AIDSTAR-One Emergency Planning for HIV Treatment Access in Conflict and Post-Conflict Settings: The Case of Northern Uganda

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During emergencies, the fragile healthcare infrastructures in many developing countries cannot address acute injuries while continuing to manage chronic illness. Potential interruptions in …

During emergencies, the fragile healthcare infrastructures in many developing countries cannot address acute injuries while continuing to manage chronic illness. Potential interruptions in antiretroviral therapy (ART) for people living with HIV are serious concerns because continuity of treatment is critical to prevent transmission and ensure individual and community health. This case study documents Uganda's planning process for continuity of HIV programs in the event of emergencies and highlights changes to the process since the violence from northern Uganda's civil war ended.

http://www.aidstar-one.com/focus_areas/treatment/resources/case_study_series/treatment_access_uganda

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  • 1. AIDSTAR-One | CASE STUDY SERIES September 2011Emergency Planning for HIVTreatment Access in Conflictand Post-Conflict SettingsThe Case of Northern Uganda G lobally, 200 million people and 30 percent of sub-Saharan Africans live in a state of chronic, recurrent, or episodic emergency (World Health Organization [WHO] 2006). U.S. Agency for International Emergencies include periods of unrest and displacement caused by political upheaval, predictable or unpredictable environmental events, and short- or long-term armed conflict. Regardless Development of duration, the impact of emergencies on fragile health care infrastructure in the developing world is often devastating, leavingInternal Displacement Camp in people with acute injuries queuing for care provided by rescueKitgum, Uganda. organizations and those with chronic illness foregoing care entirely. The paucity of functional health care infrastructure to manage chronic illness during emergencies is of utmost concern in sub-Saharan Africa, where approximately 22.5 million people are living with HIV and 10.6 million require treatment with antiretroviral therapy (ART; WHO 2010). Continuity of treatment for HIV is critical to the health of the individual, to prevent transmission of infection, and to ensure effectiveness of the ART regimen for the population as a whole. Though providing care and treatment to people living with HIV (PLHIV) is challenging in these settings, WHO has published a consensus statement that states that emergencies should not impede a patient’sBy Bisola Ojikutu access to HIV services and that the provision of care and treatment is “an inalienable human right and a public health necessity.” Furthermore, emergency preparedness and contingency planning for HIV service provision must become a priority for national governments andAIDSTAR-OneJohn Snow, Inc.1616 North Ft. Myer Drive, 11th Floor This publication was produced by the AIDS Support and Technical Assistance ResourcesArlington, VA 22209 USA (AIDSTAR-One) Project, Sector 1, Task Order 1.Tel.: +1 703-528-7474 USAID Contract # GHH-I-00-07-00059-00, funded January 31, 2008.Fax: +1 703-528-7480 Disclaimer: The author’s views expressed in this publication do not necessarily reflect the views of the United Stateswww.aidstar-one.com Agency for International Development or the United States Government.
  • 2. AIDSTAR-One | CASE STUDY SERIESinternational agencies both in official policy and in north remains a post-conflict region facing manyresource allocation, or universal access to care and challenges in HIV service provision, includingtreatment will never be achieved (WHO 2006, 1). ensuring access to treatment for transient, displaced populations.The United Nations has identified three stages ofemergency that occur irrespective of cause: acute This case study describes the challenges of HIVemergency, post-emergency, and reconstruction. care and treatment in northern Uganda duringAlthough settings where emergency events are both the conflict and post-conflict periods andunfolding often attract significant attention, there highlights interventions such as those funded by thehas been little focus on the post-emergency U.S. President’s Emergency Plan for AIDS Reliefand reconstruction periods. These stages are (PEPFAR) that have been successful in improvingcharacterized by resettlement and repatriation and access to treatment. This case study also suggestsmay extend for years following the initial emergency clinical, policy, and programming recommendationsevent (U.N. High Commissioner for Refugees 2005). to ensure continuous access to HIV care andIn the case of HIV care and treatment, contingency treatment in the future.plans must include the inevitable need for long-termsupport in the