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Uganda Health Reporter The Uganda Health Communica>on Alliance Vol. 2, No. 7  

          05 October, 2009 

Let’s follow up on medical male circumcision By Kakaire Ayub Kirunda


ecember 2006 marked a major medical achievement in the fight against HIV/ AIDS. Clinical trials revealed that men had their chances of HIV infection during sex with women halved if they were medically circumcised. So significant were the findings that the editors of the prestigious medical journal Lancet called the discovery “a new era for HIV prevention.” Similarly, the Time magazine ranked medical male circumcision for HIV prevention as the No.1 medical breakthrough of 2007. To some, circumcision may seem like an old story. But it all did not end with the 2006 announcement of results from the circumcision studies. For media practitioners there is still plenty of room for follow up. Issues to explore include: How does the public feel about medical male circumcision? With Uganda having a diversity of cultures with different beliefs, it would be worthwhile to find out the thinking of cultural leaders on the issue because their views can determine how widely the procedure is adopted Is our health system ready to implement widespread circumcision? It is almost three years since the medical male circumcision study results came out. How prepared is the health system? Are hospitals readying themselves for the possible exodus of men seeking circumcision once government puts in place a policy? Are medical workers seeking skills to be able to carry out the procedure safely? What policies should govern circumcision of minors ? What do medical ethics say about performing surgery on minors who cannot decide for themselves? Can parents decide for their children below 18 years? Is it right to expose minors to the pain yet they are not yet sexually active? Should circumcision be integrated with HIV testing? If circumcison is implemented as a HIV control measure, should voluntary counselling and

testing for HIV be included in the programme? How do the two complement each other?

of messages going out and how they are being received.

What are medical providers’ attitudes about circumcision? Some doctors are said to be hesitant about promoting circumcision. What are their reasons? How will this affect acceptance of the procedure?

Why is a circumcision policy been so slow in coming? Unlike other countries where circumcision studies were done, Uganda is yet to write a policy on medical male circumcision. Why is this so and what are the implications of the delay? ☻

Could advocacy of circumcision lead to complacency concerning HIV? Is complacency likely to defeat the good intentions of the promoters of circumcision? Is there a counter-measure for this? Are the proponents of circumcision clearly spelling out that the procedure is not a 100 percent protection against getting the virus? Let us analyse the kind

For useful resources on medical male circumcision, see page 2 Kakaire Kirunda is a fellow with Makerere University School of Public Health-Centers for Disease Control HIV/AIDS programme. He is attached to UHCA Health Communication Partnership

Family Planning: A Closer Look


n 22-24 September, UHCA conducted a workshop on family planning, unintended pregnancies and unsafe abortion in Uganda. Leading health practitioners and policy makers discussed the issues and represented loads of quality information and statistics during the program, which was funded by the Population Reference Bureau, a Washington, D.C.-based nongovernment organisation ( Dr. Olive Sentumbwe from the World Health Organization discussed attitudes, beliefs and practices concerning family planning in Uganda. Dr. Charles Kiggundu, a consultant gynecologist at Mulago Hospital, discussed the huge health problem that unsafe abortion represents. Sister Victoria Nabuule, a senior nurse at Mulago hospital, described the daily appearance at the hospital of women who have been injured and are distressed by unsafe abortions. Robinah Kaitirimba, National Coordinator for the Health Consumers and Users Organisation,

Also in this issue: Medical Male Circumcision Resources..........................…...…………...........................................Page 2 What’s wrong with Ugandan Health Repor>ng........................................................................Page 3 Water and Sanita>on ........................................ ..........…...………….…........................................Page 5 Water and Sanita>on Resources...................................…...………….…........................................Page 6 

Dr. Olive Sentumbwe  of  the World Health Organiza:on at the UHCA‐PRB workshop

discussed how the problem could be handled from a reproductive-health rights approach. Plus, Reproductive Health Uganda disclosed results of a new survey on the attitudes of Parliamentarians concerning unwanted pregnancy and abortion. It brings out some very interesting news☻ To see the presentations and other resources that came out of the workshop, visit http://www. nt&view=article&id=76:reporting-on-reproductivehealth-in-uganda-&catid=28:headline&Itemid=37 Uganda Health CommunicaCon Alliance P.O Box 36600, Kampala, Uganda Phone +256 414 669523

