AIDS In Uganda Research Articles

Stigmatization of People Living with AIDS in Uganda: Historical Context, Cultural Implications, and Community Interventions

Stigmatization of People Living with AIDS in Uganda: Historical Context, Cultural Implications, and Community Interventions

Performances studies of a basket-based solar cooker for humanitarian aid in Uganda

This study explores the suitability of a basket-based solar cooker for cooking in Uganda, an equatorial country. The solar cooker is designed to be easily constructed and based on recycled and locally available materials. Its performance in terms of cooking potential, power, and energy efficiency is evaluated. A nodal model is developed, validated and used to assess cooking capabilities. Results indicate effective cooking days in Bidi Bidi refugee settlement for rice, plantains and sweet potatoes of, respectively, 328, 314 and 295 days annually, with considerations for cloudy days and energy-intensive meals. Solar cookers offer substantial advantages, including fuel independence, financial savings, and reduced environmental impact. To promote adoption, the establishment of solar cooking centres for education and cooker construction is proposed. Widespread solar cooker use has the potential to mitigate deforestation, improve health, and enhance education.

Crowd in or crowd out? The subnational fiscal response to aid

The fiscal response of aid recipients is crucially important to understanding the effects of aid. The dynamics of governments’ fiscal response to receiving aid can help reconcile the micro–macro aid puzzle, as well as having important implications for studying the micro effects of aid. I explore, in the context of Uganda from 2010 to 2017, whether IDA aid crowds out or crowds in government spending at the district level. To do so, I use an instrumental variables approach combining subnational variation with temporal variation and rich and detailed data on project aid and government budgets in Uganda. I find evidence that IDA funding leads to increases in government spending, and further evidence that these dynamics are more complex than simple follow-on in the same sector as IDA projects. These results suggest critical and underexplored dynamics in subnational fiscal responses to foreign aid, which may have important implications for the study of aid effectiveness.

Does project-level foreign aid increase access to improved water sources? Evidence from household panel data in Uganda

Empirical evidence from cross-country studies on the effectiveness of aid to the water, sanitation and hygiene sector (WASH aid) points to significant heterogeneity across countries and highlights the need for further research at the sub-national level to assess and quantify the effectiveness of WASH aid within countries. This paper combines geocoded sub-national data on the location of WASH aid projects in Uganda with nationally representative household-level panel survey data to examine whether proximity to aid-funded WASH projects improves household access to water. Access to water is evaluated along three dimensions: access to an improved water source, travel time to an improved water source and waiting time at an improved water source. The results of a difference-in-difference regression analysis suggest that while aid-funded WASH projects increase household access to improved sources of water, households may also see the time burden of water collection increase, as they may need to travel longer distances and also experience longer wait times due to congestion at water service points. This is an indication that the supply of improved water sources financed by WASH aid in Uganda remains insufficient relative to demand as measured by the population density.

Reflections on the cultural adaptations and implementation challenges of mental health first aid in Uganda: A case study.

Untreated mental illness as a result of trauma is a significant health concern leading to increased morbidity and mortality. Individuals in post-conflict countries, like Uganda, are at risk for poor mental health outcomes because of trauma as a result of decades of violent conflict coupled with a lack of access to quality psychological care. Community-based psychological service delivery programs, like Mental Health First Aid (MHFA), have been found to be effective in helping individuals with mental and emotional problems access care. However, little is known about the cultural adaptations needed and implementation considerations of these kinds of community programs for under-resourced nations. This case study describes key considerations for the implementation of the MHFA curriculum in various regions throughout the country of Uganda. Specifically, this case study gathered observations while implementing MHFA and highlights challenges, such as cultural adaptability and country infrastructure, that must be addressed when attempting to implement Western mental health curricula in non-Western nations, like Uganda. Recommendations for the use of psychological service delivery programs in developing countries are presented. If incorporated, these recommendations will serve to increase access to mental health services in the regions of the world that need them most. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Donor Commitments and Disbursements for Sexual and Reproductive Health Aid in Kenya, Tanzania, Uganda and Zambia.

