The price of sex in Uganda: unsafe abortion deaths and life-long scarred lives

More than a half of all pregnancies in Uganda are un-intended and nearly a third of them end in abortion, according to survey results unveiled by Dr Kiggundu Charles, a consultant Gynecologist at Mulago Hospital.

‘’Probably half of  all of you seated in front of me today were not intended by your parents’’ Dr Kiggundu told a fully- packed Palm conference room at Kabira Country Club on the outskirts of Kampala which had  gathered to hear the highly anticipated results of the study

The study results released by the US-based, Guttmacher Institute and the Center of Health, Human Rights and Development, also reveal that Ugandan women on average wished they had at least two children less, a phenomenon also called ‘excess fertility’.

On average, each woman in Uganda gives birth to 6.7 children which is high even by Sub-Saharan African standards. The study results which were released are based on analysis of Uganda’s 2011 Demographic and Health Survey(UDHS).

At the centre of the millions of un-intended pregnancies in Uganda is  essentially non-use of contraception.

Only an estimated 25% of women in Uganda have access to modern contraception methods pointing to a staggering lack of access to modern and safe contraception.

One in three married women in Uganda had an unmet need for contraception according to the survey results.

‘‘It is also a question of having less options of contraception’’ added Dr Frederick Mugisha, a health economist who maintained that Ugandan women do not have many choices when it comes to contraception.

Clearly, investments targeted at increasing access to family planning and contraception for women of reproductive age in Uganda would save the country phenomenal sums of monies spent on treating post abortion complications and having fewer mouths to feed, educate and would be kinder to the environment.

If all Ugandan women had met their wish of having two children less than they currently have the population of Uganda would have been undoubtedly impacted with gains in per capita income and a better quality of life achieved for millions of Ugandans. Indeed

It emerged at the meeting that myths and misconceptions about modern contraception methods as causing cancer and fibroids is widespread and is a barrier to contraception utilization by Ugandan women.

‘’The traditional medicine men have hijacked contraception education. There are several programs on local radio and television stations that are misinforming many women on safe contraception in preference for crude, riskier methods’;

Dr Zainab Akol, of the Ministry of Health regretted that the medical profession in

Uganda has ceded the ground for offering scientific and evidence-based contraception information to misinformed ‘medicine men’ on whose inaccurate advice many rural and uneducated women depend for decisions on birth control and family planning.

 ‘’Unsafe abortion and contraception is a human rights, public health, legal and moral issue in Uganda  that must be addressed’’ emphasized Moses Mulumba, head of the Centre for Health, Human Rights and Development who revealed that 26% of all maternal deaths  are attributed to unsafe abortion.

Prof Ben Twinomugisha,Dean of the School of Law at Makerere University emphasized that human beings have a right to enjoy sex and then when debating issues surrounding abortion ‘the woman should be at the centre’ of the debate.

Studies done by the Guttmacher institute show that there is a co-relation between restrictive laws on birth control and increased abortion. Countries, especially in Europe, which have a liberal stance on birth control have fewer deaths from unsafe abortions and spend less on post abortion complications.

Dr Mugisha’s results show that Uganda spends about 4.7% of the national health budget on post abortion complications money which could be used to treat more deserving natural conditions.

 Annociata  Kampaire, head of Alliance for integrated Development and Empowerment called for the legalization of abortion in Uganda which according to Article 22 of the Uganda constituion is illegal except ‘under conditions’ provided by law.

Uganda is a conservative country and Prof Ben Twinomugisha reminded those present that the religious and conservative lobby defeated attempts to legalize abortion in the Kenyan constitution of 2010.

He called for a  human rights-based approach to the debate of  contraception and abortion in Uganda by respecting both sides of the spectrum- a woman’s right of  access to safe abortion and a right of a woman to continue to full term with an un-intended pregnancy on religious and moral grounds.

‘’unintended pregnancy is the root cause of most abortions-and the injuries and deaths that often follow-providing better family planning services would dramatically improve maternal health in Uganda’’ said Moses Mulumba.

‘

Madam Speaker, pass the Uganda Tobacco Control bill 2012

On  4th February 2013, the Ugandan parliament will reconvene from an eventful recess in which a head-on collision between two competing arms of government was averted through  the choice, by one arm, of ‘ a path of least resistance’.

More earnestly, today is an opportune moment for our August house to reflect on the task before them especially of dispensing with a long queue of backlog bills, about 23 of them inherited from the 8^th parliament alone.

These include; the controversial anti-homosexuality bill, the anti-counterfeit bill, Plant Varieties Bill and the critically important Industrial properties bill which could help legalize generic HIV drugs on which millions survive.

But first, the Tobacco control bill 2012.

