The Dilemma of Safe Sex and Having Children: Challenges Facing HIV Sero-Discordant Couples in Uganda

Background: Sixty percent of new HIV infections in Uganda occur in stable relationships between HIV discordant couples. Given the importance of fertility in Uganda; we hypothesized that unsafe sexual practices may be used to found a family/replace a dead child. Thus; we explored sexual practices to understand to what extent these are influenced by the desire to have children and the implications for HIV transmission among discordant couples. Methods: A cross-sectional survey of 114 HIV discordant couples in Kampala; and in-depth interviews with 15 purposively selected couples. Quantitative data were analysed using STATA. Multivariate logistic regression analysis done to identify factors associated with consistent condom use. Thematic content analysis of qualitative data was done using NVIVO 2. Results: Participants wanting children and those with multiple sexual partners were less likely to use condoms (Adj OR 0.51; and 0.36 respectively). Three of the five types of sexual practices used by couples do not allow pregnancy to occur. Main reasons for wanting a child included: ensuring lineage continuity and posterity; securing relationships and pressure from relatives to reproduce. Challenges included: risk of HIV transmission to partner and child; lack of negotiating power for safer sex; failure of health systems to offer safe methods of reproduction. Conclusions: HIV sero-discordant couples with strong desire for childbearing have a dilemma of risking HIV infection or infecting their spouse. Some risk transmission of HIV infection to reproduce. We need to address gender issues; risky behaviour and reproductive health services for HIV sero-discordant couples

"Appropriate Health Transport in Rural Africa: A Case Study of ""ENGOZI"" in South Western Uganda."

"Bsckground: The study was carried out in the mountains South Western part of Uganda. The residents are predominantly agricultural subsistence farmers. Lack of transport is a serious problem in this area; the road network is poor and very few vehicles are available. The transport problems are coupled with minimal economic activities and lack of cash. In an effort to respond to these problems; a local solution has been the ""ENGOZI"" or basket stretcher for carrying patients. Objectives: This study was undertaken in order to ""examine a system of health transport that utilises appropriate technology and is affordable to the community""."

The Economic Impact on Onchocerciasis the Case of Mbale District in Uganda

Onchocerciasis; a chronic parasitic infection caused by Onchocerca volvuli; is known to be a serious health problem. Relatively little evidence is available on how households react to onchocerciasis and its impact on household expenditure and time allocation patterns. This study was designed to investigate the impact of OSD on school attendance; cost of health care; amount of labour input by economically active individuals and whether its effects vary by gender in Mbale district. A longitudinal community based on 201 households case-control study that lasted 24 weeks in Bunabutiti parish; Mbale district provided information on use of various sources of treatment; their cost to households; time loss by people with the disease; the extent to which household members provided assistance and any financial losseses associated with onchocerciasis and related diseases. The cases studied did not fit the definition of OSD but rather onchocerciasis based primarily on the presence of nodules which indicate infection; rather than that of skin disease. School attendnance results indicated a higher rate of school attendance for households with oncherciasis (52.9) than non-onchocerciasis households (47.1)implying that onchocerciasis status of the household did not affect school attendance. Expenditure on health care differed slightly between the two cohorts with cases reporting a 0.9higher expenditure than controls. Gender analysis revealed that males spent 9.3more money on health care than females whereas among cases; males used 27more money than females while among controls females used 6.5more money than males. Productive work categorised into farming; gathering; housework; processing and tradea had more time from females among controls (42.7more time compared to males). Cases put more time (3.8) into productive activities than controls. Non-productive work basically categorised into fatique; sickness and social reasons was dominated by males among cases (108 more time compared to females) and controls (22.5more time compared to females). A longer period of sickness was reported by males among controls (169.2longer compared to females) and by females among cases (10.3longer compared to males). surprisingly; controls lost slightly more productive hours (4.4) than the cases through sickness. The majority of households appeared to cope without great difficulty with the reduction in labour supply caused by the disease; by drawing largely on the time of adult family members. A conservative total economic loss opf US$ 28;558.4 per year to the parish due to Onchocerciais and related diseases has been forecasted. This is because the intangibale costs like psycho-social effects and stigmatization have not been valued in addition to government expenses on the disease. The direct and indirect costs while 3.5was attributed to direct costs. This money could go a long way toward uplifiting the status of the parish if the disease is eradicated. it is envisaged that the report will be valuable in informing health policy makers; particularly in relation to setting priorities and onchocerciasis treatment. Since this was designed as a multi-country study of the Economic Impact of OSD; the differences in results are due to differences in the important definition of OSD. It can be concluded that onchocerciasis and other health related illnesses have a major impact on the economic and social well-being of the indiviiduals and the community. Policies to address education; women empowerment; sensitization of the masses about the causes; symptoms and effects of onchocerciasis should be formulated and implemented as a matter or priority. Direct costs can be reduced by putting up more dispensaries and the exisiting ones be more stocked with drugs. Indirect costs of medical care can be reduced by improving the roads; putting up more dispensaries to reduce the time spent in seeking health care and of course eradicating the disease