Aids 'ground zero'
As the world marks World Aids Day on 1 December, little has changed in the Ugandan village where the first cases of the virus were discovered 25 years ago. The fishing community of Kasensero has been ravaged by HIV/Aids and is in desperate need of direct aid, says Killian Stokes
In rural Uganda, on the western shores of Lake Victoria, is a village known as the ‘ground zero' of Aids. The remote fishing community of Kasensero is where the first known cases of Aids were discovered 25 years ago.
Kasensero is little more than a beach, lined with long boats and crowds of fishermen. The air is thick with sand flies and the smell of fish. A constant wind blows sand in from the lake and marabou stork pick their way around the boats scavenging through the rubbish.
Community leaders still recall how, in 1981, 17 local fishermen fell ill and died of a mysterious disease marked by recurrent fevers, rashes and blisters. The illness slimmed the patients down to the bone. As the death toll rose and international interest grew, medical teams and NGOs began to descend on the district.
In those early days, the absence of a proper medical system in Kasensero and a lack of knowledge meant needles were shared in the treatment of the sick. By the time visiting doctors had discovered and named the Aids virus, up to 80 per cent of the local population had become infected. Whole families, communities and in some instances villages perished from the spreading plague.
Since the deaths of those 17 fishermen, the world knows how the virus has grown. Over 30 million people around the world have perished from Aids – including one million Ugandans – and today 40 million people globally are living with the virus.
Sub-Saharan Africa, which is home to only 10 per cent of the world's population, is home to 60 per cent of those infected with HIV/Aids.
Despite Kasensero's original role in the Aids story, the community remains poor and neglected. While the foreign doctors have moved on, the scourge of Aids has not and high numbers of local fishermen continue to contract the disease. A small two-roomed concrete building serves as the community's health centre. Three rusty beds and a table offer overnight care for the sick. The facility is ill-equipped to provide HIV testing services to the community and lacks the medicines to offer anti-retroviral treatment to those infected with HIV.
The community is also over-burdened with large numbers of young orphans. Globally, there are over 15 million children who have lost one or both parents to Aids, more than one million of these in Uganda. On the outskirts of Kasensero, the local primary school hosts 630 children, the majority orphaned by Aids. Local leaders fear for the future, worrying how, without outside help, they will be able to feed, clothe and properly raise these children.
Without the proper support structures, a large percentage of them will leave school early and end up on the streets. Research by the UN in Uganda indicates that 50 per cent of these vulnerable children will themselves become infected with HIV/Aids before they reach their 20s.
An hour's drive inland from Kasensero, in the Rakai district, lives Richard, a young boy orphaned by Aids. Richard is 16 but looks 12 and since his parents died, he has looked after his older, mentally-disabled brother John.
When their parents first died, the boys lived rough, stealing food. But then a few years ago the Rakai Counselors' Association (RCA) came to their aid. Supported by international donors including the Irish agency Concern, this small local organisation built the boys a mud brick house on a small plot of land where they could grow their own food.
In the afternoon sun, the view from their land looks good; the valley below is lush with banana trees, cornstalk and coffee groves, but their circumstances are tough.
“They do not have running water, a proper toilet or access to electricity,” explains Fred Kasozi of the RCA, “and a barbed-wire fence surrounds the land to prevent other orphans stealing the boys' scarce crops.”
“The nearest well is a 30-minute walk away – one-hour roundtrip – and without a wheelbarrow the boys can only carry a limited amount of water each day.”
There are no goats or chickens here so the boys rarely get to eat meat. Neither attends school, nor do they receive agricultural training as the collage is too far away to walk to.
Barefoot and dressed in rags, Richard looks tired and malnourished. Without a mosquito net he regularly gets sick. This day he is only suffering from a headache and a mild temperature but when the RCA last visited, they found him bedridden with malaria and had to give him money to buy medicine.
Despite the struggle, the boys are fortunate. Compared to their counterparts in Kasensero and the thousands of other orphans across Uganda, they are better off and have someone concerned for their welfare.
It is hard to imagine that these scenes are coming from a country whose response to the Aids epidemic has been deemed the success model for others to follow. Uganda is unique in having reduced its national infection rates from a high of 20 per cent to around 6 per cent during the 1990s.
The country's now famous “ABC” model – Abstain, Be Faithful or Use a Condom – has become the global blueprint in fight Aids.
The personal commitment of Ugandan President Yoweri Museveni in the fight against Aids has helped draw the support of a multitude of international donors to the country, and today almost 70 per cent of its funding to combat Aids comes from overseas agencies and Bilateral Aid. The Irish government has increased direct aid to the Ugandan government from €9m in 2004 to €32.5m in 2006.
However, Uganda's success story is starting to come under fire. The latest UNAIDS report, released just last month, notes that national infection rates in the country are beginning to rise once more and it criticises poor efforts to alleviate the plight of the country's growing orphan population.
The World Bank and the Dutch, Swedish and UK governments have all frozen or reduced bilateral aid to Uganda following increased charges of corruption. In 2005 the Global Fund to Fight Aids, Tuberculosis and Malaria suspended €201m in funding after uncovering evidence of serious mismanagement of funds. Its probe commission recommended three former Ugandan health ministers be investigated for fraud.
Critics of the Irish approach to aid, including John O'Shea of GOAL, argue that funds could be more effectively used and the risks of embezzlement reduced if money was channelled directly to those most in need, groups like the Rakai Counselors' Association, and directly into the hands of communities like Kasensero.
Meanwhile, the Ugandan government spends 20 per cent of its national budget on the military but has done little to end the conflict in the north of the country, where a horrific 20-year civil war has left 1.3 million women and children living in camps, dependent on food aid to survive.
HIV rates in these camps are three times the national average (16-18 per cent) and according to estimates from the Ugandan government, 1,000 people are dying each week from violence, malaria, HIV and suicide.
Analysts argue that Museveni is deliberately ignoring the conflict to keep his powerbase in the south of the country strong, and to justify his ‘war on terror' and fund expansionist policies into neighbouring Congo. At the end of 2005, the International Court of Justice ruled that Uganda should pay compensation to the tune of $10bn to the Democratic Republic of Congo for looting during the 1998-2003 war.
Suspending aid completely would only harm those most at need, people like Richard and his brother.
As we left Rakai that sunny afternoon, I asked Fred how we could use Irish aid to improve the lives of these boys.
“Simple,” he said. “A few small items could make a huge difference. Some tomato plants, a wheelbarrow for water, perhaps a goat and some chickens and a mosquito net. But a bicycle would mean Richard could cycle to the agricultural college. This way he could learn to help himself.”
Killian Stokes worked with Concern in Uganda