HIV_Prevention_Girls_and_Young_Women_Uganda by IPPF

RESEARCH DOSSIER: HIV PREVENTION FOR GIRLS AND YOUNG WOMEN

UGANDA

This Research Dossier supports the Report Card on HIV Prevention for Girls and Young Women in Uganda produced by the United Nations Global Coalition on Women and AIDS (GCWA). It documents the detailed research coordinated for the GCWA by the International Planned Parenthood Federation (IPPF), with the support of the United Nations Population Fund (UNFPA), United Nations Program on AIDS (UNAIDS) and Young Positives. The Report Card provides an ‘at a glance’ summary of the current status of HIV prevention strategies and services for girls and young women in Uganda. It focuses on five cross-cutting prevention components: 1. Legal provision 2. Policy context 3. Availability of services 4. Accessibility of services 5. Participation and rights The Report Card also includes background information about the HIV epidemic and key policy and programmatic recommendations to improve and increase action on this issue in Uganda. This Research Report is divided into two sections: PART 1: DESK RESEARCH: This documents the extensive desk research carried out for the Report Card by IPPF staff and consultants based in the United Kingdom. PART 2: IN-COUNTRY RESEARCH: This documents the participatory in-country research carried out for the Report Card by a local consultant in Uganda. This involved: •

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Two focus group discussions with a total of 19 girls and young women aged 15-24 years. The participants included girls and young women who are: living with HIV; in/outof/school; involved in sex work; living in urban and suburban areas; and working as peer activists. Six one-to-one interviews with representatives of organisations providing services, advocacy and/or funding for HIV prevention for girls and young women. The stakeholders were: a country representative of an international NGO; a nurse at a national NGO focusing on sexual and reproductive health; a counsellor at an NGO/government voluntary counselling and testing centre; a programme officer of a United Nations agency; and a Technical Adviser of an international donor agency. Additional fact-finding to address gaps in the desk research.

Contents: PART 1 - Desk Research Country profile Prevention component 1: Legal Provisions Prevention component 2: Policy Provisions Prevention component 3: Availability of services Prevention component 4: Accessibility of services Prevention component 5: Participation and Rights PART 2 - In-Country Work Focus group discussion with girls and young women, 15 â&#x20AC;&#x201C; 22, urban area Focus group discussion with girls and young women, 15 â&#x20AC;&#x201C; 21, rural area Interview with programme manager, National AIDS Commission Interview with national coordinator, Young Positives Interview with programme manager and Medical coordinator, Family Planning Association Interview with programme officer, PLHIV network for women Interview with youth worker, local treatment centre

Abbreviations ACOW AIC AIDS AMREF ART ARV CBO CCM CEDAW CIA CRC EU FBO FGM FHRI FP GFATM GIPA HIV IEC IPPF MCH MGLSD MOH NGEN+ NGOs PEPFAR PICSAY PLWHA/PLWA PMTCT SRH STD STI STF TASO TB UAC UN UNAIDS UNASO UNDP UNFPA UNGASS UNICEF UNIFEM USAID VCT WHO YSOs

AIDS Care Orientation Workshop AIDS Information Centre Acquired Immune Deficiency Syndrome African Medical and Research Foundation Anti-Retroviral Therapy Anti-Retroviral Community based organisation Convention on Consent on Marriage Convention on the Elimination of All Forms of Discrimination against Women Central Intelligence Agency Convention on the Rights of the Child European Union Faith based organisation Female genital mutilation Foundation for Human Rights Initiative Family planning Global Fund to Fight AIDS, Tuberculosis and Malaria Greater Involvement of People Living with HIV/AIDS Human Immunodeficiency Virus Information, education and communication International Planned Parenthood Federation Maternal and child health Ministry of Gender, Labour and Social Development Ministry of Health National Guidance and Empowerment Network Nongovernmental organisation President's Emergency Plan for AIDS Relief Presidential Initiative on the AIDS Strategy for Communication to the Youth People living with HIV and AIDS Prevention of mother to child transmission Sexual and reproductive health Sexually transmitted disease Sexually transmitted infection Straight Talk Foundation The AIDS Support Organization Tuberculosis Uganda AIDS Commission United Nations Joint United Nations Programme on HIV/AIDS Uganda Network of Aids Service Organisations United Nations Development Programme United Nations Population Fund United Nations General Assembly Special Session United Nations Children's Fund United Nations Development Fund for Women United States Agency for International Development Voluntary counselling and testing World Health Organisation Youth Service Organisations

For further information about this Research Report, or to receive a copy of the Report Card, please contact: HIV/AIDS Department, International Planned Parenthood Federation (IPPF) 4 Newhams Row, London, SE1 3UZ, United Kingdom Tel: +44 (0) 207 939 8200. Fax: +44 (0) 207 939 8300. Website: www.ippf.org

PART 1: DESK RESEARCH

COUNTRY PROFILE • • • • • • • • •

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Size of population: 28.816 thousand http://www.unaids.org/en/Regions_Countries/Countries/Uganda.asp(Date accessed 07/04/06)) Life expectancy at birth: Total population: Men: 48 Women: 51 http://www.unaids.org/en/Regions_Countries/Countries/Uganda.asp (Date accessed 07/04/06)) % of population under 15 (0 – 14 years): 50.1% (CIA (2005) The World Factbook – Uganda, http://www.cia.gov/cia/publications/factbook/geos/ug.html (Date accessed 07/04/06)) Population below income poverty line of $1 per day: 35% (2001 est.) (CIA (2005) The World Factbook – Uganda, http://www.cia.gov/cia/publications/factbook/geos/ug.html (Date accessed 07/04/06)) Female youth literacy (ages 15-24 years): Health expenditure per capita (2002): $57 (WHO (2004) - http://data.unaids.org/Publications/FactSheets01/Uganda_EN.pdf (Date accessed 07/04/06)) Contraceptive prevalence: “All methods 22.8%, Modern methods 18.2%” WHO march 2004 “An Advocacy tool for improving maternal & new born survival in Uganda” Maternal mortality rate: 880 per 100000 (2000) (WHR 2004, http://data.unaids.org/Publications/FactSheets01/Uganda_EN.pdf (Date accessed 07/04/06)) Ethnic groups: Baganda 17%, Ankole 8%, Basoga 8%, Iteso 8%, Bakiga 7%, Langi 6%, Rwanda 6%, Bagisu 5%, Acholi 4%, Lugbara 4%, Batoro 3%, Bunyoro 3%, Alur 2%, Bagwere 2%, Bakonjo 2%, Jopodhola 2%, Karamojong 2%, Rundi 2%, non-African (European, Asian, Arab) 1%, other 8% (CIA (2005) The World Factbook – Uganda, http://www.cia.gov/cia/publications/factbook/geos/ug.html (Date accessed 07/04/06)) Religions: Roman Catholic 33%, Protestant 33%, Muslim 16%, indigenous beliefs 18% (CIA (2005) The World Factbook – Uganda, http://www.cia.gov/cia/publications/factbook/geos/ug.html (Date accessed 07/04/06)) Languages: English (official national language, taught in grade schools, used in courts of law and by most newspapers and some radio broadcasts), Ganda or Luganda (most widely used of the Niger-Congo languages, preferred for native language publications in the capital and may be taught in school), other Bantu languages, Nilo-Saharan languages, Swahili, Arabic (CIA (2005) The World Factbook – Uganda, http://www.cia.gov/cia/publications/factbook/geos/ug.html (Date accessed 07/04/06)) Adult (15-49) HIV prevalence rate (end of 2003): 4.1% (range: 2.8%-6.6%)6.7 (5.7 – 7.6) (UNAIDS, (2004) - Report on the Global AIDS Epidemic http://www.unaids.org/en/Regions_Countries/Countries/Uganda.asp (Date accessed 07/04/06) Number of women (15-49) living with HIV (end of 2003): 270 000 520,000 (450,000 – 590,000) (range: 170 000-410 000) (UNAIDS (2004) - Report on the Global AIDS Epidemic http://www.unaids.org/en/Regions_Countries/Countries/Uganda.asp (Date accessed 07/04/06)) Number of children (0-15) living with HIV (ages 0-14 years, 2003): 80 000 110,000 (39,000 – 200,000)) (UNAIDS, (2004) - Report on the Global AIDS Epidemic http://www.unaids.org/en/Regions_Countries/Countries/Uganda.asp (Date accessed 07/04/06)) Estimated number of orphans (0-17 years): Estimated more than two million (UNAIDS, (2004) Report on the global AIDS epidemic http://www.unaids.org/en/Regions_Countries/Countries/Uganda.asp (Date accessed 07/04/06)) AIDS deaths (adults and children) in 2003: 78 000 (range: 54 000-120 000) (UNAIDS, (2004) - Report on the Global AIDS Epidemic http://www.unaids.org/en/Regions_Countries/Countries/Uganda.asp (Date accessed 07/04/06))

PREVENTION COMPONENT 1: LEGAL PROVISION (national laws, regulations, etc) Key questions: 1. What is the minimum legal age for marriage? 18 years (United Nations Statistics Division- (24 August 2005) Table 2C, http://unstats.un.org/unsd/demographic/products/indwm/ww2005/tab2c.htm (Date accessed 07/04/06)) “The legal age for marriage is 18 years, but the marriage of young girls by parental arrangements was common, particularly in rural areas. According to the 2002 census, 36 thousand girls and 29,031 boys entered into marriage below the age of 15”. (U.S. Department of State, Country Reports on Human Rights Practices- (2005), http://www.unfpa.org/swp/2005/english/ch5/chap5_page3.htm (Date accessed 07/04/06)) “Christian and Muslim communities are now enforcing the marriage age of 18, requiring girls to produce birth certificates. The King of Busoga called for the reintegration of young mothers into the school system”. (UNFPA - State of World Population 2005 (Chapter 5), http://www.state.gov/g/drl/rls/hrrpt/2005/61598.htm (Date accessed 07/04/06)) 2. What is the minimum legal age for having an HIV test without parental and partner consent? “The age of consent for VCT should be the age at which the child understands the results considered 12 years. The right to testing should also start at age 12. For children between 12 and 18, the legal age of consent, the child should consent but with the approval of the parent or guardian.” “If a child below the age of 12 asks for HIV testing, their parents or guardians should be involved” (pg13) (Ministry of Health 2003, Uganda National Guidelines for HIV Voluntary Counselling and Testing, http://www.aidsuganda.org/pdf/Final_VCT_Policy.pdf (Date accessed 07/04/06)) “4.1.2 Increasing Utilisation of VCT by Young People: Young people aged 12 and above should have access to VCT services if they so desire without any barriers. Parents or guardians of children under 12 of age who have been exposed to HIV such as through MTCT, child abuse or blood transfusion should be encouraged to seek HIV testing for these children. To ensure that VCT services are youth friendly VCT programmes should provide the following: 1. Youth-oriented advertisement and promotion of services. This may include outreach activities to educate and mobilise young people for VCT. 2. Youth-friendly counselling and referral to other health and psychosocial support services. These may include ongoing counselling and youth-friendly post-test clubs. 3. Non-judgemental health care providers. 4. Access to particularly vulnerable young people such as out-of-school and street children. 5. Access to partner and premarital counselling and testing for young people.” (Ministry of Health - Uganda Nation Policy Implementation Guidelines for HIV Voluntary Counselling and Testing Services (2003) http://www.aidsuganda.org/pdf/Implem_guide_final.pdf (Date accessed 07/04/06)) “HCT for children HCT services for children in Uganda are guided by the UN Convention on the Rights of the Child (UNCRC). Specifically, any intervention for childrenshould be done in the best interest

of the child and should be aimed at improving health, development, and social wellbeing. HCT service providers must also protect a child’s rights to privacy and access to appropriate information while respecting the rights and duties of parents and guardians to guide anddirect childrenin the exercise of their rights. (pg 14) Ministry of Health – July 2005 “Uganda National Policy Guidelines for HIV Counselling and Testing” Informed consent for children Children age 12 and older may receive HIV testing services at all HIV Counselling & Testing (HCT) sites without knowledge or consent of their parent(s) provided they have the capacity to understandthe implications of the results of the HIV test. Children age 12 and older may be provided services if they seek the services freely and without coercion on the part of parents or others. Youth receive their results according to the protocol and results are not shared with parents or guardians except at the request of the child. For children below 12 years of age, consent by parents or guardians must be documented. For children below 12 years of age without a parent orguardian, the head of the institution, health centre, hospital, clinic or any responsible person may give consent”. (pg 16) [Ministry of Health – July 2005 “Uganda National Policy Guidelines for HIV Counselling and Testing”] 3. What is the minimum legal age for accessing SRH services without parental and partner consent? The National Policy/guidelines and services standards for Reproductive Health Services talks about eligibility for family planning services. “All sexually active male and females in need of contraception are eligible for family planning services provided that: - they have been educated and counselled on all available family planning methods and choices Attention has been paid to their current medical, obstetric contra-indications and personal preferences CONSENT FOR family planning services No verbal or written consent is required from parent, guardian or spouse before a client can be given family planning services” (pg. 10) [Ministry f Health – May 2001 “The national Policy Guidelilnes and Service Standards for Reproductive Health Services” 4. What is the minimum legal age for accessing abortions without parental and partner consent? “In Uganda, abortion is permitted only to save the life of the women, preserve physical health, or preserve mental health (it is not permitted in case of rape or incest). Although the law does not require the approval of the committee, the consent of two physicians is usually sought before a legal abortion can be performed. Illegal abortions are common and are more prevalent among young women (pg 56)”.(University Of California San Francisco (UCSF) Country AIDS Policy Analysis Project (HIV in Uganda 2003, http://www.aidsuganda.org/pdf/Uganda_HIV_profile_U_Calif.pdf (Date accessed 07/04/06)) 5. Is HIV testing mandatory for any specific groups (e.g. pregnant women, military, migrant workers, and sex workers)? “Some employers, foreign governments and institutions have policies that require knowing the HIV status of certain persons before they are allowed to apply for particular privileges or

services. Such policies are usually discriminatory against people living with HIV/AIDS and should be condemned” (pg11) (Ministry of Health-2003, Uganda National Guidelines for HIV Voluntary Counselling and Testing, http://www.aidsuganda.org/pdf/Final_VCT_Policy.pdf. (Date accessed 07/04/06)) The Uganda national Policy Guidelines for HIV Counselling and Testing talks about only 4 approaches and protocols for HCT: a. Voluntary counselling and testing (VCT) b. Home-Based HIV Counselling and Testing (HBHCT) c. Routine Testing and Counseling (RTC) and d. HIV Testing for Post Exposure Prophylaxis (PEP) (pgs. 11-13) Ministry of Health – July 2005 “Uganda National Policy Guidelines for HIV Counselling and Testing” Though it is known that these days for anybody to join the armed forces: military and policy , they have to be tested for HIV, we haven’t been able to get any documented evidence. 6. Is there any legislation that specifically addresses gender-based violence? “The Domestic Relations Bill is a crucial piece of legislation for Ugandan women. It addresses women's property rights in marriage and women's right to negotiate sex on the grounds of health, sets the minimum age of marriage at eighteen, prohibits FGM and criminalizes widow inheritance. As a compromise measure, bride price will not be prohibited, but the payment of bride price will no longer be essential for the formalization of customary marriages, and any demands for the return of marriage gifts will be an offence. The bill criminalizes marital rape and provides for civil remedies, such as compensation and restricting orders. The grounds for divorce are equally applicable to both spouses and alimony is provided for.” “The Domestic Relations Bill continues to exclude cohabitation from the presumption of marriage, but provides parties to such relationships with certain rights, including the right to register the fact of cohabitation and particulars of any monetary or non-monetary contributions made. A competent court may then distribute the property equitably in accordance with those contributions, and may do so even when registration has not taken place. Polygamy is also strictly regulated by guidelines that provide for the economic support of all wives. The bill also provides for equal sexual rights and establishes more equitable grounds for divorce. The paper discusses domestic and international law and Islamic Family Law in arguing that the reforms, while a step forward, do not go enough, offers arguments and alternatives and examines the particular situation of Muslim women. It questions the wisdom of promoting Khadi Sharia courts and discusses the Indian Shah Bano case as germane to Uganda's dilemma on issues of religious rights conflicting with issues of gender equality in contexts of Sharia personal law.” (Abstract, VANESSA M.G. VON STRUENSEE Independent (July 2004) - The Domestic Relations Bill in Uganda: Potentially Addressing Polygamy, Bride Price, Cohabitation, Marital Rape, Widow Inheritance and Female Genital Mutilation http://papers.ssrn.com/sol3/papers.cfm?abstract_id=623501 (Date accessed 07/04/2006)) “Sexual harassment also was common. For example, in January, the Women's Commission for Refugee Women and Children reported that security forces, teachers, and others in the north sexually abused female "night commuters," the adults and children who fled their homes each night to seek shelter from LRA attacks and abductions. In March, Parliament registered complaints from women being asked for sexual favors during job interviews. Traditional and widespread societal discrimination against women continued, especially in rural areas. Many customary laws discriminate against women in the areas of adoption, marriage, divorce, and inheritance. In many areas, women could not own or inherit property or retain custody of

their children under local customary law. Traditional divorce law in many areas requires women to meet stricter evidentiary standards than men to prove adultery. Polygamy is legal under both customary and Islamic law. In some ethnic groups, men can "inherit" the widows of their deceased brothers. Women did most of the agricultural work but owned only 7 percent of the agricultural land. During the year, employers in the private sector frequently failed to apply the statutory provision that provides women maternity leave.” (U.S. Department of State - Country Reports on Human Rights Practices (2004) http://www.state.gov/g/drl/rls/hrrpt/2004/41632.htm (Date accessed 07/04/06)) “The Universal Declaration of Human Rights and the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) outline basic and fundamental human rights regarding gender discrimination and "security of the person," which has been interpreted, inter alia, in terms of sexual behavior. Uganda ratified CEDAW more than two decades ago, yet the overall legal environment in the country is still not fully protective of women and girls, nor does it facilitate justice for victims of sexual or gender-based violence. For example, sexual contact outside of marriage with girls under the age of 18 is known in Uganda as "defilement," not rape. Though the official punishment for defilement is death, in practice, according to a variety of human rights NGOs in Uganda, "defilers" are rarely subject to any form of punishment stronger than a slap on the wrist. Especially in, but not limited to, Northern Uganda, families will often forgive the perpetrator (and/or not press charges) if he agrees to either marry the girl, pay a fine for his actions, or, preferably, both. In some cases, the desire on the part of a victim's family to receive compensation rather than seek punishment through the judicial system is primarily motivated by dire economic straits. In other cases, it occurs because the family knows they are unlikely to achieve any sort of result — legal or monetary — if they take their chances with the judicial system. Girls in displaced families are in an even more precarious situation since they are almost fully dependent on government and army assistance for survival, are generally poorer than non-displaced families, and often lack even the most basic education and knowledge of their rights. It is especially difficult for women and girls who have been assaulted by soldiers to come forward with their accusations. As a result, few, if any soldiers, are ever prosecuted — leading many to continue their actions in relative impunity. According to a variety of NGOs in Northern Uganda, as well as displaced women themselves, the most severe punishment a soldier implicated in rape is likely to receive is a transfer to a different camp. Stories abound of individual army soldiers and commanders that have been transferred over and over again for this reason, yet never brought to court. Moreover, victims of sexual and gender-based violence who do come forward are put in a harsher spotlight than the perpetrators. Uganda's highly patriarchal society generally views girls as a financial burden on their families who should be married off as soon as possible. In this environment, rape or other forms of sexual assault are not always interpreted as crimes in the first place — by anyone except the victims." (Erin Patrick- Migration Policy Institute Surrounded: Women and Girls in Northern Uganda (June 1), 2005,http://www.migrationinformation.org/Feature/display.cfm?id=310 (Date accessed 31/05/06)) 7. Is there an AIDS Law – or equivalent – that legislates on issues such as confidentiality for testing, diagnosis, treatment, care and support? “2.1 Client registration: VCT registration does not have to be anonymous. Clients may register with their names. All VCT sites are bound to ensure confidentiality of client information. Where VCT is provided in health facilities VCT clients may register like other patients at the outpatient department to avoid being stigmatised.”

