HIV and its Cultural Adornments: Let us adopt all People Living With HIV; The Case of Uganda

After 3 decades, Uganda now has a critical number of HIV Long survivors. This population group should now have facilitation to engage in quality life practices. The LGBT community should not be denied the long list of logistics and accessories to establish and maintain LGBT-led HIV prevention and care. 

At MARPS in Uganda, join many others in providing tips on how the direction of the fight and eventual ending of HIV should go. This requires understanding of the collective physical, cultural and non physical influences. 

When we do not do this, we miss out on addressing a polarization that seems to rear its head every time resource allocation to facilitate HIV work takes place. For this blog, the writer argues three main points. Point one is that there is an HIV-culture with all characteristics of a culture as defined by Lustig, M. W., & Koester, J. 2013, " beliefs, values, norms and social practices which are stable over time and roughy lead to similar behaviors across similar situations" (p.78). Point number two, it is possible that not fully resolving the feelings and experiences, at a national level, caused by ten events which occurred between 1979-1986 may still be a problem as Uganda takes on HIV. Point number three is that, looking into the genealogy of HIV care can help place treatment and care at the disposal of all people living with HIV irrespective of nationality, social status, gender, sexual orientation, origins, race and culture.

                                                  

When it comes to HIV, we should not dismiss an ancestry rooted in African health belief models on the one hand and the Eurocentric one that Uganda borrows from her colonizers. These are two influences (we limit ourselves for purposes of this short blog) affect the way people experience and develop feeling about HIV and life. The pattern and predictability of the influences have physiological and cognitive elements that influence behavior. Examples of cognitive (identifiable feelings) and physical changes could be seen in the promptness or reluctance for people to care for others who are battling HIV. Economic or structural causes may explain why even this care may be inaccessible. Those who get care and medication consider themselves "lucky" or "fortunate!" 

This irrationality tantamounts to a misnomer which at its worst is insensitive and assumes a Biblical Heaven and Hades dichotomy. This same irrationality seems to persist in the minds of some who meet an unknown be it at sexuality, gender, orientation, racial, status, nationality and religious levels. When such a person is vested with power, money and a life and death influence, then it becomes dangerous. When an opportunity is availed for people who are living with HIV, to participate at all levels in planning, programming and implementing HIV care services it becomes more innovative and creative than when provider-only or policy-maker only homogeneous work groups are left to plan for all concerned. At ethnic diversity of Uganda has tended to be seen as a disadvantage by some scholars and organizational reports such as the HRW 1999 report. Diversity may be a cause of tension but is also the spark for reconciliation. Barriers blinding some to cultural diversity come in form of: an inability of establishing relationships; irrational fear for those who are culturally, ethnically and sexually; and personal level inability to deal with what is considered counterproductive (p. 283). This is borne out by testimonies and established interventions be they physical structure facilities in form of offices or internet based information platforms. One can now access information at a touch of a keyboard on organizations in Uganda like: the National Forum for People Living with HIV/AIDS Networks in Uganda (NAFOPHANU); MARPs Network; MSH Marps; or they can access a documented effort showing how using systems of redress in Uganda that encourage dialogue can help resolve grievances (Asia Rusell, 2015). Two other avenues that can be used to make known abuses is by sharing stories with other organizations (Failure to Make MSM a Priority) as well as joining larger networks.

Being part of larger networks increases chances of support, interaction and resource sharing. We can draw lessons into problem-solving techniques that culture continues to provide humans. If two parents chose to have children, the expectation that culture put in place is for them to also accept the consequences that arise from childbearing: providing for them in form of parental care; housing; health; education; and grooming. Perhaps, someone is already saying: 'obviously,' 'of course' and 'come on' for those who are questioning my drift. I used to make these kinds of assumptions until I was guided by two Professors of Law at Makerere University to use story capturing and telling as part of increasing visibility for what may not be visible to a naked but apparent to reasoning. A problem still persists even humans learn to hide their heads in the sand. An unresolved trauma tends to turn into a physiological or emotional deprivation for those who are denied redress. As we saw earlier this feeds into a polarization that seems to rear its head again. For the sake of HIV, resource allocation to facilitate HIV work then seems to go to the ones who are deemed deserving and leave out those who are now considered condemned. This structural exclusion should be addressed if HIV work is to be effective.