Male Circumcision Resources

Medical Male Circumcision Resources


Prof. David Serwadda, Principal Investigator, Rakai Health Sciences Programme [Phone: +256-414-545001, Email: dserwada@imul. com, dserwada@musph.] Prof. Nelson Sewankambo, Acting Principal Makerere University College of Health Sciences [Phone +256 782 366751, Email: ] Prof. Fred Wabwire-Mangeni, Principal Investigator Makerere University Walter Reed HIV Vaccine Project [Phone: +256-414-532207, Email:, fwabwire@imul. com]. Dr Freddie Ssengooba Lecturer Makerere Universty School of Public Health [Phone: 25641-543888, Email:] Mr Venansio Ahabwe, Health Communication Partnership [Phone: +256-755 682254, Email:]☻


The print media has attempted to tackle some of these issues and here are some of the outstanding stories. Kakaire Ayub Kirunda in the Daily Monitor explored the worrying trend that some young people in the circumcising Bugisu sub region are getting a false sense of security that they cannot get infected with HIV after all. http:// Circumcision_Bugisu_s_Achilles_heel_in_the_ fight_against_Aids_79718.shtml. Kakaire also reported on the recent research findings that Medical Male Circumcision Resources does not protect women from HIV but they can benefit in the long run as a result of limited exposure to infected men. http://www. circumcision_does_not_reduce_the_risk_of_ HIV_88432.shtml. Shifa Mwesigye in the Observer explored how involving teachers would get the right information about medical male circumcision

to the young people. In the same story she reported that more mothers want their sons to get circumcised. php?option=com_content&view=article&catid= 34%3Anews&id=1972%3Amore-mothers-wanttheir-boys-circumcised&Itemid=96. Meanwhile Joseph Matovu, training coordinator Makerere University SPHC-CDC HIV/AIDS fellowhip programme tackled in the Observer the sexy issue of whether circumcision increases or reduces a man’s potency or enjoyment of sex by women. http://www. &view=article&catid=39%3Arelationships&i d=1310%3Amale-circumcision-vis-a-vis-sexualsatisfaction&Itemid=72


For basic background - like the rate of new infections, HIV incidence in various countries, and other quick facts and figures visit www.avert. org and, by the NGO Avert and the Kaiser Family Foundation respectively. The Uganda Aids Commission’s website, also offers some basic background World Health Organization and UNAIDS, two United Nations organisations, also offer invaluable, two UN agencies also offer invaluable information on Male Circumcision. The following are the links to these resources: topics/malecircumcision/en/index.html and Prevention/MaleCircumcision/

For information on vaccination research, see the Makerere University Walter Reed Project http:// and Uganda Virus Research Institute-International Aids Vaccine Initiative For basic data relating to HIV/AIDS and its prevalence in Uganda , see the HIV/AIDS SeroBehavioural Study 2004-2005 http://www. Note pages 35-37 especially. (Warning: This is a large document that is not easy to download). html also shows where all prevention research trials are ongoing elsewhere in the world including Uganda and what exactly is being tried.

Medical Male Circumcision in Uganda Background characteris>c

Percentage circumcised

Region Central




East Central




Clearing House on Male Circumcision is an online global global resource centre on male circumcision research, programme implementation, documentation, and information. It can be accessed on http://www. You could as well join their mailing list for free. The website also has a link to media resources for journalists covering HIV.