(pg18) (Ministry of health (July 2003), Uganda National Policy Implementation Guidelines for HIV Voluntary Counselling and Testing Services, http://www.aidsuganda.org/pdf/Implem_guide_final.pdf (Date accessed 27/04/06)) CONFIDENTIALITY “HCT services Must assure that information gathered from testing or counselling of individuals during HCT is kept strictly confidential. HIV test results and patient records should be kept in a locked file with access limited to HCT personnel. The HCT site will not release test results to anyone other than the client unless the client requests such release in writing or a court order requires it. Counselling must be conducted in an area where privacy and confidentiality can be assured” PG.7: Ministry of Health – July 2005 “Uganda National Policy Guidelines for HIV Counselling and Testing” [July 2006] 8. Is there any legislation that protects people living with HIV/AIDS, particularly girls and young women, from stigma and discrimination at home and in the workplace? Testing for people seeking employment, studies or certain services: Some employers, foreign governments e.g the US government and institutions have policies that require knowing the HIV status of certain persons before they are allowed to apply for particular privileges or services. Such policies are usually discriminatory against people living with HIV/AIDS and should be condemned.” (p11) (Ministry of Health - Uganda National Guidelines for HIV Voluntary Counselling and Testing (2003) - http://www.aidsuganda.org/pdf/Final_VCT_Policy.pdf (Date accessed 07/04/06)) ”Further, tendencies of discrimination, stigma, isolation, and other acts that constitute (deliberate or unconscious) violation of human rights are commonly cited in everyday aspects of life. There is considerable concern about job insecurity and discrimination in the employment sector, quiet screening tests before selection of new entrants in some agencies, and fragmented 'policies' for persons suspected to be living with HIV/AIDS. Recent discriminatory public talks about PHAs and students benefiting from public sponsorship in higher institutions of learning have riled wide sections of society. Further, breach of confidentiality about the sero-status of clients of medical and other care and support agencies, or persons known to be infected by HIV/AIDS, is not covered under the law (UAC 2003). HIV/AIDS-related human rights include the right to: • Life, liberty and security of the person • The highest attainable standard of mental and physical health • Non-discrimination, equal protection and equality before the law • Freedom of movement • Seek and enjoy asylum • Privacy, the right to freedom of expression and opinion • Freely receive and impart information • Freedom of association • Marry and found a family • Work • Equal access to education • An adequate standard of living • Social security, assistance and welfare • Share in scientific advancement and its benefits • Participate in public and cultural life • Be free from torture and other cruel, inhuman or degrading treatment or punishment (UNAIDS/OHCHR, 2001)." (Pg7) (The National Strategic Framework for HIV/AIDS Activities in Uganda: 2000/1-2005/6,

Mr. Kyomuhendo Swizen- Mid-Term Review Report Theme 3: Psychosocial Support, Protection and Human Rights (December 2003), http://www.aidsuganda.org/pdf/Annex_3_TWG_3_Report.pdf (Date accessed 25/05/06)) 9. Are sex workers legally permitted to organise themselves, for example in unions or support groups? “Prostitution was illegal; however, it was common. There were no credible statistics available on the occurrence of prostitution, including child prostitution, during the year. There were reports of trafficking in women, girls, and babies during the year (see Section 5, Trafficking).” (U.S. Department of State - Country Reports on Human Rights Practices (2004) http://www.state.gov/g/drl/rls/hrrpt/2004/41632.htm (Date accessed 07/04/06)) Yes - Lady Mermaid’s Bureau – A Community based organisation, Founded in 2002 Po. Box 70890, Kampala, Uganda “The organization serves women sex workers. The absence of information to give a national image about sex work in Uganda not withstanding, conservative estimates of the active participants in the activity would put the number to around 10000. Over fifty percent of these are based in Kampala. The number of SWs in an area appears to increase with the volume of commercial activities. In major towns like Mbarara, which are growing faster, sex workers are reportedly on the increase. This is the same with towns like Busia, Mbale and Fortportal. An estimate of children in sex work in Kampala and Entebbe is 2,400 in contrast to the number between 7,000 and 12,000 nationally affected by sex exploitation in general. However rough estimate served by LMB in Kampala’s suburbs and Entebbe is between “1800-2000.” Majority of sex workers 68% are youth aged 15-24 while children below 18 years account for about 24%. (Also see Matsamura (2002 report) who reports on child prostitution is on the increase.) 100% of SWs are females. Men participate in the activity as clients rather than providers of sex services. Unconfirmed reports however suggest that men are slowly but progressively penetrating into the trade. SWs fall between the age brackets 15 -24. This implies that majority of SWs are still youth or young people. They represent a category of people most threatened with the HIV/AIDS problem, infection with other STIs, early pregnancy and related sexual and reproductive health problems. SWs without a child or who have never produced a child represent 19.4%. This implies that 80% of SWs have a child or more. This information suggests that they have been exposed to contract HIV and AIDS, with the related diseases. (Lady Mermaid’s Bureau produced an information material to assist SWs in their daily health life; the title of which is ‘Your Emotional Health and STDs/STIs as a sexworker, Along with FACTS ABOUT HIV / AIDS)” (Extracted from a proposal that was submitted for funding to – The Collaborative Fund for women and Families (extracted in July 2006) 10. Are harm reduction methods for injecting drug users (such as needle exchange) legal? “Studies on injecting drug use in East Africa are reviewed. The existing studies document the spread of heroin injection in Kenya and Tanzania, both countries where HIV rates are high. No data from Uganda on injecting drug use was found by the authors. A case study of the growth of heroin injection in a Kenyan coastal town is presented. The need for needleexchange programmes and other prevention services is discussed.” (Harm Reduction Journal (2005) http://www.harmreductionjournal.com/content/2/1/12 (date accessed 07/04/06)) “Limited information is available on the drug control situation in Uganda. However, recent seizures show that illicit trafficking is on the increase in the country as well as the drug abuse problem. The Ugandan government has voiced concern over increasing reported drug abuse. Cannabis, heroin and methaqualone are the most available and consumed drugs.”

(UNODC website, http://www.unodc.org/kenya/en/country_profile_ugan.html (date accessed 07/04/06) Discussion questions: •

Which areas of SRH and HIV/AIDS responses are legislated for?

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What are the biggest strengths, weaknesses and gaps in legislation in relation to HIV prevention for girls and young women?

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Is action taken if laws are broken (e.g. if a girl is married below the legal age)?

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Is there any specific legislation for marginalised and vulnerable groups1? If yes, is the legislation supportive or punitive? And what difference does it make to people’s behaviours and risk of HIV infection?

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To what extent are ‘qualitative’ issues – such as confidentiality around HIV testing – covered by legislation?

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How much do girls and young women know about relevant legislation and how it relates to them? Are there any initiatives to raise awareness about certain laws?

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Overall, how is relevant legislation applied in practice? What are the ‘real life’ experiences of girls and young women? What difference does it make to their vulnerability to HIV infection?

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How do the effects of legislation vary among different types of girls and young women, such as those in/out of school, married/unmarried, in rural/urban areas, living with HIV/not aware of their HIV status?

PREVENTION COMPONENT 2: POLICY PROVISION (national policies, protocols, guidelines, etc) Key questions: 11. Does the current National AIDS Plan address the full continuum of HIV/AIDS strategies, including prevention, care, support and treatment? `“1.3 Focus of the National Strategic Framework (2000/1 – 2005/6) ... Various sectors and line ministries have played an important role in HIV/AIDS prevention, care and mitigation of the socio-economic impact of HIV/AIDS during the last decade. Therefore, this National Strategic Framework recognises that HIV/AIDS should be integrated into all aspects of developmental work, service provision, planning and implementation by line ministries, local governments, religious and cultural organisations, the private sector and NGOs/CBOs. The framework is the national guideline and source of inspiration to the sector wide HIV/AIDS planning and implementation and lays emphasis on collaboration and co-ordination among all stakeholders working towards HIV/AIDS prevention and care.” (Government of Uganda, Uganda AIDS Commission, Joint United Nations Programme on AIDS, Other Stakeholders in HIV/AIDS - The National Strategic Framework for HIV/AIDS Activities in Uganda: 2000/1 – 2005/6 (2000) http://www.aidsuganda.org/pdf/nsf.pdf (Date accessed 07/04/06)) 1

Examples include: people living with HIV/AIDS, sex workers, injecting drug users, migrant workers, refugees and displaced people, street children, school drop-outs, lesbians and ethnic minorities.

“3.3.2 Priority areas for 2000/1 – 2005/6 ...Given the large number of PHAs, more resources need to be devoted to this category. Their principal need is care including treatment of AIDS itself, the opportunistic infections and providing social support. The Drug Access Initiative should be a major component of this strategy” 12. Does the National AIDS Plan specifically address the HIV prevention and SRH needs of girls and young women? The National Strategic Framework for HIV/AIDS aims to: • “Sensitise the public on the dangers of early sex, infidelity, unprotected sex and alcohol/substance abuse in relation to HIV/AIDS; • Promote AIDS education and counselling to students in schools, colleges and institutions of higher learning; • Increase condom accessibility and affordability; • Intensify awareness on the rights of children, youth and women vis-à-vis HIV/AIDS; and • Intensify life and psychosocial skill development of youth and other vulnerable groups.” (pg xxi) • Initiate a phased implementation of PMTCT in selected health units; • Strengthen awareness and sensitisation on PMTCT in order to facilitate informed decision making and reduce pregnancies among HIV positive and discordant couples; • Promote utilisation of disposable or sterile and other necessary MCH/FP and safe motherhood equipment; • Promote cheaper alternative feeding programmes to breast feeding for HIV positive mothers” (pg xxv) • Reduce the vulnerability of individuals and communities to HIV/AIDS with a focus on children, youth and women.” (pg xxxvi) (Government of Uganda, Uganda AIDS Commission, Joint United Nations Programme on AIDS, Other Stakeholders in HIV/AIDS - The National Strategic Framework for HIV/AIDS Activities in Uganda: 2000/1 – 2005/6 (2000) http://www.aidsuganda.org/pdf/nsf.pdf (Date accessed 07/04/06)) 13. Does the National AIDS Plan specifically address the HIV prevention and SRH needs of marginalised and vulnerable groups, including people who are living with HIV/AIDS? The National Strategic Framework for HIV/AIDS aims to: • “Sensitise the public on the dangers of early sex, infidelity, unprotected sex and alcohol/substance abuse in relation to HIV/AIDS; • Promote AIDS education and counselling to students in schools, colleges and institutions of higher learning; • Increase condom accessibility and affordability; • Intensify awareness on the rights of children, youth and women vis-à-vis HIV/AIDS; and • Intensify life and psychosocial skill development of youth and other vulnerable groups.” (pg xxi) • Initiate a phased implementation of PMTCT in selected health units; • Strengthen awareness and sensitisation on PMTCT in order to facilitate informed decision making and reduce pregnancies among HIV positive and discordant couples; • Promote utilisation of disposable or sterile and other necessary MCH/FP and safe motherhood equipment • Promote cheaper alternative feeding programmes to breast feeding for HIV positive mothers” (pg xxv) • Reduce the vulnerability of individuals and communities to HIV/AIDS with a focus on children, youth and women” (pg xxxvi) • “4.1.2 To mitigate the health and socio-economic effects of HIV/AIDS at the individual, household and community level • Mitigation of the effects of the epidemic shall be pursued through: Providing care, support and protection of rights to at least 50% of the families most affected by

HIV/AIDS.” (pg xxxvi) “Constraints: Inappropriate IEC messages in terms of medium, context, target group and proposition of safer behavioural alternatives. For example, special IEC messages should be developed for the vulnerable population such as children, adolescents, women and high-risk groups such asmen, IDPs and refugees, the military, truck drivers and sex workers.(Pgxxi)” (Government of Uganda, Uganda AIDS Commission, Joint United Nations Programme on AIDS, Other Stakeholders in HIV/AIDS - The National Strategic Framework for HIV/AIDS Activities in Uganda: 2000/1 – 2005/6 (2000), http://www.aidsuganda.org/pdf/nsf.pdf (Date accessed 07/04/06)) 14. Does the National AIDS Plan emphasise confidentiality within HIV/AIDS services? 2.1 “Voluntary counseling and testing (VCT): HIV counseling is the confidential dialogue between a person and a care provider aimed at enabling the person to cope with stress and make personal decisions related to HIV/AIDS. Counseling is an important component of voluntary confidential counseling and testing [VCT] and follow-up care for people living with HIV/AIDS [PLWHA] including those receiving antiretroviral therapy.” (Uganda Ministry of Health - National Antiretroviral Treatment and Care Guidelines for Adults and Children (2003) http://www.aidsuganda.org/pdf/ARV_Clinical_Guidelines_Final_draft.pdf (Date accessed 07/04/06)) Confidentiality is illustrated in the Uganda National Policy Guidelines for HIV Counselling and Testing: “HCT services must assure that information gathered from testing or counselling of individuals during HCT is kept strictly confidential. HIV test results and patient records should be kept in a locked file with access limited to HCT personnel. The HCT site will not release test results to anyone other than the client unless the client requests such release in writing or a court order requires it. Counselling must be conducted in an area where privacy and confidentiality can be assured”. (pg. 7) Ministry of Health – July 2005 “Uganda National Policy Guidelines for HIV Counselling and Testing” “Decreased stigmatisation and discrimination due to the shared confidentiality which minimise denial and increases use of voluntary testing and counselling services;(Pgxxviii)” (Government of Uganda, Uganda AIDS Commission, Joint United Nations Programme on AIDS, Other Stakeholders in HIV/AIDS - The National Strategic Framework for HIV/AIDS Activities in Uganda: 2000/1 – 2005/6 (2000), http://www.aidsuganda.org/pdf/nsf.pdf (Date accessed 31/05/06) 15. Does the national policy on VCT address the needs of girls and young women? “4.1.2 Increasing Utilisation of VCT by Young People: Young people aged 12 and above should have access to VCT services if they so desire without any barriers. Parents or guardians of children under 12 of age who have been exposed to HIV such as through MTCT, child abuse or blood transfusion should be encouraged to seek HIV testing for these children. To ensure that VCT services are youth friendly VCT programmes should provide the following: 6. Youth-oriented advertisement and promotion of services. This may include outreach activities to educate and mobilise young people for VCT. 7. Youth-friendly counselling and referral to other health and psychosocial support services. These may include ongoing counselling and youth-friendly post-test clubs. 8. Non-judgemental health care providers.

9. Access to particularly vulnerable young people such as out-of-school and street children. 10. Access to partner and premarital counselling and testing for young people.” (Ministry of Health - Uganda Nation Policy Implementation Guidelines for HIV Voluntary Counselling and Testing Services (2003) http://www.aidsuganda.org/pdf/Implem_guide_final.pdf (Date accessed 07/04/06)) 16. Does the national protocol for antenatal care include an optional HIV test? "The Ministry of Health policy for reducing mother-to-child-transmission of HIV has the following recommendations regarding the use of VCT in preventing MTCT: • Voluntary Counselling and HIV testing within the antenatal clinic is recommended for pregnant women with at least two laboratory tests: one for screening and another for confirmation. • This procedure necessitates training and reorientation of counsellors and health workers on issues related to MTCT. It is recommended that VCT be available at the same facility where antenatal care is offered.” (Ministry of Health - Policy for reduction of mother-tochild HIV Transmission in Uganda (2001" (Pg 7) (Ministry of Health - Uganda National Policy Implementation Guidelines for HIV Voluntary Counselling and Testing Services (2003) http://www.aidsuganda.org/pdf/Implem_guide_final.pdf (Date accessed 07/04/06)) 17. Does the national protocol for antenatal care include a commitment that any girl or young woman testing HIV positive should be automatically offered PMTCT services? “The PMTCT services are provided to pregnant women and their partners who attend antenatal care. Pregnant women are counseled and given information about mother to child transmission of HIV. They are then counseled to voluntarily take an HIV test. If the pregnant mother test HIV positive, she and her partner are counseled and given a range of services available to prevent HIV transmission to their child. Mother to child transmission of HIV can occur during pregnancy, birth or breastfeeding. PMTCT services provided range from comprehensive antenatal care, administration of anti-retrovirals particularly Nevirapine, modification of birth practices and safe infant feeding. Dr Ojera said.” (The Ministry Health – Prevention of Mother to Child Transmission of HIV/AIDS - PMTCT Program by Moses Bwalatum, Newvision, (2003) http://www.aidsuganda.org/pdf/PMTCT_Programme_Article.pdf (Date accessed 07/04/06)) 18. Is there a national policy that the protects the rights and needs - including HIV prevention, SRH services, employment opportunities and education - of young women or girls at risk or affected by early marriage? “Impediments in access to justice deny women equal protection of the law.334 Property violations committed by spouses and in-laws transgress constitutional provisions affording every person protection from the deprivation of property.335 Forced sex, women’s inability to negotiate condom use and procreation, unequal rights over children, and discriminatory grounds for divorce contravene women’s entitlement to equal rights during marriage, and at its dissolution under article 31(1) of the constitution.336 Polygynous unions, which entitle husbands to marry multiple spouses, are also inconsistent with article 31(1).337 The failure of the government to enact legislation such as the Domestic Relations Bill contravenes Parliament’s constitutional obligation to make appropriate laws for the protection of the rights of widows and widowers to inherit the property of their deceased spouses and to enjoy parental rights over children.338 The state also has a responsibility to “take affirmative action in favor of groups marginalised on the basis of gender, age, disability or any other reason created by history, tradition or custom, for the purpose of redressing imbalances which exist against them.”339 Parliament has the responsibility to make laws to give full effect to this

clause.340.” “NGOs have contributed memoranda to the Constitutional Review Commission341 specifically requesting that people living with HIV/AIDS be included as a category of marginalized groups requiring affirmative action under article 32(1) of the constitution. They have also recommended that article 33(3) be amended to protect women’s sexual and reproductive rights, including: the right to determine the number and spacing of children; freedom from forced conception; freedom from marital rape; freedom to use a contraceptive method of one’s choice; freedom from sex that endangers health; and freedom from cultural practices that endanger the sexual and reproductive functions of women’s health, such as female genital mutilation.342” (Human Rights Watch, (August 2003) http://www.hrw.org/reports/2003/uganda0803/6.htm# _Toc47260360(Date accessed 07/04/06)) “While attention to paediatric AIDS care initiatives has increased, issues unique to this target group including counselling approaches, appropriate treatment formulations, and the needs of adolescents with HIV must be addressed. Involvement of private sector and PHAs in care and treatment initiatives, (Pg19)” “Significant progress has been achieved in building life skills of youth, both those in and out of schools, through the efforts of Government, Civil Society Organisations (CSO) and Faith-Based Organisations (FBO).(Pg20)” (Government of Uganda,The Revised National Strategic Framework for HIV/AIDS Activities in Uganda: 2003/04 – 2005/06 February, 2004,http://www.aidsuganda.org/pdf/Revised_National_Strategic_Framework_for_HIV_ 2003-06.pdf (Date accessed 31/05/06) 19. Is HIV prevention within the official national curriculum for both girls and boys? “Promote AIDS education and counselling to students in schools, colleges and institutions of higher learning.” (Government of Uganda, Uganda AIDS Commission, Joint United Nations Programme on AIDS, Other Stakeholders in HIV/AIDS - The National Strategic Framework for HIV/AIDS Activities in Uganda: 2000/1 – 2005/6 (2000) http://www.aidsuganda.org/pdf/nsf.pdf (Date accessed 07/04/06)) "5. Goal: The overall goal of the program is to increase the capability of young people to adopt life-long attitudes and practices that contribute to the prevention of disease, with special attention to HIV/AIDS, at individual, community and national levels. The program will aim at enabling young people to postpone sexual debut as long as possible, make prevention of disease part of their (sexual) lifestyles, and seek proper sexual health services (including counseling) whenever necessary. The program will also aim at instilling gendersensitive values to the youth and ensure the internalization and respect for the different roles and expectations that society places on them as men and women. These goals will be achieved through direct communication to youth through a multi-media strategy (including interpersonal communication) and community capacity building and mobilization The Program will be guided by the need to build on, rather than re-invent the wheel with regard to youth issues in Uganda. The Program will therefore seek to: o Identify and upscale on-going youth communication initiatives already going in the country. o Advocate for communications programming that go beyond the sexual health model thereby immediately meeting the communication needs of the nonsexually active youth. o Build on lessons learned and bring Ugandan (and other) best practices to bear onto communications programming for youth. o Continuously seek to build partnerships with Youth Service Organizations o YSOs, in order to ensure a comprehensive approach to the program goals.