HIV work is perceived in its entirety as a collective of: initiatives, programmes, actions, inactions, praxis, executions and interactions whose aim is to fight HIV. These are in form of human behavior, social services, household level family support mechanisms, extended-family support mechanisms, community level support mechanisms, International Community of Women Living with HIV (ICW), Global Fund, Joint United Nations Programme on HIV/AIDS (UNAIDS) President's Emergency Plan for AIDS Relief (PEPFAR), Uganda AIDS Commission (UAC), The AIDS Support Organizations (TASO), Most at Risk Population Society in Uganda and (MARPS in Uganda). This continues to provide context and continues to inform direction, programing and policy on HIV eradication.

When HIV eradication in Uganda was based on the bedrock of the social-bio-medical approach, it helped demystify myths surrounding HIV and care. It is possible to live longer with HIV if those who are positive also adhere to medication and have good support facilities. Uganda should now empower communities to allow conversation and talk about surviving with HIV a norm. Although, this may come slowly with time. A look into the genealogy of HIV work is provided to illuminate any form of skepticism or disparagement for those who deny care to people living with HIV.  The collective mind of a Ugandan black African in the early days of the HIV disease took on a multi-faceted dimension. In the earlier days (early 1980's) following the 1979 Liberation war which culminated in a regime change and ushered in the road to democratic governance (Uganda: Tanzanian Invasion, 1979-1980) . After that war rumours were rife of a disease far away from Kampala City Authority's comfortable zones. Othering those who had the disease was the norm. A vacuum and disconnect between those who were to provide services and recipients opened up. It was open market for the herbalist and other providers who promised cures which were not real. Between 1979-1986, Uganda experienced tensions at political, social and cultural levels which in turn affected the way people experienced life and decided on what to prioritise. A mass austerity automatically kicked in even without the government's say so. People made austerity practices that touched on food provision, sleeping arrangement, mobility, choices for wellness and investing in quality life. People became a dumping ground for trauma characterized by severe deprivation and comfort in living in squalid conditions that has gone on even after it has been established that Uganda has one of the best government systems in Africa today. Somehow, this trauma has demotivated many from taking initiative. HIV work that facilitates community meeting spaces, may be a psychoanalytic elixir for Ugandans who have gone through life without attending a psychotherapy services. Community meetings spaces make it possible for beneficiaries to meet, share experiences, interact with other humans on the subject of HIV and hold dialogue on HIV-related problem solving. This will be Uganda's way of addressing many unmet past recession, depression and austerity episodes. 

Other countries went through periods of recession, depression and austerity because of war, cataclysm or government policy. Ireland, Germany, U.S. (What was 'The Great Recession') and many African countries come to mind. Austerity with hope in a government that will come around to address historical wrongs in all the spheres at political, community and household level is galvanizing. The U.S. has gone through periods of austerity and two come to mind: The Depression, the 2008 recession and the 2013 government shutdown did not stop the The U.S. social systems to provide a minimum redress. This gives people hope. Hopefully Uganda which has gone through traumatizing events can use HIV work to build faces and spaces of hope for diverse communities. It will be possible to help many who may privately be grieving not only for HIV but loss of property due to wars. This grief followed the 1979 war, the "war in the bush" and HIV/AIDS.

Ten events followed in the heels of one another that directly informed process of HIV interventions in Uganda: the 1979 war; the austerity practices; the "War in the Bush"; HIV/AIDS; economic recession; the evangelization of HIV-care; the medicalization of HIV-care;  HIV-related Stigma; HIV-related Discrimination; the social-bio-medicalization of HIV-care. All these ten tragedies became the raw material for problem diagnosis, prioritizing, shelving and/or solving. Culture as we saw earlier is a system of  beliefs, values, norms and social practices which are stable over time and roughy lead to similar behaviors across similar situations. A culture of accountability that looked into political abuses was put in place in Uganda and this saw people who had committed atrocities serve sentences. A psycho-medical intervention exists in Uganda and this is commendable. But when it comes to HIV, the tendency should be to provide support for all to access HIV testing, treatment and prevention in all its forms. Increasing on number of spaces for care may even be an opportunity for communities to have next-door counselling services or self-help groups since HIV work and interventions cover holistic spheres of life.  This is what we term the multicultural face of HIV.

