HIV/AIDS Treatment Literacy Empowerment Workshop

1. HIV/AIDS Treatment Literacy Empowerment Workshop Organized by Community Health And Information Network (CHAIN) in Partnership With Uganda Peoples’ Defence Forces, Uganda Police & Uganda Prisons 27th – 30th Nov 2005 Ankrah Foundation – Mukono District

2. Participants at the workshop

3. CHAIN’s BACKGROUND • CHAIN is an international not for profit organization, registered as a charity and company in the United Kingdom and Uganda. Set up in 1998, CHAIN promotes the empowerment of people living with HIV/AIDS, lobby for increased access to Antiretroviral drugs, promotes treatment literacy, promotes good policies on HIV treatment and care and provides Capacity Build Support to Community Based Organizations. Most of the CHAIN’s work is undertaken in Africa and currently in the Great Lakes Region (Uganda, Kenya, Rwanda, Burundi, Tanzania & Democratic Republic of Congo).  • CHAIN has to date worked in partnership with key stakeholders in the Great Lakes Region of Africa, addressing HIV prevention, care, education, policy development, treatment advocacy. CHAIN co-ordinates HIV Treatment Literacy and Capacity Building workshops in these countries and a biannual Great Lakes Conference on HIV/AIDS. • CHAIN is committed to developing programmes of work that support and enhance concerted international efforts to reverse the HIV epidemic.

4. CHAIN’s BACKGROUND – Cont’d • The organisation runs both national and international HIV/AIDS health programmes with a focus on capacity building and strengthening networks and partnerships of grass roots non governmental organisations operating in the HIV/AIDS sector in Africa. The main thrust of CHAIN’s effort is to galvanise key stakeholders in the struggle against HIV/AIDS. This is done through workshops, seminars, international conferences and community symposia which bring together activists and community leaders. • CHAIN’s interest areas are HIV prevention, treatment and care, policy development, treatment advocacy, monitoring and evaluation. Projects are informed by the needs of People Living with HIV & AIDS. There is a fundamental belief in increasing the capacity of communities and organizations to become more efficient and more effective in the work they do. CHAIN has had a focus on improved project programming, monitoring and evaluation.

5. The Workshop • Participants 50Representatives attended the workshop as follows: I. Health care professional in UPDF hospitals & clinics ii. Health care professionals in Uganda Police hospitals & clinics iii. Health care professionals in Uganda Prison hospitals & clinics • Objectives • To bring together all the health care professionals in the above institutions and discuss HIV treatment updates and prevention technologies. • To impart knowledge and skills to Health care Professionals working in the above institutions. • To discuss barriers around scaling up on HIV treatments and literacy in these institutions and how best to overcome these barriers. • Explore areas of collaboration and partnership development especially around HIV/AIDS Treatment Literacy and OVC programmes between the above institutions and Civil Society Organisations i.e. CHAIN. • To share practical experience and methods of good practice in the above institutions.

6. Workshop Outcomes • Increased knowledge on HIV/AIDS Treatment strategies and prevention technologies. • Increased awareness on the barriers to scaling up on HIV treatment and literacy programmes in the four institutions and how best to overcome these barriers. • Increased understanding on how to develop effective and productive partnerships between the above institutions and Civil Society Organisations like CHAIN. • Increased awareness on the National Government HIV/AIDS response and how best the above institutions can play an active part.

7. Opening Ceremony Speech by Guest of Honor - Brig. Dr. Samuel LwangaAssistant Chief Medical Services - UPDF • Thanked CHAIN for taking this initiative for bringing health care professions working in the UPDF, Police, Prisons & The President’s Office in form of this workshop. • Emphasized that partnership is the only way forward and no single organisation can work on their own to fight HIV/AIDS effectively. Partnerships need to be built at all levels, International, Regional, National & on grass root levels. There is need to see more partnerships between Government & Civil Society Organisations to share a lot of expertise, knowledge and resources. • He stated that there is new evidence that adult HIV infection rates have decreased in certain countries and that challenges in behaviour to prevent infection such as increased use of condoms, delay of first sexual experience and fewer sexual partners have played part in these declines. • Despite decreases in the rate of infection in certain countries, the overall number of people living with HIV has continued to increase in almost all regions of the world. This poses a great challenge to all of us the providers. Unless people are empowered with up to date treatment information, which is simple to read and understand, they will continue to fail their drugs hence leading to developing resistance. Treatment Literacy is key and needs to be urgently promoted by all of the providers. • He appreciated CHAIN for producing a simple and friendly publication called Great Lakes Positive Handbook – A Guide to Anti retroviral Therapy. This will continue to empower patients who are on medication or about to go on medication. • Issues like stigma & discrimination, lack of adequate capacity within our institutions and organisations, poverty and inadequate up to date resources are still real bottlenecks in the struggle against HIV/AIDS. Its only through developing such initiatives that we can all work towards eradicating HIV/AIDS. • He requested participants to not only talk the talk but also walk the talk and implement all the recommendations, which will be made at the end of this workshop.

