The Link Up programme (2013-2016), funded by the Dutch Ministry of Foreign Affairs, has been established to create better linkages between sexual and reproductive health (SRH) and HIV services for young people (aged 10-24) living with HIV and those most affected in Bangladesh, Myanmar, Burundi, Ethiopia and Uganda.
In Uganda, the programme will build on the existing networks and partners of our Linking Organisation, Alliance Uganda, as well as the country programme of Marie Stopes International in Uganda to ensure that programme design is fully informed by the needs and expectations of young people. To this end, a country mapping exercise was completed in early 2013.
In the 1990s, Uganda was one of the countries most affected by the HIV epidemic in sub-Saharan Africa. By 2005, it had made huge progress in its response. Political leadership, commitment and openness, as well as community action, helped reduce the rate of new infections.
Today, the Ugandan government has supportive policies around the integration of HIV and sexual and reproductive health (SRH) services for youth and people living with HIV.
However, it also has one of the most hostile policy environments in Africa for groups that are particularly vulnerable to or affected by HIV. Homosexuality, sex work and abortion are illegal.
Edith Mukisa, Executive Director of Alliance Uganda, says: “Uganda has the world’s youngest population.* 78% are below 30 years of age. Unfortunately this young population is faced with multiple sexual and reproductive health challenges including: early and unwanted pregnancies; unsafe abortion; STDs; HIV and AIDS and substance and sexual abuse to name just a few.
“Limited access to integrated SRH services, and the effects of accelerated urbanisation and poverty, means many young Ugandans are potentially at higher risk of HIV.”
Targets in Uganda
Link Up in Uganda aims to reach around 275,000 young people from the target groups (predominantly young people living with HIV and young sex workers and children who are exploited for sex). It will train 320 service providers to provide quality services, information and commodities in ten districts of Uganda.
(Note: Link Up has a separate target for its programmes in Bangladesh, Burundi, Ethiopia and Myanmar).
Country mapping methodology
Several tools were utilised: one to map national policies and existing programming effort, another to assess the capacity of the partners to implement the project. In addition, sixty seven key informant interviews were conducted with facility based managers and administrators and 20 focus group discussions took place with young people.
Gaps in services
The country mapping has identified three gaps for the project to address. Firstly, there are government policies on SRH and HIV services for the 15-49 age group and some agencies/organisations have adapted their services for young people above the age of 15 years. However, there are very few if any services for the 10-14 years age group and specific to young key populations. Secondly, none of the SRH services had been tailored to meet the needs of young people living with HIV.
Finally, there are limited services tailored to the needs of men who have sex with men or people who use drugs – those that are available are provided by civil society groups and not government health facilities, creating concerns about sustainability and accessibility.
Quotes from young people interviewed as part of the country mapping exercise include:
“In my religion, family planning is not allowed. God ordered us to produce as many children as possible. What I know, our parents can’t allow their children to go for family planning … they said that some family planning methods like swallowing of pills can cause pain in the stomach and affect the uterus, leading to operations.”
“We are told that if you want your husband to love you very much, you use a local herb from the Omusita tree when delivering; it prevents men from going to love other women.”
And a call to action:
“We should have a youth centre separate from the elderly, because a youth centre is good and feels secure with a sense of belonging.”
Link Up – a great opportunity
Edith Mukisa explains: “Link Up is an opportunity to turn this situation around, to bridge the gaps through integrated SRH and HIV service delivery. We are excited and energized to be part of this exciting project. We are confident we will make a difference to the many young Ugandans living with and affected by HIV. The contribution of this project globally cannot be understated; it’s a big step in the right direction.”
* 2012 State of Uganda Population report.