Uganda Health Reporter
Uganda Health Communication Alliance
Uganda Health Reporter The Uganda Health Communication Alliance
Vol. 4, No.1
uhca@healthuganda.org
January, 2011
The Basics in HIV/AIDS Reporting: Who, What, When, Where, Why and How
T
hink of the major interdisciplinary, complex stories of our time; stories that are worldwide, ongoing and urgent. Perhaps you think of politics, climate change or famine. None of these is like the HIV/AIDS pandemic. AIDS is a story of great breadth and sharp contrasts; covering it requires knowledge and sensitivity around personal issues such as sexuality, addiction and social vulnerability. At the same time, it is a global story requiring a broad understanding of international politics, the counties economics and diverse cultural traditions. Interwoven with these strands of the AIDS story are the scientific, medical and healthcare stories, which a reporter must be able to “translate” for the general public. That’s what makes it complicated.
Journalists interviewing a man during one of UHCA’s organised field trips
UPC: We need to re frame health as a national security issue By Kakaire A. Kirunda Last year Ugandan civil society led by the Action Group for Health, Human Rights and HIV/AIDS (AGHA) Uganda organised a public debate in Kampala and invited political parties to explain their health agenda for Uganda. The leading political parties in the country –National Resistance Movement, Forum for Democratic Change and Democratic Part- did not show up. However, presentations were made by the leader of the newly formed Uganda Federal Alliance (UFA) Ms Betty Kamya, People’s Development Party (PDP) President Dr Abed Bwanika, while Dr Dickson Apul represented the Uganda People’s Congress. In our last two issues, we gave you UFA’s Health care plan and a summary of PDP’s plans as captured by AGHA Uganda. In the last part of this series we reproduce what UPC’s Dr Apul said as recorded by AGHA verbatim: “This country is undergoing traumatic events with respect to provision of adequate healthcare services.” Continued on page 4
The HIV Discovery Ever since the first cases of a mysterious, new disease were noticed by doctors in 1981, public awareness and education has been a crucial part of the battle against the spread of HIV and its effects. As journalists, we have an opportunity—and a responsibility—to provide the public with clear, accurate, respectful reporting on the pandemic and the larger social forces that drive it forward. In the absence of a cure or preventive vaccine, information is still one of our best weapons available. With the numbers of people infected rising each day, the need today for thorough, ethical reporting is more urgent than ever. According to Dr. Ario Alex Riolexus of STD/AIDS Control Program, Ministry of Health; • HIV prevalence in the general population is still high – 6.4% • Prevalence higher in women (8%) than in men (5%) • Prevalence higher in urban areas (10.1%) than in rural areas (5.7%) Continued on page 2
Corruption and Waste in Uganda’s Health System By Akumu Ooko Vincent The director of the Medicines and Health Service Delivery for the National Drug Monitoring Unit Dr. Diana Atwine says many challenges stand in the way rooting out corruption among drug suppliers and medical-care providers in particular.
I
n her 2010 Annual Report, Dr. Diana says that Medical crimes are highly organised. “The crimes committed are technical, therefore highly skilled investigators are needed to catch them.” And Uganda does not have a clear “investigative framework.” She said enforcement efforts suffer from a lack of manpower, training manuals, and clear laws on medical malpractice. She also decried public ignorance of the law and individual rights. Her report cite concerns about budget prioritisation within the health sector and some aspects of health workers’ practice continue to negatively impact on the would-be resources for health. For example, it has been
In this issue: The Basics in HIV/AIDS Reporting ...........................1 UPC’s need to re-frame health sytem........................1
A health facility opened by one of the residents in Soroti
estimated that widespread absenteeism costs the Ugandan health sector up to Shs26 billion annually. Although these estimates were based on daily health worker absentee levels at 37%, the findings found absenteeism levels to be as high as 88%, therefore, the Shs26 billion could be an underestimation. Generally health services have been worn thin by Continued on page 3 Corruption in Uganda’s Health System.........................1 HIV/AIDS myths............................................................2 Deus’ experience at scientific conference in Canada....3
Uganda Health Communication Alliance P.O Box 36600, Kampala, Uganda, Phone +256 414 669523 Email: uhca@healthuganda.org www.healthuganda.org
Uganda Health Reporter
Uganda Health Communication Alliance
Myths about HIV/AIDS
The Basics in HIV/AIDS Reporting • •
HIV and AIDS can be cured. While many make claims of miraculous cures, the sad truth is there is no cure for HIV and AIDS. Be careful of claims or cures and miracles. If it sounds too good to be true it probably is.