North Central


West Nile








The Rakai Health Sciences Program http:// conducted the male

























All others


Facts About Medical Male Circumcision and HIV Prevalence •It is estimated that more than 80% of HIV infections worldwide occur through sexual activity. •In Uganda, 120,000 new infections occur every year •HIV prevalence in Ugandan males 15 – 49 years: 6.4% •HIV prevalence in circumcised Ugandan men: 3.7%, regardless of age, ethnicity, region or urban vs. rural residence.

circumcision study in Uganda. The Rakai research facility based at Kalisizo in Rakai District can also be reached on the email: info@rhsp. org Some of the facility’s Principal Investigators (PIs) can also be contacted. Among the senior PIs are Professors Serwadda, Sewankambo and Wabwire-Mangeni, whose contact information can be found above

•24.8% of circumcised




•Studies done in Uganda, Kenya and South Africa, showed that new infections among the circumcised men were 50-60% less compared to the uncircumcised. •Circumcision in Uganda by region and ethnicity.

Uganda Health Reporter - 5 October 2009


Source: Uganda HIV/AIDS Sero-Behavioural Survey 2004-05


Health Reporting

The gaps in our health reporting By Deusdedit Ruhangariyo


a single medical doctor, pregnant women dying

irst of all, I congratulate us, the health

in queues as doctors rush off to their personal

reporters, for the work we are doing

clinics or drug shops.

to bring the health challenges in our

communities and country to light.

You will find millions of children are being infected with HIV because their infected mothers

Today we do better health journalism than ever

refused to deliver at health centers for fear of

before. However, as a journalist I feel we still

abusive and violent mid wives. Children with TB

have gaps to fill.

who are being treated using adult TB drugs and

Corruption in the health sector Martin Luther King Jr., once said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” Are you as a health journalist aware of the injustice King was talking about?

He was talking about

discrimination and corruption in the health sector. ‘My son was vaccinated with water because we were too poor to pay the health worker an extra fee.’ Such statements reveal how people are being treated by our health care providers. As health reporters let us talk about these issues. Let us dig out stories about medical workers who refuse to help patients because they have not paid some unofficial money; about collusion among bidders to state higher

Deusdedit Ruhangariyo

many others die every day of malnutrition-related

in all forms of media in Uganda. For example

illnesses yet our country has enough food. These

what happens to the health budget? Why it is

are the things our people expect us to talk about

that health reporters in this country don’t cover

as health reporters.

the rules that govern drug selection in Uganda? disease in Uganda may not be the same drug

Drugs, side effects and alternative treatments

being used in Kenya? I expect a health reporter

When do we report about quality of drugs in

to report cases of patients being made to pay

Uganda or their costs, potential harms and

for drugs and treatment at government health

alternative treatments?

Why is it that a drug for treating a certain

centers. What about the issues the pharmaceutical

The elite are proud of eating processed foods as opposed to unprocessed foods and now the villagers are picking the attitude up too.

bidder‘s performance. All this corruption leads to higher costs and low quality. These are the stories I wish health reporters in Uganda would dig out. When you read our papers, political corruption dominates coverage. But many millions of dollars worth of drugs that are being swindled as the reporters get more and more carried away by such stories as the developments in the NRM party and the debate of whether President Yoweri Museveni should choose a successor or not. I am not saying that we stop reporting about this, but we should not do it on the expense of the health of our people. Corruption in the health sector is virgin material

about possible side effects and how they can be countered. And we have to investigate whether people are adequately informed about the proper use of medicines. All too but without proper instruction on how to use

kickbacks to influence the selection process for bribes to public officials monitoring the winning

about their drugs? We need to ask experts

often, people leave pharmacies with drugs

bidding prices for medical supplies; about drugs and other medical equipment and about

industries don’t want us and the public to know

them. The pharmaceutical industries in their What about medicines that are dispatched from

advertisements will not tell our people how some

the medical stores but never reach health centres

foods can multiply the toxicity of the drugs they

or only spend a day at them before disappearing?

are taking. As health reporters I expect us to tell

Can we follow medicine allocations to the last

our people what to avoid eating with any given

tablet? Who said investigative journalism should


be limited to politics?

And we need to investigate whether there are safe and natural alternatives to drugs for some

Grassroots journalism is wanting

health problems.