8. Opening Ceremony Speech by Guest of Honor - Brig. Dr. Samuel LwangaAssistant Chief Medical Services - UPDF

9. Guests who attended the opening and closing ceremonies of the Workshop • Dr. Gerald Kalegyeya - Deputy Director Medical Services - Uganda Police • Mr. Keefa Kaweesa, Secretary Works & Technical Services - Mukono District • Mrs Mary Kaddu- Director HIV/Aids Training programmes - Uganda Prisons • Major. Dr. Kusasira- ACP Coordinator - Uganda Peoples’ Defence Forces • Dr. Tom Makumbi, CHAIN Treasurer • Dr. Johnson O.R. Byabashaija - Commissioner General, Uganda Prisons (Chief Guest – Closing) • Brig. Dr. Samuel Lwanga – Assistant Commissioner, Medical Services – UPDF (Chief Guest – Opening)

10. Topics and Trainers / Presenters • Natural History and pathophysiology of HIV – Dr Hannah Kibuuka- Makerere Walter Reeds Project • Update on ARVs, how they work and the Principles of ART - Dr. Stephen Watiti Clinical Manger – MildMay Centre • National HIV/AIDS Treatment Strategy, Care guidelines, accreditation process of treatment centres & the Role of NGOs in this strategy -Dr. Elizabeth Namagala-ACP, MOH • Common Opportunistic Infections (O.Is) and Septrin Prophylaxis - Dr. Barbra Mukasa- Mild may Centre.

11. Topics and Trainers / Presenters - Cont’d • The role of National Planning Authority (NPA) in HIV/AIDS Treatment and care strategy- Constantine Bitwayiki-Director Research Innovation, M &E • Common side effects of the four first line ARV regimens and how to manage them- Dr. Lillian Nabiddo - Medical Officer Mild May Centre. • Sustainability of ART- Mrs. Mary Kaddu- Director HIV/AIDS Training Programmes Prisons. • HIV Treatment & Care Sharing experiences of Prisons, Police & Short Presentations by: • Uganda Police- Ms. Mbabazi Francis • Uganda Prisons- Dr. Alex Kakoraki • Uganda Peoples’ Defence Forces- Dr. Fiona Kalinda

12. Topics and Trainers / Presenters - Cont’d • Orphans & Vulnerable Children (OVC) support strategies - Mrs Catherine Barasa, HIV/ Aids Advisor Ministry of Education • National response & policies in place to support OVC – Ms. Ester Sempiira, OVC Secretariat, Ministry of Gender, Labour and Social Development • The role of NGOs in supporting OVC- Peter Ogenga - Advocacy Officer- CHAIN • Adherence and how to avoid drugs resistance – Dr. Watiti Stephen - Clinic Manager MildMay Centre. • Stigma and discrimination and how it affects treatment- Dr. Stephen Watiti-Clinic Manager- MildMay

13. Highlights from situational analysis reports in Police, Prisons and UPDF • The workshop was the 1st opportunity in Uganda for uniformed service men and women to meet in a forum to discuss HIV/AIDS Treatment. • HIV/AIDS prevalence in uniformed service institutions is 2-5% higher than the rest of the community. • Uniformed service institutions are characteristic of low stakeholder support and participation in HIV/AIDS programs and activities. • There are programs supported by USAID and DFID especially in the prisons but insufficient. • HIV/AIDS has greatly affected productivity from uniformed service institutions. The effect is greatly compounded by the living conditions and the nature of work, which is characteristic of abrupt deployments and marital tensions. • The global trend of the fight against HIV/AIDS requires continued formation of partnerships to share resources and reinforce capacity to effectively respond to the effects of the disease. • UPDF was recognized as having more advanced and well developed programs for its servicemen, youth and children • The ABC strategy was commended as yielding great results in uniformed communities. • Prisons and Police were challenged to develop more comprehensive child and youth HIV/AIDS and OVC programs.

14. Group discussions focused on how to scale up treatment literacy& care services in Prisons, Police & UPDF as follows: Group 1.Developing an HIV/AIDS Treatment and Care Program. Feedback: Objectives: • Sensitize all institutional personnel on HIV/AIDS • Train medical personnel on care and treatment • Establish a VCT Center with Drugs and equipment Target: Staff, spouses, children Constraints: • Busy staff and abrupt deployments • Understaffing • Getting experts to conduct sensitisation and training. • Resources for equipment • Stigma • Sustainability

