When Hillary Clinton first came to Uganda in the mid 1990s, Uganda had, in her opinion, the best HIV/AIDS prevention and control programme in the world. The HIV prevalence rate had been drastically reduced from over 20% to below 7%.
But things have since changed and the figures are frightening. The HIV prevalence rate rose from 6.4% in 2005 to 7.3% in 2011, with about 120,000 Ugandans getting infected each year.
So Clinton had to find time off her tight diplomatic schedule to visit an anti-HIV/AIDS initiative her government supports. On the afternoon of Aug. 3, the US secretary of state had flown from South Sudan to meet President Yoweri Museveni at State House Entebbe before proceeding to Kasenyi where she presented the UPDF Special Forces with 12 Raven unmanned aircrafts for use in Somalia. That Uganda is not only taking the lead role in pacifying Somalia and fighting Al Shabaab combatants but that its cooperation is vital to resolving the crisis in Democratic Republic of Congo is important for Clinton and America.
At Reach Out Mbuya Parish HIV/AIDS Initiative (ROM), the wait was long, for she arrived shortly after 7pm, three hours late. But the message she had to deliver was urgent. "Uganda is the only country in sub-Saharan Africa where the rates of (HIV) infection are going up," Clinton said, momentarily dampening the mood of her otherwise upbeat hosts. "We have to keep our funding commitments," she said, and then suggested that probably a change in approach in the fight against HIV is necessary.
And that's probably why she chose to visit ROM. Founded in 2004 with only 14 people at Our Lady of Africa Church in Mbuya, ROM currently has 5000 permanent clients with thousands more also accessing its services. According to Dr. Stella Talisuna, the ROM executive director, over 60,000 people access HIV counselling and testing at ROM every year. Between 50 and 100 men undergo circumcision at ROM to fight prevent HIV infections.
To support these programmes, ROM gets funding from different sources, the US being one of the biggest. Since 2004, the US government under the Presidential Emergency Plan for AIDS Relief (PEPFAR) has provided $ 17.3m to support ROM activities and Clinton has "heard a lot about Reach Out".
As Clinton made her way to ROM, she was "looking forward" to meeting Robert Engole, the first person worldwide to receive anti-retroviral therapy under PEPFAR programme in 2004 and continues to be treated at ROM.
The US Embassy says that over 300,000 Ugandans receive anti-retroviral therapy through support from PEPFAR.
Talisuna speaks with optimism. She hopes her initiative will get more financing to enroll more people. She says their approach is unique because it focuses on the affected, with 45% of ROM staff HIV positive. "Where the clients are too poor to afford transport to come for treatment, we give them some money," Talisuna said.
Talisuna adds that under their programme, no new born child contracts HIV from their mother anymore while less than 5% of their patients missed their treatment appointments and the services offered expanded from Mbuya to include areas like Bweyogerere. ROM has also rolled out its activities to Kasaala in Luweero district. ROM also provides immunisation and family planning services.
Talisuna says they were the first in the world to implement the discordant couples' intervention with funding from Centers for Disease Control in 2007, with 120 couples participating to date. In total, Talisuna says, what makes ROM tick as an HIV initiative is their comprehensive approach.
Among those who eagerly waited for Clinton was Ivan Wakama, 17. His father died when he was five and his HIV positive mother met difficulty keeping him in school until he was enrolled on the ROM school fees programme. He is now looking forward to completing S4 this year and, he says, "Glory be to God".
Wakama is one of 1500 on ROM's social support programme, which also covers psychosocial support, savings and credit scheme, medical care, nutrition and legal support.
Another client, Jasper Magezi, had come for something else. Magezi had been told that circumcision could save him from contracting HIV. On the day of Clinton's visit, he was among those lined up for circumcision. During the pre-circumcision counselling session, Magezi said, he was told that in case he were to be exposed to HIV during sex after circumcision, he stood chances of escaping getting infecting. He was also told, however, that he would still need to continue using condoms and stick to one sexual partner. But one thing kept nagging him; was the pain he was about to suffer worth it?
As Clinton was conducted around to greet ROM's clients, she came face to face with a family that wasn't to be deterred by her security. Sarah Nassolo, a mother of two, knelt as her Ganda tradition commands to thank Clinton for the help from America that has enabled her to see a "miracle". Nassolo and her husband Charles Byabakama are both HIV positive but their two sons, Ignatius, 3 and Isaac, 6, are both negative, thanks to the mother-to-child transmission programme at ROM.
Clinton thought the ROM approach works. She said: "We need to review our strategy (and) emphasise what we think can work ... like avoiding mother- to-child transmission".