Despite the recognized accomplishments made by the Government of Uganda (GoU) and the Ugandan people in decreasing the HIV prevalence in the country over the years, the current state of affairs in northern Uganda as a result of the 20 year conflict presents a risk for increased HIV infection due to heightened vulnerability, particularly amongst girls and women, as well as gaps in HIV and AIDS service provision to the internally displaced persons (IDP) population. As such, the need to clearly identify the gaps in service provision through the collection of data using standardized methods is critical to facilitate future planning and implementation of HIV and AIDS interventions in northern Uganda. Additionally, the need to map out the services by health facility and other service providers for information sharing amongst all stakeholders at all levels, including the GoU, ie: the Ministry of Health (MoH) and the district authorities, particularly the district HIV and AIDS Focal Officers (DFO), in addition to UN Agencies, international, national and community based organizations, as well as the IDP community members themselves, is essential to an effective response and an equitable distribution of services.
Due to the need for increased coordination of HIV and AIDS service provision to the IDP population at the district level, IOM was requested to conduct a comprehensive HIV and AIDS mapping exercise in northern Uganda as a component of the Joint UN Programme on Health, Nutrition, and HIV and AIDS. The districts included in the mapping exercise are: Gulu, Amuru, Kitgum, Pader, Lira, Oyam and Apac.
The results of the HIV and AIDS mapping indicate that overall, upon observing HIV and AIDS service provision by district, Pader district is the least serviced district by IDP location. In particular, access to treatment services is minimal, with the majority of IDP leadership respondents stating access to testing and provision of ARVs at Dr. Ambrosoli Memorial Hospital in Kalongo or hospitals in Kitgum town, which are located at a far distance from the IDP locations. Furthermore, IDP leadership respondents in Pader district were noticeably less knowledgeable of HIV and AIDS service provision as compared to other districts. On the other hand, Lira district noted the most positive responses from the IDP leadership in regards to HIV and AIDS service provision in comparison with the other districts, whereas Kitgum district indicated a number of service providers accessing a geographically wider range of IDP locations as compared to other districts.
In regards to the type of service provided, IEC was largely noted as the most common HIV and AIDS related service provided to the IDP locations. Condom distribution was also highly noted by the IDP leadership as a service offered, although it was further stated that there were not enough condoms to be distributed. Pediatric HIV treatment was immensely noted as an area where little or no services were being provided, with many of the IDP leadership not being able to provide any information on access nor did they have much knowledge of the needs. Generally speaking, it can be said that even when it is stated that a particular service is offered in a particular IDP location, the service does not accommodate all in need in the community. The most perfect example is assistance to orphans and other vulnerable children (OVC) since there are an overwhelming number of beneficiaries with limited resources, as noted by service providers and IDP leadership alike.
A discrepancy has been noted between what is stated to be available from service providers and where the IDP leadership has noted accessing the services. The majority of HIV and AIDS services are accessed at hospitals and health centre IVs, with a small number indicated accessing services from a limited number health centre IIIs, according to the IDP leadership. Exceptions are visible in certain IDP locations with organizations providing comprehensive HIV counseling and testing (HCT) and other HIV and AIDS services, however generally it was explained that while a variety of HIV and AIDS services are being provided by health centres and organizations, particularly in regards to HIV testing, the services either do not have the capacity to meet the demand or are available in specific IDP locations and do not meet others.
Problems related to referral services were overwhelmingly stated in interviews with service providers as well as the IDP leadership. Service providers complained of lack of feedback on referred clients and overall lack of coordination, clients not receiving the service in which they were referred, and no means to support referral (ie: transport especially). The IDP leadership indicated similar issues of long waiting times due to too many beneficiaries, lack of resources and/or capacity of referred facility to provide service, and expense in accessing service (ie: transport and other related costs). As such, a clear call for a better established and systematic referral network to be set up at district level was affirmed.
HIV and AIDS coordination structures are in existence in all districts, with the exception of Amuru and Oyam, as the newly established districts were still in the process of determining the structures at the time of the mapping. Generally speaking, the HIV and AIDS coordination meetings or sector working groups convene monthly, whereas the District AIDS Committees (DAC) convenes quarterly, although this varies by district. Issues of limited resources for the DAC meetings have been raised by the district authorities. Furthermore, at the time of the mapping, no district had functioning Subcounty AIDS Committees (SAC) or Parish AIDS Committees (PAC), however the district HIV and AIDS Focal Persons stated to be currently working in establishing the SACs. Findings indicate that Kitgum district is stated to have the most developed and functioning coordination system, with Gulu and Lira also having positive results, whereas Pader district faces many challenges in coordination.