6. Objectives: The program has three levels of objectives, i.e. Communication objectives, community mobilization objectives and capacity building objectives. 6.1. Communication objectives o To intensify and sustain HIV and AIDS education for school-going children and young people in the country o To increase the capacity of parents, teachers and health service providers to engage in constructive deliberations with young people on matters related to HIV and AIDS o To increase public debate on HIV and AIDS in support of youth serving o HIV and AIDS prevention initiatives 6.2. Community mobilization objectives o To identify, engage and increase the capacity of community support structures to support young people HIV/AIDS prevention behavior o To engage different law and policy instruments to support youth HIV and AIDS prevention initiatives. o To foster networking among all Youth Service Organizations (YSOs) 6.3.Capacity building objectives o To train core personnel from different sectors on youth HIV and AIDS prevention methods. o To improve the delivery of services to youth through the “youth friendly services” concept in collaboration with partners already working in this area o Engage in resource mobilization for the program 7. Priority Audiences: I. Phase One- Primary School pupils o Primary age youth o Communities and policy support structures o II Phase Two Secondary schools o Secondary school age o Youth out of school o Youth at work (apprentices etc), Youth leaders o Communities and policy support structures 5 III Phase Three Tertiary level youth Communities and policy support structures(Pg3-5)” (Uganda AIDS Commission – National Young People HIV/AIDS Communication Program for Young People Concept Paper (2001), ttp://www.aidsuganda.org/pdf/piacy_doc.pdf (Date accessed 31/05/06)) "As part of its outreach to young people, Uganda also has a lively monthly newspaper called Straight Talk that contains articles on sexuality and intimacy written by secondary school students. …. The Government of Uganda estimates that approximately 10 million young people receive AIDS education in the nation’s classrooms, many of whom entered school for the first time when fees were eliminated in the 1990s. In one school district more than 60 per cent of students aged 13 to 16 had reported that they were sexually active in 1994. By 2001, that figure was reduced to fewer than 5 per cent." (A Joint Report by UNAIDS/UNFPA/UNIFEM - Women and HIV/AIDS- Confronting the Crisis, http://www.unfpa.org/hiv/women/report/chapter5.htm (Date accessed 31/05.06)) 20. Is key national data about HIV/AIDS, such as HIV prevalence, routinely disaggregated by age and gender? Key data cited by Uganda Demographic Health Survey, UNAIDS, WHO, USAID, etc. is broken down by both age and gender. (Uganda Demographic Health Survey 2000/01, http://www.measuredhs.com/hivdata/surveys/survey_detail.cfm?survey_id=420) (Date accessed 26/04/06) Discussion questions: •

To what extent are relevant bodies – such as the Ministry of Education, NGO networks,

religious organisations, etc – engaged in policy-making around HIV prevention for girls and young women? •

To what extent do those bodies work in partnership or in isolation? What areas of HIV prevention responses (e.g. behaviour change, counselling, treatment, home-based care) have national protocols or guidelines?

•

To what extent do those protocols address the needs of girls and young women, including those that are marginalised and vulnerable?

•

What does school-based sex education cover? Does it help to build young people’s confidence and skills, as well as knowledge?

•

To what extent do policies help to reduce stigma and discrimination? For example, do they encourage people to stop using derogatory language or ‘blaming’ specific groups for HIV/AIDS?

•

To what extent are different areas of policy provision – such as for HIV/AIDS and antenatal care – integrated or isolated?

•

What policy measures exist in relation to consent, approval and confidentiality? For example, can girls and young women access services such as VCT without having to notify their parents and/or partner? And are they informed of their right to confidentiality?

•

Overall, how are relevant policies applied in practice? What are the ‘real life’ experiences of girls and young women? How much do they know about them and how they relate to them? What difference do these policies make to their vulnerability to HIV infection?

•

How do the effects of policies vary among different types of girls and young women, such as those in/out of school, married/unmarried, in rural/urban areas, living with HIV/not aware of their HIV status?

PREVENTION COMPONENT 3: AVAILABILITY OF SERVICES2 (number of programmes, scale, range, etc) Key questions: 21. Is there a national database or directory of SRH and HIV/AIDS services for young people? “UNASO Membership Directory: This Directory lists contact details and service profiles including contact names, addresses, telephone and fax numbers, email addresses of UNASO member organisations throughout the country, working in the field of HIV and AIDS” (Uganda Network of AIDS Service Organisations Website http://www.unaso.or.ug/directory.php (Date accessed 07/04/06) “3.1 Distribution of HIV/AIDS Agencies in Uganda: The survey identified 717 agencies which are in place and actively engaged on HIV/AIDS activities, however, detailed analysis was possible on 712. Many agencies appeared in the district lists as having HIV/AIDS activities but, in reality, they had ceased to operate by the time of the survey primarily because funding from the STI project, or other sources, had been exhausted. They

2 (Refers to the full range of SRH and HIV/AIDS services relevant to girls and young women. These include antenatal care, STI information and treatment, HIV prevention, condoms, VCT and other counseling, positive prevention, treatment of opportunistic infections, care and support, treatment (including ARVs), skills building, economic development, etc).

are excluded from the inventory.” (African Medical and Research Foundation (AMREF-UGANDA) in partnership with The Uganda AIDS Commission Secretariat – Inventory of Agencies with HIV/AIDS Interventions in Uganda - A Review of Actors, Interventions, Achievements and Constraints Relating to the HIV/AIDS Challenge in Uganda (2001) http://www.aidsuganda.org/pdf/hiv_agencies_inventory.pdf (Date accessed 07/04/06)) 22. How many SRH clinics or outlets are there in the country? “Health Infrastructure: Service outlets comprise 1,738 facilities, of which 1,226 belong to government, 465 belong to NGOs and 47 belong to the private sector. The facilities include 104 hospitals (57 government, 44 NGO and 3 Private), 250 health centres (179 government, 68 NGO and 3 private), palliative care 2 (government 1, NGO 1) and others (989 government, 352 NGO and 41 private).” (Uganda Ministry of Health Website, http://www.health.go.ug/health_units.htm (Date accessed 07/04/06)) Table 26 – Distribution of AIDS Cases by Health Care Facility as of 31st December 2002 lists 187 distinct health care facilities dealing with AIDS Cases (STD/AIDS Control programme – Ministry of Health - STD/HIV/AIDS Surveillance Report 2003 – http://www.health.go.ug/docs/hiv0603.pdf (Date accessed 07/04/06) “Reproductive health services in static clinics and outreaches, is at present being implemented in 17 IPPF sponsored static clinics backed up by 47 outreach clinics offering family planning, immunization, ante/post natal care, STD management, etc.” (Uganda Country profile, http://www.ippf.org/imspublic/IPPF_CountryProfile/IPPF_CountryProfile.aspx?ISOCode= NE (Date accessed 31/05/06)) 23. At how many service points is VCT available, including for young women and girls? “HIV testing and counselling sites: number of sites - 2004 - 400 - Ministry of Health”. (WHO – Summary country profile for HIV/AIDS treatment scale up (2005) http://www.who.int/3by5/support/june2005_uga.pdf (Date accessed 07/04/06)) 24. Are male and female condoms available in the country? “50 million male condoms and 110,000 female condoms were distributed within the first six months of 2002 with special emphasis to improving accessibility by high-risk groups.” (Pg 14) “Promotion of condom use – distribution of condoms is an integrated service within the country's primary health care system and the MOH has issued a guide on how to increase the accessibility of condoms to the grassroots especially to the high risk target populations.” (Pg 29) (UNGASS – Follow-Up to the Declaration of Commitment on HIV/AIDS – (2003) http://www.aidsuganda.org/pdf/ungass_report_final.pdf (Date accessed 04/07/06)) Century Gothic “Some people in Uganda who cannot afford to purchase condoms have started boiling used condoms with steam produced from cooking food in an attempt to sterilize and reuse them.This was highlighted by Makerere University Professor Sam Luboga at the opening of the university's AIDS Actions Week which aims to highlight the challenges the country faces in providing effective HIV/AIDS related services. "We are promoting condom use, but do people have the money?" Luboga asked. "The people are poor, they re-sterilize condoms ... to use them again

because they don't have money," he said, adding, "Poverty is their biggest problem.”" (The UK Times, (April 2006)http://www.timesonline.co.uk/article/0,,200-2122794,00.html (Date accessed 07/04/06)) 25. Is a free HIV test available to all pregnant girls and young women who wish to have one? “The cost of VCT (1500 USh) is hampering people from accessing the services. Kyetume gets testing kit supplies from the government, but the supplies has been inadequate and irregular. This may be improved in future as Kyetume will be supplied directly in future.” “VCT will not be widely accessible unless provided free or at low cost. HIV testing kits must be procured so that VCT can be provided free or at subsidized rates." (International Council on Management of population Programmes - Increasing Institutional Capacity of RH and HIV/AIDS NGOs for Linked Response - Uganda HIV/AIDS Sero-Behavioral Survey 2004-05 http://www.icomp.org.my/Inno_prog/inno-LRuganda.htm(Date Accessed 07/04/06) “The AIDS information Centre (AIC) promotes VCT on special days and provides coupons for free services. Other possibilities are to provide coupons for women receiving PMTCT (prevention of mother-to-child transmission) services to give to spouse, encourage them to seeek free VCT. Another consideration is to hold a national day for free VCT in all facilities. (Pg3)” (Ministry of Health (July 2003)- Uganda National Policy Implementing Guidelines for hIV Voluntary Conselling and Testing Services http://www.aidsuganda.org/pdf/Implem_guide_final.pdf (Date accessed 26/04/06)) “In Uganda, Anglican and Muslim leaders have publicly declared support for voluntary HIV counselling testing and condom use, respectively, for married young couples. Emphasis on the availability and confidentiality of services has encouraged young people to seek HIV testing.” (UNFPA-State of the world population (2005), Chapter 5Unmapped: Adolescent, Poverty and Gender,http://www.unfpa.org/swp/2005/english/ch5/chap5_page3.htm (Date accessed 01/06/06))) 26. At how many service points are PMTCT services (such as nevirapine) available for pregnant girls or young women who are HIV positive? “As of March 2005, USG supported 15 prime partners in the six prevention program areas. Between October 2004 and March 2005, these partners, working in different program areas, reached more than 3.48 million individuals with community-based behavioral change interventions focusing on abstinence and faithfulness, including more than 3 million reached with abstinence activities. USG continued to expand quality prevention of mother-to-child HIV transmission (PMTCT) services. USG supported PMTCT services, including counselling and testing, are now available in 177 facilities in 33 districts. Where pregnant women 131,200 receives prevention of mother to child HIV transmission ( PMTCT) services” (CDC-Global AIDS Programme- The Emergency Plan in Uganda http://www.cdc.gov/nchstp/od/gap/countries/uganda.htm (Date accessed 26/04/06) 27. At how many service points are harm reduction services for injecting drug users available? Unknown 28. Are there any specific national projects (such as camps, conferences and training courses) for boys/girls and young people living with HIV/AIDS? “This program is expected to result in a multiplier effect in creating HIV/AIDS awareness among youth and empowerment of young people, especially those out of school, and

enhancing young people’s action against HIV/AIDS through capacity building of youth in leadership positions. This demands for follow-up action to support youth leaders in their mobilization efforts and also provide technical and financial support to the generated youth initiatives. This will be a shared task among key stakeholders in this field.” “District HIV/AIDS Coordination structures will be responsible for sustaining mobilization efforts at district and lower levels and organization of periodic information sharing fora to facilitate knowledge a experience sharing among young people from different localities UACP/MAP, the GFATM and development partners through the Partnership structure will be encouraged to provide financial and technical support to youth initiatives at district and community levels and assist in enhancing and sustaining initiatives that have come-up as a result of this project”. (Pg 11) (Office of the President, Ministry of Gender Labour and Social Development, UN Country Team and Uganda AIDS Commission Kampala, (June 2003)-Implementing the Presidential Initiative on the AIDS Strategy for Communication to the Youth- Enhancing HIV/AIDS Awareness and Dialogue Among Youth Lleadership in Uganda, http://www.aidsuganda.org/pdf/HE_Advocacy_Initiative.pdf (Date accessed 26/04/06)) “If the client chooses to take the test (irrespective of their test results) they are encouraged to join a youth Post Test club for continuing professional counseling and social support, educational talks, orientation seminars on sexual and reproductive health, games, educative videos, inter-club competitions, music, dance and drama and information, education and communication materials (including Straight Talk and Young Talk).” (AIDS Information Centre Uganda - Knowledge is power, now your HIV status website, http://www.aicug.org/index.php?option=displaypage&Itemid=99&op=page (date accessed 01/06/06) 29. At how many service points are ARVs available to people living with HIV/AIDS? “Currently, 25 sites have been accredited in Uganda and 23 are providing ARV therapy. Of the 11 regional hospitals, 6 are providing ARV therapy including Arua, Mbarara, Kabale, Lira, Masaka and Gulu.(Pg5)” (WHO/HIV/06/2003 - Perspective and Practice in Antiretorival Treatment Scaling Up Antiretorival Therapy Ugandan Experience http://www.ahfgi.org/global_pdf/uganda_study.pdf (Date accessed 26/04/06) 30. Are there specific positive prevention services, including support groups, for young women and girls living with HIV/AIDS? “To develop a PHA forum owned HIV/AIDS Knowledge Centre including documentation, internet access, providing services such as group therapy, individual counselling, telephone help line, play pen and also housing the forum Secretariat”. (Seeta, (May 2003), Declaration of the People Living with HIV/AIDS Networks and Associations http://www.aidsuganda.org/pdf/Declaration_of_PHA.pdf (Date accessed 26/04/06)) “If the client chooses to take the test (irrespective of their test results) they are encouraged to join a youth Post Test club for continuing professional counseling and social support, educational talks, orientation seminars on sexual and reproductive health, games, educative videos, inter-club competitions, music, dance and drama and information, education and communication materials (including Straight Talk and Young Talk).” (AIDS Information Centre Uganda- Knowledge is power, now your HIV status website, http://www.aicug.org/index.php?option=displaypage&Itemid=99&op=page (date accessed 01/06/06)

“More support services are needed for counseled youth in Uganda. Ugandan providers said they want to be able to refer youth who have been raped, threaten suicide, plan to leave home or school, or plan to harm their partners, but few youth-appropriate services or support groups exist. Providers in one clinic formed posttest clubs for youth to help them maintain safe behavior.” (Horizons- HIV Voluntary Counseling and Testing Among Youth-Results from an exploratory study in Nairobi, Kenya, and Kampala and Masaka, Uganda, (October 2001) http://www.popcouncil.org/pdfs/horizons/vctyouthbaseline.pdf (Date accessed 01/06/06))) Discussion questions: •

What scale and range of HIV prevention services is available for girls and young women? For example, do programmes go beyond ‘ABC’ strategies? Do programmes cover social issues (e.g. early marriage)? “PEARL Project implemented by the Ministry of Gender, Labour and Social Development (MGLSD) to expand youth services, peer counselling and social marketing of condoms to 8 districts in northern Uganda. The AIDS Support Organization (TASO) to support a programme for counselling and care for people living with HIV/AIDS. AIDS Information Centre (AIC) to establish centres for voluntary and confidential HIV counselling and testing in 8 northern Uganda districts. Matany Hospital to support outreach activities. Straight Talk Foundation (STF) to support production and distribution of information on adolescent sexual and reproductive health in all 13 districts in Northern Uganda. Marie Stopes Uganda (MSU) to support family planning and reproductive health services in 3 districts in Northern Uganda. The project has achieved the following: it has established clinics, centres for voluntary counselling and testing, out reach centres for both HIV and family planning counselling. It has also developed trainers of trainers, peer educators and mobilisers (parent & youth). (Delegation of the European Commission Website – EU & Uganda http://www.deluga.cec.eu.int/en/eu_and_uganda/popsec.htm (Date accessed 07/04/06) “a) The youthfulness of the population and the need to intensify prevention among young people. Several agencies have programmes on the youth in the country. What is required is a systematic and comprehensive evaluation of these interventions, identification of best practises and formulate a mechanism of scaling up those most effective strategies in a coordinated manner.” Page 20 (UNGASS – Follow-Up to the Declaration of Commitment on HIV/AIDS – (2003 http://www.aidsuganda.org/pdf/ungass_report_final.pdf (Date accessed 04/07/06)) “Save the Children has achieved real impact at the local level, with more children accessing a better education, disadvantaged parents coming together to solve local problems, a community-wide awareness of the danger AIDS, how to avoid it and how to support those affected. Save the Children then uses its practical experience on the ground to advocate at national level for changes to policy that would benefit all children in Uganda. Recently, Save the Children has been on the national task forces to develop the Policy for Education for the Disadvantaged and the Policy for Early Childhood Education. Along with the Ministry of Health and other organizations, Save the Children supported and facilitated the first national symposium on maternal mortality. Save the Children has three key strategies in Uganda: direct support to address the immediate needs of children in need; local capacity building for self-reliance in the longer term; and experience-based advocacy to promote a better environment for all children”. (Save the Children, http://www.savethechildren.org/countries/africa/uganda.asp

(Date accessed 26/04/06) “In interviews with Human Rights Watch, long-time AIDS activists supported the targeting of out-of-school children and youth leaders in rural districts as a way of further educating young people on HIV prevention. But they questioned the applicability of the information provided at the rallies, with its emphasis on abstinence and its denigration of condoms—particularly as participants were largely men and women in their twenties who were already sexually active. They equally raised concerns about the apparent blending of politics and HIV prevention in a way that may alienate those who do not support the president”. (Pg41) (Human Rights Watch- March 2005 Vol. 17, No 4(A)-The Less they Know, the better abstinence-Only HIV/AIDS Programme in Uganda, http://hrw.org/reports/2005/uganda0305/uganda0305.pdf (Date accessed 08/04/06)) •

To what extent are SRH, HIV/AIDS and broader community services integrated and able/willing to provide referrals to each other? For example, could most SRH clinics refer a girl testing HIV positive to a support group for people living with HIV/AIDS?