post-emergency and reconstructionperiods until treatment access is fully re-established. As violence became a recurrent theme in the lives of northern Ugandans, so did HIV.The Crisis in NorthernUganda Armed Conflict in NorthernLike many countries in sub-Saharan Africa, Uganda Ugandahas faced a number of complex emergencies, fromfloods in the central region, to sporadic violence The civil war in northern Uganda was incited byby armed nomadic tribes in the Karamoja region in religious fervor, ethnic tension, and the desirethe northeast, to frequent droughts leading to food for political power. In 1986, the current presidentinsecurity and famine across the country. But none of Uganda, Yoweri Museveni, came to power byhas been as long-lasting or destructive as the civil coup. Soon afterward, the Lord’s Resistance Armywar in northern Uganda that began in the mid-1980s, (LRA), a self-defined spiritual movement seekingpeaked between 2002 and 2004, and finally quelled to overthrow the Ugandan government, beganin 2006. engaging in random, sporadic acts of violence in the north. For the next 20 years, the LRA raped,As violence became a recurrent theme in the lives maimed, and kidnapped residents of the Acholi andof northern Ugandans, so did HIV. The most recent Lango subregions (see map).data suggest that HIV prevalence in northernUganda is 8.2 percent, while nationwide prevalence By 2006, through military action and negotiationsis 6.7 percent (Mermin et al. 2008; Ugandan Ministry led by the Ugandan Government, the LRA signedof Health 2009). Though the cause can be debated, the Cessation of Hostilities Act, and peace wasdisproportionately higher HIV prevalence is just restored to the region. However, by the time theone factor that differentiates this previously war- violence subsided, tens of thousands of peopletorn region from the rest of the country. Today, the had been killed and more than 60,000 children had2 AIDSTAR-One | September 2011
  • 3. AIDSTAR-One | CASE STUDY SERIES LRA assaults, armed guards patrolled the perimeter, and curfews were imposed. Conditions in the IDP camps have invariably been described as deplorable. Violence was rampant. In a WHO survey of three district camps, more than 4,000 people were killed and 1,300 were abducted in one year (WHO 2005). Though rapes were reported, no data were aggregated. Few residents were employed and, with little to occupy their time, alcohol abuse was rampant. Poor sanitation and close living conditions led to frequent outbreaks of cholera and other communicable diseases. Overall mortality rates Map of Uganda. were higher than in the rest of Uganda (WHO 2005). Though living conditions were suboptimal, there werebeen forced to become child soldiers, laborers, and abundant services provided by nongovernmental“wives” for the LRA. Moreover, at the height of the organizations (NGOs). Because northern Ugandaconflict, more than 1.8 million people—80 percent was in a state of emergency, international reliefof the population of northern Uganda—had been organizations provided funding, supplies, and staffdisplaced. Some fled to urban centers in the south, to support service provision. Daily food rations werebut most were forced to live in camps for internally distributed, and schools were opened within thedisplaced persons (IDPs). camps. Health care was also provided. Most health care workers fled to cities, leaving NGO volunteers to serve as temporary clinic and hospital staff.Life in Internal DisplacementCamps HIV Service Provision inAs violence escalated throughout the north, thenational government began to institute policies to Internally Displaced Personprovide safer living conditions for inhabitants of the Campsregion. Under the Protected Villages Policy, peopleliving in affected areas were forced to leave their The spread of HIV in Uganda has disproportionatelyhomes and move to IDP camps in each district. affected the northern subregions, with higherTo provide continuous access to health care for prevalence in the north than the average nationwide.residents, these camps were established around Mermin and colleagues (2008) have noted that theexisting health centers, such as clinics or hospitals. risk of HIV in north central Uganda was three timesAt the height of the conflict, each IDP camp was higher than in central Uganda, including the capitalhome to between 2,000 to, in the largest camp in city of Kampala.Pabo, Amuru District, as many as 60,000 individuals.Each family lived in a small hut separated from their Despite the dire need for HIV services and theneighbors by approximately five feet (see photo of presence of NGOs, HIV services in the IDP campsIDP camp in Kitgum). To protect camp residents from were severely limited. In most of the camps, the only Emergency Planning for HIV Treatment Access in Conflict and Post-Conflict Settings: The Case of Northern Uganda 3