5% of cohabiting couples are HIV sero discordant 43%, 46% and 10% of new infections contributed by monogamous relationships, multiple concurrent partnerships and commercial sex workers respectively
There is no need of a condom for oral sex. Again, untrue and a very dangerous myth. Condoms must be used each and every sexual encounter; vaginal, anal and oral.
Of course HIV/AIDS is similar to many stories but none brings so many disparate parts together. As reporters, we find ourselves challenged by the subject and inspired by the people we meet along the way. If inspiration wins, our coverage will be there for the long-term, to help our readers, listeners and viewers fight the spread of the virus.
Having HIV and AIDS, one can’t have children. This used to be true but not anymore. Women living with HIV and AIDS can and do have families. While certain steps and precautions have to be taken, women can now have the families they always dreamed about.
Achieving Fairness and “Balance” When Myths Are Rampant In the early years of the epidemic, myths were widely circulated and in some cases, the media helped spread misinformation. Because some of these early myths persist, our reporting must continuously reinforce the basic facts. For example, HIV cannot be spread by mosquitoes, through donating blood or casual social contact.
national and international days of observance, there may be local milestones or events that you might use as pegs for your reporting.
One of the most damaging and persistent myths is, “HIV does not cause AIDS”. This is incorrect; HIV does cause AIDS. Despite overwhelming scientific evidence, a few “denialist” scientists question this fact, claiming a legitimate controversy exists. But this is an example of a myth masquerading as a discussion and unless handled with careful skepticism, can be very misleading.
Timely News and Information Every ongoing story has occasional news hooks, which provide clear rationales for your reporting. Stay apprised of upcoming developments by staying in touch with your sources and monitoring primary research documents. Your primary research should include the major peerreviewed scientific journals and online proceedings from medical and social science meetings.
Use Language Responsibly In general it is essential to exercise caution with your words. We know that scientific language is difficult to follow and can be easily misunderstood. We are prepared to insure the accuracy and clarity of our statements.
Ongoing Reporting: AIDS is Not Over Between the moments of news, there are long stretches when HIV and AIDS disappear from the public spotlight. But of course the epidemic continues. Complacency is very dangerous as it can lead to a false sense of security among people at risk, who may then place themselves at even greater risk.
But in AIDS reporting there is an additional burden on our language. We must avoid stereotypes. Regardless of how someone encountered the virus, he or she is an individual. The words we use to characterize social and personal information can have strongly negative connotations.
“Who” Should I Think About When I Start an AIDS Story? The answer is “everyone.” The virus does not discriminate. Since HIV/AIDS affects people from all socioeconomic groups and countries, “Who?” can be anyone. Increasingly, the most vulnerable people are young women.
“What” Are the Stories?
Most people think first of HIV/AIDS as a health story, but there are numerous AIDS stories embedded in specific reporting beats outside health and medicine. HIV/AIDS is a story that can be told from the perspective of business, international news and analysis, politics, law, the arts, and culture.
“When” Should We Report on HIV/ AIDS? Pegging the Story to Recurring Events You might consider proposing and writing or producing pieces around the milestone years in the epidemic, or the yearly events around HIV/ AIDS. A few of those annual events include World Health Day and World AIDS Day. Aside from these
“Why” Report on HIV/AIDS?
Unfortunately, we all know or have experienced times of unpreventable suffering. But HIV and AIDS are preventable. By helping increase awareness of HIV, how it is transmitted and how to avoid it, your reporting will be part of the solution. Your work will help prevent some of the needless suffering of people at risk of HIV, their families and loved ones, and their communities.
