Working Together Toward an HIV/AIDS Free Generation; A case of Mythology, Uganda and The United States of America

Icarus and his father Daedalus, attempt to escape from Crete by means of wings that his father constructed from feathers and wax. Icarus' father asks him that he fly neither too low nor too high, so the sea's dampness would not clog his wings or the sun's heat melt them. Icarus ignored his father's instructions not to fly too close to the sun, when the wax in his wings melted and he fell into the sea.

The chubby furrow skinned elephant and the cunning grey spotted hyena were always close. The chubby furrow skinned elephant left her children with the the cunning grey spotted hyena whenever the chubby furrow skinned elephant had to travel the long distance to clean the meeting place under the large Baobab tree of wisdom. The cunning grey spotted hyena would also leave her children with the chubby furrow skinned elephant when she went to the far off place where the moon meets the sun. The cunning grey spotted hyena always thought of the day, she will have a meal of beef, bones and hide. She thought of the day she would have the chubby furrow skinned elephant's children for supper, for breakfast and lunch. "Oh! A plentiful a meal that would be," she mused. One day, after a long time had passed the chubby furrow skinned elephant told the cunning grey spotted hyena about the sand raising harmattan of Africa that was sweeping its way to these parts of the world. It was the sand raising harmattan that buried everything in its path, villages, crops, birds, animals and even the poor wriggly wiggly little earthworm. "So sad," remarked the cunning grey spotted hyena. "My sentiments exactly," rebutted the chubby furrow skinned elephant. But, the chubby furrow skinned elephant had to go on the regular errand to clean the meeting place under the large Baobab tree of wisdom. It was a long journey that took years on the to and an equal number of years on the fro. The cunning grey spotted hyena killed and ate all the chubby furrow skinned elephant's children. It was a meal of beef, bone and hide that lasted many years. But still the cunning grey spotted hyena and her children wanted more beef, bone and sinew. The mother planned to kill the the chubby furrow skinned elephant with the help of her children. The cunning grey spotted hyena laid the trap. It was where the path that led to the Baobab tree of wisdom met the path to where the moon meets the sun. The paths met at a narrow valley. The chubby furrow skinned elephant came back from the long journey huffing and puffing. The cunning grey spotted hyena and her children lying stealthly, had heard the chubby furrow skinned elephant from a distance. The cunning grey spotted hyena came out of her hiding place and told the chubby furrow skinned elephant to be careful as he she passed through the narrow valley for small and large stones had been dislodged by the previous rains. "When small stones roll down from the top just walk on," said the cunning grey spotted hyena.  "When it is the big ones, stop and look up but don't move," advised the cunning grey spotted hyena. As true as harvest time follows sowing, chubby furrow skinned elephant stopped and looked when the two large stones came rumbling and hurling themselves down the valley with the force that broke all bones in the chubby furrow skinned elephant. The cunning grey spotted hyena and her children had a meal of beef, bone and hide for many years. For the chubby furrow skinned elephant was large and long in breadth, girth and height. The cunning grey spotted hyena had not asked why the cunning grey spotted hyena had come puffing and huffing. Perhaps, if the cunning grey spotted hyena had heard the story, they would have moved out of the way of the sand raising harmattan that buried everything in its path. While the cunning grey spotted hyena and her children were asleep, the sand raising harmattan that buried everything in its path buried them so deep into the bowels of earth.

One the surface, these two legends illustrate a complacency and hubris that humans tend to adopt. But it also shows that we can have control over the virus. We are reminded day and night by cues, word of mouth, logic and caution of this fact. HIV and AIDS has unsettling facts. But, it also has motivating ones. 

The complacency and hubris of Uganda is around its health providers' status and community's level of readiness to deal with basic health needs manageable within their communities. Uganda’s health sector staffing situation is below the established norm. The lower cadre providers are overworked and demotivated. With proper remuneration, facilitation in form of proper housing and training to link the social practices' influence on people's behaviors, it is hoped they will provide quality services for people living with HIV. This should go hand in hand with community-based empowerment initiatives to allow communities manage basic needs.

The complacency and hubris of USA is at population level; people who are unaware of their HIV-positive status;  resource allocation to regions, populations and prevention strategies where they will have the greatest impact. In USA, empowering the consumer with knowledge and skills; existing infrastructure at state, regional and federal levels with autonomy to provide rapid appropriate interventions; and surveillance make the United States  has helped figure out how to provide effective HIV services. 

Scientific advances have provided us a glimpse into both the ways and means in which the HIV suppresses the human immune system. This very mechanism is also the Achilles' point.  Stuart L. Schreiber and Gerald R. Crabtree (1992), demonstrated that CsA and FK506 in operating as prodrugs, they bind endogenous intracellular receptors, the immunophilins, and the resulting complex targets the protein phosphatase, calcineurin, to exert the immunosuppressive effect. Theresa R. Gamble, Felix F. Vajdos, Sanghee Yoo, David K. Worthylake, Megan Houseweart, Wesley I. Sundquist and Christopher P Hill (1996) demonstrated that Cyclophilin A is a sequence-specific binding protein that has to happen with a nonspecific prolyl isomerase. Disrupting this sequence, in turn disrupts integrity of the virion.  A weakening of the association between capsid strips, promotes disassembly of the viral core. Barry D Adam (2011) demonstrated that biomedical frame of mind in the field of HIV prevention has shown the extent to which treatment is prevention. Sociology of science has expanded the full range of how much prevention is needed in all population groups.