Many health reporters are concentrated in town. When they hear about village health teams, the

The pharmaceutical industries will not tell our

powers that arrange for their travel to Wakiso

people that drugs on the market are of different

district a surburb of Kampala City where they

qualities. They simply tell them the difference

will see the wonders the village health teams are

in prices without giving reasons. But as health

doing for their communities.

reporters, I expect us to bring this information to

Ladies and gentlemen, let us not be deceived.

the public and show them for example how to

Village health teams in real villages are finding it

tell the difference between low-quality and high-

rough because they are not facilitated. If you visit

quality vitamin supplements.

any rural health centre, you will be shocked to

Continued to next page

find long dysfunctional theatres, centres without

Uganda Health Reporter - 5 October 2009


Health Reporting

The gaps in our health reporting...cont. Nutrition

change and social justice in our country, as we

As health reporters we

bridge the gap between the poor and the rich in

should be the champions

access to healthcare services.




Some people could avoid

Lastly, I wish you courage as you enter the field of

visits to a doctor by eating

health journalism in Uganda. Aluta continua!☻

more fruits. But do you know that some so called

Deusdedit Ruhangariyo is the editor of

literate people in our

Orumuri newspaper

country say that fruits are meant for children? The people who flock to

A Na:onal  Drug Authority staff member showing UHCA members the equipment used for tes:ng drugs.

fast-food restaurants have

healing from personal illness, a sense of well

gone to school but consider it trendy to eat

being, social acceptance and prevention of

deep-fried foods .

spread of illness to others.

Colleagues, you know as well as I do all the

Do you know that the Sixth Water and Sanitation

dangers of these foods. And you also know the

Sector Performance Report (SPR) 2008 in

advantages of eating so called ‘local food.’.

Uganda says the degradation of our water

Why can’t we for goodness’ sake liberate our

resources is a result of inadequate compliance to

people from the misconceptions about ‘the

water-resources regulations, and this is leading

literate food’?

to many health problems in this country?

The elite are proud of eating processed foods

The report also says that improvements to rural

as opposed to unprocessed foods and now

people’s access to improved water supplies

villagers are picking the attitude up too. Villagers

are barely keeping up with population growth

too no longer want to eat unpeeled potatoes

but there has been a significant decline in the

even though they are more nutritious than

sector budget, both in absolute figures and as

peeled ones. The skins which contain all the best

a proportion of the national budget over the

nutrients for human beings, are fed to the pigs!

last five years? Have you told your audiences what this translates to in terms of their health and

What about maize? People tend to prefer finer


but less nutritious maize flour to the darker, cheaper but more nutritious kind.? These and

Do you know the pit latrine coverage in Uganda?

many more are the issues I expect us to cover

According to figures at the ministry of health, 80

in our pages, on our radios and TVs about

per cent of Uganda’s disease burden is caused


by poor sanitation conditions like lack of pit latrines and safe water sources.

As health reporters, can we talk more about disease prevention properties of good nutrition?

Ladies and gentlemen, these are some of the issues that affect our people. I strongly believe

Hygiene and sanitation

that with such kind of information, editors would

Do you know that some important people in our

start using health stories as leads in our daily

society don’t know the importance of washing

and weekly papers and on their television news

their hands with soap? If we as health reporters


Award, Fellowship



he population secretariat is calling for entries for their annual media awards. Stories on reproductive health, gender relations, population growth, migration, urbanisation, human resource and employment should be reach the secretariat before October, 15th, 2009. Last year’s award winner got sh700,000. Entries clearly labeled “Media Awards” should be posted or hand delivered to The Population Secretariat, 2nd Floor Statistics House, 9 Colville Street . P.O. Box 2666 , Kampala Attn:Head Information and Communication Department.


very year, the Thomson Reuters Foundation sponsors about 30 mid career journalists from both print and broadcast media to study at Oxford University in the UK on journalism fellowships of either three six or nine months. Applicants must have a minimum of five years experience in any branch of journalism and a very good command of English. They must submit a research proposal for a journalistic research project they intend to do during the fellowship. For details on how to apply go to http://reutersinstitute. html#c669

were seriously encouraging personal hygiene it would lead to the reduction of personal illness,