  • 4. AIDSTAR-One | CASE STUDY SERIESHIV service offered to residents was information, Barriers to offering and accessing ART includededucation, and communication focused on ABC lack of staff training and limited drug supply. Duringstrategies (abstinence, be faithful, and use condoms) periods of LRA insurgence, travel to health careand prevention of sexually transmitted infections. facilities was difficult, which sometimes disruptedCondoms were available in a number of camps, the supply chain for ART and HIV commoditiesalthough stockouts were frequent. HIV testing (Ario 2010). Because drug supplies were limited,and counseling services for adults and children sites offering ART were quickly overwhelmed withwere primarily available at higher-level clinics and patients, and waiting lists were common (IOM 2006).hospitals located in or near camps. Lower-level However, health care workers who provided care andclinics that may have been more accessible to camp treatment to adult patients at that time believe that onresidents rarely provided HIV testing (International average clinical outcomes were optimized becauseOrganization for Migration [IOM] 2006). adherence to care and treatment was high. Patients were easy to track because they lived nearby, andTreatment for opportunistic infections (OIs)— home visits within the camp provided ongoing careprimarily co-trimoxazole and tuberculosis (Onek 2010).treatment—was available at most health facilitiesirrespective of level. However, the limited availability Patients who wanted to start treatment but wereof HIV testing, laboratory services, and radiology unable to do so at camp facilities were forced tolimited the ability to diagnose and treat specific OIs. travel outside of the camp to obtain treatment. Though there is no documentation of such incidents,To prevent mother-to-child transmission of HIV, the risk of abduction and violent attack by the LRAnevirapine or zidovudine was available free of charge was high (Oloya 2010).at 38 percent of higher-level clinics and hospitals(see Figure 1). HIV-positive women were encouraged Pediatric HIV treatment was largely unavailable.to give birth there as opposed to giving birth at home Few service providers within the camps offered ARTor at lower-level clinics. However, in many cases to children during the period of conflict. However,that was not feasible, and maternal morbidity and ART for children was offered at larger hospitals andmortality were disproportionately high. higher-level clinics. Health care workers providing HIV care to children in 2005 note that, though theART became available at some higher-level clinics programs were small, quality of care was high.and hospitals located near IDP camps in late 2005. Follow-up was conducted optimally and up to 95 percent of children benefited from long-term retentionFigure 1. Percentage of Health Facilities in Northern (Atim 2010).Ugandan IDP Camps Offering HIV Services (IOM 2006) IDP health facilities HIV service offering these services (%) Internally Displaced and Adult HIV testing 44% Pediatric HIV testing 27% HIV-Positive Persons Treatment for opportunistic 97% There are no estimates of the number of HIV- infections positive individuals who were displaced and Prevention of mother-to- 38% lived in IDP camps during the period of conflict. child transmission services However, some HIV-positive individuals who spent (ART for prophylaxis) years struggling to access care and treatment in4 AIDSTAR-One | September 2011
  • 5. AIDSTAR-One | CASE STUDY SERIESthe camps became advocates and leaders in thePLHIV community. Many expressed the belief that PLHIV Speak Out on Stigma in IDPstigma was pervasive and that overt rejection was a Campscommonplace occurrence. The biggest problem for people living withIn addition to medical care and treatment, psychological HIV in the camps was stigma. People weresupport was identified as an unmet need for HIV- congested, one on top of another. Oncepositive IDP camp residents, but few health facilitiesprovided these services. Peer-led support groups were you disclosed to even one person, everyoneformed in the larger camps, but gatherings were not would know. No one would want to sharewell attended for fear of public disclosure and resultant the latrines with you.stigma from other camp residents (HIV-positive patient –Raphael Ocholo2010). A few PLHIV were trained in human rights andstigma reduction (IOM 2006). Rejection was also a problem. PeopleThough camp life presented numerous challenges thought we were going to die and werefor PLHIV, the proximity of health care services useless.