Since the bill was first introduced to parliament, 13,500 Ugandans have died from tobacco-use diseases-according to credible statistics by the Center for Tobacco Control in Africa (CTCA).

The Ugandan tobacco industry continues to engage in unprecedented open print media advertising in blatant contravention of a 1995 Uganda government directive banning tobacco advertising, promotion and sponsorship with no regulatory regime to bring the industry to account.

Children as young as six can buy, unfettered, a stick of cigarette at kiosks and stalls across the country.

Cigarette sales in Uganda have been rising consistently for the past three years. BAT (Uganda) in its published report in 2011 announced a 29% increase in cigarette sales. Little wonder then that western tobacco giants see unregulated Africa as the lucrative alternative to dwindling profits in  heavily regulated western markets.

Smoking among middle-class young females in Uganda is visibly on the increase with many’ sophisticated’ young Ugandan women tragic victims of the industry’s peddled myth of ‘smoking is cool’.

Smoking of ‘shisha’ has become a craze in up market bars in Kampala and the growing exotic community, with smokers deluding themselves that it is harmless to them and those around them.

Tobacco farmers in Arua, Kanungu and Masindi continue to live a life of extreme poverty and bondage by the tobacco industry which enslaves them with loans for agricultural inputs such as fertilizers while paying them a paltry sum for their hard-labour produce.

In the Tobacco growing areas in Kanungu district which I personally witnessed, widespread use of fertilizers for the tobacco crop has literally poisoned the waters for people, animals and crops alike.

Any concerned Ugandan can do a random sample of ten bars in Kampala and light up (even when ‘no smoking’ signs are erected) and you can be sure no one will stop you. The truth is that smoking in public places in Uganda is banned by law (since 2004), although not a soul has been charged in court for this widespread offence.

I am a perennial visitor to the Uganda Heart Institute at Mulago and anyone can see that an unprepared Uganda is already in the throes of an epidemic of diseases of the heart and blood-vessels and a study we did last year confirmed that a significant percentage of those attending the institute have a history of smoking, our lifestyles aside.

The lung cancer case load at Uganda Cancer Institute is swelling. A study done by Fredrick Musoke of Makerere University shows that 75% of oral cancer patients at Mulago Hospital have a history of tobacco-use and that it takes as little as three years to contract oral cancer.

The tobacco control bill 2012 proposes a committee with statutory powers and oversight function on tobacco control in the country with sufficient regulatory flexibility to respond to changes in the industry. It prohibits tobacco advertising, promotion and sponsorship; it protects individuals from exposure to second hand smoke; provides for price and tax measures for tobacco control; prohibits sale to and by minors; calls for alternative livelihood crops for tobacco farmers.

The Ugandan tobacco industry has sponsored a sustained a media campaign against the bill through tobacco ‘farmers’ front groups and peddling falsehoods which include that the bill bans tobacco crop  growing.

Uganda is already behind its East African counterparts; Tanzania and Kenya (in 2007) which have already passed tobacco control laws.

Forget the statistics: I recently lost a friend to Tuberculosis

When I went to see him in his tiny hospital room at Makerere University hospital, in the outskirts of Kampala, he had easily lost a third of his normal body weight. 

Tugume Benon was still his old cheerful self. Cracking jokes even when he was in excruciating pain, physically a shadow of his former self. As if to defy the fate that grounded him to a rickety old hospital bed for days on end he kept cheering me  up instead.

‘''’Tell people not to worry about me. I will be fine and out of hospital in a few days.’’ he said. He told me he had been diagnosed with Tuberculosis (TB) and was on the dreaded six months- long DOTS regimen- the known treatment for TB.

True to his word, he was finally discharged from hospital. Well, not in a few days as he had predicted but in a matter of months.

'See, I told you. I told you I would be out of hospital. How is everyone? I am going around the office saying my hellos to friends'.

That was the last time I saw my friend alive.

About a month later, I got phone call  in the middle of the night to announce that Benon had finally succumbed to TB.

I was astounded. Benon had been on treatment and he been discharged from hospital and was making plans for the future and trying to resume his degree program.

Benon Tugume was in his mid forties-in the prime of his life. With a young wife and family. He had even gone on to study for a Bachelors degree two decades after his peers. He was in the second year of a three-year Bachelors' degree at Makerere University.

Many regard TB as an old vanquished disease. But TB is on the rise in Uganda.

According to UNAIDS, TB is the leading cause of death for people living with HIV/AIDS.

''Why spend billions of dollars on treating HIV/AIDS and let people die eventually of TB'' asks Prof Lee Reichmann, head of the New Jersey Global TB institute.

According to Dr Adatu, head of Uganda's national TB program, 60% of all people diagnosed with Tuberculosis in Uganda are also HIV positive.

