Uganda Soldiers And HIV Treatment Dilemma
The Army should not only think that having a policy in place is good enough. They should be certain that this policy is working in all their units. Adherence to ARVâ€™s is a matter of life.
[International: Commentary On Fighting HIV/Aids]
On 24th April 2008, a man dressed in casual civilian wear walked into our Justice and Peace Commission of Gulu Archdiocese office and asked us for help.
He introduced himself as a Uganda People’s Defense Forces (UPDF) soldier of the 5th Division based in Acol - Pi, Pader District, and a client of the ‘A- Clinic’ of St. Joseph’s Hospital, Kitgum. ‘A-Clinic’ is a department where HIV AIDS victims are attended to. He wanted help on a pressing human rights issue that we so often tend to overlook.
This man is one of the many UPDF soldiers on ARVs drugs. Their status requires strict adherence to the drug and regular test schedules to ensure that their CD4 counts are monitored by the doctors appropriately.
The ARVs are given to them to last a 30 day period, and every client is required to report back for more stock on particular dates. The doctors emphasize to the clients that there should be no break in the dosage, lest the overall effectiveness of the ARVs to prolong their lives shall be greatly reduced. Missing the exact time for taking the pills for even just a few hours is discouraged.
The UPDF man is always on duty like any other soldier. However, it has always occurred to him and many other service men that whenever they request for leave to enable them travel for medical examination and to get more drugs, their commanders decline to grant such permission. They are forced to miss their appointment by up to seven days.
They are often forced to sneak out of their units without leave to attend to the ‘A – Clinic’. To make matters worse, whenever they skip their schedule for that long, the doctors will require more comprehensive tests that will make them stay around for two or more days. On return, they are punished heavily, sometimes tortured for being absent without official leave.
That particular Thursday, up to three of them under similar circumstances had traveled to get treatment after missing their schedule by three days. When they arrived at the hospital, their doctor told them they needed tests that would be carried out the next week on Tuesday, a whole five days away!
Their choices were limited. It was important for their health to wait for the tests and collect their dosage for the next 30 days. At the same time a whole five days away from duty without leave would be grave. They also knew that if they went back to their units without completing their tests and getting their drugs, they wouldn’t be granted permission to come back on the appointed date. By then they would probably still be reeling from their punishments.
Doctors who attend to these patients contend that this delay increases the virus load and breeds resistance to the drugs. It also exposes them to greater risks of opportunistic infections. Missing the drugs for days like in this case will render the drugs regiment of the patient ineffective.
This may mean the drug regiment should be changed. But if the patients continue skipping the drugs, their virus may become resistant to all available ARV’s and there will be no alternative. This simply means they will have to die.
The life of an HIV-positive person dependant on ARVs is very delicate. They should not be subjected to very strenuous work. But the soldiers say at the moment they are involved in clearing land that is compulsory. They have asked to be given less strenuous work but their commanders have persistently ignored their request.
This further exacerbates their already precarious situation. They are now torn between self and duty. They cannot quit without being officially retired. They would otherwise be charged with desertion. Besides, they need to work to support their families.
The UPDF on their side contend that they have the drugs in their own hospital, at the Division Headquarter in Acol – Pi. That they have a policy in place that caters for the interests of People Living With HIV AIDS. What is not clear is whether this policy is applied in practice.
Whereas we appreciate that the Army may take seriously the issue of HIV/AIDS at the policy level, the case may be different in the various units.
The soldier who came to us has treatment notes indicating that he has been receiving treatment and nutrition supplements from St. Joseph’s Hospital since 2006.
The same documents indicate that for five months in a row he has been missing his appointments.
He and his colleagues claim that even those who get treatment from the Military Hospital undergo the same ordeal. The Army should not only think that having a policy in place is good enough. They should be certain that this policy is working in all their units.
Adherence to ARV’s is a matter of life.
This is, no doubt, a serious human rights issue that we all need to ponder.
Oweka James writes for The Black Star News from Uganda