15. Group 2 • Develop appropriate guidelines to enable the continuation of HIV/AIDS treatment activities to inmates and fellow servicemen and women during deployment • Feedback: • Should map out all treatment centers for HIV/AIDS for easy transfer and access to such services by personnel who are always on the move. • Develop a functional network in the relevant services for effective patient monitoring and enabling continued treatment. • Ongoing sensitization of all officers in charge and staff on HIV/AIDS status disclosure and ARV use • On deployment, those who know their zero-status should be given light duties and deployed on duties with close proximity to ARV centers. • Treatment referral form to be given to concerned servicemen and women. • Ongoing VCT, RCT, mobile VCT/HBHCT, PMTCT, MCT etc

16. Group 3 • Advantages of disclosing and sharing confidentiality in the administration of ARVs in relation to sustainability • Feedback • Reduces stigmatization. • Promotes adherence • Improves affordability by employers, community, family members, etc • Encouragement of the community and friends toward VCT. • Improves provision and administration of drugs. • Reduces and can stop the spread of HIV/AIDS

17. Group Discussions

18. Highlights from participants evaluation forms • The workshop was an eye opener, revealing the varying institutional approaches and access to resources for HIV/AIDS treatment and literacy. • There is an urgent need for dialogue and effective communication by institutional medical officers to engage their senior officers to support and promote literacy and access to treatment facilities by all service men, women and their families. • School communities in Uganda Prisons and Uganda Police are neglected areas in accessing HIV/AIDS awareness, prevention and treatment information and other programs. • Good training was done during the workshop and shared with participants information on ART but less attention was given to Patient Counseling. • Participants promised to immediately address issues of stigma and VCT as priority tasks to improve treatment programs and activities when they go back.

19. Recommendations • Setting up an Inter-institutional committee comprising of at least one representative from UPDF, Police, Prison Services and CHAIN Uganda to act as a forum to achieve the following: - To take forward the recommendations / resolutions of this workshop - Spearhead more programs and promote cross-institutional co-operation in promoting treatment literacy. - Combine to mobilize resources to supplement institutional resources in ensuring effective responses to HIV/AIDS treatment and other support programs.

20. Recommendations – Cont’d • Increased communication and networking with relevant stakeholder institutions and organizations to create opportunities and mobilize resources for treatment literacy empowerment. • Increased institutional advocacy and lobbying to scale up programs and activities for HIV literacy and treatment. • Follow-up workshops and training activities to address the issues identified during the workshop as inhibiting to effective HIV/AIDS literacy and treatment empowerment i.e: a.Stigma through its various forms. b.Resource mobilization. c.Galvanizing stakeholder support and participation. d.Counseling for staff, family members and the youth. e.Networking.

21. Recommendations – Cont’d • CHAIN should assist Uganda Prisons and the Uganda Police to secure a CD4 Count Machines. • A similar program for medical officers in the Army, Police and Police Institutions should be organized for the East African Region to increase on consultations and information sharing.

22. Closing CeremonySpeech by Guest of Honor, Dr Johnson ByabashaijaCommissioner General – Uganda Prisons • Congratulated participants and organisers for the initiative of bringing health care professions working in the UPDF, Police, Prisons & The President’s Office in form of this workshop. • Observed that this was the beginning of a true partnership with CHAIN and the above mentioned institutions, i.e to come together for the first time as health care professionals in the four institutions and share expertise and methods of good practice on how to effectively fight HIV/AIDS. He however reiterated that problems are many and its only working in partnership that a significant and sustainable impact can be made. • With more people going on treatment as part of the Government’s National Treatment Strategy, adherence and resistance still pose major challenges for both the patient and the doctor. The doctor – patient relationship is very important and this has to be promoted. There is no doubt, an empowered patient makes the life of the doctor easier. • He also observed that uniformed services still face so many challenges. Issues of deployment taking into account the client’s health status, being away from home for many months or even years, lack of adequate health infrastructure within our institutions, treating inmates etc. Resources are still very limited and partnerships like these ones have come at the right time. • He promised to work with CHAIN in disseminating The Great Lakes Positive Handbook – A Guide to Antiretroviral Therapy, but requested that it should be translated into local languages so that all patients can have access to this resource, since the guide is simple and very user friendly.

23. Awarding of Certificates during the Closing Ceremony by Guest of Honor, Dr Johnson Byabashaija

24. Regina M.N Kamoga, Country Manager – CHAIN at the Closing Ceremony

25. Workshop SongComposed and sung by the participants • Lets keep up the fight • A fight against AIDS • Giving hope to the hopeless • Giving help to the helpless • Don’t give up the fight • A fight against AIDS • That we may have a better world • A safe place to live

26. Special program events • A Name and Person Identification game was played by all participants. This helped participants to interact and know more about each other as they identified themselves. • The silence-game was played to demonstrate the need to break the silence / stigma against ones HIV/AIDS status. • Various energizers were performed to ensure alertness and full participation of all participants all the time. • Hand-out notes of all presentations were given to participants. Find copies attached. • Each participant received a Certificated of attendance at the closing ceremony.

27. Person / Name Identification and Silence Games

28. Networking over Tea Break