(even though many were suboptimal and did not –Molly Ajoyoffer ART) was advantageous. According to JimmyOloya, an HIV-positive individual who agreed to be Other people did not want us to participateinterviewed, “At least then everyone knew where to in activities like income generation offeredgo to get services.” As mentioned previously, follow- by the NGOs. They would tell us to go away.up of patients was feasible because huts were closetogether and patient residence was documented at –Anonymousthe local clinics. who had no home to return to. However, some couldPost-Conflict and not travel even to those sites. By the end of 2010, an estimated 182,000 people remained in either transitResettlement sites or former IDP camps. Most of these individuals are elderly, disabled, or living with HIV (InternalWith the signing of the Cessation of Hostilities Displacement Monitoring Centre [IDMC] 2010).Agreement, relative peace was restored to northernUganda in 2006. As the violence subsided, the While returning to their communities is the ultimateUgandan Government announced that IDP camp goal for IDPs, many in northern Uganda haveresidents would be asked to voluntarily return to returned to find shells of their former villages.their home communities. In 2007, supply shipments The pace of return has significantly outpaced theto IDP camps decreased significantly, and many rebuilding effort. Homes need to be rebuilt, andNGOs began to close their camp operations. By lives need to be re-established. In most instances,the end of 2009, 1.4 million of the 1.8 million IDPs basic services are poor or completely lacking.had either returned home or established alternative School buildings are dilapidated, and few teachersresidences outside of the camps. Alternative are available. In many districts, clean water is notresidences included “transit sites,” which are camp- yet available. Health facilities are unstaffed and inlike residences established by former camp residents disrepair. Inadequate health care infrastructure and Emergency Planning for HIV Treatment Access in Conflict and Post-Conflict Settings: The Case of Northern Uganda 5
  • 6. AIDSTAR-One | CASE STUDY SERIESpoor sanitation have led to outbreaks of hepatitis E with HIV put it, “Some traveled back to the clinicsand the re-emergence of polio in several districts in the camp or just stayed there [in the IDP camps](IDMC 2010). because there was nothing at home.” Loss to follow- up was difficult to assess during this period, but HIV program managers interviewed believed that it wasHIV-Positive Individuals extremely high (Makumbi 2010).Return Home As mentioned previously, minimal support services existed for HIV-positive individuals in the IDP camps.For HIV-positive individuals, the return home Psychosocial support became even more limited aspresented additional concerns. Where would people dispersed. Health care providers who treatedtreatment be available? Would health care workers patients at outlying clinics described mental healthbe available to provide care? How far would the services as a need second only to HIV treatmenttreatment site be from home? How would one travel for HIV-positive IDPs. In addition, the lack of basicthere? According to PLHIV who lived in the camps, services, food shortages, risk of malnutrition, andformal referrals to health care facilities were not lack of clean water in the home villages may haveoffered, and there was no coordinated system to had a greater impact on those living with HIV.identify treatment sites for patients to access oncehome; according to one person living with HIV, “It Though many were ostracized in the camps, therewas up to the patient to find their way to health care.” was some semblance of community among thoseDespite the expectation that there would be delays who were HIV-positive: “Camp life was a culture forin accessing treatment, patients were reportedly us and probably for others too. But for us we knewnot given additional medications because of limited the pain of stigma together. It was difficult to existsupply and lack of buffer stock. Patients were not and cope outside of the camps,” said Oloya.counseled about how to stop medications safelyin case the next month’s supply was delayed. Inaddition, most did not leave the camps with officialmedical records that could be helpful when they Human Resourceattempted to access care at distant sites (Makumbi Challenges2010). “When there is war, the health system breaksdown and people who have diseases like HIV really During the period of conflict, many health caresuffer. When war ends and there is nothing left, our workers fled to towns or larger cities in southerntrials are just beginning,” said Oloya. Uganda; few were left to staff the health care facilities in the home villages. Though peace had beenThese fears were warranted. For those who left the restored and no LRA activity was reported after 2006,camps in 2008 and 2009, treatment availability was many did not want to return to northern Uganda. Theextremely limited in outlying villages. The lower-level police force has not been fully restored. Housing, ifhealth facilities nearest to the villages did not have available, is still suboptimal, and general amenities arethe capacity to manage HIV treatment. Those that lacking. According to a study of human resources foroffered treatment experienced frequent stockouts health in northern Uganda, most districts are facing aof ART and OI prophylaxis and treatment. PLHIV critical shortage of staff (see Figure 2).were forced to travel and incur transportation coststo access services. The health care facilities in the Lack of training in HIV care and treatment is ancamps were still operational; as one person living ongoing issue. Programs such as the successful6 AIDSTAR-One | September 2011