•

To what extent are HIV prevention services available through ‘non-traditional’ outlets (e.g. religious organisations, youth clubs)?

•

Are there community programmes on gender awareness/dialogue for girls/boys and young women/men? Do they explore power differences and social ‘norms’ for sexual behaviour? Is there mentoring, peer support and economic development that targets females? How available is prevention information and support for girls and young women living with HIV/AIDS?

•

How available are HIV prevention ‘commodities’ (e.g. condoms)? How are they distributed?

•

How much do girls and young women know about the availability of services, such as where to get condoms or ARVs?

•

Overall, what does the availability of HIV prevention services mean in practice? What are the ‘real life’ experiences of girls and young women? What difference do these services make to their vulnerability to HIV infection?

•

How do the effects of availability vary among different types of girls and young women, such as those in/out of school, married/unmarried, in rural/urban areas, living with HIV/not aware of their HIV status?

PREVENTION COMPONENT 4: ACCESSIBILITY OF SERVICES (location, user-friendliness, affordability, etc) Key questions: 31. Are all government HIV prevention and SRH services equally open to married and unmarried girls and young women? The National Policy /guidelines and services standards for Reproductive Health Services talks about eligibility for family planning services. All sexually active male and females in need of contraception are eligible for family planning services provided that: - they have been educated and conselled on all available family planning methods and choices Attention has been paid to their current medical, obstetric contra-indications and personal preferences

CONSENT FOR family planning services No verbal or written concent is required from parent, guardian or spouse before a client can be given family planning services (pg. 10) [Ministry f Health – May 2001 “The national Policy Guidelilnes and Service Standards for Reproductive Health Services” The services offered in government institutions are open to all irrespective of age, sex, marital status etc. 32. Are all government HIV prevention and SRH services equally open to girls and young women who are HIV positive, negative or untested? “Services provided: A range of centre-based and outreach sexual and reproductive health services including: family planning and contraceptive services; contraceptive social marketing; ante- and post-natal care; female sterilisation; vasectomy; primary health care; youth services; the prevention, diagnosis and treatment of sexually transmitted infections (STIs); STI/HIV/AIDS awareness-raising initiatives; and voluntary confidential counseling and testing for HIV/AIDS clients.” (Marie Stopes International, http://www.mariestopes.org.uk/ww/uganda.htm (Date accessed 07/04/06) (Date accessed 26/04/06)) 33. Are VCT services free for girls and young women? “1.9 (pg 17) financing VCT services. VCT should be considered a public health preventive service and should be free in public health facilities.” (Ministry of Health 2003, Uganda National Guidelines for HIV Voluntary Counselling and Testing, http://www.aidsuganda.org/pdf/Final_VCT_Policy.pdf. (Date accessed 07/04/06)) 34. Are approximately equal numbers of females and males accessing VCT services? Unknown 35. Are STI treatment and counseling services free for all girls and young women? Unknown 36. Are condoms free for girls and young women within government SRH services? “Uganda rejects condom shortage claims: The Ugandan Government has denied reports that it is facing a massive shortage of condoms, just days after allegations that funding for HIV/AIDS prevention is being mismanaged. The US Centre for Health and Gender Equity says Uganda is risking its status as an AIDS success story. Uganda reduced its AIDs rate from 15 to 5 per cent through an aggressive condom campaign but the centre says the country is now trying to encourage abstinence instead of protection under pressure from religious conservatives. It is claimed that Uganda has less than a fifth of the 150 million condoms needed to meet HIV prevention targets but the Government denies there is a shortage. The allegations come days after Uganda's funding from the Global Fund for AIDS and TB was frozen amid allegations of mismanagement.” (ABC News Online, http://www.abc.net.au/news/newsitems/200508/s1448823.htm (Date accessed 07/04/06)) 37. Are ARVs free for all girls and young women living with HIV/AIDS? “Uganda began one of the first test programmes in Africa distributing life-saving antiretroviral medication. It began in 1998 and aimed to see how an ARV programme could be set up

and run in a resource-poor country. The patients involved had to pay for their medication, although at reduced prices. There are places like the private practices where patient pays for services including ARV's. ………….. Only very recently, in June 2004, has Uganda begun to offer free ARV medication to people living with HIV. The initial consignment was funded by the World Bank, with future drugs to be paid for by a Global Fund grant of US$70 million. Further funds have come from America's PEPFAR initiative……. Uganda's target was to have 60,000 on treatment by the end of 2004. According to UNAIDS/WHO estimates, this target was missed, and between 40,000 and 50,000 people were receiving drugs. It is estimated that 114,000 people are in need of ARV drug treatment in Uganda”. (Avert – HIV & AIDS in Uganda http://www.avert.org/aidsuganda.htm (Date accessed 01/06/06) “7 . ELIGIBILITY & ACCESS Aligibility and access to ART are critical elements of this policy. The policy is a long-term vision and framework that aims at ultimately providing ART to adults and children who are clinically eligible. The policy does not create additional or separate eligibility criteria for choosing beneficiaries, but rather lays down a framework to gradually expand access to ART using a phased approach. 7.1 Principles for eligibility The commitment of the government of Uganda to expand access to ARV drugs will be guided by the following principles: The ultimate goa is universal access to ARV drugs to those in need The core value of the policy is equity in access to ART services Access will be expanded using a phased approach through a public-private partnership 7.2 Criteria for provision of free-of-charge ARV drugs Currently in Uganda, there are many HIV-infected pateients who need ART than the resources available to provide this service. It is recommended that priority access for free ARV drugs be provided: 1. For the prevention purposes Prevention of mother-to-child transmission of HIV (PMTCT) Post-exposure prophylaxis (in case of accidental exposure for health workers or to rape victims) 2. For treatment purposes - Treatment of HIV-infected mothers identified in PMTCT Programmes and to their HIVinfected family members (PMTCT-Plus) - Treatment of children and infants infected by HIV through mother-to-child transmission, blood transfusion, sexual abuse or infected needles - Treatment of HIV-infected people already enrolled in care and support activities - HIV-infected participants involved in health research projects for HIV/AIDS, whose access to ARV drugs is interrupted after completion of the research protocol” (pgs37-38) Ministry of Health – June 2003, “Antiretroviral Treatment Policy for Uganda”. NOTE: Due to the phased nature of treatment many young girls and women are located in areas where access is difficult and thus cant access ART. Secondly because majority of those who are HIV positive don’t know their status, most young girls and women are among and thus cant even access ARVs even though they are in localities where they are free and available. Stigma and discrimination is another isusse etc. 38. Are issues relating to HIV/AIDS stigma and discrimination included in the training curriculum of key health care workers at SRH clinics? 39. Are issues relating to young people included in the training curriculum of key health care workers at SRH clinics?

“Inform communities about availability and advantages of VCT through radio and TV programmes, posters and print media in English or local languages as appropriate. Collaborate where possible with related programmes already using mass media to promote health services such as the health information programmea in Ministry of Information, the health education and Health Promotion Division of the Ministry of Health (MoH) as well as the AIDS control programmes of the ministries.” (Pg1) (Ministry of Health (July 2003)- Ugandan National Policy Implementation Guidelines for HIV Voluntary Conselling and Testing Services, http://www.aidsuganda.org/pdf/Implem_guide_final.pdf (Date accessed 26/04/06)) A training curriculum for health workers is is available (Trainee handbook) and (a content outline & Facilitators’ guide) and all issues of Adolescent and SRH are very clear and the handbooks are simple to understand. (Ministry of Health Reproductive Health Division – July 2001) “National Training Curriculum for Health workers on Adolescent Health and Development”. 40. Are there any government media campaigns (e.g. television commercials and newspaper advertisements) about HIV/AIDS that specifically address prevention among girls and young women? “Presidential Initiative on communicating to young about HIV/AIDS: The President of Uganda called on partners in the fight against HIV/AIDS in the country to utilize existing opportunities and structures, such as the Universal Primary Education Policy, to intensify education, information and communication (IEC) initiatives to reach young people. UAC spearheaded the exercise of implementing this initiative together with key stakeholders. Major stakeholders were involved in the conceptualization process ( PIASCY Concept document ) and have also supported the Ministry of Education to come up with the Teachers Handbook for Primary Teachers and HIV/AIDS Assembly messages.” (Uganda AIDS Commission – Country Response, http://www.aidsuganda.org/response/priorities/piascy.htm (Date accessed 07/04/06)) “Global Challenges | HIV Prevalence in Uganda Drops 70% Since Early 1990s Because of Public HIV/AIDS Prevention Campaign, Study Says [Apr 30, 2004]: HIV prevalence in Uganda has dropped 70% since the early 1990s primarily because of a "successful" public HIV/AIDS prevention campaign that encourages avoiding "casual" sexual activity, according to a study published in the April 30 issue of the journal Science” Kaiser Network Daily Reports (Website), http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=23482 (Date accessed 07/04/06)) “The broad objective of STF is to contribute to the improved mental, social and physical development of Uganda adolescents (10-19) and young adults (20-24). The programme also aims to keep its audience safe from HIV/STD infection and early pregnancy and to manage challenging circumstances such as conflict and deprivation. More specifically, Straight Talk Foundation aims, through its communications projects, to increase the understanding of adolescence, sexuality and reproductive health, and to promote the adoption of safer sex practices. The foundation also aims at helping adolescents acquire the necessary life skills and grasp of child and human rights to make the passage through adolescence safely.” (Straight Talk Foundation Website – Communication for better health, http://www.straight-talk.or.ug/sthm/index.html (Date accessed 07/04/2005)) Discussion questions: •

Are HIV prevention services truly accessible to girls and young women, including those that

are marginalised and vulnerable? For example, are they: safe? Affordable? Reachable by public transport? in appropriate languages? Non-stigmatising? open at convenient times? •

What are the cultural norms around prioritizing females and males for health care?

•

To what extent are informed and supportive SRH services accessible for girls or young women living with HIV/AIDS?

•

What are the client/service provider ratios in different types of HIV prevention services? What is the gender ratio for staff in those services?

•

Do services make proactive efforts to attract girls and young women? For example, do SRH clinics have separate rooms for young women so that they do not risk seeing family members or familiar adults?

•

What are the attitudes of service providers to girls and young women, including those who are marginalised and vulnerable? Are they kind, non-judgemental and realistic (for example about young people’s sexual pressures and desires)? Can they encourage girls/boys to assess their risks of HIV infection and change their behaviour? Are attitudes generally getting better or worse?

•

Do HIV prevention information campaigns, etc, target girls and young women? For example, are they culturally and linguistically appropriate? Are materials distributed through appropriate media and outlets?

•

Is there a national monitoring and evaluation framework? Does it encourage data to be disaggregated (according to gender and age) – to help assess the extent to which girls and young women are accessing programmes and services?

•

Are referrals and follow-up provided during HIV/AIDS, SRH and antenatal care services for young women and girls?

•

Overall, what difference does accessibility to services mean in practice? What are the ‘real life’ experiences of girls and young women? What difference is made to their vulnerability to HIV infection?

•

How do the effects of accessibility vary among different types of girls and young women, such as those in/out of school, married/unmarried, in rural/urban areas, living with HIV/not aware of their HIV status?

PREVENTION COMPONENT 5: PARTICIPATION AND RIGHTS (human rights, representation, advocacy, participation in decision-making, etc) Key questions: 41. Has the country signed the Convention on the Rights of the Child (CRC)? 30th of September 1997 (United Nations- Committee on Rights of Child to Meet in Geneva from 12 TO 30 (September 2005), http://www.unhchr.ch/huricane/huricane.nsf/0/27C5E4EBD0E81D9AC1257075004B0A74 ?opendocument (Date accessed 26/04/06))

42. Has the country signed the Convention on the Elimination of all Forms of Discrimination against Women (DECAW) and the Convention on Consent Marriage, Minimum Age of Marriage and Registration of Marriages (CCM)? CEDAW was signed on 1st Feb 1991 (Office of the United Nations High Commissioner for Human Rights - status of ratifications of the principal International Human Rights Treaties as of 09 June 2004 http://www.unhchr.ch/pdf/report.pdf (date accessed 01/06/06)) CCM has not been signed (United Nations Treaty Collection [As of 5 February 2002] 3. Convention on Consent to Marriage, Minimum Age for Marriage and Registration of Marriages New York, 10 December 1962 http://www.unhchr.ch/html/menu3/b/treaty3_.htm (date accessed 01/06/06)) “Women in Uganda contend with discriminatory marriage and divorce laws, unequal rights with respect to owning, acquiring, and disposing of property, and limitations on their rights over their own children.470 The Ugandan government maintains the legality of polygynous unions and ignores the coercive nature of widow inheritance, which clearly conflicts with the right of women to enter into marriage only with free and full consent. The Ugandan government has done little or nothing to prohibit such widespread practices as widow inheritance and the payment of bride price, nor has it addressed customary law and practices that inhibit women’s full realization of their rights to property ownership." (Human Rights Watch- August 2003- volume 15, No 15A,Section (Vi)Uganda’s Obligations Under International and Regional Law http://www.hrw.org/reports/2003/uganda0803/7.htm# _Toc47260368m (Date accessed 26/04/06))) 43. In the National AIDS Council (or equivalent), is there an individual or organisation that represents the interests of girls and young women? The Uganda HIV/AIDS Partnership The 2001 coordination review exercise agreed on a structure that promotes participatory and self coordination. A concept note on the Partnership approach was later developed and the mechanism was agreed on through stakeholder consultations. The Partnership structure started functioning in 2002 and is still being developed. The Uganda Partnership Coordination mechanism consists of the Partnership Forum, the Partnership Committee, 12 Self-Coordinating Entities and the Partnership Fund http://www.aidsuganda.org http://www.aidsuganda/pdf/HIV_AIDS_partnership_brochure_finalle.pdf NOTE: Though the youth self coordinating entity is not on the structure as accessed on the internet, it was adopted later and currently the youth representative is a male. ( Still trying to access the minutes under which it was adopted from the Coordinator – will avail it to you soon I get it (July 2006) 44. In the National AIDS Council, is there an individual or organisation that represents the interests of people living with HIV/AIDS? “We, fifty People Living with HIV/AIDS, representing the following PHA networks and 2

associations at central and district/ lower levels in Uganda: The National Community of Women Living with HIV/AIDS in Uganda (NACWOLA), National Guidance and Empowerment Network (NGEN+), AIDS Information Centre-Post-test Club/Philly Lutaaya Initiative (AICPTC/PLI), the AIDS Support Organisation (TASO), Traditional Healers and Modern Health Practitioners Together Against AIDS, Support on AIDS and Life Through Telephone Helpline (SALT), Together Against AIDS Positive Association (TAPA), Good Shepherd Support Action Centre (GOSSACE), Women Treatment Action Group (W-TAG), NAMIREMBE DIOCESE, Uganda Peoples Defence Forces (UPDF), Uganda Network of Aids Service Organisations (UNASO), Positive Men’s Union (POMU), World Vision International (WVI), Friends of Canon Gideon Foundation (FOCAGIFO), Mildmay Clients Support Association (MICSA) and other relevant organisations. • Acknowledging the effort of the Uganda government in developing policies and strategies to combat HIV/AIDS in human rights based approach, remain concerned about the human right violations of Ugandans living with HIV/AIDS at home, workplace, worship places, and at health units. • Recognising that the lack of a well coordinated PHA Forum weakened the influence PHA could have on HIV/AIDS policies and programmes and • Having considered the operationalisation of greater Involvement of People Living withor affected by HIV/AIDS (GIPA) principle which is formally a guiding principle of the HIV/AIDS Partnership”. (Pg1) (Declaration of the People Living with HIV/AIDS Networks and Association. http://www.aidsuganda.org/pdf/Declaration_of_PHA.pdf (Date accessed 26/04/06) Uganda AIDS Commission has a person living with HIV on its board – a Commissioner, the National HIV/AIDS Partnership Committee formed under the Uganda AIDS Commission has a person living with HIV representing the self coordinating entity of people living with HIV & AIDS (Refer to the website quoted in No. 46). On the Country Coordinating Mechanism (CCM) of the Global Fund to fight TB, AIDS & Malaria, there are three people representing people with the three diseases and all these are living with HIV. On the PEPFAR Advisory board, there is a PLHIV representative. (July 2006) 45. Was the current National AIDS Plan developed through a participatory process, including input from girls and young women? “Coordinated by the Uganda AIDS Commission (UAC), the Presidential Initiative on the AIDS Strategy for Communication to the Youth (PIASCY) wa.s developed in 2001. This Initiative is to be implemented in different phases, involving young people in different circumstances. The education sector is spearheading the development of tools for addressing young people in primary, secondary and tertiary institutions of learning. The long-term phase will focus on the out of school youth, and community mobilization and capacity building to communicate with and support young people in adopting positive behaviours. Under the PIASCY strategy and in recognition of the President’s experience in HIV/AIDS mobilization, this proposal seeks to bring together young people in positions of influence throughout the country for further guidance and empowerment through dialogue with H.E the President and other actors in this field. Direct personal involvement of H.E will further empower young people and revive consciousness for fighting the epidemic in the country. It will also boost existing HIV/AIDS and young people initiatives by various partners, including national and international NGOs, the UN and bilateral agencies, for intensified action. This project will specifically involve youth in leadership positions, youth opinion leaders and those young people that have gained experience and skills in HIV/AIDS to create further awareness and empower them to mobilize and communicate to their peers about HIV/AIDS.(Pg4)” (Office of the President, Ministry of Gender Labour and Social Development, UN Country Team and Uganda AIDS Commission Kampala, (June 2003)- Implementing the Presidential Initiative on the AIDS Strategy for communication to the Youth Enhancing HIV/AIDS awareness and dialogue among youth leadership in Uganda,

http://www.aidsuganda.org/pdf/HE_Advocacy_Initiative.pdf (Date accessed 26/04/06)) THE NATIONAL STRATEGIC FRAMEWORK The objectives of the National Strategic Framework are: To provide a brief review of trends in HIV sero prevalence; To describe the efforts undertaken to prevent HIV infection and mitigate the adverse health and socio-economic effects of the epidemic in Uganda; To provide overall guidance for activities geared towards preventing the spread of HIV/AIDS and mitigating its effects; To serve as the basis for the mobilisation of resources to implement the national AIDS Programme. This Framework traces the national response to HIV/AIDS since 1982 when the disease was first identified. The government has been consistently vigilant and the response has been characterised by a policy of openness and has benefited from support and commitment from the highest level of Government. There is full recognition that HIV/AIDS has far-reaching consequences beyond the health sector. It gives the situation analysis of the HIV/AIDS problem. It contains information on trends, differentials by age, sex, and geographical regions. It reviews the progress made so far, identifies the critical needs and makes recommendations. The recommended actions are cast in a log frame format indicating the activities, key players, indicators, means of verification and a list of sine qua non conditions for carrying out these activities. Implementation and co-ordination arrangements for the identified HIV/AIDS activities are articulated and suggestions for monitoring implementation have been put forward. 1.7 Process of Drafting the National Strategic Framework The preparation of this National Strategic Framework was undertaken in two stages. The first draft was prepared and adopted by stakeholders to cover the period 1998 - 2002. However, following a period of implementation and review by a number of stakeholders, it was found to contain gaps. In particular, a number of policy and action plans of the Government have emerged since the drafting of the 1998-2002 framework and this called for the re-orientation of HIV/AIDS programmes and activities. The Strategic Framework was revised from October 1999 to February 2000. The National Strategic Framework for HIV/AIDS Activities in Uganda – 2000/1 to 20005/6 Iv The earlier draft of the Framework emerged from a protracted process of consultations organized by the Uganda AIDS Commission together with a group of stakeholders involved in the fight against HIV/AIDS. Among the stakeholders, a Core Group of 11 members was constituted and specifically charged with drafting the Strategic Framework. The CG11 included representatives from the Ministry of Health (MoH), Ministry of Local Government (MoLG), Ministry of Finance, Planning and Economic Development (MoFPED), and other line ministries. In addition, this group drew membership from NGOs, research institutions and organisations of people living with HIV/AIDS. The work of the CG11 was organised around the thematic areas of prevention, care, mitigation and research and drew on expertise beyond its membership. The whole group through workshops and meetings subjected drafts for the respective subjective areas to review. These were later merged and a consensus workshop was held to adopt the framework. The consensus workshop included a broad spectrum of stakeholders. This revision of the Strategic Framework has similarly been undertaken as a collaborative and multisectoral undertaking of all Government Ministries, local governments, NonGovernmental Organisations (NGOs), the private sector, development partners and other stakeholders in the fight against HIV/AIDS. External Support Agencies made invaluable contributions during this process. The following materials were the major sources of information in the drafting of the National Strategic Framework 2000/1 - 2005/6: The National Strategic Framework, which was to cover the period 1998 – 2002; The Poverty Eradication Action Plan (PEAP) of the Government; The Local Government’s Act of 1997; The National Health Policy, August 1999; The Health Sector Strategic Plan of the Ministry of Health, October 1999; National AIDS Control Policy Proposals (1996); Periodic Reports of various stakeholders; Annual Reports of the Uganda AIDS Commission; Reports of ACPs in line ministries;