Looking at the HIV multiculturally, empowers one to appreciate the genealogy, the critical short and long-term efforts since 1985. The ten events have morphed into cultural patterns which require one to re-orient all effort to address stigma, discrimination and come to terms with dealing with diversity. Society should not promote efforts and actions that fuel polarization due to stigma, discrimination and fear. This schism" is counterproductive in the era when we want to eradicate HIV. We should be investing so much in creating critical numbers of initiatives that disrupt HIV transmission. Wellness clubs, post test clubs and self help therapy organizations should be empowered with logistics and accessories to come up with prevention tools and services. The days when HIV was seen as cursed are long behind us. A combined scientific logic and parental filiality has shown that HIV is a treatable disease and not a curse whose transmission could be scientifically verified. Like discerning parents who did not want to look at their children who had acquired HIV who dismissed the "curse" irrationality parlayed by certain social gatekeepers, we can look at people with HIV as our own. If the parents asked "how could a child born with HIV have engaged in any untoward behavior whose consequence was getting infected?" Let us gain a collective epiphany and become communities where it is possible to adopt any person living with HIV. Where we can mobilize and organize to seek justice for say, people criminalized for their HIV status like Lillian Mworeko did.  Luckily enough ARV's have continued to feature highly play as an important treatment and care product. 

Let us adopt people living with HIV. The fight and eventual ending of HIV requires collective physical, cultural and non physical influences. This will make it possible to come up with appropriate resources to facilitate HIV work.

References:

Asia Russell. 2015. Key affected populations in Uganda continue struggle to ensure their legitimate direct representation in Uganda’s Global Fund Country Coordinating Mechanism. Retrieved from: http://www.healthgap.org/key_affected_populations_in_uganda_continue_struggle_to_ensure_their_legitimate_direct_representation_in_uganda_s_global_fund_country_coordinating_mechanism. Retrieved on January 7th 2017.

Failure to Make MSM a Priority. rma-rectalmicrobicides.blogspot.com/2012/03/failure-to-make-msm-priority.html?m=0. retrieved on January 7th 2017.

HRW 1999. Retrieved from: https://www.hrw.org/reports/1999/uganda/Uganweb-06.htm. retrieved on January 7th 2017.

ICW. International Coalition of Women Living with HIV. Retrieved from: http://www.icwglobal.org/. Retrieved on January 7th 2017.

Interview with Lillian Mworeko. Retrieved from: http://www.thebody.com/content/art4927.html. Retrieved on January 7th 2017.

Lillian Mworeko. Lillian Mworeko,Uganda.  Retrieved from: http://www.ibj.org/programs/justicemakers/fellows/2014-justicemakers-fellows/lillian-mworeko/. Retrieved on January 7th 2017

Lustig, M. W., & Koester, J. (2013). Intercultural competence: Interpersonal communication across cultures (7th ed.). Boston, MA: Pearson.

MARPS in Uganda. Retrieved from: http://marpsinuganda.blogspot.com/2013/07/being-part-of-solution-in-uganda.html. Retrieved on January 7th 2017

MARPs Network. Retrieved from: http://www.marps.net/current-projects/. Retrieved on January 7th 2017

MSH. Marps. Retrieved from: https://www.msh.org/our-work/health-areas/hiv-aids/most-at-risk-populations-marps. Retrieved on January 7th 2017

MOST AT RISK POPULATIONS' SOCIETY IN UGANDA (MARPS IN UGANDA). Retrieved from: http://msmgf.org/info-hub/organizations-directory/most-at-risk-populations-society-in-uganda-marps-in-uganda/#ixzz4V9dEh7ve. Retrieved on January 7th 2017

National Forum for People Living with HIV/AIDS network Uganda.Retrieved from: http://nafophanu.org/. Retrieved on January 7th 2017.

PEPFAR.

Kirsten Appleton and Veronica Stracqualursi.  2014. Here’s What Happened the Last Time the Government Shut Down. retrieved from: http://abcnews.go.com/Politics/heres-happened-time-government-shut/story?id=26997023. Retrieved on January 7th 2017.

TASO: Retrieved from: https://www.tasouganda.org/index.php/component/content/article?id=51. Retrieved on January 7th 2017.

The War in The Bush 1981-1986.

Retrieved from: https://www.onwar.com/aced/chrono/c1900s/yr80/fuganda1981.htm. retrieved on January 7th 2017.

UAC. UGANDA AIDS COMMISSION. Retrieved from: http://www.aidsuganda.org/. Retrieved on January 7th 2017

Uganda: Tanzanian Invasion, 1979-1980.

Retrieved from: http://www.worldhistory.biz/sundries/41817-uganda-tanzanian-invasion-1979-1980.html. Retrieved on January 7th 2017. 

UNAIDS. Retrieved from: http://www.unaids.org/en/resources/documents/2016/Global-AIDS-update-2016. Retrieved on January 7th 2017.

What was 'The Great Recession. Retrieved from: http://www.investopedia.com/terms/g/great-recession.asp. Retrieved on January 7th 2017.