Background: Sexual and Reproductive Health and Rights (SRHR) investments are critical to people's well-being. However, despite the demonstrated returns on investments, underfunding of SRHR still persists. The objective of this study was to characterize donor commitments and disbursements to SRH aid in four sub-Saharan countries of Kenya, Tanzania, Uganda and Zambia and to compare trends in donor aids with SRH outcome and impact indicators for each of these countries.Methods: The study is a secondary analysis of data from the Organization for Economic Co-operation and Development's Assistance creditor reporting system and SRH indicator data from the Global Health Observatory and country demographic health surveys for a 16-year period (2002–2017). We downloaded and compared commitments to disbursements of all donors for population policies, programs and reproductive health for the four African countries. SRH indicators were stratified into health facility level process/outcome indicators (modern contraceptive prevalence rate, unmet need for family planning, antenatal care coverage and skilled birth attendance) and health impact level indicators (maternal mortality ratio, newborn mortality rate, infant mortality rate and under five mortality rate).Results: Donor commitments for SRH aid grew on average by 20% while disbursements grew by 21% annually between 2002 and 2017. The overall disbursement rate was 93%. Development Assistance Cooperation (DAC) countries donated the largest proportion (79%) of aid. Kenya took 33% of total aid, followed by Tanzania 26%, Uganda 23% and then Zambia (18%). There was improvement in all SRH outcome and impact indicators, but not enough to meet targets.Conclusion: Donor aid to SRH grew over time and in the same period indicators improved, but improvement remained slow. Unpredictability and insufficiency of aid may be disruptive to recipient country planning. Donors and low- and middle-income countries should increase funding in order to meet global SRHR targets.

Impact of a Family Economic Intervention (Bridges) on Health Functioning of Adolescents Orphaned by HIV/AIDS: A 5-Year (2012-2017) Cluster Randomized Controlled Trial in Uganda.

Objectives. To investigate the long-term impacts of a family economic intervention on physical, mental, and sexual health of adolescents orphaned by AIDS in Uganda.Methods. Students in grades 5 and 6 from 48 primary schools in Uganda were randomly assigned at the school level (cluster randomization) to 1 of 3 conditions: (1) control (n = 487; 16 schools), (2) Bridges (1:1 savings match rate; n = 396; 16 schools), or (3) Bridges PLUS (2:1 savings match rate; n = 500; 16 schools).Results. At 24 months, compared with participants in the control condition, Bridges and Bridges PLUS participants reported higher physical health scores, lower depressive symptoms, and higher self-concept and self-efficacy. During the same period, Bridges participants reported lower sexual risk-taking intentions compared with the other 2 study conditions. At 48 months, Bridges and Bridges PLUS participants reported better self-rated health, higher savings, and lower food insecurity. During the same period, Bridges PLUS participants reported reduced hopelessness, and greater self-concept and self-efficacy. At 24 and 48 months, Bridges PLUS participants reported higher savings than Bridges participants.Conclusions. Economic interventions targeting families raising adolescents orphaned by AIDS can contribute to long-term positive health and overall well-being of these families.Trial Registration. ClinicalTrials.gov registration no. NCT01447615.

Impacts of AIDS on Women in Uganda

This paper discusses the broad impacts of AIDS on women in Uganda. An extensive literature review and analysis demonstrate that not only is the risk of HIV-infection and AIDS higher for women than for men in Uganda, individual and social impacts of the disease on Ugandan society disproportionately affect women. Both afflicted and nonafflicted women are greatly affected by the AIDS scourge through their multiple roles as individuals, caregivers, and mothers. Research demonstrates that AIDS in Uganda presents severe socioeconomic implications for women as well as a higher risk for infection due to cultural expectations, subordinate status, and patriarchy in the society.

Sexual risk associated with gambling among the youth in Rubaga Division, Kampala.

The status of sexual and reproductive health of youths and adolescents in urban areas across the globe is alarming. Evidence from Uganda Aids Indicator Survey 2011 indicates that over 31% youths who have never married are engaged in sexual intercourse but have never tested for HIV. Gambling is clearly on the increase in major towns and cities drawing in several youths. However, the risk that this practice poses on the youth's sexual behavior has not been investigated in Uganda. This study intended to fill this gap. This study examined the sexual risk associated with gambling among youths in Rubaga Division of Kampala Capital City of Uganda. The study employed a quantitative cross sectional design to survey 397 youths aged 15 to 24years. It employed a systematic sampling scheme in selecting households with youths who responded to the household survey questionnaire. Results showed that more male than female youths are engaged in gambling, majority of whom start gambling below 18years. Most of the gambling youths are pulled by competition with peers and desire to earn money. Compared with nongambling youths, gambling youths have more sexual encounters, initiate sexual activity at a young age, have unprotected sex, have sex with more than one partner whom they do not know their HIV status, and have sex under the influence of alcohol. The study recommends for government to form and enforce policies to regulate gambling with a view of minimizing its associated risks especially unsafe sex. Through the ministry of health and civil society organizations, government can create programs to reach the gambling youths with sexual reproductive health services.

