mama to help advocate for her. She was able to get counseling and the medication that she’ll take for the remainder of her pregnancy. After the birth we’ll again take her to the health center where she’ll get more medicines. It is not fun to inform somebody that they have a disease which everyone knows is a death sentence. Even with medications which are available everyone knows somebody who has gotten sick and died a horrible death too early in her life. This mother took the news the way all women here take everything, completely stoic with no show of emotion. I expect that she’ll come in soon to have her baby.
Last week we had a lovely birth with an HIV pos mama. She was having her fourth baby. She has three healthy children at home and her husband is negative. Although the government wants all HIV pos women to birth at the hospitals many women choose to come to us where they know they will be treated with dignity and respect. Of course we take extra precautions to make sure we don’t get any fluids on ourselves, we really do a good job of that anyway. We also take them to the health center as soon as possible after the birth where they’ll receive more counseling and medications. It is a privilege to serve these women.
I promise to have a less depressing post next time! We just had a great meeting with all the Lacolos (Traditional Midwives) in the area and a fun multi cultural thanksgiving!