BY ESTHER MAKULA
KAMPALA – In alignment with the Ugandan government’s effort to reduce new HIV infections, caregivers are now more equipped and confident to practice safe disclosure. This follows an intensive two-day training in Kampala for participants, including social workers, para-social workers, and linkage facilitators under Reach Out Mbuya (ROM). This training is part of the USAID Orphans and Vulnerable Children (OVC) Kampala Activity—a five-year initiative aimed at preventing new HIV infections and reducing vulnerability among orphans and vulnerable children and their caregivers, with ROM serving as a key implementing partner.
HIV disclosure entails a process of informing individuals, particularly those living with HIV, about their HIV status. It involves sharing this critical information with the person affected, as well as potentially with others such as family members or caregivers, depending on the context and age of the individual. According to the Uganda HIV Testing Services Policy and Implementation Guidelines 2016, the recommended age for disclosure to adolescents is eight (8) years.
Racheal Namunje, a social worker, highlighted that the USAID OVC Kampala Activity is their primary entry point into households, particularly those with children living with HIV. She emphasised that social workers are fully responsible for managing cases where a child has a high viral load. Their visits aim not only to document but to identify the underlying causes of non-suppression, often linked to the lack of disclosure about the child’s HIV status.
“We have found that a significant reason for non-suppression among adolescents is the lack of disclosure about their HIV status. This training has been incredibly beneficial for us, as we have learned the steps to support both parents and children through the disclosure process.
We now understand that disclosure is not a one-time event but a process. While it may not lead to immediate viral suppression, we have learned that it has positive long-term effects. Over time, children begin to understand and appreciate why they were informed about their status, and this adjustment often leads to better health outcomes, including a suppressed viral load,” she noted.
Steven Kasirivu, a para social worker working in Kawempe National Referral Hospital noted, “We have observed that non-suppressors are mostly adolescents between 9 and 17 years old. By the time they reach this age, they often become weary of taking their medication. Sometimes, parents have not yet disclosed to them that they are HIV positive.”
Adding, “In the training of disclosure, we have learned to help our OVCs aged 8-12 understand their HIV status and the importance of taking their medication. This is achieved through a gradual process designed to prepare them. The process helps them come to terms with their condition and encourages them to adhere to their medication regimen and attend appointments consistently, ensuring they remain on track with their treatment wherever they go.”
Statistics presented in the Joint United Nations Programme on HIV/AIDS (UNAIDS) Fact Sheet 2024 indicate that in Uganda, young people, especially girls and boys aged 15-24, have lower viral load control rates, with 57.8% for girls and 43.5% for boys. This calls for more strategic interventions geared to minimizing the challenge.
Mary Nkiinzi Nagawa, a lead para social worker serving under the Activity noted, “When we attend such trainings, we are better equipped to perform our roles effectively. For example, in terms of care and protection, I understand how a child should be treated. If I identify that a child is not safe, I ensure their safety before leaving. If the child’s health is at risk, I make sure that they are secure, that their mother is taking her medication, and that the child has been properly disclosed to. Additionally, I aim to ensure that the child is attending school regularly.”
Faith Turyahabwa, a linkage facilitator at the Makerere University – Johns Hopkins University Research Collaboration (MU-JHU) Clinic at Mulago National Referral Hospital, praised Reach Out Mbuya for significantly enhancing their capabilities in HIV treatment and prevention, as well as in other areas of sexual and reproductive health and rights (SRHR).
“This training is crucial for our beneficiaries, especially children and adolescents living with HIV. Disclosure is particularly important from around 8 years old, as it helps these children take ownership of their lives and better manage their condition,” she said.
Meanwhile, Richard Kibwama, a trainer and Division Coordinator under the USAID OVC Kampala Activity, emphasized that not all adolescents will be open to discussing their disclosure and post-disclosure experiences.
He added, “However, it is crucial for the team to meet with the adolescent after their initial disclosure. It is recommended to have this meeting while their thoughts and feelings are still fresh and to schedule a follow-up meeting within the next few weeks to allow them time to process the experience.”
To further empower adolescents to manage their health and improve their quality of life, he advised developing a disclosure assessment plans.
“This plan should be reviewed every month, with a final assessment conducted at the end of 12 months,” he said.
95-95-95: Treatment targets to help end the HIV epidemic
It should be recalled that UNAIDS set the 95-95-95 targets with the aim that by 2025, 95% of all people living with HIV will know their HIV status; 95% of all people with diagnosed HIV infection will receive sustained ART; and 95% of all people receiving ART will have Viral Load Suppression (VLS).
At the end of December 2023, 30.7 million [27–31.9 million] people were accessing antiretroviral therapy, up from 7.7 million [6.7–8 million] in 2010, but still short of the 34 million target for 2025, according to the UNAIDS Fact Sheet 2024.