Correlates of HIV status awareness among older adults in Uganda: results from a nationally representative survey

BackgroundRecent evidence suggests that HIV prevalence is generally higher among older than younger persons. However, few studies have explored issues regarding HIV testing and awareness of HIV status among older persons. We explored the correlates of HIV status awareness among older adults (aged 45+ years) in Uganda.MethodsThis paper is based on secondary analysis of existing data on persons aged between 45 and 59 years from a nationally representative Uganda AIDS Indicator Survey which was conducted between February and September 2011. Records on the socio-demographics and HIV/AIDS-specific indicators for 2472 persons were extracted for analysis. Individuals were considered to be aware of their HIV status if they reported that they had tested and received their HIV test results within the past 12 months. Data analyses were done using the sample survey procedures to take into account the sampling structure of the data. Odds ratios were used to quantify the associations between receipt of HIV test results and potential factors.ResultsOf the 2472 respondents, 48% had ever tested and received their HIV test results while 23% tested and received their HIV results in the past 12 months or already knew that they are HIV positive. Individuals with the following characteristics had higher odds of being aware of their HIV status: being female (adjusted Odds Ratio (AOR) = 1.26; 95% CI: (1.04, 1.53), having high comprehensive knowledge of HIV/AIDS (AOR = 1.28; 95% CI: 1.04, 1.58), having attended secondary school education (AOR = 2.10; 95% CI: 1.47, 2.99) and engagement in high risk sexual behaviors (AOR = 1.53; 95% CI: (1.11, 2.10). A high level of stigma (holding at least three stigmatizing attitudes toward people living with HIV) was negatively correlated with awareness of HIV status (AOR =0.60; 95% CI: (0.45, 0.78).ConclusionLess than a quarter of older Ugandans are aware of their current HIV status. High levels of stigma and low comprehensive knowledge of HIV/AIDS remained critical barriers to HIV testing and awareness of HIV status. These findings suggest a need for innovative HIV testing strategies to increase HIV status awareness among older adults in Uganda.

Social support and school outcomes of adolescents orphaned and made vulnerable by HIV/AIDS living in South Western Uganda

ABSTRACTThe goal of this study is to examine the role of social support from multiple sources, including the extended family, caregivers, classmates, peers and teachers, in improving the school outcomes (grades and attendance) of children orphaned by AIDS in Uganda. Data for this study comes from a 4-year randomized control trial, called Suubi-Maka (Hope for families), conducted in the Southwestern part of Uganda from 2008 to 2012. Using multivariate regression modeling – controlling for several individual-level and school-level characteristics, we find that social support (perceived emotional and information support received from parents, classmates and teachers), caregiver’s acceptance and warmth, and family cohesion have positive effects on children’s school grades and attendance. This finding underscores the importance of strengthening relationships within the extended family and the school environment to serve as a net of strength that can influence not only family functioning but also vulnerable adolescents’ educational trajectories.

Using Positive Health, Dignity and Prevention (PHDP) framework to explore experiences of Young People Living with HIV and AIDS (YPLHIV) in Uganda

Using Positive Health, Dignity and Prevention (PHDP) framework to explore experiences of Young People Living with HIV and AIDS (YPLHIV) in Uganda

Cost-Effectiveness of a Savings-Led Economic Empowerment Intervention for AIDS-Affected Adolescents in Uganda: Implications for Scale-up in Low-Resource Communities