  • 7. AIDSTAR-One | CASE STUDY SERIESFigure 2. Percent of Positions Filled at Health Centers in African Development Bank, have committed support.Four Districts in Northern Uganda in 2008 (Kyobutungi However, it is uniformly agreed that the Government2008) of Uganda must take the lead in these efforts.100 90 In regards to HIV program scale-up in northern 80 Uganda, program managers commented that funding 70 for HIV services has been severely limited. Globally, 60 54 funding levels have not risen enough to adequately 50 44 39.5 38.2 meet the need. This has led to decreased treatment 40 initiation at the site level (Makumbi 2010). In the north, 30 resource limitation has been more difficult to manage 20 because the needs are greater. In some areas, health 10 care infrastructure needs to be completely rebuilt. 0 Kitgum Gulu Pader AmuruNorthern Uganda Malaria, AIDS & TuberculosisProgramme (NUMAT; see following Programmatic Policy and HIV in NorthernInterventions section) are funded by the U.S. UgandaPresident’s Emergency Plan for AIDS Relief, throughthe U.S. Agency for International Development, Several policy initiatives have been created inin part to recruit health care workers and expand Uganda to provide guidance during conflict andtraining for nurses, clinical officers, and doctors in post-conflict periods. Uganda is one of the fewthe region. However, in Uganda, health care workers African nations to establish a policy framework toare often transferred from one location to another. address internal displacement. Ratified in 2004,Too often, patients at sites where trained staff have the policy framework provides protection to IDPsbeen transferred do not reap the benefits of new HIV and outlines a human rights approach to internaltreatment knowledge (Makumbi 2010). displacement and resettlement. Although health care is discussed in this document, there is no mention of access to HIV services.Post-Emergency Resource An IDP Resettlement Plan was developed inDecline 2005. This plan sets forth a step-by-step approach to preparing IDPs for return to their villagesRecovery and resettlement needs for all northern and rebuilding infrastructure, including policeUgandans are significant. The transition froman emergency lasting greater than 20 years to When there is war, the health system breaksredevelopment is inherently complex. A large influx down and people who have diseases like HIVof funding and international support is necessary to really suffer. When war ends and there issupport development and rehabilitation in the north.Unfortunately, resources previously provided by nothing left, our trials are just beginning.international agencies have decreased by more than50 percent since the conflict began (IDMC 2010). –Jimmy Oloya,Various bilateral and multinational organizations, living with HIV in northern Ugandaincluding the United Nations, the World Bank, and the Emergency Planning for HIV Treatment Access in Conflict and Post-Conflict Settings: The Case of Northern Uganda 7
  • 8. AIDSTAR-One | CASE STUDY SERIESdepartments, prisons, schools, and health care collaborated with the International HIV/AIDS Alliancefacilities. But it is unclear whether any aspect of that to train more than 100 HIV-positive volunteers asplan has been implemented. Network Support Agents (NSAs). Using a mobile approach, NSAs help link PLHIV with facility-basedThe Peace, Recovery and Development Plan care and treatment services, work to improve(PRDP) for northern Uganda was developed in 2007, health literacy, advocate for stigma reduction,but formal implementation was delayed for two years promote adherence to both care and treatment,due to funding deficits. Its primary goal is to reduce and lead support groups throughout their assigneddisparities in development between the north and communities. Their efforts have led to over 35,000the south. International aid agencies have donated referrals to a variety of HIV services, including, as ofU.S.