“How” Can the Lessons Learned During the History of HIV/AIDS Inform Our Reporting? Since 1981 when the first cases were diagnosed, experts have fought many battles on all fronts and learned three broad lessons. As journalists, we can use these lessons to locate stories, and then to make our reporting better. • Positive Leadership is Crucial • Denial, Stigma and Discrimination Are the Virus’ Best Friends • Prevention Works In many ways, AIDS is a sad story. Many lives have been lost and more are still at risk. There are unjust inequities and impossible choices. But ultimately, AIDS is an inspirational story. Throughout the epidemic, there have been heroes whose actions made a difference in the lives around them. As journalists, we have the privilege and responsibility of meeting and giving voice to these
People over 50 don’t get HIV and AIDS. Don’t bet on it. In fact, people over 50 make up a rapidly growing segment of the HIV and AIDS population. A couple that has HIV and AIDS don’t need a condom. Not true. Experts are seeing more an more incidences of re-infection, making HIV and AIDS treatment even more difficult. Having just one partner at a time protects you from HIV. Anyone can be infected. Even if you have only one partner, that person can be infected. If a man pulls out before “cumming” (ejaculating), then sex is safe and you wont become infected. Even if the man pulls out, both people could still be exposed to HIV. Preejaculatory fluid in an HIV-positive male contains the virus, and the cervical secretions of an HIV-positive female can also contain the virus☻
Additional Resources Kaiser Family Foundation. Global Health Facts website, www.globalhealthfacts.org UNAIDS. Terminology Guidelines, http:// data.unaids.org/pub/Manual/2007/20070328_ unaids_terminology_guide_en.pdf Pan American Health Organization. HIVrelated Language: PAHO 2006 Update, http://www.ops-oms.org/English/AD/FCH/ AI/HIVLANGUAGE.PDF HIV/AIDS Learn it Live It: http://www. learnitliveit.org/english/index.html
people☻ Compiled by Akumu Ooko Vincent
Uganda Health Communication Alliance P.O Box 36600, Kampala, Uganda, Phone +256 414 669523 Email: uhca@healthuganda.org www.healthuganda.org
2
Uganda Health Reporter
Uganda Health Communication Alliance
My experience at international scientific conference Deusdedit Ruhangariyo is a health reporter with one of the leading print media houses in Uganda and an active contributor to UHCA. Recently he attended a Keystone symposium in Canada and shared his experience with the rest of health reporters in the country.
“I
A lady being admitted in one of the improvised health facilities in Soroti
have attended various international health conferences, meetings and workshops, but the scientific knowledge that I saw at the Keystone Symposium at Fairmont Hotel Vancouver in Canada was unprecedented.
many issues such as drug pilferage, false accountability, professional misconduct and corruption. The report says, basic medicines and services that rightfully belong to the people have not reached them. Disparities in human resources for health are massive and the country’s doctor to patient ratio of 1:36,000 is far from the World Health Organisation (WHO)’s recommendation (1:5-10) for effective service delivery.
I am talking about a scientific conference about Tuberculosis: Immunology, Cell Biology and Novel Vaccination Strategies a part of the Keystone Symposia Global Health series that took place at Fairmont Hotel Vancouver, in British Colombia, Canada between January 15 – 20th that I had a privilege of attending. The meeting was organized by Keystone Symposia on Molecular and Cellular Biology a non-profit organization directed and managed by the scientific community and based in, Colorado in the United States of America. The meeting, which had participants from over 40 countries in six continents around the world, was taking place concurrently with another one about Mycobacteria: Physiology, Metabolism and Pathogenesis – Back to the Basics. I was the only journalist at the meeting and I ably represented the Uganda Health Communication Alliance and was proud to share with several participants the work we are doing in Uganda. Allow me to summarize for you what the two meetings which were held concurrently and in which participants were free to attend any given session of any day of the two meetings in all the five days. You very well know that the global epidemic of Tuberculosis (TB) stems from three main problems: 1) HIV/AIDS (TB is the number one cause of death for HIV – infected individuals); 2)the requirement for long-term multidrug therapy that in turn leads to noncompliance and relapse of transmissible infection; 3) the only available vaccine, BCG affords partial protection against disseminated TB in young children but not against adult pulmonary TB which is the main source of mycobacterium tuberculosis (mtb) transmission.