PurposeNearly 12 million children and adolescents in sub-Saharan Africa have lost one or both parents to AIDS. Within sub-Saharan Africa, Uganda has been greatly impacted, with an estimated 1.2 million orphaned children, nearly half of which have experienced parental loss due to the epidemic. Cost-effective and scalable interventions are needed to improve developmental outcomes for these children, most of whom are growing up in poverty. This article examines the direct impacts and cost-effectiveness of a savings-led family economic empowerment intervention, Bridges to the Future, that employed varying matched savings incentives to encourage investment in Ugandan children orphaned by AIDS. MethodsUsing data from 48 primary schools in southwestern Uganda, we calculate per-person costs in each of the two treatment arms—Bridges (1:1 match savings) versus Bridges PLUS (1:2 match savings); estimate program effectiveness across outcomes of interest; and provide the ratios of per-person costs to their corresponding effectiveness. ResultsAt the 24-month postintervention initiation, children in the two treatment arms showed better results in health, mental health, and education when compared to the usual care condition; however, no statistically significant differences were found between treatment arms with the exception of school attendance rates which were higher for those in Bridges PLUS. Owing to the minimal cost difference between the Bridges and Bridges PLUS arms, we did not find substantial cost-effectiveness differences across the two treatment arms. ConclusionAfter 24 months, an economic intervention that incorporated matched savings yielded positive results on critical development outcomes for adolescents orphaned by AIDS in Uganda. The 1:1 and 1:2 match rates did not demonstrate variable levels of cost-effectiveness at 24-month follow-up, suggesting that governments intending to incorporate savings-led interventions within their social protection frameworks may not need to select a higher match rate to see positive developmental outcomes in the short term. Further research is required to understand intervention impacts and cost-effectiveness after a longer follow-up period.

Preaching Prevention: Born-Again Christianity and the Moral Politics of AIDS in Uganda. By Lydia Boyd

Preaching Prevention: Born-Again Christianity and the Moral Politics of AIDS in Uganda. By Lydia Boyd

The experiences of caregivers of children living with HIV and AIDS in Uganda: a qualitative study

BackgroundHome-based care for HIV patients is popular in contexts severely affected by the epidemic and exacts a heavy toll on caregivers. This study aimed at understanding the experiences of caregivers and their survival strategies.MethodsA total of 18 caregivers (3 males and 15 females) were interviewed using a semi-structured interview guide, and thematic analysis was used to analyse the data.ResultsAnalysis suggests that the caregivers are burdened with insecure provisions for food and difficulties in accessing health care. They however survived these strains through managing their relationships, sharing burden with care-recipients, social networks and instrumental spirituality. These findings are discussed under two major themes: 1). Labour of caregiving and 2). Survivalism.ConclusionsHome-based care presents huge opportunities for community response to the HIV/AIDS epidemic in African settings. It is however burdensome and thus should not be left for families alone to shoulder. There is therefore an urgent need for protecting home-based care for HIV children in Uganda. Implications for improving and strengthening social interventions in home-based care of HIV/AIDS in the Ugandan context are addressed.

Militarization going places?

ABSTRACTA number of recent military practices, including contributions to humanitarian relief and reconstruction, as well as counterinsurgency and stability operations, emphasize socio-economic needs of distant populations as one of the key adversaries in this ‘era of persistent conflict’. Such developments warrant a critical inquiry into the potential normalization of military approaches to societal issues. The aim of the article is to contribute to current discussions on militarization as a social practice through a study of the involvement of military actors in the delivery of humanitarian assistance and aid in Kenya and Uganda. The article zeroes in on three themes in relation to projects implemented by US civil affairs teams: first, how do military personnel make sense of this ‘non-traditional’ military practice; second, what are local recipients’ expectations about the role of the military in societal issues; and, third, what are potential adversary effects of such ‘productive’ interventions in contexts that share a memory of military coercion? If we assume that militarization cannot be untied from questions of institutionalized coercion, and if the inquiry to be followed is process- and context-oriented, then attention needs to be directed to potential coercive moments engendered in the context of interventions presented as being benevolent. I assert that it is through a careful study of mundane military practices that we can further add nuance to the concept of militarization in the military-humanitarian realm.

Fiscal Reforms and the Fiscal Effects of Aid in Uganda

Uganda implemented public expenditure and revenue management reforms from the early 1990s with specific aims of improving budget planning and aligning aid with fiscal priorities. The dynamic relationship between aid and domestic fiscal aggregates is analysed using a Cointegrated Vector Autoregressive model with annual data for 1972–2008 and quarterly data for 1997–2014. Aid has been a significant element of long-run fiscal equilibrium, associated with increased tax effort and public spending and reduced domestic borrowing. Fiscal reforms have improved aid and expenditure management, contributing to improved fiscal performance in Uganda, with lessons for other African countries.

HIV/AIDS knowledge, attitudes and behaviour of persons with and without disabilities from the Uganda Demographic and Health Survey 2011: Differential access to HIV/AIDS information and services.