STD/HIV Sentinel Surveillance Reports of the Ministry of Health (1991 - 1999); Review Reports on HIV/AIDS policy, legal and ethical issues (1997); Review of HIV/AIDS activities in Uganda (1996); HIV/AIDS research inventory (1997); Summary of the HIV/AIDS research results (1997); HIV/AIDS status Report (1997); NGO/CBO inventory (1997); and Several Documents from UNAIDS, Uganda and AIDS Information Centre. http://www.aidsuganda.org/pdf/nsf.pdf (July 2006) 46. Is there any type of group/coalition actively promoting the HIV prevention and SRH needs and rights of girls and young women? “Youth Protection and Development: Youth are the most vulnerable to HIV/AIDS, particularly girls. Save the Children supports youth groups in schools with education and materials, so that the members can reach out through drama, songs and talks to other young people and help keep them safe from HIV/AIDS. Reproductive Health/HIV: Community volunteers trained and supported by Save the Children provide information and services to vulnerable women and men who do not access government health services. Maternal and Child Health: Save the Children is starting a project where vulnerable mothers with young children will receive support and help with antenatal care, immunization, and advice on how to feed and care for babies”. (Save the Children, http://www.savethechildren.org/countries/africa/uganda.asp (Date accessed 26/04/06)) “These include: • Youth friendly reproductive health services • Behavior change • Vocational skills training • Child rights protection • Peer-to-peer activities • Drug and substance abuse prevention • HIV/AIDS prevention • Collaborative research projects • Drop-in center activities All activities in Uganda Youth Development Link (UYDE) are guided by a set of principles and core values, i.e. non-discrimination, community involvement, gender sensitivity, and full promotion and protection of all rights of marginalized young people”. (http://www.icomp.org.my/Inno_prog/inno-LR-uganda.htm# HiwotEthiopia) “National Adolescent Health Policy. This policy is an integral part of the National Development process. It complements all sectoral policies and programmes and recognises the critical role adolescents themselves can play in promoting their own health and development. The policy further seeks to strengthen and to provide an enabling social and legal environment for the provision of high quality accessible and adolescent friendly interventions.” Page 28 (UNGASS – Follow-Up to the Declaration of Commitment on HIV/AIDS – (2003 http://www.aidsuganda.org/pdf/ungass_report_final.pdf (Date accessed 04/07/06)) 47. Is there any type of national group/coalition advocating for HIV prevention (including positive prevention) for girls and young women? “The broad objective of STF is to contribute to the improved mental, social and physical development of Uganda adolescents (10-19) and young adults (20-24). The programme also aims to keep its audience safe from HIV/STD infection and early pregnancy and to manage challenging circumstances such as conflict and deprivation. More specifically, Straight Talk Foundation aims, through its communications projects, to increase the understanding of adolescence, sexuality and reproductive health, and to promote the adoption of safer sex

practices. The foundation also aims at helping adolescents acquire the necessary life skills and grasp of child and human rights to make the passage through adolescence safely.” (Straight Talk Foundation Website – Communication for better health http://www.straight-talk.or.ug/sthm/index.html (Date Accessed 07/04/2005) 48. Is the membership of the main network(s) for people living with HIV/AIDS open to young people, including girls and young women? “The goal of NGEN+: Bringing together People Living with HIV/AIDS and empowering them to participate in HIV prevention and AIDS care activities in the country. Promotion of GIPA. 3.0 Background of NGEN+: For many years, HIV had been looked at as a disease for the wrecked of the earth. People with HIV were shunned, discriminated and stigmatised every day of their life. Apart from the culture, this condition was precipitated by religious moralism, which created bad attitude and made sex a dirty thing. Many people who found themselves HIV infected were living in a world where they did not belong! There was no body they could talk to and that made HIV/AIDS one of the most debilitating disease the world has ever had. There was lack of focus and hope which made people even more dangerous to the community. They could easily spread the virus out of frustration. It was therefore found necessary to build a Network of people living with HIV in order for them to find people they could relate with and share the problem. Networking among People Living with HIV/AIDS has turned out to be a very important forum and it is already yielding fruits in terms of people accepting their HIV/AIDS status and acting as a real face for HIV/AIDS and as agents of positive change in the fight. This has given Ugandans more understanding of the problem. They now know that HIV/AIDS is real, it does not discriminate, every one is vulnerable to it, it is a danger to both the old and the young, and the best way to fight is to get everybody change their behaviour, and attitude towards people infected with the disease. Therefore, bringing together all people with HIV/AIDS in Uganda will go along way to stem the rapid spread of HIV especially in the rural community. For the Network to succeed, it needs support nationally and internationally and in all forms”. (Uganda AIDS Commission, http://www.aidsuganda.org/response/govt_sectors/cso_programs/ngen.htm (Date accessed 26/04/06)) 49. Are there any programmes to build the capacity of people living with HIV/AIDS (e.g. in networking, advocacy, etc)? “4.0 Objectives of NGEN+: 4.1 Mobilise PHA in Uganda into local level Networks so as to create a common voice to advocate and lobby for an improved quality of life e.g. in care given by Non-Governmental Service Organisations and Government Institutions. 4.2 Empower positive persons to share experiences, skills and power in order to promote positive living among themselves and prevention practices. This is intended to expand survival options. (Uganda AIDS Commission, http://www.aidsuganda.org/response/govt_sectors/cso_programs/ngen.htm (Date accessed 26/04/06)) “Financing is crucial. People living with HIV need access to antiretroviral drugs and other essential care, and they need to receive a salary or other paid compensation for their time and contributions. Otherwise, their capacity to participate in the AIDS response is seriously hindered. One example of an innovative effort to plug the gap is in Uganda. A Treatment Fund for HIV/AIDS Advocates in Uganda currently provides six advocates with antiretroviral treatment, and is funded by Rotary International, and its Belgian and Ugandan branches (Uganda AIDS Commission and UNAIDS, 2003). The Fund is co-managed by the Persons Living with HIV/AIDS Forum, which brings together all of Uganda’s relevant networks and

associations”. (UNAIDS- Report on the global AIDS epidemic (2004)-4th global report http://www.unaids.org/bangkok2004/GAR2004_html/GAR2004_13_en.htm (Date accessed 26/04/06)) 50. Are there any girls or young women living with HIV/AIDS who speak openly about their HIV status (e.g. on television or at conferences)? No

Discussion questions: •

How are international commitments (e.g. CRC, CEDAW, and CCM) applied within the country?

•

Is the national response to HIV/AIDS rights-based? For example, does it recognise the SRH rights of women living with HIV/AIDS?

•

Do key decision-making bodies (e.g. the Country Coordinating Mechanism of the Global Fund to Fight AIDS, TB and Malaria) have a set number of seats for civil society? Are any of them specifically for representatives of girls and young women or people living with HIV/AIDS?

•

Are HIV prevention programmes generally developed ‘for’ or ‘with’ girls and young women, including those who are marginalised and vulnerable? Are girls and young women seen as ‘implementers’ as well as ‘receivers’ of services?

•

To what extent are girls and young women aware of decision-making processes? Are they encouraged to have a voice? Are they seen as an important constituency within committees, management groups, etc?

•

How high are issues relating to HIV prevention for girls and young women (e.g. early marriage and stigma) on the agendas of local leaders and decision-making groups (e.g. district AIDS committees)? To what extent do girls and young women participate in those type of bodies?

•

To what extent are people living with HIV/AIDS organised, for example in networks? Are girls and young women involved in those bodies?

•

How are issues of participation affected by stigma? For example, is it safe for people living with HIV to speak openly about their HIV status?

•

Overall, how are participation and rights applied in practice? What are the ‘real life’ experiences of girls and young women? What difference is made to their vulnerability to HIV infection?

•

How do the effects of participation and rights vary among different types of girls and young women, such as those in/out of school, married/unmarried, in rural/urban areas, living with HIV/not aware of their HIV status?

PART 2: In-Country Work

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Focus group discussion: 15- 22 year olds Age group: 15-22 years Number of participants: 11 Profile of participants: included some girls and young women who are: in-school; out-of-school; living with HIV/AIDS, peer activists; widowed; HIV negative/don’t know their status; married with children; orphans; and unmarried from the city centre-urban areas and from suburban areas Place: Kampala - Kamwokya

Prevention component 1: Legal provision What do you know about laws in Uganda that might affect how girls or young women can protect themselves from HIV? For example, do you know about any laws that: allow girls to get married at a young age? do not allow girls or young women to have abortions? Prevent girls from using services unless they have the consent of their parents? These laws are in existence in Uganda in principle but not in practice, For example, there is a law on defilement, any man/boy found having sex with a girl below the age of 18 is to be prosecuted; but many girls marry below that age. ‘ I don’t see how these laws work, I was married at the age of 15 but nobody intervened to stop me’ These laws are also overridden by corruption; a man may defile a girl and he is taken to police but he may pay his way out of the law. Abortion is illegal but it is like this law does not translate to everybody it is not in practice. Abortion - yes is done in hiding, Doctors continue to carry out these abortions and nobody ever reports them to the authorities therefore girls continue to abort and they are not even prosecuted. Prevention component 2: Policy provision: What type of education have you received about issues such as relationships, sex and AIDS? For example, what have you been taught about your sexual and reproductive health in school? A little education other than that in the school syllabuses, sex education has been done in schools in Uganda by organisations like Straight Talk foundation, Youth Alive and at times resource persons from the Youth centres visits the schools. The talk about Abstinence, Relationships, Use of condoms, and HIV/AIDS, but very few primary and secondary schools in Uganda have benefited. At home information is got from the mass media like the radio programs and also sisters, brothers and friends talk about similar things, while very few parents will talk to the children about HIV/AIDS. ‘The traditional ‘Aunties’ only tell you what you are supposed to do in marriage and not about HIV/AIDS’ What could the government of Uganda do to fight fear about AIDS in your community? The government should also create opportunities, job opportunities for the young women and girls and ensure a favourable environment where they are not taken advantage of (abused sexually) The government should put in place sensitisation programs in schools for all the young people especially the girls without discrimination by age since the age of first sexual contact has decreased for the girls.

It should also bring the services near to the people and support the initiatives of people living with HIV/AIDS with resources to carry forward the HIV/AIDS messages. Prevention component 3: Availability of service What sort of HIV prevention services are there for girls and young women in your community? For example, where would you go to get: information? condoms? treatment for a sexually transmitted infection (STIs)? an HIV test? There are HIV prevention services in our communities and they vary in different localities. These include testing centres like The AIDS information centres which carries out testing for HIV virus, testing is also done in referral hospitals; Post test clubs which carry out sensitisations on the HIV/AIDS, and youth /teenage centres most specifically is the Naguru Teenage Centre in Kampala which offer free services of treatment of STI, information, testing for HIV, counselling and provision of free condoms to the youth. Free male condom distribution is also done by many AIDS organisations for example The AIDS Support Organisation (TASO). Other than the Naguru Teenage centre which is accessed by the young people the rest are for everybody in the community. These centres are few and very far out of reach by every young girl who needs the services. There are only two Youth Centres in Kampala - Naguru Teenage centre, and the Kawempe centres in the city centre due to transport costs to get there. ‘When I think that to move from Kamuli my home place to Naguru teenage centre, you need to have Ug. Shs 20,000/= yet one may not have even 500/= on you’ There is HIV testing done by clinics in town but it is very expensive besides there is a belief that these results are not reliable and most times ethics like counselling are not offered. Condoms given out in these places are male condoms; the young girl cannot decide to use it on her own. The men have such power. Condoms are also sold in retail shops, and Information is being given by HIV post test clubs and also organisations like Straight Talk foundation and Youth Alive. Clubs have been formed in schools which carry forward the messages and offer peer support. In the referral hospitals, reproductive Health services are offered but these are for everybody and the service providers are not reaching out to the communities. They have attitudes which often scare away young people. How much do boys and young men know about HIV prevention services in your community? What is their role in supporting HIV prevention for girls and young women? The boys are more informed than the girls about the HIV preventive services than the girls. This is because more emphasis was put for example on male condoms. Young men and boys in which all localities have grown up knowing that they have to protect themselves. In town you would find young men with condoms in their wallets and pockets! Participants also feel that it is only the condom that the boys know of and not HIV/AIDS and STI. Besides they don’t even use these other services like testing or treatment for STI or HIV. If one was to take a sample of the support groups like the Uganda Young Positives, they are dominated by females. Boys have a role in supporting the young girls but this, if done, is minimal. One participant shares an experience of volunteering in Naguru Teenage Centre, “I have the experience of treating some girls with the same STI over and over again, and when you ask her what could be happening, she says, she still had unprotected sexual intercourse with her boyfriend who has adamantly refused to come for treatment since he has no signs and symptoms” Young men and boys are blaming. When the two are in a sexual relationship and both tested positive for any infection- HIV or STI, the boys will blame the girls for bringing the infection in the

relationship. The young women girls therefore often choose not to disclose the problem for fear of blame “If the environment was conducive for us, we would express ours selves otherwise the support is not there” Even with the condom information that the boys have, most times they refuse to use them, often judge the girls by the appearance and if their relationship has stayed for sometime, then they will put off the condom with out even considering the HIV test first. What sort of HIV prevention services would you like more of in your community? How would that make a difference to your life? Increase of the youth friendly centres in the communities instead of having one or two which are far out of reach for the young women and girls. Intensify the sensitisations about the need to use these services like HIV testing and STI treatment and where they are; for both in school and out of school young women and girls. The participants felt that if the young positive people are involved in these sensitisations, it would make a great impact. “When you are thinking about doing something bad, you quickly remember the testimony of your fellow young person” The female condoms also need to be rejuvenated, so that the young women can protect themselves even if the boy refuses. Service providers also need to be sensitised to stop blaming the young people when they have get any infection especially in the referral hospitals, if such attitudes are changed, then more young people will access the services. Prevention component 4: Accessibility of services What are your experiences of using HIV prevention services in your community? In what way have those experiences been good or bad? Participants expressed that they had been treated with respect and love when they visited the Youth centres and the AIDS Information centres, PMTCT centres, AIDS service organisations and treatment centres like PIDC- Paediatric Infectious Disease control Centre, for the services than when they went to the government hospitals where everybody else goes. “When I was in my Senior 4, I got courage to go and test, I visited a government hospital but what I experienced was very disgusting, I was in a queue with very older people, they were all looking at me. Even before I tested, the mere mention that I wanted to do so implied to them that I had AIDS, They were gossiping in my presence, I took off, until I got courage last year, I went to Naguru Teenage centre, where I got a good reception, My HIV results were positive, which came as a shock to me but I was comforted, encouraged, and referred to Uganda Young Positive for more support” What are the main barriers that you have faced when trying to use HIV prevention services in your community? For example, what difference does it make if a service is: expensive? Too far away? Unfriendly? The main barriers included; the fact that youth friendly service centres being out of reach because of the long distances thus very expensive to reach and also being very few. Besides the attitudes of the service providers and the fellow clients are not friendly more specifically in the general medical settings

In what way are HIV prevention services easier or harder for particular types of girls and young women to use? For example, what difference does it make if you are: unmarried? out of school? HIV positive? For the Naguru teenage centre, the services are very friendly and there is no discrimination who ever you are as long as you fall within their age range and you are on time. However participants expressed unfriendly treatment from the other government and general medical settings both from the service providers and the other clients when one is HIV positive and also when young. “These older people; imagine as old as your mum; start backbiting and gossiping about you, that ‘The world is finished, imagine that young girl has also HIV’ you fear to go back to that place” “The worst experience was some years back when I visited a government hospital in Mityana, I was lined up with other persons but when I entered the Doctor’s room, he blasted me, asking me, when and how I got the infection, I said to hell with treatment! I will never go back, it took me 3 years to seek medical care again wish I was empowered enough then, I would have looked for that Doctor” “In a hospital I visited recently I was asked me to tell the story of how I got infected, how long I have lived with it. I was feeling very bad because that is not part of the treatment I wanted” Prevention component 5: Participation and rights Have there been any projects in your community to bring together girls and boys or young women and young men to talk about HIV prevention? If yes, what did they involve and what did they achieve? Yes there are such projects like the Uganda Young positives that supports of young people; both male and female who are living with HIV/AIDS. Here the youth share their experiences of living with HIV/AIDS, support each other, share HIV/AIDS information and discuss issues of Positive living In schools youth clubs have been formed including Straight Talk clubs, Youth Alive Clubs and these address issues to do with about Body Changes, Pregnancy, and a bit of HIV/AIDS specifically Abstinence. What would encourage you to get more involved in HIV prevention in your community? Participants felt that what inspires them to get involved in the HIV prevention activities in their communities is the support that they receive from each other while in these groups, they meet friends who are experiencing the similar problems and freely discuss HIV/AIDS without the fear of being treated differently. Summary What are the 2-3 most important changes that could be made – for example by the government or community leaders – to help girls and young women in Mozambique to protect themselves from HIV? The government should reinforce the laws that have been put in place to protect the young women and girls from HIV infection; otherwise these have been overridden by corruption. In addition, the policies that address HIV/AIDS stigma and discrimination should be put in practice. Addressing stigma and discrimination should go up to the lower levels including families, hospitals and schools. ‘It is the environment at the service delivery points which is not favourable and free for HIV+ thus fuelling the denial and fear’

The government should provide free antiretroviral drugs for those young women and girls who are need them so that they can become health and support themselves economically. Government of Uganda should put in place systems to ensure that money that have been sent in for HIV/AIDS Program reach the beneficiaries instead of being diverted into other programs The female condom should be reinforced since it will empower the young women and also the government should intensify on the advocacy for the microbicides which will protect the young women and the girls from the HIV infection

Focus group discussion: 15-21year olds Age group: 15 - 21years Number of participants: 11 Profile of participants: These included young women and girls from Gulu town a war affected sub urban town in Uganda and some were; HIV+ and members of support networks, married with children while others were orphaned and in vocational training schools; HIV negative /didn’t now their status; un married and in school, living with HIV; and unmarried. Place: Gulu Town - ACORD Office compound

Prevention component 1: Legal provision What do you know about laws in Uganda that might affect how girls or young women can protect themselves from HIV? For example, do you know about any laws that: allow girls to get married at a young age? Do not allow girls or young women to have abortions? prevent girls from using services unless they have the consent of their parents? 50% of the participants had knowledge of the law against abortion and that if any girl is found aborting, she would be imprisoned ‘even if one is raped she should not abort but give birth and probably if she cannot afford to look after the baby, would give it a baby care centres instead of aborting’ Some had knowledge of the children’s rights, that protects children from all forms of abuse and that if a girl is forced into sex, the man who does this should be imprisoned. The law against defilement of the girl below the age of 18 years and rape was also mentioned Nevertheless participants felt that none of these laws are being implemented, young women and girls have been raped and defiled but the law has not protected them. Some times the families are ignorant of the laws so they don’t take action at all. Besides most men bribe their way out of police “3 months ago a five year old girl was raped by an 18year old man from Koki-Kweyo, the man was taken to the police but he bribed the police and the file was ‘misplaced’ and the man is free now yet the young girl is very sick and maybe she may never heal” Shared a participant That Abortion is also very common, young girls use local herbs which are inserted in their vagina and the unwanted pregnancy is eliminated, while those who can afford can privately go well known doctors who carry out the abortion at about Ug. Shs 80,000 only Prevention component 2: Policy provision: What type of education have you received about issues such as relationships, sex and AIDS? For example, what have you been taught about your sexual and reproductive health in school?