It was found out that health workers have absconds from work while others take on the work for which they are unsuitable. Illegal drug shops and clinics operating. Weak management and support/supervision systems, inadequate coordination and many other issues have resulted in fewer health outcomes than expected from the initiatives of government and other stakeholders. For example, at 435 per 100,000 live births, Uganda still has one of the highest rates of maternal mortality in the world.
Deus Ruhangariyo in Vancouver, Canada
Therefore, the meeting primarily focused on immune responses underlying pathology of and protection against TB. This was aimed at paving the way towards a better understanding of basic mechanisms of host defense and also provide the basis for novel intervention strategies. On this, it was able to provide information relevant for the design of novel vaccines and strategies to counteract Immune Reconstitution Inflammatory Syndrome (IRIS), which increasingly occurs in HIV/TB infected individuals under antiretroviral therapy. The second meeting about Mycobacteria: Physiology, Metabolism and Pathogenesis – Back to the Basics, emphasized the pathogen. The two meetings attracted all scientists and clinicians from the different areas of TB research and therefore facilitated the coming together of a wide variety of researchers: wet-lab researchers interested in molecular biology of the TB germ or the pathogen; immunologists and cell biologists interested in host response; clinicians developing novel intervention measures including diagnostics, vaccines and drugs and one health journalist (this author). Continued on page 4
Kiiza Adrian, Senior Principal Inspectorate Officer in the Inspectorate of Government, says the problem pervades all sectors of society, undermining good governance, eroding the rule of law, hampering economic growth and distorting both business transactions and social and human values. Calling it “pervasive, endemic and chronic,” Kiiza warns that if we together do not arrest corruption, of which the time is now, Uganda could become a failed state. Yet amid all this, Uganda has one of the best legal frameworks – laws and institutions – in the world for promoting good governance and anti-corruption. However, according to Ms Kundhavi Kadiresan, the World Bank’s Country Manager for Uganda, “there is a huge gap between Uganda’s good governance and anticorruption laws on the books and the actual enforcement of those same laws.” Speaking at a health journalism symposium late last year, she specifically cited ineffective auditing and monitoring of the income and assets of political leaders, and a decline in service delivery “brought about by ineffective decentralization.” Kadiresan decried severe decline in service delivery brought about by ineffective decentralization. And she said Uganda now has “the highest public service absenteeism rate in the world, which would explain why basic service delivery is falling.”
How can the journalists help fight corruption
Dr. Ian Clarke, a medical doctor and a columnist in the New Vision newspaper says that journalists should hold health officials accountable. But that requires journalists to develop a clearer understanding of the underlying causes of problems in the health system. “It’s not enough to say the situation is terrible,” he said. “You need to know why it is terrible.” Dr. Diana concludes by saying: “Knowing is not enough; we must apply. Willing is not enough; we must do.” ☻ Additional source: Uganda health journalism Summary.
Uganda Health Uganda Communication Health Communication Alliance P.O Box Alliance 36600, P.O Kampala, Box 36600, Uganda, Kampala, Phone Uganda, +256 414 Phone 669523 +256www.healthuganda.org 414 669523 Email: uhca@healthuganda.org www.healthuganda.org
3
Uganda Health Reporter
Uganda Health Communication Alliance
My experience at international scientific conference At this juncture I need to mention that we were only two Ugandans at the meeting the other one being Patrice Akusa Mawa an immunologist from the Uganda Virus Research Institute Entebbe who presented a poster but whose findings are still under embargo but will soon be published.
But does this percentage reflect what is happening in our communities? Let us find out. Let us as health journalists talk to the health workers are the trained supervisors about the DOTS program, ask them about their challenges and report on them in our dailies, weeklies, radios and televisions.
What are the lessons for a health journalist?
Let us also interview the success stories about men and women who had TB but because of adherence and cooperation with the trained supervisors and health workers managed to beat the disease.