According to CDC, America has positioned itself to address HIV by: empowering the consumer with knowledge and skills; putting infrastructure in place for regions to have autonomy and provide rapid appropriate interventions; at population level, six aspects provide direction in how interventions are provided. These are: sexual Orientation; gender; race/ethnicity;age; and sexual-behavioral/ or proxemic aspects; 1,178,350 Americans are living with HIV; of those, approximately 240,000 are unaware of their HIV-positive status. Increasing the number of persons who are aware of their status is a critical strategy for preventing HIV infections so when it comes to testing, three core areas are emphasized and these are: expanded HIV Testing and African Americans; HIV Expanded Testing Program; and HIV Testing among Adolescents. In order to continue informing the impact of programming, America invested in the kind of surveillance whose outcomes are nationwide health improvement priorities in form of: Healthy People 2020 Leading Health Indicators Objective HIV-13: Proportion of Persons Living with HIV who know their serostatus; surveillance systems supported by the Division of HIV/AIDS Prevention; surveillance brief: terms, definitions, and calculations used in CDC HIV surveillance Publication; using viral load data to monitor HIV burden and treatment outcomes in the United States. Prevention is linked to ART, and rooted in  high-impact HIV prevention strategy, which aims to achieve the greatest possible reductions in HIV infections by making sure that resources go to the regions, populations and prevention strategies where they will have the greatest impact. Establishing reporting structures, makes it possible to make predictions. By 2019, HIV prevention investment of more than $10.1 billion, would save as much as $66 billion in averted lifetime medical costs. More than 1.1 million people are currently living with HIV, nearly 18,000 people with AIDS still die each year, and lifetime medical care for those who become infected with HIV each year is estimated to cost $20 billion. Gay and bisexual men of all races, African-Americans, Latinos, and injection drug users are most affected. 

By 2019, expanding HIV prevention efforts could reduce national HIV incidence by 40 percent (from 55,400 to 33,300 new infections) — preventing as many as an additional 215,000 new infections. HIV prevention efforts in the United States to date have averted more than 350,000 HIV infections and saved more than $125 billion in medical costs. It was realised that comorbidities and coinfections complicate outcomes of diagnosis and treatment in people with HIV and Viral Hepatitis or HIV and TB. Therefore, testing, treatment, vaccination and counselling have been offered in order to reduce  complications or deaths.Risk behaviors have been linked to HIV infection where bodily fluids are exchanged. This is seen in the following scenarios: oral sex; anal sex; vaginal sex and HIV risk; substance use; injection Drug Use. Social issues impact risk and this is seen in the high numbers of HIV rates in say, impoverished urban areas of the United States; intimate partner violence; HIV in Women; and immigrants.

In the case of Uganda, Health services in Uganda are delivered within the framework of decentralization policy. In 1995, the Government of Uganda decentralized delivery of services in order to improve administrative oversight and service delivery. Local governments were empowered to appoint and deploy public servants including health workers within the districts through the District Service Commission. Local governments also planned and oversee service delivery within the districts (Constitution of the Republic of Uganda 1995). Health services are provided by the public (government) and private sectors. The private health sector comprises of the Private-Not-for-Profit organizations (largely faith-based organizations), Private Health Practitioners (or Private for Profit health providers) and the Traditional and Complementary Medicine Practitioners. About 75 percent of the faith-based health facilities exist under four umbrella organizations i.e. Uganda Catholic Medical Bureau, the Uganda Protestant Medical Bureau, the Uganda Orthodox Medical Bureau and the Uganda Muslim Medical Bureau. This study excluded the Complementary Medicine Practitioners who include indigenous traditional or complementary practitioners such as the practitioners of Chinese and Ayurvedic medicine. Reports showed that about 60 percent of Ugandans actually sought healthcare from Complementary Medicine Practitioners especially for minor illnesses.  The public health sector in Uganda is organized in a hierarchy effectively starting from Health centre (II) to general hospitals (formerly called district hospitals), then the regional referral hospitals, and the national referral hospitals. Below the general hospitals are the Health sub-District health centers. Regional Referral Hospitals and National Referral Hospital were semi-autonomous institutions with financial autonomy. Human resources, health information management system, governance, pharmaceutical, vaccines and equipment/logistics were still centralized. District health services and general hospitals are managed by local governments. At the national level, the proportion of approved positions in the public sector filled by trained health professionals was 56% during the fiscal year 2010/2011. Midwives filled 67%, nurses 58%; clinical officers filled 66%, health assistants 61%, Radiographers 52%, doctors 52%, and pharmacists 28% of the established norms. Uganda’s health sector staffing situation is below the established norms. With supporting policy and support supervision in Uganda, task shifting will enable lower cadre health workers perform the roles of highly trained health workers. shortage of well-trained health workers provision antiretroviral therapy, intermittent preventive treatment of malaria in pregnancy, home-based management of malaria, family planning services and in Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome, patient assessment, antiretroviral treatment and treatment of tuberculosis with directly observed short therapy. Nurses, midwives and clinical officers also prescribe drugs, and carry out circumcision, incision and drainage, surgical toilet, eye cataract removal, set up intravenous drips and community health visits (Sebastian Olikira Baine & Arabat Kasangaki. 2014). 