Then we would cause the much needed social

Uganda Health Reporter - 5 October 2009


Water and Sanitaion

Chronic Underfunding Still Plagues Uganda’s Water and Sanitation Sector and sanitation sectors of developing

region in meeting the seventh MDG target

countries, while Mr. Natumanya and

of halving the number of people without

Mr. Twesigye brought the discussion

sustainable access to safe water and basic

close to home by highlighting the water

sanitation by 2015. At the current rate,

and sanitation challenges in rural and

targets for water and sanitation and MDGs

urban areas respectively. All speakers

inAfrica will only be achieved in 2040

offered possible solutions to the acute

and 2076 respectively. But even then, the

shortage of safe water and sanitation

World Bank says, 400 million Africans will

facilities in Uganda. Their presentations

still lack access to safe water and sanitation

gave participants a wealth of facts and


figures on the issue. According to the World Health Organization Above all, one major conclusion was

(WHO), the worldwide cost of disease

drawn from the discussion: underfunding

totals US$4.1 trillion each year. Lack of safe

of the sector is still a major problem.

sanitation is the biggest cause this disease

Other important facts that emerged from

burden. WHO says a 10percent global

the discussion include the following.

reduction in cases of diarrhea could lead to an annual health-related costreduction of

Although 88 percent of Ugandans, or

US$7.3 billion.

25 million people, live in rural areas, those receive only about 27% of the

Money put into improving sanitation should

overall water budget.

be considered a profitable investment, not expenditure. Research shows that

Although official figures show that Unsafe water: Car washers use unclean water to wash cars, such  water is dangerous. (photo courtesy of Nicholas Kajoba)

hand washing with soap could lead to a

57% and 54% of

rural Ugandans

47 percent reduction indiarrhea-related

have access to safe water and basic

disease. Considering that a 2004 second

By Ronald Musoke



health sector strategic plan noted that over


Natumanya pointed out that the figures Uganda’s national

75% of Uganda’s disease burden is caused

mask considerable disparity between

budget allocation for water and sanitation fell from

by poor inadequate sanitation facilities

and within districts and hardly consider

almost 5% in 2004/2005 to just 1.8% currently. This

and ractices, investing in proper sanitation

the functionality of water sources.

would drastically reduce the disease burden

ccording to the World Bank,


is despite the fact that Uganda is lagging behind in the race to

and therefore reduce public expenditure on

meet the seventh millenium development goal on halving the

Only 10% of residents of Kampala,

number of people without sustainable access to safe water and

Uganda’s capital city, are connected

basic sanitation by 2015.

to the city sewerage system. The rest of

For more detailed facts and figures and

the city population has on-site sanitation

presentations from the UHCA water

In early September, UHCA brought together experts to examine

facilities such as latrines which often

and sanitation workshop, go to www.

the question: “Clean Water, Can Uganda Meet the Challenge?”

discharge untreated effluent.☻

Bank country co-ordinator for the Africa Water and Sanitation

On continental level, 56 per cent of

Ronald Musoke reports for

Project; Ezra Natumanya, a lecturer at Makerere University’s

about 753 million Africans use improved

Enviroconserve AFRICA Magazine

Institute of Environment and Natural Resources and Mr. Paddy

water and sanitation facilities, 37%

Twesigye, Projects Manager at National Water and Sewerage

access adequate sanitation. Out of that

Corporation (NWSC).

number, 53 per cent are urban and 28

these diseases.

Speakers at the workshop were: Mr. Samuel Mutono, World

per cent rural. A third of the people in Mr. Mutono examined the challenges of investing in the water

Uganda Health Reporter - 5 October 2009

Africa engage in open most off-track sub-


Water and Sanitation


Resources on sanitation and water

Halima Shaban writes in The New Vision on why the simple practice of hand washing can save people from water-borne infections. Find the article, Hand Washing, The Shield Against a Third of Diseases on: stories/200709100496.html Carol Natukunda and Moses Odongo investigate in this New Vision story whether schools are providing safe water to pupils. The feature: Safe Water-Life or Doom for schools? Can be found on: stories/200909010906.html

in partnership with Barclays Bank, to improve the lives of more than 25000 people in Katine SubCounty in the eastern Uganda district of Soroti. And The Observer’s (Uganda) Richard Kavuma has made many visits to the area to report for the Guardian on the progress of several projects, including water and sanitation. In this particular one, Kavuma visits Katine’s boreholes and already finds problems with quality and maintenance costs. Find the story at: http:// concern-over-water-supply

Websites The Daily Monitor’s Angelo Izama and Zahra Abigaba discuss the state of Kampala’s sewerage system and enumerate the insurmountable challenges that the National Water and Sewerage Corporation (NWSC) is facing to improve the situation.