$600 million to this effort. As is the case with the 2008, HIV treatment.IDP policy and the IDP Resettlement Plan, HIV islargely overlooked in the PRDP. The AIDS Support Organization (TASO): TASO began working in northern Uganda in 2005. Its initial mission was to provide HIV counselingSuccessful Programmatic and peer-led social support to IDP camp residents in Gulu. It also worked to reduce stigma againstInterventions PLHIV, a challenging task in camp settings. Once resettlement began in 2006, TASO shiftedA number of program interventions have been its focus to helping PLHIV access care in theirsuccessful at increasing access to care during the home communities and tracing patients who leftconflict and post-conflict periods in northern Uganda. the camps to link them to treatment in their home communities. TASO now also provides home-basedNorthern Uganda Malaria, AIDS & HIV testing and counseling as well as treatmentTuberculosis Programme: Funded by adherence counseling.PEPFAR, NUMAT has provided comprehensive HIVservices in the region since 2006. NUMAT’s primarygoals are to increase access to and uptake of high-quality HIV, tuberculosis, and malaria treatment Recommendations services. A focal point of the program during IDP Based on findings from this case study andresettlement was assisting with re-establishment suggestions from key informants, the followingof health care infrastructure in home communities. recommendations support continuous access toSince its inception, NUMAT has been dedicated HIV care and treatment during both the conflictto training health care workers in HIV care and period (IDP camp) and the post-conflict periodtreatment, providing site mentorship, recruiting health (resettlement).care workers, improving laboratory services, anddecreasing stockouts of key commodities. There During the conflict:are currently more than 7,100 adults and childrenaccessing NUMAT-supported treatment, the majority • Create a referral plan for PLHIV to nearbyof whom are former IDPs. treatment facilities: Patients should be provided with a copy of their records, which should includeA critical component of NUMAT’s access strategy their current ART regimen and any recentis the involvement of PLHIV. In 2006, NUMAT laboratory results. A list of nearby clinics offering8 AIDSTAR-One | September 2011
  • 9. AIDSTAR-One | CASE STUDY SERIES ART should also be provided in case patients • Institute a patient referral and follow-up plan: need to urgently flee from their home village and Patients should be referred to specific clinics in cannot make it to a camp where ART is provided. their home villages. Instituting a tracking system with unique identification numbers would be• Provide patients with an extra supply of ART: helpful to determine loss to follow-up during Patients should be given an additional one-month resettlement. supply of ART in case they cannot get to referral sites or if travel to IDP camps is extended. • Educate and prepare patients for treatment interruptions and new clinics: Provide additional• Provide ongoing access to HIV services within drug supplies to cover the period during which the camp: HIV services, including ART, should the patient will be traveling home or trying to be available to all in the camp who need them. re-establish care. As noted previously, patients Patients should not be required to travel outside should be provided with a personal copy of their of the camp and risk danger to access necessary clinical records that details their regimen and any health care. Trained health care stuff must be recent laboratory results so that transition to new present in camp facilities, and buffer stock of treatment sites can be easily facilitated. ART should be available in case of disrupted • Make buffer stocks of antiretrovirals and treatment drug supply. for OIs available: Having buffer stock available is important during both the conflict and post-conflict• Establish support groups for PLHIV: Few support period because the transport of drugs may be mechanisms were available in northern Ugandan limited by violence and/or destruction of roadways. IDP camps. Formal support group structures through organizations such as TASO or groups • Provide incentives to health care workers to work such as NSAs help decrease stigma and address in less desirable areas: Incentives may increase psychosocial issues. their willingness to return to staff health facilities.• Introduce campaigns to decrease stigma and • Provide mental health services training: All discrimination: Sensitization campaigns using patients will benefit if health care workers media and increasing widespread HIV education stationed in conflict and post-conflict settings can should be initiated in the camps in situations of offer mental health services. long-term displacement. • Include HIV care and treatment in resettlement• Prioritize the needs of PLHIV: IDP policies should plans: Plans must include budgets and funding ensure that the needs of PLHIV receive priority, so that contingency initiatives can actually be particularly in high-prevalence settings. implemented.During the post-conflict period: Planning for Future Conflicts• Prioritize building HIV care and treatment capacity at health facilities in the home villages: This The 20-year-long armed conflict in northern ensures that HIV care and treatment are available Uganda was a tragedy. Although peace has finally before resettlement begins. arrived, much remains to be done to restore basic Emergency Planning for HIV Treatment Access in Conflict and Post-Conflict Settings: The Case of Northern Uganda 9