The increasing prevalence of HIV/AIDS rates in Uganda, now projected at 7.3% compared to 6.4 in 2005, has driven up TB cases in the country and led to a re-emerging TB epidemic in the country.

People living with HIV are especially prone to Tuberculosis due to weakened immunity. According the International Union against Tuberculosis and Lung Disease, a third of healthy humans live with the TB bacteria in their bodies but are able to suppress it due to healthy immunity levels. This situation is similar to Candida in women which comes to the fore mostly when women’s' immunity levels decline.

Because of the widespread TB-HIV co-infection, a joint, integrated treatment is now standard procedure-according to the World Health Organization.

It is now advisable to test all those with TB for HIV and all those diagnosed with HIV for Tuberculosis.

How I wish I had had the guts to task my friend to go for an HIV test. Benon Tugume may still be alive today.

Sentimental as I clutch the last print edition of 'Newsweek'.

I am feeling sentimental as I clutch my copy of the very last print edition of Newsweek magazine. Truly the end of an era.

As a child, my father brought copies of Newsweek  at home. It was the days of bold font. I recall images of Ronald Reagan and 1980's America on one of the covers.

Newsweek was always there every single week. Nothing would beat a serene Saturday afternoon at Serena hotel reading Newsweek with its cousin TIME magazine . They always made for  terrific company. Unrivaled in many ways.

I still keep land mark copies of these magazines going back in time. A testimony to the timeless writing and journalistic standards set by these American imports.

Even when I was worked up and needed to unwind, a fine edition of Newsweek would do it for me in a way several pints of bear would do it for an Irishman after a long day at the office.

For expert analysis of current affairs, global events and those land mark events such as the 9/11 attacks, the Fall of the Berlin wall, the 2008 global financial meltdown. Newsweek was there for us.

Well  Newsweek is  not actually dead,  as it transforms into a  new digital life on ipads. In Uganda where we still like it in hard copy, this almost an obituary. The vagaries of modern commerce and changing consumer tastes, e-everything couldnt spare our beloved Newsweek. The end of an era indeed.

Arbitrage: My movie of the year

In a year where I am hard pressed to pick worthy Oscar contenders and where Ben Affleck 'Argo'is a shoo in for an award, I nominate 'Arbitrage' for movie of the year.

Give Richard Gere, the Oscar for best Actor already.

Who knew Richard Gere had stuff still in him for a movie turn like that he has put out  in for 'Arbitrage'?.

I will make it simple. The movie is about a hedge fund investor, who is adored by the American public and is on the cover of Forbes. However this is all a facade.

Trouble is he has made one major bad judgement by betting on a Russian copper mine and as search has stretched himself thin  financially enough to need a friend to pitch in $400 million to plug the hole in the books till he can sell his firm to a bank and pay back the loan.

That seems the least of his worries when his mistress is accidentally killed in an accident in which he is the driver. He desperately toils to keep the strings that bind his life together from unraveling. Eager to keep this news from flowing out as he is on the eve of a multi-million dollar sale of his company. He treads the path of a financial philanderer,criminal fugitive and family outcast. Its utterly amazing how the Richard Gere character manages to keep all the  various parts of his world together under the most intense pressures.

Given the enduring global financial crisis and the 2008 meltdown, the movie clearly takes a dig at Wall street excesses, financial impropriety, 'cooking the books' in the investment world and the facade that is the public image of ultra success. This is  clearly a morality tale in the frame of 'Changing Lanes',and 'Wallstreet'.

Without torturing you with financial and investment- world jargon, 'Arbitrage' is very accessible to the ordinary viewer.

It is hard to believe the movie is directed by a first-time director.

For me, 'Arbitrage' is the best movie I have seen this year and I have seen a couple of them this year.

