Uganda's northeastern Karamoja region is set apart from the rest of the country, both by geography and by the traditions of its inhabitants, most of whom are semi-nomadic livestock herders. Throughout the 1980s and 1990s, this isolation kept Karamoja safe from the HIV/AIDS epidemic - rates of infection with the disease were 75 percent lower here than elsewhere in Uganda.
But a number of changing factors, including epidemic levels of rape and increasing migration to large urban areas like the capital Kampala, have been accompanied by skyrocketing rates of infection: 3.5 percent of those aged 15-49 are infected, compared with less than two percent just a few years ago. The HIV prevalence rate is still lower than the national rate of 6.5 percent, but the rate of increase is alarming.
"There is a real crisis here, and we don't have much time before it's out of control," said Drametu Jimmy, an IRC HIV/AIDS program officer.
In response to the situation, the IRC recently launched a new program in Karamoja focused on the prevention of transmission of HIV/AIDS from pregnant mothers to their children. At twenty IRC-supported health centers spread across the region, HIV positive women going into labor receive the antiretroviral drug nevirapine, a treatment that can be up to 85 percent effective at preventing infection in the children of HIV/AIDS positive mothers. In the first three months of the program, 25 mothers have received the treatment.
"I thought that my life would end quickly," said Florence Okot, 32, when she learned of her HIV diagnosis.
She was sure that the child that she was pregnant with would be infected too. But after a few months of treatment with antiretroviral therapy and drugs designed to prevent HIV from being transferred from mother to child, Okot was smiling and holding a healthy, HIV-free baby boy in her arms. The rashes on her forehead and arms had cleared and her exhaustion had lifted.
Florence Okot now has enough energy to run her own small business mending clothing in Kotido, a district in northern Uganda. In a community where HIV/AIDS still bears a stigma, Okot said that she was now accepted.
"I am able now to say, 'Look at my child. Look at my work. Am I not alive? I am as much a part of this community as you.'"
Reaching potentially infected mothers is a significant challenge in Karamoja, where the population moves widely across a rural area with poor or non-existent infrastructure.
Under the UNICEF-funded program, the IRC trains and sponsors mobile health to travel to rural settlements five times per month. They offer HIV testing and treatment, and encourage pregnant women to deliver their babies at the nearest health center where nevirapine can be administered.
"If we are able to get the mothers to the health centers for delivery, we can achieve remarkable results," said Alex Opio Chono, the IRC's HIV/AIDS
coordinator in Uganda.
Because HIV/AIDS is still relatively new to Karamoja, knowledge and attitudes about the disease lag behind the rest of the country. A recent study conducted in 2005 by the Government of Uganda found that only 15 percent of women of reproductive age knew that transmission of HIV/AIDS from an infected mother to her child was preventable, compared with 35 percent elsewhere in Uganda.
Chono said that the spread of HIV/AIDS within Karamoja is closely related to the frequency of rape during violent cattle-raiding among the region's different clans, as well as during courtship. Another contributing factor is the still-common practice of bride inheritance, in which newly widowed women are taken as wives by a male member of their deceased husband's family. Where a widow has been infected with HIV by her husband there is a risk that she in turn will unknowingly infect her new husband.
To counter these practices, the IRC provides education and counseling to survivors of rape in three Karamoja health centers and offers community education programs about the effects of rape and violence against women.
The IRC also sponsors community gatherings where drama groups perform plays and songs with HIV-related educational themes (photo).
"The performances convey to male audiences that rape and abuse of women are flatly unacceptable," said Drametu Jimmy.
The performers in the dramas act out of their own life experience - many are HIV-infected themselves.
"I do this to soften the hearts in the community," said Amuge Patricia, a member of a drama group based in Kotido district. "I want them to know that being infected does not make you cursed or a monster."