The participants shared that most of the information about sex and AIDS is got from Radio programs. A little is got from schools where the Senior Women Teachers talk about sex and sexuality to the young girls. A few parents talk to their children about HIV/AIDS and dangers of sex but this is very rare, One participant shared that the Church has also given them some information about HIV/AIDS. It organised a youth conference for a week and one of the most important things emphasized was that sex before marriage was against God’s Commandments’ Organisations like The AIDS Support Organisation (TASO), World Vision, and Straight Talk Foundations has given information to the communities and the children in schools but the participants emphasised that this only in the town area, this information does not reach the young people in the villages and the camps. What could the government of Uganda do to fight fear about AIDS in your community? The government of Uganda should put in place more HIV/AIDS health Units and these must emphasise counselling; as one of the major components. These services must be spread up to the people in the communities especially in the camps where most people don’t consider HIV/AIDS as a priority in their lives Prevention component 3: Availability of service What sort of HIV prevention services are there for girls and young women in your community? For example, where would you go to get: information? condoms? Treatment for a sexually transmitted infection (STIs)? an HIV test? There are services in existence In Gulu town, organisations like World Vision, TASO, Joint Clinical Research centre, and Health Alert which provide HIV/AIDS preventive services like HIV/AIDS counselling, information about HIV/AIDS, and free supply of male condoms to the communities and people living with HIV/AIDS. Participants noted that services are for all the general population. Specific services for young women and women are provided by the Gulu Youth centre and partly Health Alert and this target the age group between 15 – 24 years of age. Service provided includes and information about HIV/AIDS, and treatment and information about other sexually transmitted diseases, information on Abstinence and also supplies free male condoms to those who want them. Nevertheless similar services are not found in the communities beyond Gulu Town. World Vision and TASO are trying to extend their services to the communities but haven’t achieved a lot in terms of coverage. They have only reached few settlement camps. How much do boys and young men know about HIV prevention services in your community? What is their role in supporting HIV prevention for girls and young women? Some young men and boys know about HIV preventive services and this especially from the radios programs aired out on HIV/AIDS and from the Youth Clubs when they go there. “At the youth Centres I sometimes hear some boys say that they will test for HIV/AIDS before I get married, others speak of condom use while others speak of abstaining from sex” Participants shared that there is a great change in the young men and boys acceptance to seek for support. Before boys never used to go for counselling and or attend HIV/AIDS drama show, bur these days there is a great number of boys who visit the Youth centre and access the services. Participants feel that these young men and boys do not support the girls in HIV prevention That “I have met some young men and boys who say that instead of leaving a beautiful girl, I would rather die”

‘When you meet a boy who tells you that he loves you he will also suggest having sex with him in a very short time. If you refuse or suggest to use a condom, he will say that you want to use a condom because you have HIV, the Doctors say that it is HIV positive people who must use condoms, and for him he know he doesn’t have it.’ What sort of HIV prevention services would you like more of in your community? How would that make a difference to your life? Participants feel that there should be more youth friendly treatment centres like Gulu Youth Centre, and these should be spread to the whole district so that even other young people in the community can access them. There should be counselling training centres set up to train more counsellors and then distribute them in the communities also so that people can access them more easily. HIV/AIDS information centres should be set up and these should be able to provide also free condoms to the young women and girls There should also be introduction of sex education in schools and institutions, this will make a difference in young people’s lives as they will be able to have HIV/AIDS information and protect themselves from the infection Prevention component 4: Accessibility of services What are your experiences of using HIV prevention services in your community? In what way have those experiences been good or bad? All the participants who visited the Gulu Youth centre, TASO, and The Joint Clinical Research Centre shared that they have been always treated well at those centre’ ‘You are given what ever service you want whether counselling or condoms with a lot of attention and care’. But in the communities’ one cannot just go to a shop to buy a condom as young woman, that “People will laugh at you that what do you want it for? That is why we fear to go there to buy it” What are the main barriers that you have faced when trying to use HIV prevention services in your community? For example, what difference does it make if a service is: expensive? too far away? Unfriendly? It is the attitudes of the service providers that hinder the young women and girls from using the HIV preventive services provided in other healthy centres other than those HIV specific preventive centres. Besides ignorance of their existence, and also their absence in the community is also a major hindrance to their access. This especially goes for people in the rural areas. Most HIV preventive services are in the town and not in the rural areas therefore they are not accessible by every body Organisations like World Vision and TASO have tried to go beyond the town centre but only reach a few camps. ‘In camps like Bobi, and Minakul, TASO has tried to take HIV/AIDS information there but young women and girls fear to go and access these services that other people will say that they are infected with HIV or that they are sexually active which is very bad” In what way are HIV prevention services easier or harder for particular types of girls and young women to use? For example, what difference does it make if you are: unmarried? out of school? HIV positive?

Participants shared that HIV preventive services are a lot easier to access in the Youth Centre as young women and girls than in the general Health service places, this is because this centre the services are specific for the Young people for youth. One participant shared that “One time I went to the clinic and I just joked with the nurse that I wanted to buy a condom, she laughed at me and even called her colleague and told her that Look at this daughter of the teacher, she is becoming a harlot, I felt very bad and left but when I went to Gulu Youth Centre, I felt very comfortable and I was given the condoms when I asked” If one was HIV positive and visited Joint Clinical Research centre or TASO, they are always treated with more kindness than the other ordinary patients else where. They are treated with care and love. This time they are not treated with blame, because HIV has affected almost all families in the communities. Well as participants shared that the young married women cannot just buy condoms in the shops. It is the men who are supposed to that. If the women are seen doing so they will be considered ‘terrible’ “In our culture men are free to do anything but not the women” Prevention component 5: Participation and rights Have there been any projects in your community to bring together girls and boys or young women and young men to talk about HIV prevention? If yes, what did they involve and what did they achieve? Yes, In Gulu Town there are organisations like Straight Talk and Comboni Samaritan who form clubs for young women and men and these groups carry out sensitisation in the schools and in the communities. Straight Talk Foundation also airs out radio talk shows in the local language in Gulu but this only reaches the town communities. In the rural areas, the people cannot afford the radios and for those who have them only listen to music and not such programs. Health Alert also brings together young HIV positive people, for psychosocial support and access to treatment of opportunist infection and also referral for HIV drug therapy Gulu Youth Centre targets both young men and women between the age of 15-24 years, and this provides counselling and guidance, HIV/AIDS information and sensitisation, Drama activities, provision of treatment of STI and free condom distribution. This has attracted most youth to seek these services and get correct HIV/AIDS information. What would encourage you to get more involved in HIV prevention in your community? Participants felt that they get encouraged to participate in the community activities which are specific to young people because they are not treated differently and they learn a lot from each other through sharing and drama activities. The services are also free and therefore one doesn’t have to spend any money to access them and also the other activities like the drama shows are very interesting and allow the participation of the young people Summary What are the 2-3 most important changes that could be made – for example by the government or community leaders – to help girls and young women in Uganda to protect themselves from HIV The government should put up a strict law against the police and judiciary that are found participating in corruption and bribery in the rape and defilement cases forwarded to them.

While the local leader need to become more serious and forward the defilement cases to court instead of settling them on their own. More HIV/AIDS sensitisation should be carried out and empowerment of young women and girls to freely access the condoms and also use them. Government should continue providing free medicines (ART) to young people. Poverty is a major cause of HIV/AIDS in the communities; therefore the government should introduce programs that address poverty. Some young girls have been made total orphans by both the war and HIV/AIDS and yet some are now heading families. They resort to selling their bodies to feed their siblings because they have no choice.

One-to-one interview: Uganda AIDS Commission – Social Scientist & In charge of Civil Society Organisations in Uganda (Female)

General What is your impression about the general situation of HIV prevention for girls and young women in Mozambique? Are things getting better or worse … and why? It is worse, we realise that the prevalence rate is still high and more and more young women are getting infected day by day despite the increase and improvement in the preventive services. Prevention component 1: Legal provision In your opinion, what laws in Mozambique are making HIV prevention for girls and young women better or worse? The laws are in existent and are meant but to be useful but it is more of the conditions that the young women and girls face than the laws. There is general poverty which is a big problem; the weak economic empowerment for women; lack of the source of incomes for the women. In Uganda there is the social problem and phenomenon of women always expecting to receive from men even when they have more money than men, and the situation for young women and girls is worse. The implementation of the law is very weak, girls are married off earlier than 18 years, and in some communities it is some parents are looking for a rich man to take their daughter because they themselves are needy, “These things happened before and are still happening now; Karamonjongs have been selling their virgin daughters for Ug. Shs 3000” How does legislation affect different types of girls and young women and their vulnerability to HIV? The young women and girls out of school and in the rural area are more vulnerable to HIV infection despite the laws. They are attracted to small offers “Even a few words like ‘I Love you from the men entices them, and at times when they are told that she is moving to town she feels that there will be better life from the village life, with running water ,electricity,” Well as the girls in urban setting have more exposure and have opportunities to be in school and are more focused, and have targets looking forward to getting the better life. They have seen role models they admire. It also depends largely on the environment, if it is supportive the young woman is likely to take precautions but if not supportive like they are house maids with bosses demanding for sex, being exposed to rape, then they are also very vulnerable to HIV/AIDS

Overall, what laws could the government change, abolish or introduce to bring the greatest improvements to HIV prevention for girls and young women? Dissemination of the existing laws to the communities is paramount; most times even the parents are ignorant about the law; one and cannot seek for the rights of their girls Secondly there is a need to fight the existing corruption that affects the implementation of the laws. In cases of defilement, the corruption does not even benefit the persons or family affected but the officials who are meant to help the families. Prevention component 2: Policy provision What type of government policies or protocols – for example in relation to antenatal care, condoms or voluntary counselling and testing – make HIV prevention for girls and young people in Uganda better or worse? The government policies and protocols are very clear and are meant to protect the young women and girls, for example in Uganda promotes the ABC strategies but when it comes to its application to the women or girls it is lack of empowerment to negotiate now for the safer sex that disables them. Culturally women are supposed to be shy and therefore cannot look straight in the eyes of the men boldly tell them what they want. It is the men who use the condom not the women Do girls and young women – and also boys and young men - receive any type of official sex education? For example, what are they taught about their sexual and reproductive health and rights while in school? Yes we now have the PIASCY focusing on the young girls and boys in schools, the teachers are being trained to use the package and the school curriculum has integrated HIV/AIDS. For those out of school, some non governmental organisations are targeting them although there coverage is still very small. Overall, what policies or protocols could the government change, abolish or introduce to bring the greatest improvements to HIV prevention for girls and young women? There some areas of focus that need to focus on for example the youth are engaged for drug abuse that is also increasing the risk of HIV infection among the young people; government needs to come up with a policy to address this. There are groups of young people who joining the societies of men having sex with fellow men and these groups have sprung up among our youth and children in schools, they have been neglected with no information on the HIV infection or the dangers involved, therefore the government needs to open up and realise their existence and give appropriate information. Prevention component 3: Availability of services What type and scale of HIV prevention services are available for girls and young women in Uganda? The services are available although the female condom is non existent, it was introduced but wasn’t appreciated, not promoted and many people complained that it wasn’t culturally compliant, beside it was very expensive. The male condom has been widely distributed by government and other civil society organisations although still in some communities people feel stigmatised to talk about it and even to purchase it. STI information is available but of late it has been underplayed and there is no wide education about them as before, although the treatment is free, and the drugs are available. “ARVs in Uganda are available and free and yet ARV in Uganda are not available” This is a big dilemma as people who are supposed to take this treatment freely still lament on the expenses they incur at the same time those who need them have not started on the therapy. “We have tried but we need to do much more”

What type and scale of HIV prevention services are available for particular types of girls and young women? For example what services are there for those who are: Unmarried? Out of school? Involved in sex work? Orphaned? Injecting drug users? Migrants? Refugees? HIV positive*? There are no particular services for particular girls in Uganda, The type and scale of services is affected by the surroundings. The young women and the girls in the in urban areas have better facilities than the girls in the rural area. For example in Kampala we have the Naguru Teenage centres and other youth friendly services which are not in the rural areas. What type and extent of HIV prevention services and information are available for boys and young men? How does this affect the situation for girls and young women? We try promoting equity among men and women however reproductive health is perceived to be a feminine package, and at times men are perceived not to know about reproductive health and yet we are looking at a situation where both men and women play a role. “That is why PMTCT is still very weak; it is because the male involvement is still very low” Overall, what type of services most urgently needs to be increased to improve HIV prevention for girls and young women? Education is number one and then creating a supporting environment. For example we are saying that the young girl should have sex after a certain age 18 and above but if this girl is not supported to have the basic needs to keep in school, then some one else will exploit the situation in the name of “providing” and use this girl. We also need to bring the parents and school staff on board so that the young girls and boys learn to speak for themselves and about the issues that affect them. Prevention component 4: Accessibility of services What are the main barriers to girls and young women using HIV prevention services in Uganda? Some of the services are very far so the distance is a big barrier which is aggravated by the lack of money to get there. Stigma especially where there are not youth friendly services also impinges on the accessibility of the services, some times the young women may be lacking the required necessities in the health setting like the gloves, and therefore feel stigmatised to go there and prefer to use the traditional birth attendants. The attitudes of the service providers are at times affected by their lack of motivation and therefore they may treat their clients with patience or love. Are HIV prevention services easier or harder for particular types of girls and young women to access? For example, is it easier or harder if they are: Married or unmarried? In school or out of school? HIV positive? It is harder for married Women to access young women to access the services, than the unmarried women, because marriage gives the ‘passport to access you as when he feels, our cultural set up is that the man manages sex from the time you marry and he reinforces that at any time whether you are aware that he has been sleeping out with another woman and you cannot tell him that you want to use a condom. When one is in school it easier to access information from peers, from the teachers and from literature, than when you are out of school then unless one has an STI bothering her is when she may access the service But on the contrary the one out of school can freely go out to seek for say condoms than the one in school especially the boarding schools. What role do boys and young men have in making HIV prevention services easier and better for girls and young women? Boy and men play a very big role because ‘they are the master of sex’ they can use a condom, and it is easier for the boy to promote abstinence than the girl if he is sensitised. For a girl

suggested to a boy that lets wait and that boy isn’t sensitised, he will refuse and instead say that the girl doesn’t love him so the girl either give in or the relationship ends Overall, what priority actions could be taken to make HIV prevention services more accessible to girls and young women? We need to redesign our programs, and to balance care and prevention as a country. Majority of people in Uganda are not infected so there is a lot to be done for those not infected but also, comprehensive care for those infected is a prevention strategy. We need to re enforce the people who are infected, build their capacity, working with them and put them at the fore front in the prevention than saying that we criminalise the HIV infection. We need to identify the challenges in accessing the services for example the lack of PMTCT drugs for those mothers who need them, and who miss out on the opportunity to use them even when they are willing, we therefore have to sit down with all stake holders and identify each ones roles and work on the challenges. Prevention component 5: Participation and rights How are international commitments (such as the Convention on the Rights of the Child and the Convention on the Elimination of all Forms of Discrimination against Women) applied in Mozambique? Uganda has signed all these and has justified some. We operate within an international framework and legal frame work which are laws, the problem is within implementation of The Laws from the Global to our communities are which are in existence; we are not observing them. ‘Even when it comes to marital disputes women have lost their property yet we have established institutions to protect the rights of women and other marginalised groups; at times corruption overrules the law” To what extent is the national response to AIDS ‘rights-based’? The National AIDS policy recognises that women has that natural role to perpetuate society, at one time women who were HIV positive and pregnant were blamed for it and scandalous and yet they have a right to choose to have a baby/s and the policy addresses that. It also talks about prevention of stigma and avoidance of stigma To what extent are girls and young women – including those that are living with HIV - involved in decision-making about AIDS at the national level? We have tried in our country through the GIPA, although it has not been very effective, but there has been efforts through for example the National Forum Of PLHIV in Uganda, to involve PLHIV in all Foras , whether policy making, strategy designing, they are included. Young people are considered as a separate coordinating entity in the Partnership Forum. We have an equal opportunity provision for all in our constitution where we are supposed to promote opportunities for women Overall, what priority actions could be taken to support girls and young women to be more involved in national level decision-making about AIDS? We need educate young women and girls as a primary action and then we need to get them in the positions of powers and decision making position for example the director General of UAC could be a woman, so that when she is propelling policies of HIV/AIDS she has that understanding from the feminine perspective. She will be influencing realistic polices that are placed from experience and practice. Summary In summary, what are the 3-4 key actions – for example by the government, donors or community leaders - that would bring the biggest improvements to HIV prevention for girls and young women in Mozambique?

Bring in more money for donors, redesign the strategies to make them generate responses but make them the men are brought on board and are at the fore front. If you focus on women alone which women are not living in isolation, then we would have wasted a lot of time.