  • 10. AIDSTAR-One | CASE STUDY SERIESservices, particularly health care infrastructure. For HIV-positive patient. Discussion on June 9, 2010.PLHIV, these basic services include continuousaccess to ART, which is critical both to the health Internal Displacement Monitoring Centre. 2010.of the individual and to the community at large. Available at www.internal-displacement.org/Contingency planning must include strategies to countries/Uganda (accessed August 2011)ensure ongoing access to treatment during theacute phase of the emergency and throughout the International Organization for Migration. 2006. HIVpost-emergency resettlement period until access and AIDS Mapping: HIV and AIDS Service Provisionto care and treatment are newly established or to IDP Communities in Northern Uganda. Kampala,restored. These plans must be well funded to avoid Uganda: International Organization for Migration.implementation delays. Kyobutungi, N. 2008. An Assessment of HRH NeedsEmergencies of this kind are inevitable. In the in Nine Districts of Northern Uganda. IntraHealthcase of Uganda, it is quite possible that the events International, The Capacity Project.similar to those leading to the war will recur. Makumbi, Med (Northern Uganda Malaria, AIDS &Though the LRA was driven out of Uganda, LRA Tuberculosis Programme). Discussion on June 10,activities have continued in neighboring Sudan, the 2010.Democratic Republic of Congo, and the CentralAfrican Republic. For Ugandans, particularly those Mermin, J., J. Musinguzi, A. Opio, et al. 2008. Riskliving in the north, planning ahead and allocating Factors for Recent HIV Infection in Uganda. Journalresources to emergency preparedness in the case of the American Medical Association, 300(5):of recurrence is prudent. For those living with HIV, it 540–549.is imperative. g Oloya, Jimmy (HIV-positive Network Support Agent). Discussion on June 9, 2010.REFERENCES Dr. Onek (District Health Officer). Discussion onDr. Ario, Alex (National AIDS Council). Discussion on June 8, 2010.June 7, 2010. Ugandan Ministry of Health. 2009. The HIV/AIDSDr. Atim, Pamela (St. Joseph’s Hospital, Kitgum). Epidemiological Surveillance Report 2005-2007.Discussion on June 11, 2010. Kampala, Uganda: Ugandan Ministry of Health.10 AIDSTAR-One | September 2011
  • 11. AIDSTAR-One | CASE STUDY SERIESU.N. High Commissioner for Refugees. 2005. ACKNOWLEDGMENTSUNHCR’s Strategic Plan on HIV and AIDS for 2005-2007. Geneva, Switzerland: U.N. High Commissioner Thanks to the NUMAT team, especially Andrewfor Refugees. Ochero, Med Makumbi, Julian Jane Atim, and Luigi Ciccio. Thanks also to Robert Ferris and Tom MiniorWorld Health Organization. 2005. Health and with the U.S. Agency for International Development inMortality Survey Amongst Internally Displaced Washington, DC for their support of this case study.Persons. Geneva, Switzerland: World HealthOrganization. RECOMMENDED CITATIONWorld Health Organization. 2006. ConsensusStatement: Delivering Antiretroviral Drugs in Ojikutu, Bisola. 2011. Emergency Planning for HIVEmergencies, Neglected but Feasible. Available Treatment Access in Conflict and Post-Conflictat www.who.int/hiv/events/arvemergencies.pdf Settings: The Case of Northern Uganda. Case Study(accessed August 2011) Series. Arlington, VA: USAID’s AIDS Support and Technical Assistance Resources, AIDSTAR-One,World Health Organization. 2010. Towards Universal Task Order 1.Access: Scaling up Priority HIV/AIDS Interventions inthe Health Sector, Progress Report 2010. Chapter 4 Please visit www.AIDSTAR-One.com foravailable at: www.who.int/hiv/pub/2010progressreport/ additional AIDSTAR-One case studies and otherch4_en.pdf (accessed August 2011) HIV- and AIDS-related resources. Emergency Planning for HIV Treatment Access in Conflict and Post-Conflict Settings: The Case of Northern Uganda 11
  • 12. AIDSTAR-One’s Case Studies provide insight into innovative HIV programs and approachesaround the world. These engaging case studies are designed for HIV program planners andimplementers, documenting the steps from idea to intervention and from research to practice.Please sign up at www.AIDSTAR-One.com to receive notification of HIV-related resources,including additional case studies focused on emerging issues in HIV prevention, treatment,testing and counseling, care and support, gender integration and more.