As a health journalist what I understood from the meetings was one message, that although there 11 TB vaccine trials, there still is a long way to go to get the vaccine. So as health journalists, I advise that we do the following in order to help our communities fight against the disease whose synergy with HIV has caused already caused untold suffering to our people. And that is prevention. Today, TB and HIV are frequently referred to as dual-epidemics due to their high rate of coinfection let us therefore talk to the health workers in various communities about what our communities can do to prevent this dangerous scenario. The internationally recommended approach for TB control is DOTS, or ‘directly observed therapy short-course’, which aims to decrease TB-related morbidity, prevent TB deaths and decrease TB transmission. Under DOTS, once patients are diagnosed with active TB, health workers or trained volunteers supervise them as they take the full course of medication. In 2007, WHO estimated that 87% of TB positive cases in DOTS programs were successfully treated.
In that way, other people who have the disease and are not complying with the treatment will be encouraged and we shall have done our duty to the community. Lastly, you as a health journalist, community health worker or health professional who reads our newsletter, can also be able to attend Keystone Symposia meetings. Keystone Symposia on Molecular and Cellular Biology, have what they call Global Health Travel Award sponsored by Bill and Melinda Gates Foundation, where you apply and compete for a scholarship that includes air travel, paid accommodation and perdiem while at one of their meetings. I was privileged to win such an ward and attended the said meeting in Canada. To know more about them and how you could be one of their meeting attendees visit their website on: www. keystonesymposia.org. And for quick information you can use info@keystonesymposia.org”☻
Facts About Tuberculosis (TB) Tuberculosis (TB) is a contagious disease. Like the common cold, it spreads through the air. Only people who are sick with TB in their lungs are infectious. When infectious people cough, sneeze, talk or spit, they propel TB germs, known as bacilli, into the air. A person needs only to inhale a small number of these to be infected. Left untreated, each person with active TB disease will infect on average between 10 and 15 people every year. But people infected with TB bacilli will not necessarily become sick with the disease. The immune system “walls off” the TB bacilli which, protected by a thick waxy coat, can lie dormant for years. When someone’s immune system is weakened, the chances of becoming sick are greater.
UPC’s need to re-frame health sytem He said health should form a “cornerstone of our party as far as moving this country forward” and that “healthcare financing is at the centerpiece.” He bemoaned that Uganda’s health financing “is grossly inadequate” and he questioned the sustainability of Uganda’s dependence on donors. He said that around 70 percent of Ugandans’ healthcare expenditure is out-of-pocket and thus financed by individuals. He said, “Healthcare is not a social good. We need to reframe health as a national security issue. We need to give it that sense of urgency and priority. We invest in other systems, but healthcare tends to take a backseat.” He said he believed that the Abuja Commitment target allocation of 15 percent is inadequate and that Uganda can uphold 18 percent. He said there were various revenue streams to fund health, mentioning oil discovery as one inlet. He emphasized development of sound policy frameworks that prevent waste. Without donors, he said, the healthcare system would have crumbled. He related the fact that donors like the US government is funding HIV/AIDS treatment, care, and support, having invested more than 1.5 billion US dollars. He called on the political establishment to take responsibility for leveraging existing donor resources and filling the coverage gap for the remaining Ugandans who need ARVs but don’t have access. He said that he did not think disease-specific programs were necessary, given that they do not represent the concerns of the people who, he said, should be able to get all health services at primary care health centers. In conclusion, he called for the consolidation of good governance. “There are a lot of good things that have happened in this government, especially in HIV/AIDS. But we must remember that challenges for healthcare will grow. We need to remember that these challenges cannot be picked up by development partners alone. We need to hold our leaders accountable…. Healthcare will remain [UPC’s] primary concern.” He called on attendees to “elect leaders that are informed, practical, faithful, and who care about the issue. Money alone will not do it, there’s the issue of moral ethics. We’ve been told about corruption. We should not look at these issues on individualized basis; we need to integrate these issues together.” His final point was that health could bring political parties together. “Health does not segregate; healthcare affects all of us.”☻
* Overall, one-third of the world’s population is currently infected with the TB bacillus. * 5-10% of people who are infected with TB bacilli (but who are not infected with HIV) become sick or infectious at some time during their life. People with HIV and TB infection are much more likely to develop TB☻
Uganda Health Communication Alliance P.O Box 36600, Kampala, Uganda, Phone +256 414 669523 Email: uhca@healthuganda.org www.healthuganda.org
4