Water and Sanitation Backgrounder: This presskit prepared by the Stockholm International Water Institute (SIWI) before this year’s World Water Week conference has lots of story ideas, statistics and issue-based backgrounders. Log on:

Find their story, Kampala residents caught between lake and the sewer at: http:// Kampala_residents_caught_between_lake_ and_sewer_70934.shtml

A 2005 WaterAid-Uganda paper discusses why government needs to close the remaining water sector finance gaps. Find the report in PDF format by logging on: http://www. ugandasnapshotweb.pdf

The UK’s Guardian newspaper has been tracking Amref’s three-year development project

Development in this briefing paper ‘Where every drop counts: tackling rural Africa’s water crisis’ introduce a new concept, “water poverty” arguing that in rural Africa, water poverty can literally destroy lives and livelihoods. Find the paper at: php?o=17055IIED ‘Africa’s water crisis: a quarter of a billion dollars down the drain’ is a paper recently done by the London-based non-profit research institute: International Institute for Environment and Development (IIED). The report critises donors, governments and NGOs for wasting hundreds of millions of dollars on non-viable water projects in rural Africa. Find the report and paper at: The medical journal, The Lancet discusses the benefits of keeping one’s hands clean: Find the paper, ‘Clean hands reduce the burden of disease,’ by logging on: http://www.thelancet. com/jour nals/lancet/ar ticle/PIIS01406736(05)66886-9/fulltext (But you will need to log in using a password which will take less than a minute to create).

The International Institute for Environment and

Contacts Organiza>on

Contact Person



Mr. Davis Ddamulira, Head of Advocacy and Communication

Plot 90 Luthuli Ave.Bugolobi, P.O.Box 11759 Kampala Tel: 0414-505795/7, Fax: 0414-505 796

National Water and Sewerage Corporation (NWSC)

Dr. William Tsimwa Muhairwe, Managing Director

Plot 39, Jinja Road, P.O.Box 7053 Kampala Tel: 0414-315000 Dir. 0414-315 139/315141, Fax: 0414-346532/234802, E-mail: OR Ms Miriam Kadaga, NWSC Principal PRO, Mob: 0772439104

World Bank Water and Mr. Samuel Mutono, Sanitation Project-AFRICA Country Co-ordinator

Office: 0414-302256 Mob: 0772843383, E-mail:


Ms. Phoebe Kasoga

Plot126 Luthuli Ave.Bugolobi, P.O.Box 12075, Kampala, Tel: 0414- 305000

Uganda Water and Sanitation NGO Network (UWASNET)

Mrs. Doreen Kabasindi Plot 475M Butabika Rd Luzira, P.O.Box 33396, Kampala Wandera, Executive Director Tel: 0414-223135, Mob: 0776367888 OR Mr. Alex Mbaguta, The Liaison and Communication Officer, UWASNET Mob: 0772 666240 UWASNET has a database of over 170 members organizations involved in different activities under the water and sanitation sector. These include international and local-based NGOs and CBOs. Find the list by logging onto:

Makerere University School of Public Health

John Bosco Isunju, Lecturer

Mob: 0772346304 E-mail: or

Shadow Minister for Water and Environment

Hon. Betty Anywar, Member of Parliament

Woman MP for Kitgum District) 0772998724

Uganda Health Reporter - 5 October 2009


Uganda Health Reporter Newsletter: Vol. 2 No. 7  

In this issue of the Uganda Health Reporter Newsletter, Makerere fellow Kakaire Kirunda suggests questions for journalists looking at the po...

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