Francis Imbuga is dead

I met him when I was hardly 15.  The man was a genius.
He really could tell the story of the disillusionment of post-independence Africa like no dramatist I knew.
And I was a young, skinny secondary school student but could still read into his play 'Betrayal in the City' way beyond my years.
I only learnt later that Francis Imbuga was Kenyan.
The fictionalized country of Kafira seemed more akin to  1960s Nigeria or some other hard-knock African tragedy. Kenya seemed a little more distant from his world of Kafira.
And the soliloquies of his protagonist (Mulili) were steeped in high-grade philosophy.
I actually didnt meet Francis Imbuga in real life. I met him through his works.
'Betrayal in the City' was a set play in O' level literature in English but I fell in love instantly.
We memorized those lines long after we had to pass O' level literature.
The year was 1990 and I was an impressionable student of literature in English at Mbarara High School.
It is these kinds of works of literature that set me on the path to liberal arts even when I vaguely wanted to be an engineer- a childhood answer to 'what do you be when you grow up?'.
As a student of literature, our task was clear in making a 'literary appreciation' of a play such as 'Betrayal in the City'.
Oh I still remember, the themes and ideas, dramatization, character and characterization,  use of language and choice of words...
I could very well do a damn national exam in that play if I was required to like I was in those grey days in 1992.
'Betrayal in the City' is a play set in a fictional country of Kafira but it could well be post independent Uganda, Kenya, Nigeria, Zambia.. name it.
It is a story of dashed hopes of post independence Africa. The British Colonialists are replaced by African elite who actually  end up being 'an enemy of the people'to paraphrase another illustrious work of literature.
I still recall a line in the play 'the fruits of Independence, we get them second hand'.
Some say we were better off under the British. A little extreme there but look at all the corruption, mal administration, political thuggery, mass poverty, dilapidated hospitals and Schools and yet look at the top of the range Mercedes Benzes,Swiss bank accounts, the latest private jets..the sheer opulence of African elite amidst the crushing poverty and hopelessness of the African people.
'When the troubles of an entire nation disturbs a solitary mind, it is not enough to say the man is mad'.
Fare thee well, Francis Imbuga. I was blind and you began to open my eyes.

The coming armageddon:HIV funding cuts amidst Uganda's escalating infection rates

On 1st December 2012,  the world will commemorate the annual World AIDS day.

For Ugandans, December 1st should offer a sobering reminder of what has gone wrong with Uganda's once touted HIV success story.

For the past  twenty years, Uganda has had reason to look forward to every first of December with glee. You see, Uganda for many years was a global leader in taming run way HIV infection rates from an all-time high prevalence rate of 30% in the  80s to single digits in a matter of years.
HIV epidemiologists and country HIV control teams  from all over the world shuttled in and out of Kampala for many years. Uganda was an HIV prevention mecca of sorts. But that was then.

Earlier this year, Health Minister, Christine Ondoa announced results from a large national survey that show that Uganda's HIV prevalence rate has risen to 7.3% in 2012 from 6.4% in 2005.

''We feel embarrassed when we attend international HIV meetings and are terrified to announce we are from Uganda. Everyone wants to know what happened to Uganda's HIV success story?'' a Health Ministry official who didn't want to be identified intimated to me.

Unless one hasn't been keenly paying attention, it is not hard to seen where the train run off the rails.
Dr  Charles Watiti, a renown HIV treatment columnist(who is himself is living with HIV) acknowledged in his Monday, 26th November 2012 New Vision column that antiretroviral treatment (ART) ironically, has bred a tragic complacency.Uganda's mixed HIV prevention messages and strategies have also been cited as have an increase in concurrent multiple sexual partnerships especially among supposedly monogamous couples.

A few days ago, UNAids announced an astonishing decrease in HIV infections in Sub Saharan Africa. Malawi registered a 73% decrease,Botswana 71%,Namibia 68 and Zambia 58.
 As for Uganda, it was among the 69 countries which have not registered a decline in HIV infections between 2005 and 2011.

Last year, AIDS Information Centre's Dr Byarugaba announced that Uganda's annual HIV infection rate have reason to 150,000 cases continuing a trend for the past four years.

Uganda is headed for an Armageddon unless current HIV infection rates are reversed. Over 85% of HIV treatment costs are met the American tax payer through PEPFAR with the Global Fund running a close second.

In a joint report, WHO,UNAids and Unicef in 2011 revealed that international funding for HIV programmes fell from $8.7bn to $7.6bn in 2010. Contrast this with a recent World Bank study which projects that Uganda's annual HIV treatment costs will rise from a current $ 250 million to$ 1.5 billion in 2025.

Uganda's dependence on the US and the Global fund for HIV treatment remains threatened by the enduring global financial crisis and changing political climates in the Western Europe and US( the Obama administration was initially keen on switching from PEPFAR to child and maternal health causes).

The Global fund last year deferred  the next round of funding for HIV/AIDS,TB and Malaria till 2014 due to declining contributions from the mainly western donor countries.

As I write, several of those who are becoming clinically eligible for enrollment on antiretroviral therapy (ART) are being turned away at ART treatment centres who citing funding caps dont allow for enrollment of new patients. TASO earlier this year closed several of its outreach centres.

Can we treat our way out of the HIV epidemic? A study published in the Lancet last year suggested that, yes we can with $ 63 bn, the world could eradicate HIV in a couple of years by testing and treating all with HIV.

Global HIV funding trends however suggest that this may fiscally be a tall order for as long as the funders of HIV treatment remain the rich western world and the epicenter of the epidemic remains a needy SubSaharan Africa.

l

l