Between a rock and a hard place: stigma and the desire to have children among people living with HIV in northern Uganda

Abstract Background: HIV-related stigma, among other factors, has been shown to have an impact on the desire to have children amongpeople living with HIV (PLHIV). Our objective was to explore the experiences of HIV-related stigma among PLHIV in post-conflictnorthern Uganda, a region of high HIV prevalence, high infant and child mortality and low contraception use, and to describehow stigma affected the desires of PLHIV to have children in the future.Methods: Semi-structured interviews were conducted with 26 PLHIV in Gulu district, northern Uganda. The interviews,conducted in Luo, the local language, were audio recorded, transcribed and then translated into English. Thematic data analysiswas undertaken using NVivo8 and was underpinned by the ‘‘Conceptual Model of HIV/AIDS Stigma’’.Results: HIV-related stigma continues to affect the quality of life of PLHIV in Gulu district, northern Uganda, and also influencesPLHIV’s desire to have children. PLHIV in northern Uganda continue to experience stigma in various forms, including internalstigma and verbal abuse from community members. While many PLHIV desire to have children and are strongly influenced byseveral factors including societal and cultural obligations, stigma and discrimination also affect this desire. Several dimensionsof stigma, such as types of stigma (received, internal and associated stigma), stigmatizing behaviours (abusing and desertion)and agents of stigmatization (families, communities and health systems), either directly, or indirectly, enhanced or reducedPLHIV’s desire to have more children.Conclusions: The social-cultural context within which PLHIV continue to desire to have children must be better understoodby all health professionals who hope to improve the quality of PLHIV’s lives. By delineating the stigma process, the paperproposes interventions for reducing stigmatization of PLHIV in northern Uganda in order to improve the quality of life and healthoutcomes for PLHIV and their children

Prevalence of severe mental distress and its correlates in a population-based study in rural south-west Uganda

BACKGROUND: The problem of severe mental distress (SMD) in sub-Saharan Africa is difficult to investigate given that a substantial proportion of patients with SMD never access formal health care.This study set out to investigate SMD and it's associated factors in a rural population-based cohort in south-west Uganda. METHODS: 6,663 respondents aged 13 years and above in a general population cohort in southwestern Uganda were screened for probable SMD and possible associated factors. RESULTS: 0.9% screened positive for probable SMD. The factors significantly associated with SMD included older age, male sex, low socio-economic status, being a current smoker, having multiple or no sexual partners in the past year, reported epilepsy and consulting a traditional healer. CONCLUSION: SMD in this study was associated with both socio-demographic and behavioural factors. The association between SMD and high risk sexual behaviour calls for the integration of HIV prevention in mental health care programmes in high HIV prevalence settings

Bottlenecks in the implementation of essential screening tests in antenatal care: Syphilis, HIV, and anemia testing in rural Tanzania and Uganda.

OBJECTIVE: To identify and compare implementation bottlenecks for effective coverage of screening for syphilis, HIV, and anemia in antenatal care in rural Tanzania and Uganda; and explore the underlying determinants and perceived solutions to overcome these bottlenecks. METHODS: In this multiple case study, we analyzed data collected as part of the Expanded Quality Management Using Information Power (EQUIP) project between November 2011 and April 2014. Indicators from household interviews (n=4415 mothers) and health facility surveys (n=122) were linked to estimate coverage in stages of implementation between which bottlenecks can be identified. Key informant interviews (n=15) were conducted to explore underlying determinants and analyzed using a framework approach. RESULTS: Large differences in implementation were found within and between countries. Availability and effective coverage was significantly lower for all tests in Uganda compared with Tanzania. Syphilis screening had the lowest availability and effective coverage in both countries. The main implementation bottleneck was poor availability of tests and equipment. Key informant interviews validated these findings and perceived solutions included the need for improved procurement at the central level. CONCLUSION: Our findings reinforce essential screening as a missed opportunity, caused by a lack of integration of funding and support for comprehensive antenatal care programs

Evidence, politics and Uganda's HIV success: moving forward with ABC and HIV prevention

Uganda's HIV success story has become increasingly focused around the idea of 'ABC' (Abstain, Be faithful or use Condoms). During the George W. Bush administration, the US Government has promoted one specific ABC model for its development agencies, with a particular emphasis on abstinence. Yet other actors have contested this view. To understand Uganda's success, it is imperative to look at what ABC was in Uganda when critical changes in behaviour were occurring. This paper investigates Uganda's HIV success, the politicised meanings of 'ABC', and the implications this may have for future HIV prevention in Uganda and beyond. Copyright (C) 2010 John Wiley & Sons, Ltd