Uganda is among the first to use the Washington Group Short Set of Questions on Disability to identify persons with disabilities in its Demographic and Health Survey. In this paper, we review the HIV Knowledge, Attitudes and Behaviour component of the 2011 Ugandan Demographic and Health Survey, analysing a series of questions comparing those with and without disabilities in relation to HIV/AIDS knowledge, attitudes and practices. We found comparable levels of knowledge on HIV/AIDS for those with and those without disabilities in relation to HIV transmission during delivery (93.89%, 93.26%) and through breastfeeding (89.91%, 90.63%), which may reflect increased attention to reaching the community of persons with disabilities. However, several gaps in the knowledge base of persons with disabilities stood out, including misconceptions of risk of HIV infection through mosquito bites and caring for a relative with HIV in own household (34.39%, 29.86%; p<0.001; 91.53%, 89.00%; p = 0.001, respectively). The issue is not just access to appropriate information but also equitable access to HIV/AIDS services and support. Here we found that persons with multiple disabilities were less likely than individuals without disabilities to return to receive results from their most recent HIV test (0.60[0.41–0.87], p<0.05). HIV testing means little if people do not return for follow-up to know their HIV status and, if necessary, to be connected to available services and supports. Additional findings of note were that persons with disabilities reported having a first sexual encounter at a slightly younger age than peers without disabilities; and persons with disabilities also reported having a sexually transmitted disease (STD) within the last 12 months at significantly higher rates than peers without disabilities (1.38[1.18–1.63], p<0.01), despite reporting comparable knowledge of the need for safer sex practices. This analysis is among the first to use HIV/AIDS-related questions from Demographic Health Surveys to provide information about persons with disabilities in Uganda in comparison to those without disabilities. These findings present a more complex and nuanced understanding of persons with disabilities and HIV/AIDS. If persons with disabilities are becoming sexually active earlier, are more likely to have an STD within the preceding 12 month period and are less likely to receive HIV test results, it is important to understand why. Recommendations are also made for the inclusion of disability measures in Uganda’s AIDS Indicator Survey to provide cyclical and systematic data on disability and HIV/AIDS, including HIV prevalence amongst persons with disabilities.

Effective Contraceptive Use Following Unplanned Pregnancy Among Ugandan Women Living with HIV

BackgroundPrevention of unplanned pregnancy is critical for women living with HIV (WLWH) to safely achieve their reproductive goals, and forms the second prong of the Global Plan to eliminate perinatal transmission of HIV. Family planning services need to identify women at risk of unplanned pregnancy to be effective. This study examines the relationship between unplanned pregnancy and subsequent use of effective contraception among WLWH in Uganda.MethodsThis is a retrospective analysis of data from the Uganda Aids Rural Treatment Outcomes study, which was a longitudinal cohort of individuals initiating antiretroviral therapy. Women with incident pregnancies between 2011 and 2013 who reported on intent of the pregnancy were included in this analysis. The exposure of interest was referent pregnancy intent, using questions derived from the CDC PRAMS instrument. The primary outcome was self-report of effective contraceptive use 9–15 months post-partum (hormonal methods, intrauterine device, sterilization, or consistent condom use).ResultsAmong 455 women who enrolled with a baseline median age of 29 years, CD4 count 403 cells/mm3, and living with HIV for 3.8 years, there were 110 incident pregnancies with reported intent. Of these pregnancies, 50 (45%) were reported as unplanned, and 60 (55%) as planned. Postpartum, 51% of women with unplanned and 44% with planned pregnancy reported effective contraception (P = 0.52). In models adjusted for pregnancy intent, only partner pregnancy desire was significantly associated with contraceptive use, with aRR 0.37 (95% CI 0.18–0.76, P = 0.01) for effective contraceptive use when the participant reported that her primary partner “definitely or probably” wants her to have a child compared with “never discussed or don’t know”.ConclusionAlmost half of incident pregnancies among WLHW in this cohort were unplanned. Unplanned pregnancy was not associated with effective contraceptive use post-partum. These results demonstrate continued unmet need for family planning services in this population. Creative strategies to support the planning of families among women living with HIV are needed. Engaging men is likely to be a critical approach.Disclosures J. E. Haberer, Merck: Consultant, Consulting fee; Natera: Shareholder, Stock ownership

Preaching Prevention: Born-Again Christianity and the Moral Politics of AIDS in Uganda by Lydia Boyd Athens, OH: Ohio University Press, 2015. Pp. 250. $32.95 (pbk).

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