Development partners and civil society have played a key role in supporting HIV interventions work in Uganda. Funds are provided by different organizations such as UNICEF, ActionAID and others which have empowered  communities, women, youth, men, children, most at risk populations. Many organizations use multifaceted approaches to stopping the epidemic including prevention, treatment, protection and care, as well as support for children and adolescents who are most at risk (Child Survival HIV/AIDS). In order to address the real HIV needs, it is imperative that the providers are also provided training to deal with sexuality, orientation and gender  issues.

The current HIV prevalence in Uganda is estimated at 6.4% among adults, with women and sexual minorities are disproportionately affected. Social and biological factors put them at a higher risk of the infection. For this reason money should be invested in community mobilization and organization to provide an infrastructure through which they can access HIV care services and information ( Educating Women About HIV/ AIDS in Uganda). 

As earlier seen, Uganda’s health sector staffing situation is below the established norms. So, equipping communities with life skills to build knowledge and reduce risky behaviors; vocational training enabling girls to establish small-scale enterprises are some of the services targeting nearly 60% of Uganda’s population which is aged below 20. This generation faces health challenges associated with HIV, coupled with economic challenges arising from an uncertain transition into the labor market. We evaluate the impacts of a programme designed to empower adolescent girls against both challenges through the simultaneous provision of (Oriana Bandiera, Niklas Buehren, Robin Burgess, Markus Goldstein, Selim Gulesci, Imran Rasul & Munshi Sulaimany. 2012). 

The hope for Uganda lies in education in all its forms at formal and informal levels. In order to provide health services, Uganda reliance on a lower cadre force that is demotivated and overworked should not be a disadvantage. This would be an opportunity to identify Education needs, target health workers to empower them to deal with society's complex needs. At community levels, it would be an opportunity for communities to develop a critical mass of people with basic skills to address livelihood needs and leverage a shift away from abject poverty and destituteness. Educated people are able to identify catalytic opportunities to improve income generation (The Department of Economic and Social Affairs (DESA) of the United Nations). 

References:

Barry D Adam. 2011. Epistemic fault lines in biomedical and social approaches to HIV prevention. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194161/. retrieved on January 9th 2017. 

CDC.Retrieved from: https://www.cdc.gov/hiv/library/factsheets/. Retrieved on January 9th 2017.

Educating Women About HIV/ AIDS in Uganda. Retrieved from: http://ctb.ku.edu/en/hiv-aids-education-uganda. Retrieved on January 9th 2017. 

Child Survival HIV/AIDS. Retrieved from: https://www.unicefusa.org/mission/survival/hiv-aids?gclid=Cj0KEQiAhs3DBRDmu-rVkuif0N8BEiQAWuUJrzUwJrvVoIJSLTsNAL71nRxvNzEBlbuZ1B-5xb8HUwkaAoLw8P8HAQ. Retrieved on January 9th 2017. 

Oriana Bandiera, Niklas Buehren, Robin Burgess, Markus Goldstein, Selim Gulesci, Imran Rasul & Munshi Sulaimany. 2012. Retrieved from: http://econ.lse.ac.uk/staff/rburgess/wp/ELA.pdf. Retrieved on January 9th 2017. 

The Department of Economic and Social Affairs (DESA) of the United Nations. Retrieved from: http://www.un.org/esa/socdev/publications/FullSurveyEmpowerment.pdf. Retrieved o January 9th 2017.

Sebastian Olikira Baine & Arabat Kasangaki. 2014. A scoping study on task shifting; the case of Uganda. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4036592/. Retrieved on January 9th 2017.

Stuart L. Schreiber and Gerald R. Crabtree. 1992. The mechanism of action of cyclosporin A and FK506. Retrieved from: http://www.sciencedirect.com/science/article/pii/016756999290111J. Retrieved on January 9th 2017.

Theresa R. Gamble, Felix F. Vajdos, Sanghee Yoo, David K. Worthylake, Megan Houseweart, Wesley I. Sundquist and Christopher P Hill. 1996. Crystal Structure of Human Cyclophilin A Bound to the Amino-Terminal Domain of HIV-1 Capsid. Retrieved from: http://www.cell.com/cell/abstract. Retrieved on January 9th 2017