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 (www.prb.org). 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. healthuganda.org/index.php?option=com_conte 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 www.healthuganda.org
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. ac.ug] Prof. Nelson Sewankambo, Acting Principal Makerere University College of Health Sciences [Phone +256 782 366751, Email: email@example.com ] Prof. Fred Wabwire-Mangeni, Principal Investigator Makerere University Walter Reed HIV Vaccine Project [Phone: +256-414-532207, Email: firstname.lastname@example.org, fwabwire@imul. com]. Dr Freddie Ssengooba Lecturer Makerere Universty School of Public Health [Phone: 25641-543888, Email: email@example.com] Mr Venansio Ahabwe, Health Communication Partnership [Phone: +256-755 682254, Email: firstname.lastname@example.org]☻
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:// www.monitor.co.ug/artman/publish/news/ 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. monitor.co.ug/artman/publish/features/Male_ 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. http://www.observer.ug/index. 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. observer.ug/index.php?option=com_content &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 http://globalhealthfacts.org, by the NGO Avert and the Kaiser Family Foundation respectively. The Uganda Aids Commission’s website, www.aidsuganda.org 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: http://www.who.int/hiv/ topics/malecircumcision/en/index.html and http://www.unaids.org/en/PolicyAndPractice/ Prevention/MaleCircumcision/
For information on vaccination research, see the Makerere University Walter Reed Project http:// www.muwrp.org) and Uganda Virus Research Institute-International Aids Vaccine Initiative http://www.iavi.or.ug For basic data relating to HIV/AIDS and its prevalence in Uganda , see the HIV/AIDS SeroBehavioural Study 2004-2005 http://www. measuredhs.com/pubs/pdf/AIS2/AIS2.pdf Note pages 35-37 especially. (Warning: This is a large document that is not easy to download). http://www.avac.org/timeline-website/index. 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
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. malecircumcision.org/ You could as well join their mailing list for free. The website also has a link to media resources for journalists covering HIV.
The Rakai Health Sciences Program http:// www.jhsph.edu/rakai conducted the male
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
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
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
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
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
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
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
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
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. politics.ox.ac.uk/fellowships/applying. 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
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
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
number, 53 per cent are urban and 28
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: http://allafrica.com/ 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: http://www.allafrica.com/ 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:// www.guardian.co.uk/katine/2009/apr/03/ 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: http://www.worldwaterweek.org/facts
Find their story, Kampala residents caught between lake and the sewer at: http:// www.monitor.co.ug/artman/publish/news/ 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. wateraid.org/documents/plugin_documents/ 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: http://www.iied.org/pubs/display. 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: http://www.iied.org/naturalresources/key-issues/water/africas-water-crisisa-quarter-a-billion-dollars-down-drain 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
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: email@example.com 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: firstname.lastname@example.org
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: http://www.uwasnet.org/members/members
Makerere University School of Public Health
John Bosco Isunju, Lecturer
Mob: 0772346304 E-mail: email@example.com or firstname.lastname@example.org
Shadow Minister for Water and Environment
Hon. Betty Anywar, Member of Parliament
Woman MP for Kitgum District) 0772998724
Uganda Health Reporter - 5 October 2009