One-to-one interview: National Coordinator (Male) Uganda Young Positives

General What is your impression about the general situation of HIV prevention for girls and young women in Uganda? Are things getting better or worse … and why? The general situation of HIV prevention for young women and girls has improved in Uganda but is not comprehensive in the whole country. There are different situations depending on the location of the young women and girls. There has been more improvement in the intervention for those young women and girls in urban areas than those in the rural areas. The young women and girls in the urban areas have more intervention related to increased access to information; more access to the condom, ‘In the villages the condoms are more expensive than in the towns, the rural young women cannot opt to buy a condom at Ug. Shs 1000/= instead of buying food’ But the female condom has never been available to any girls whether rural or urban. There has been more Youth friendly treatment centre set up in the towns, and barely any in the rural, and well as organisations like Straight Talk foundation have tried to provide Sexual Reproductive Health Programs to young people in school, they live those not in school un attended to. AIDS Information Centre set up a youth friendly Information corner in its entire centre including those in the 5 rural urban centres but right now it is only the Kampala centre which is functional! Prevention component 1: Legal provision In your opinion, what laws in Uganda are making HIV prevention for girls and young women better or worse? There are laws in Uganda that promote HIV prevention in Young women and girls but then their enforcements is still ‘very loose’ for example the law that girls should not be married before he age of 18 years is not observed and even if it was to their other factors that in play for e.g. the age at which some girls start their menstrual cycle is as low as 11 years and yet she has to a whole 7 years in between to become 18 which are highly risky years, That age of consent should be reduced to 16 years as advocates are pushing. Abortion being illegal is and this is making HIV prevention for young girls worse. Right now it is being done and most time not in the proper medical way, putting the young girls at risk, but if it was legalised, then people would seek these appropriate services with proper treatment and care from the treatment centre. There is also gap between service provision and other family planning service, especially for People living with HIV/AIDS, id one visited any ART centre, there is no comprehensive information give on Family planning apart from condom use. This could the time now to integrate these two in Uganda. How does legislation affect different types of girls and young women and their vulnerability to HIV? This is evident on for example the law about the age of marriage or consent for girls is at 18years, if one is in the rural area , she is likely not to go very far in education, therefore the likely hood of this young girl to get married at an earlier age before 18 years is very high, and if one is in the urban area she is more exposed to opportunities like education and information of the law, such girls spend more years in school and are less vulnerable to HIV/AIDS. The same applies to the in and out of school young women and girls Overall, what laws could the government change, abolish or introduce to bring the greatest improvements to HIV prevention for girls and young women? The law against abortion should be abolished, the recent Sero Survey Report 2005-6 launched put the fertility level at 6.9% and if an average woman in Uganda gave birth to 6-7 children, of whom some are result of rape, unwanted pregnancies etc, children are likely to lead. The government will not at all be able to sustain such a population.

In order for this to be effective in contributing to HIV prevention for young women one has to remember the merger family resources depleted and kind of life these girls in Uganda, it should work hand in hand with enforcing the other existing laws on sexual reproductive rights of women and girls. Prevention component 2: Policy provision What type of government policies or protocols – for example in relation to antenatal care, condoms or voluntary counselling and testing – make HIV prevention for girls and young people in Uganda better or worse? There is a protocol regarding to Voluntary Counselling and Testing and this is in relation to age as to when the young people should be tested and have a right to know their status, this needs to be changed absolutely if young women and girls have to access proper services. “Young women, girls and even boys need to be guided to the service centres, facilitated with appropriate information to get there, and not guarded to the VCT services” Do girls and young women – and also boys and young men - receive any type of official sex education? For example, what are they taught about their sexual and reproductive health and rights while in school? In Uganda today the government introduced PIASCYPresidential Initiative on HIV/AIDS Strategy for Communication to Youth curriculum which is targeting young girls and boys in school only that it is difficult to measure as to how it is targeting its effectiveness in targeting their sexuality. But this being a crucial area of concern, it should be extended beyond the schools, families need to be empowered to ensure that sex education and sexuality for young people is communicated freely from the parents to the children and that the children also are able to seek support from their parents. Overall, what policies or protocols could the government change, abolish or introduce to bring the greatest improvements to HIV prevention for girls and young women? Uganda embraces the ABC strategy – Abstinence, Being faithful, and Condom Use, and one finds that the age bracket of young women and girls 15-24 years, always Abstinence has been emphasised, and yet there are those who are always sexually active within that age bracket. Then the condom must talked about. One challenge of recent is that the condom has been decampaigned, emphasising only the Abstinence, The condom has become very expensive and almost rare. The government needs to come up with protocols and policies which will be comprehensive and embrace correct information, messages, and availability of the condom because the Abstinence strategy cannot work alone for the Youth. Prevention component 3: Availability of services What type and scale of HIV prevention services are available for girls and young women in Uganda? In Uganda almost all these services listed apart from the female condom, is available but there scale differs depending on where one is. In the rural areas, these services are very limited to a little information on HIV AIDS, no youth friendly treatment centres for STD, the condom is more expensive, fewer VCT centres. The Anti Retro viral rugs are have been available but the information on ART and Treatment literacy is lacking, ; which is not the case of the urban areas. What type and scale of HIV prevention services are available for particular types of girls and young women? For example what services are there for those who are: Unmarried? Out of

school? Involved in sex work? Orphaned? Injecting drug users? Migrants? Refugees? HIV positive*? The services are the same for the every body there are no specific services for a particular type of young women or girls. Most times they are the same services which are used by the general community. Some Treatment centres have been set up for HIV positive people and in these special focus may be on the children below the age of 18 years only. Then also youth friendly centres have been set up in the urban areas, but these are used by both young men and women. What type and extent of HIV prevention services and information are available for boys and young men? How does this affect the situation for girls and young women? There are no specific services for only young men and boys, it is a fact that boys are more advantaged with a little more information than the girls, but when it comes to accessing the treatment services then the girl takes the biggest share of the services. The effect is positive but services need to target both boys and girls. Overall, what type of services most urgently needs to be increased to improve HIV prevention for girls and young women? One of such urgently needed services is correct and appropriate information and not contradicting messages of prevention “I was in forum for Young people and one presenter said don’t use condoms and yet another said you should use the condom, I wonder what type of message the young people who attended took home” There has to be free condom distribution to those who need them without coercion. VCT should be available and also accessible by communities in the rural areas, PMTCT must be friendlier to the young women and girls and not stigmatising. The government must ensure that the ARV are available to the young people who need them Prevention component 4: Accessibility of services What are the main barriers to girls and young women using HIV prevention services in Uganda? There is a cost barrier which is evident in the cost in terms of location thus impinging on the transport costs to get to the service and the cost of the medication. One may afford the transport but fail to afford the service and vice visa. For example the CD4 count machines are in only few health centres in the country some people have to move long distances and pay to access this crucial service. Lack of privacy is also critical in Health centre which do not have youth friendly services, a young girl who is pregnant having to access the same anti natal care like other women as old as her mother have experienced stigma. The mockery, comments that “imagine what was that one looking for” are big barriers and she may never come back for the service Some of the health personnel are either semi trained or lack knowledge as how to handle the young women and girls they are always blaming, “Why and how did such a young girl get infected, how come you are pregnant instead of giving you the skill of living positively with the condition” Therefore there is a combination of factors Are HIV prevention services easier or harder for particular types of girls and young women to access? For example, is it easier or harder if they are: Married or unmarried? In school or out of school? HIV positive?

Yes , the HIV prevention services are more easier to access for young girls and women who are in the urban setting where they are a number and has a choice of where to go than in the rural where they are few and definitely the young person will be easily pointed out by the community knowing her as a “culprit” For the married women they don’t have a choice without the consent of their husbands, “How can a married woman take home a condom? The husband will think she is unfaithful and will not even accept to use it” And yet the unmarried it is a lot easier. What role do boys and young men have in making HIV prevention services easier and better for girls and young women? Sometimes the young men and boys have a supportive role they play in the HIV prevention for young women and girls. This is in relation to condom use and accessing the treatment of STI but they are not consistent with their support, it is timed and has some limits. The young men may insist on the use of a condom the first 3 times only and after he will then insist on putting it off. For HIV test, if the young man is sure of his past sexual experience or that he has had none at all, he may insist on the HIV test before any sexual interaction with the girl but it is vice visa if he suspects himself. Most times older men take advantage of the vulnerable poor economic situation of the girls thus with no bargaining power for safer sex and they do what they want with these young girls. Overall, what priority actions could be taken to make HIV prevention services more accessible to girls and young women? Ensuring that young people are able to access the HIV services where ever they are is a critical area which needs to be addressed. Attitudes of the service providers need to be addressed since this is one of the determinants of whether the communities will come for the services or not. Costs have to be reduced in terms of pocket friendly services since we are in a poor country. Prevention component 5: Participation and rights How are international commitments (such as the Convention on the Rights of the Child and the Convention on the Elimination of all Forms of Discrimination against Women) in Uganda These commitments are there like Children’s Rights but it Is mostly Non Governmental organisations like ANAPCAN working outside the government that are striving hard to ensure these commitments are met. There are efforts put in although the impact is yet to be felt. The Ministry of Gender Labor and Social development in Uganda is striving to address the issues of orphans and other vulnerable children and also women issues but it is also working with the support of other independent NGO. To what extent is the national response to AIDS ‘rights-based’? ‘ I’m not sure about this the National AIDS policy is still in draft, but if at all it is pulled out of the shelf it should address Sexual Reproductive Rights of Women if HIV prevention is to be successful’ To what extent are girls and young women – including those that are living with HIV - involved in decision-making about AIDS at the national level? Yes and No, they are always called for meetings at the national level but the major loop hole is the lack of empowerment of these young people to be able to articulate issues that affect them effectively. ‘I’m aware that there is a Youth Self Coordinating entity at the HIV/AID Partnership at the Uganda AIDS Commission, but its outputs are not valid because the youth who are supposed to make it happen are not empowered to do so’.

Overall, what priority actions could be taken to support girls and young women to be more involved in national level decision-making about AIDS? There are youth councils and they have produced a book on HIV/AIDS and Young people but there is still a big need for further their involvement. During the Youth Days’ Celebration are always organised for them and they are not allowed to fully participate as desired. Even a minister for Youth should be a youth and not an old person as it is. We don’t have a youth commissioner at the Uganda AIDS Commission, all are very old people ‘One sees an old man speaking on behalf of the youth; this due to lack of empowerment. How then do we define participation for the youth?” Summary In summary, what are the 3-4 key actions – for example by the government, donors or community leaders - that would bring the biggest improvements to HIV prevention for girls and young women in Uganda? Giving the young women and girls life skills to be able to defend their right and lives and improving their livelihood to be able to access the services they need, Interventions need to focus on nutrition, getting medical support, defending their rights, and psychosocial support Making the Youth friendly Treatment services available and accessible by the young girls in which ever locality is a critical key action.

One-to-one interview: National Program Manager (Male Dr.) & Medical Coordinator (Female Dr.) Family Planning Association Uganda

General What is your impression about the general situation of HIV prevention for girls and young women in Uganda? Are things getting better or worse … and why? The general situation was first brought better but it could be stagnating now, the real danger could be compliance, our HIV prevalence rate were at first at 18% in the 1990s and it improved to 6.4% and it has stagnated for many years there. The situation improved because the awareness about HIV/AIDS is Universal and people are aware including the young women and girls. Whether knowledge has been created effectively is questionable, some people have not been able to use the knowledge for behaviour change because of other influencing factors for example location, and therefore there are variations between urban and rural, women and men; the women being less knowledgeable although these variations are not so pronounced. Prevention component 1: Legal provision

In your opinion, what laws in Uganda are making HIV prevention for girls and young women better or worse? One of the laws making the situation worse is the law on abortion; a young girl can have an abortion if it is proven by the physician that the pregnancy will be detrimental to her life. But getting that abortion done is difficult because it needs the presence of 3 physicians to endorse the abortion, what is happening is that young women and girls who want the abortion are doing the backstreet abortions were the health precaution measures are not good and thus increasing their risks to HIV infection because of the poor quality care. The age of 18 Years for marriage is still very low is Uganda bearing in mind our environment. It should be raised a bit too. How does legislation affect different types of girls and young women and their vulnerability to HIV? “In Uganda, I feel laws are operationalised depending on who you are and your status the elite usually get the law in their favour and the poor are marginalised even though the law would be there” Women and girls who are poor may not get the full protection of the law, Those whose rights have been violated and may have resorted to the law to protect these right do not have access, it is limited by their awareness of the law and the availability of the means to buy the law. Overall, what laws could the government change, abolish or introduce to bring the greatest improvements to HIV prevention for girls and young women? The abortion law could be relaxed so that we get more young women coming out seek the proper services in the right places, this may reduce the transmission of HIV/AIDS. The debate which is being going on about the Domestic ill especially the concerns as to when our girls’ consent is assumed, or whether should there be marital rape; This is a strong law which if passed will contribute greatly to HIV prevention for girls and young women especially when they are married. Prevention component 2: Policy provision What type of government policies or protocols – for example in relation to antenatal care, condoms or voluntary counselling and testing – make HIV prevention for girls and young people in Uganda better or worse? The government policies and protocols I feel are supportive because they are carried out in the participatory approach, the snag is that Policy can be written or unwritten but it is much the unwritten policy that is detrimental, and Policy can be the orientation and attitude of people in power. If you had a well written policy and the people in power had a different orientation or attitude that becomes policy in its own right. “An example is the moralistic approach to condom use in our country, the policy is clear that we can use condoms, but if the head of state or his wife says that the condoms are not to be used that in itself becomes a policy and it is a problem than the written policy” Do girls and young women – and also boys and young men - receive any type of official sex education? For example, what are they taught about their sexual and reproductive health and rights while in school? Yes they do and it is a lot better now than before, especially for school children because there is the PIASCY Program and there is a lot of education about growing up, adolescent reproductive health but the only debate now is whether the young people should be given the whole lump sum or just a bit of the sex education bearing in mind the moralistic approach. For out of school, there is a challenge because the mechanisms to deliver the education are not established; Non governmental organisations are trying but they are also scattered. Overall, what policies or protocols could the government change, abolish or introduce to bring the greatest improvements to HIV prevention for girls and young women?

The ART policy which stipulates that children at the age of 12 years should consent to the HIV test and ART has a big dilemma. There is a dilemma here because these are still children and at times parents still want to still have the full control of the children. Much as this policy is good the dilemma exists. Prevention component 3: Availability of services What type and scale of HIV prevention services are available for girls and young women in ? U We have all these in Uganda in theory but the problem is whether the population has access to the services is he question, Access could still be for the rich than the poor for example the “Anti Retro Viral Therapy in Uganda are available we say we have even gone beyond our target, set by 3 by 5 but in reality we are saying at least 150,000 people require the ART and we have reached to 66,000.There is a problem because this picture is much worse than it is actually is in the figure” In Uganda we say HIV/AIDS information is readily available but there areas where this information has not reached, ‘In our work we have identified some people for example the transit traders who are not in any particular place, you don’t get them in any one place, we assume that they know, and yet they don not know’ VCT in Uganda has gone a long way but the coverage is still limited. PMTCT, is done worst, available some few health centre in the communities but it is also affected by other factors that affect ANC. The female condom is out of stock in the country and we should not talk about its availability, well as the male condom is the available but question is whether it is accessed by every one who needs it. “The situation is pathetic in an rural areas, you can ask for it and never get it.” “We have also noticed in our youth centres that it is the male who visit our clinics for the male condoms and not the females and therefore that tells you who has the power to use it” What type and scale of HIV prevention services are available for particular types of girls and young women? For example what services are there for those who are: Unmarried? Out of school? Involved in sex work? Orphaned? Injecting drug users? Migrants? Refugees? HIV positive? The situation is different for the urban and rural girls in relation to their accessibility to services, but there are factors that influence the differences. A person in the rural centre may not even get a condom selling point in the whole rural town yet in the urban centre there are more retail shops and pharmacies selling them. “If this person is a female and young then the situation is worse, it is still very awkward for some sellers to see a young girl asking for a condom” What type and extent of HIV prevention services and information are available for boys and young men? How does this affect the situation for girls and young women? The services are the same for the young boys and the girls. Overall, what type of services most urgently needs to be increased to improve HIV prevention for girls and young women? VCT is an entry point into Prevention for HIV infection and a young person who has carried out the VCT is very empowered, before we used to talk rightly of quality and restricted it to a few places but now we have moved out of that, “In order to achieve HIV prevention we must make VCT accessible” Prevention component 4: Accessibility of services

What are the main barriers to girls and young women using HIV prevention services in Uganda? It is a combination of factors some of them are economic, social, cultural and the environment where they stay. Some of these girls are restricted by parents to visit the youth friendly centre with the bias that we promote promiscuity. Others lack the time, the house hold cores especially after school may be too many that she doesnâ&#x20AC;&#x2122;t have time even to sit down a read a leaf let on Sexual reproductive health if she had it. Some of these services are charged with a fee and yet these girls may be able to afford them. Besides these youth friendly services are not readily available in the communities. There is also a problem of the prevailing levels of Stigma and fear which exists in the people such that they fear for the positive results. The attitudes of the service providers have to be worked on we have at least given an extra training for our health workers who are in the youth clinic ad also extended the similar services to the public health institution were the attitude is felt to be more negative. Are HIV prevention services easier or harder for particular types of girls and young women to access? For example, is it easier or harder if they are: Married or unmarried? In school or out of school? HIV positive? It is harder for the married young women and especially if they are in the rural areas where accessibility to services is already identified as difficult. Well as those in school are able to receive information, they may not freely access the condoms like those out of school. What role do boys and young men have in making HIV prevention services easier and better for girls and young women? Culturally the boys are taking the lead in decision making, but the culture has not prepared them to appreciate and respect the young women. We have a missed opportunity where young boys could help in the prevention of HIV and protection of their female partners. They have been socialised to be in the lead but not to respect or protect the females, one of the problem is that they are actually ignorant even about their sexual and reproductive health so much as they may want to help. Overall, what priority actions could be taken to make HIV prevention services more accessible to girls and young women? Empowerment of the boys and girls, the girls should be empowered to know that being assertive on the use of condoms is appropriate and the boys should be empowered to know the girl who is assertive is also behaving appropriately and not offended. Governments efforts to take health services to the communities up to the parish level is commendable action, as they are taking the services nearer to the people and an entry point into prevention Prevention component 5: Participation and rights How are international commitments (such as the Convention on the Rights of the Child and the Convention on the Elimination of all Forms of Discrimination against Women) in Uganda Yes we have signed all these commitments but the barrier is that they are not well disseminated. There is a lot of ignorance among the people even those who MUST know. Yet the knowledge and appreciation of this commitment can form a spring board for HIV prevention. To what extent is the national response to AIDS â&#x20AC;&#x2DC;rights-basedâ&#x20AC;&#x2122;? The right based approach is a new approach in this country and it is beginning to be appreciated by a few people mainly those in programs. Policy makers, Managers, Leaders feel do not appreciate the right based approach, and something needs to be done deliberately to appreciate this approach this goes for the implementers and the receivers of the service.

“But we are having for the receivers is thanking all the time and not demanding for their rights” To what extent are girls and young women – including those that are living with HIV - involved in decision-making about AIDS at the national level? The representation is still weak, there is a young person at the Partnership committee but this is inadequate we should be aiming at representation at all levels. Non governmental organisations they should also be aiming at including young people in their decision making levels. Overall, what priority actions could be taken to support girls and young women to be more involved in national level decision-making about AIDS? The structures should be reviewed to accommodate young people deliberately, and the young people then should be empowered to participate actively and articulate their issues well and not passively; in the decision making processes Summary In summary, what are the 3-4 key actions – for example by the government, donors or community leaders - that would bring the biggest improvements to HIV prevention for girls and young women in Uganda? Increase access of the HIV preventive services in the communities. Empower the young girls to be able to use the available services. Operationalisation of the existing laws. A little more investment in addressing Stigma and also in making the right based approach a reality to managers and policy makers so that people start talking of respecting, protecting and demanding for their rights. Participation of the youth should be deliberately brought on board

One-to-one interview: Program Officer – National Community of Women living with HIV/AIDS In Uganda

General What is your impression about the general situation of HIV prevention for girls and young women in Uganda? Are things getting better or worse … and why? The situation of HIV prevention for girls and on general is improving as there are more HIV services available than before. In the beginning, most people including the young girls didn’t have a reason to seek these services but with the introduction of the ART, because they have realised that there are more benefits in testing and knowing ones status than before. Prevention component 1: Legal provision In your opinion, what laws in Uganda are making HIV prevention for girls and young women better or worse? The laws are there on paper and they are meant to protect the young girls but their implementation is not active. One finds that the level of child mothers is increasing but no body ever bothers to investigate under what circumstances these young girls got pregnant and bring the responsible men to book. On paper it is stated that abortion is illegal it is common practice for young girls get rid of their unwanted pregnancies although it is in stealthy ways, but no body has ever been charged for this. This law is making the situation worse as the crude methods involved, preventive of HIV is not the observed. How does legislation affect different types of girls and young women and their vulnerability to HIV? The laws affect the different types of girls differently depending on their location. In the rural areas, most times the people do not have the information in regards to the law and even if they did, they don’t have the money to follow up the cases, so they give up and always settle their grievances out of court. Overall, what laws could the government change, abolish or introduce to bring the greatest improvements to HIV prevention for girls and young women? The government should also introduce laws that hold the girls also responsible for the action they do, because at times these girls also consent to the sexual act but it is the men who are only held responsible. This age of consent being 18 years for a girl is too low it should be at least increased to 21, “The Uganda situation a girl of 18, what can she do for her self, she hasn’t even finished a study course, she is still a child, if you placed her in a shop she is not mature enough to be trusted by

customers, and as a parent do you think this girl can run a home, she cannot therefore not even ready for marriage” The abortion law should be relaxed; there are cases that one cannot avoid the abortion “Imagine if a girl was raped and she conceived, what kind of trauma would this baby bring to this young girl every time she was to look at her if at all she has to wait for full term pregnancy and deliver” Prevention component 2: Policy provision What type of government policies or protocols – for example in relation to antenatal care, condoms or voluntary counselling and testing – make HIV prevention for girls and young people in Uganda better or worse? There is a dilemma in Uganda about condom use, when the visit the health centres they get the condom and yet they are told not to use the condom; the government should be clear about the messages about the condoms to young people The policy of VCT and disclosure at the age of 12 years needs to be revisited, poses also a big challenge, because these children are known to be sexually active, and yet some have been born with HIV and they are not been disclosed to. Do girls and young women – and also boys and young men - receive any type of official sex education? For example, what are they taught about their sexual and reproductive health and rights while in school? There is sex education about the reproductive organs which has been taught in schools for a very long time as part of the school curriculum, today schools are talking about sex education in a defensive way and not giving the whole package of sex education “ For example ; If you have sex you will become pregnant, don’t have un protected sex you will get HIV; HIV kills; but they don’t give the skills of how to negotiate for condom use , or even how to use It; assuming one gets HIV and doesn’t die, what does she do- that is not given” PIASY has been introduced but the time given for it is not enough, HIV/AIDS is at times mentioned during the assemblies and a teacher gives a message about it. Which time is not enough to answer all the questions that the children have. Overall, what policies or protocols could the government change, abolish or introduce to bring the greatest improvements to HIV prevention for girls and young women? The VCT policy should be relaxed a bit so that those who feel they are big enough and want to know their status can do so. Some could have lost their parents to HIV and may be anxious that may be their parents could have passed HIV to them. Prevention component 3: Availability of services What type and scale of HIV prevention services are available for girls and young women in Uganda. These services are available but this varies depending on where one is located, for the male condom this is readily available in the urban areas and cheaper than in the rural areas. The female condom is out of stock and it wasn’t liked by the women Information has been widely spread by the government and non governmental organisations but still the rural remote areas get inadequate information. Treatment of sexually transmitted diseases is available and youth friendly services have been set up in a few towns in Uganda living the rural areas disadvantaged. In the rural areas not all health centres have the drugs

“You may get a prescription and then be told to go and buy the medication else where, In some places the testing kits for STI are not available VCT has gained a wider coverage and in some areas organisations like AIDS Information Centre and The AID support Organisation have introduced mobile clinics taking the services near to the people ARV drugs are relatively available in the country but still the big challenge may be the policy arrangements in particular centres and lack of testing kits. Some of these centres insist on policies like first in first access to ART and yet at times these may still strong people and the ones who need the drugs are left out because they joined later “I visited one hospital in the a sub urban town where mother wanted to access the PMTCT program but there were no testing kits for HIV much as the Nevarapine was there” What type and scale of HIV prevention services are available for particular types of girls and young women? For example what services are there for those who are: Unmarried? Out of school? Involved in sex work? Orphaned? Injecting drug users? Migrants? Refugees? HIV positive? Most of these services are the same for all the types of girls. Abstinence, Waiting And Condom use The preventive service which is accessed by all the groups is the information which is general, but there are messages at times developed targeting particular groups of young people for example the in - school like Abstain and wait and graduate but there are no specific message for out of school young people. Sex workers are often left out because this is still a hard group to get, the law is against their existence and there is a lot of stigma associated with their work, It assumed that injecting drug users do not exist in our society in Uganda and they have been left out and yet the young people are engaged in drug abuse like marijuana in take, excessive alcohol drinking which affects their senses to judge and reason appropriately, and they are at a great risk as they in the end they may practice all the types of unprotected sex and What type and extent of HIV prevention services and information are available for boys and young men? How does this affect the situation for girls and young women? The boys have been targeted more that the girls, they have been given information and skills for example on how to use a condom. Well as the girls have been left out with no skills of negotiating on condom use or even boldly ask for it at a service centre. This special focus on the boys lives the girl more vulnerable, she is left with no bargaining power. Overall, what type of services most urgently needs to be increased to improve HIV prevention for girls and young women? The type of information we give out should target both the boys and girls equally, for example the condoms use, “When we are demonstrating how to use a condom we use the penis module and the girl watching must think this is a man’s business, emphasis is not put on the fact that the girl can also assertively put on the condom on the man” A better improved female condom needs to be produced to still empower the young women. More health centres need to be established and with trained youth friendly personnel the ones currently there have a habit of disclosing the young people’s problems and discussing them in the corridors and in the communities, “Girls these days I don’t know what has happened to them if you could see the number of girls who came to access condom! I wonder where the world is moving,” thus breaching confidentiality. They should be equipped with adequate and consistent supply of medication and testing kits so that when the young are referred they can be able to get the services required easily. Improve on the quality service delivery and not take the whole day in the health centre

Prevention component 4: Accessibility of services What are the main barriers to girls and young women using HIV prevention services in Uganda? The cost of the service in terms of money spent on the transport fares to the service centres, the long queues one has to go through because it may be the only centre available and lastly you end up having to buy the medication; all combine to make it very expensive. Location is a major hindrance to accessibility even in towns when we say that the places seem near, one has to spend not less than 3000 Ug. Shs to and from the centre. Some young people feel stigmatised to visit near by centres where they are known by the medical personnel or the community wills see them walking there so they choose a further place if they can afford or give up completely. The centres have been openly marked for the services they provide like Home Cares centres, in Kampala Hospitals, AIDS Information Centre, and this contributes to he lack of privacy, and stigmatising, once seen entering there one automatically concludes what you have gone to do which most people do not want. Attitudes of the health providers are negative and not supportive. When the parents they find out that their daughters and sons are visiting the youth centres and accessing these services the develop mistrust for them and think they have been misbehaving/ sleeping around which is not always the case Are HIV prevention services easier or harder for particular types of girls and young women to access? For example, is it easier or harder if they are: Married or unmarried? In school or out of school? HIV positive? Most people who access VCT services come in as singles only that they are encouraged that if they had partners should bring them too. The married young girls it is harder for them to access these services because they are accountable to their husbands, they have questions to answer like: “Where did you go? Why? Who gave you the permission? And can earn you a divorce if you are not careful” “How can you introduce a condom in the house, even if it was family planning, women have been beaten for going there without the consent of their husband” In school young girls have more difficult in accessing these services than the out of school, in some situations it is abominable! How a student can get a condom, the parents might be told. It is still not easy for HIV positive young girls to access the services especially if they have not coped What role do boys and young men have in making HIV prevention services easier and better for girls and young women? Young men and boys have been able to join the Youth friendly services and the HIV clubs where they share a lot of information with the girls. ‘Men generally want to have sex without condoms and rarely suggest it thus their support to the girls is minimal’ Boys and young men have been the centre of misconceptions and myths which is s a sign of a high degree of ignorance Such are like “if you have sex once you cannot get pregnant or infected with HIV, you look so nice to have HIV” Overall, what priority actions could be taken to make HIV prevention services more accessible to girls and young women? Extend the HIV preventive services in the rural and remote areas and orienting/training staff to be able to address the concerns of young people with empathy and not blame and shame.

More education and sensitisation is needed still to deal with the misconceptions that are preventing the young people to access the services Incentives which stimulate the young women and girls to access the services may be introduced for example forming clubs which can also access other developmental activity for economic gains especially for the out of school as they help to pass on the information to others. Prevention component 5: Participation and rights How are international commitments (such as the Convention on the Rights of the Child and the Convention on the Elimination of all Forms of Discrimination against Women) in Uganda Yes through the Ministry of Gender Labour and Social development, they have tried to put up interventions that support the non discrimination of women and have also spear headed the OVC policy, “the challenge is that most of these things are left on paper and not implemented”. To what extent is the national response to AIDS ‘rights-based’? Although the Overarching National AID policy is not yet in place, the draft has tried to address the sexual reproductive rights of women To what extent are girls and young women – including those that are living with HIV - involved in decision-making about AIDS at the national level? Youth support groups have been formed and this is where the voices of young women and girls are represented. They have also participated in the National HIV/AIDS prevention campaigns but the extent of decision making at the national levels is still very low. Overall, what priority actions could be taken to support girls and young women to be more involved in national level decision-making about AIDS? Deliberately to include the young people on the decision making committees at all levels including the national levels. Summary In summary, what are the 3-4 key actions – for example by the government, donors or community leaders - that would bring the biggest improvements to HIV prevention for girls and young women in Uganda? The government need to increase the accessibility of the HIV preventive services for the young people by extending the services nearer to them and establishing more HIV preventive centres in the communities Operationalise the laws that protect young people from the HIV infection The Donors also nee to bring in more money to support HIV prevention since the rates are still going high

One-to-one interview: Counsellor - Naguru Teenage Treatment Centre (Female)

General What is your impression about the general situation of HIV prevention for girls and young women in Uganda? Are things getting better or worse … and why? The situation has improved a bit, there has been an increase in the efforts to establish HIV preventive services like now there is an increase in information about HIV/AIDS, establishment of

youth friendly treatment centres, but the underlying conditions that increase the vulnerability of young women and girls to HIV infection has not been addressed. Poverty has been a greater player in increasing their vulnerability. Some young women born from poor families are forced into having sex in order to get their basic needs in life and yet others have been orphaned and the care takers are already over burdened, and are not able to provide for them, there has been a general an increase in rape and defilement case in Uganda. Prevention component 1: Legal provision In your opinion, what laws in are making HIV prevention for girls and young women better or worse? The laws are in existence and they are supposed to protect the young girls, but most of them are not operational. Young girls have been married off or on their own before the age stipulated by the law and no body follow the up. The young girls are practicing abortion, although not openly but no body seems to bring them to book, and yet if this was reinforced, then the other young girls would learn from this and not do the same. How does legislation affect different types of girls and young women and their vulnerability to HIV? It affects them differently for example the girl in school will definitely want to abort because she wants to continue with her studies well as that one out of school may choose to have a baby. Secondly, the young girl in the rural area may be ignorant about the law and if she is also out of school then definitely she is bound to get married earlier increasing her vulnerability to the HIV infection than the urban girl who has more and better opportunities. Overall, what laws could the government change, abolish or introduce to bring the greatest improvements to HIV prevention for girls and young women? The existing laws must be put into enforced first and fore most before we think of introducing others. But most times the people are ignorant about the laws and there fore there enforcement is poor. Prevention component 2: Policy provision What type of government policies or protocols – for example in relation to antenatal care, condoms or voluntary counselling and testing – make HIV prevention for girls and young people in Uganda better or worse? The policy on condom use is well stipulated and clear that every one who wants to access the condom can do this but the messages of recent that are being passed to the young people are contradictory, they de campaign the condom and promote abstinence and yet we know that the young women and girls and even boys are sexually active. Do girls and young women – and also boys and young men - receive any type of official sex education? For example, what are they taught about their sexual and reproductive health and rights while in school? In Uganda currently sex education is more focused on in the schools than before, In the school curriculum we have subjects that address the sexual reproductive health, it focuses on body growth and development. Beyond the school settings, even at home parents are beginning to ‘talk’ to their children about sex and sexuality Overall, what policies or protocols could the government change, abolish or introduce to bring the greatest improvements to HIV prevention for girls and young women? The protocol on VCT needs to be relaxed a bit so that the young people can access it freely without necessarily getting the consent of their parents. The condoms should be made available and correct messages to the young people have to be designed instead.

Prevention component 3: Availability of services What type and scale of HIV prevention services are available for girls and young women in Uganda The male condom has been widely campaigned still find other people who are still very ignorant about it. The female condom has not been available at all to neither the rural nor the urban, the majority of the women even the elite have never seen it. Most of these services are available but the extent varies whether one is in the rural or the urban setting, the rural areas have been disadvantaged with fewer services than the urban. Well as in Uganda they say that the ART is available at Healthy centre 4, these is a problem in their availability to all and the treatment literacy is still a big challenge for both the urban and the rural young women and girls. What type and scale of HIV prevention services are available for particular types of girls and young women? For example what services are there for those who are: Unmarried? Out of school? Involved in sex work? Orphaned? Injecting drug users? Migrants? Refugees? HIV positive? In Uganda we don’t have specific services for the particular types of girls, most times, other than the Youth treatment centres like this Naguru Teenage centre, the young girls and women have to access the other services from the general hospitals where every body goes. It is only the HIV positive people who may attend special clinics and but this is still with other people. An example is the Mild May International centre in Uganda that also focuses on young children below the age of 18year and are living with HIV and the What type and extent of HIV prevention services and information are available for boys and young men? How does this affect the situation for girls and young women? The boys have similar services like the young women and boys and in the treatment centre the number of girls who come here is much more than the boys. Overall, what type of services most urgently needs to be increased to improve HIV prevention for girls and young women? More emphasis should be put on VCT, so that the young people can know their status “These children have been born in an era of HIV, so they need to know their status even if virgins”, Condoms should also be made available to the young people who need them and then of course encourage other preventive like abstinence for those who are not sexually active. Prevention component 4: Accessibility of services What are the main barriers to girls and young women using HIV prevention services ? One major barrier is stigma, “some centres have been clearly marked that they test for HIV and so these young girls fear to be seen going there as they will be queried by their friends, relatives or parents as to why they went there” They would prefer to go to some other community where they are not known and yet that has implications on their pockets, they just give up. These services are also not every where, even when one wants to access them she has to consider the transport costs and the cost of the service, Some service counsellors lack the skills in handling young people; “I could say there are those who have accidentally found themselves in the jobs or only had a counselling training for one week and then they are taken up as peer counsellors, because they are only looking for a job”

Are HIV prevention services easier or harder for particular types of girls and young women to access? For example, is it easier or harder if they are: Married or unmarried? In school or out of school? HIV positive? When one is married is it worse, most times these young women and girls are in this marriage for security and economic reasons. To suggest to her an HIV test she will say “What if I found that I’m HIV positive how will I tell my Husband, then what if he chases me where will I go?” It is yet easier for those out of school to access the services because they have all the time well as those in school are always limited, they have to find a convenient time and yet these centres close on weekends It is only easier for the HIV positive girls to access these services only if she has been counselled and she has accepted to seek support, most times young HIV positive girls live in denial, stigma and shame and fear and therefore will not access the services easily What role do boys and young men have in making HIV prevention services easier and better for girls and young women? The boys and young men have a big role to play but the majority don’t want to seek these services themselves. “We often get girls who come for HIV testing and when you ask hem whether they have discussed this with their boy friend they say yes but he refused to come one said that you go but don’t tell me your results” So how will they support their partners? Overall, what priority actions could be taken to make HIV prevention services more accessible to girls and young women? Creation of at least one-two youth friendly centre in each district, so that if the young girl finds it difficult to get to the one in her district due to stigma she can get to the nearest district, otherwise the youth friendly centres are very few in the whole country. Education and empowerment with like skill of the young women and young men especially those in the rural areas so that the can avoid sexual exploitation and early marriages for economic reasons. Prevention component 5: Participation and rights How are international commitments (such as the Convention on the Rights of the Child and the Convention on the Elimination of all Forms of Discrimination against Women) applied in Uganda? I know that many Non -organisations are targeting the women and children in Uganda and ensuring that they their rights are upheld. Even in the villages, women are sensitised against domestic violence and property rights by these organisations but I can’t tell how far the country as a whole has gone To what extent is the national response to AIDS ‘rights-based’? “These days they talk of the ‘right based approach’, I have not had a chance of looking at the National AIDS Policy but it is my wish that the rights of women living with HIV are addressed when it is passed” To what extent are girls and young women – including those that are living with HIV - involved in decision-making about AIDS at the national level? There organisations that represent young people, and this is may be how the young women and girls are represented; at the national level the government introduced a post of parliamentarian representing Youth. “In development of the National AIDS plan I’m not sure”

Overall, what priority actions could be taken to support girls and young women to be more involved in national level decision-making about AIDS? The young women and girls need to be empowered to advocate for their needs and then the government should consider also placing a position of a member of parliament who is HIV positive who will voice out the concerns of PLHIVS, just like it did for the People with Disability. Summary In summary, what are the 3-4 key actions â&#x20AC;&#x201C; for example by the government, donors or community leaders - that would bring the biggest improvements to HIV prevention for girls and young women in Mozambique? The donors should bring in more funds so that the young girls are able to continue with their education and for those who have dropped out to be able to get some economic vocational skills to support them so that they are more self reliant and not dependant The community leaders need to be sensitised and equipped with information so that they can support the girl child in their communities otherwise they are also seen to participate in the marrying off the young women and have not taken appropriate steps when the rape and defilement cases have been reported. The government should also focus on both the girls and the boys and ensure that more youth friendly services are established in the districts