New Vision (Kampala) - September 21, 2009

TWENTY five-year-old Betty Akol is a broken woman. Tears pour down her face whenever she recalls how, two years ago, her mother-in-law threw her out of her house accusing her of infecting her son with HIV.

"I tried to return to my parents but they were too poor to help. I often fell sick." Akol, a resident of Soroti district, had to struggle to provide for her four children.

At the beginning of this year, Akol came to Kampala to stay with a relative, but her condition worsened. "I did not know my sero status; I had not tested. I thought my mother-in-law had bewitched me."

In Kampala, Akol got in touch with Women of Vision, a drama group at her church and was introduced to Miriams Kawuma, the executive director of Madak Integrated Community Health Initiative (MICHI). The organisation runs a voluntary counselling and testing (VCT) centre in Kiwanga-Mawotto, Namanve in Mukono district. "Kawuma and her team counselled me and encouraged me to test. I tested positive, they put me on treatment and also provided food."

Akol is now strong and goes about her chores with much ease. MICHI, located 14km east of Kampala city on Jinja Road, provides free testing, treatment and food to 1,000 clients, thanks to Kawuma, the brain behind the centre.

Kawuma started providing VCT services at the centre after realising that people in this area lacked information about AIDS. "Many people were dying of AIDS-related illnesses, but blamed it on witchcraft. The price of goats and chicken went up because witchdoctors were asking patients to bring these items to get treatment."

Kawuma sold five of her goats to raise money to buy testing kits. "I got about sh500,000. Later, The AIDS Support organisation (TASO) gave me more testing kits." Kawuma says in the beginning, people never wanted to test. "One time, we found charms on our doorway. The witchdoctors wanted to scare us because they were losing their customers due to our sensitisation. We brought a pastor and he prayed for us," Kawuma says.

Kawuma says the community and the district leaders got involved in the sensitisation. "We moved from village to village advising people to test, counsel and get treatment."

Our areas of operation included Goma and Kyampisi sub-counties in Mukono district. "In the first three months, the turn up was very poor. We tested only three people but we never wavered because I knew information meant power. We started moving from house to house and within six months, the number of people who had tested for HIV/AIDs rose to 500 of which 100 of them tested were found to be HIV positive."

Daniel Mwesigye, the laboratory assistant at the clinic says they found out that HIV/AIDS prevalence rate stood at 10.1% compared to Mukono district average of 6.5%. He blamed poverty and risky lifestyles for the high numbers. "About 70% of the people in Kiwanga live on less than a dollar a day, put up in shacks and eke a living by doing odd jobs.

Frank Lubowa, the officer in charge of prevention of domestic violence at MICHI, says most of the men spend their money on prostitutes. "We focus on prevention. Treatment and care come later," he explains. In prevention, they preach abstinence, faithfulness and condom use. Kawuma says they have now taken prevention messages to villages, schools and churches. "We have formed HIV/AIDS clubs to disseminate information through music, dance and drama."

By 2005, they had tested 8,000 people, with about 500 testing positive. "We recommended many of our clients various centres for further treatment and care - but also remained with 50 clients for whom we provide treatment."

Kawuma explains that TASO gave them the mandate to distribute ARVs to patients throughout Mukono. "We reach out to 500 clients."

Feeding programme starts

In 2007, they realised their clients were in poor health because of poor feeding. "We told them to buy nutritious food, but they could not afford. They did not even own land to grow food, Kawuma recalls."

Through negotiations with neighbours, Kawuma secured three acres of land. "I planted a sack of sweet potato vines and then more." After six months, they harvested 100 bags of sweet potatoes which they distributed to the 500 clients and sold the surplus to get income.

"Our clients used the money to buy household items like soap, salt and paraffin. We also had to think of expanding our food base to serve the clients well." One of the clients, Betty Sewanyana, received a bag of cassava cuttings from NAADS. "She offered the cuttings for planting to benefit the entire centre and within six months, we harvested 20 sacks," says Kawuma.

"People living with HIV/AIDS are often stigmatised, but Kawuma has broken the boundaries and connected them to international organisations," says Sewanyana. OXFAM GB donated sh52m to the centre to carry out HIV/AIDS sensitisation. "We have started a prevention of mother-to-child transmission (PMTCT) programme," Kawuma explains.

Alice Nakawesi, 33, a mother of two, has been able to deliver safely through this programme. "I attended antenatal clinics at the centre and was able to give birth to a healthy baby. I have also joined the MICHI's food security programme."

Nakawesi's husband, Moses Sajabi, tested positive. "I have been given ARVs. I joined the food security programme. Recently I made sh150,000 from cassava. I paid fees for my child and my health is okay."

Kawuma has over 700 clients receiving ARVs, one-third of them men. Mwesigye says: "The number of people with HIV has reduced to about 5% but the biggest challenge is that prostitution is on the rise and new cases are coming up."

"The problem with prostitutes is that they operate at night and are difficult to track." He laments that their efforts are hampered by lack of transport because they use only bicycles and are unable to reach remote villages of Mukono.

Kawuma's earlier fight

Born in the farming village of Gomba, Mpigi district, Kawuma first heard of HIV/AIDS, by then called 'slim' in 1986.

"The disease was killing many people. A relative from Masaka warned us not to pick money or any property on the way. They thought AIDS was caused by witchcraft," she says.

Kawuma lost a brother. "But I later realised my brother would not have died if there was enough information on AIDS. This partly influenced my campaign against AIDS."

The seventh of nine children, Kawuma encouraged her younger sister to test in the 1990s. "She was positive. She opened up, got treatment and sensitised others."

Born to peasant parents, Kawuma went to Maddu Primary School in Mpigi, then Caltec Academy. Before she completed school , her father died. "My elder brother took on the responsibility of paying our fees. I finished with a diploma in secretarial studies at Kyambogo."

Later, Kawuma graduated with a bachelor of business administration from Nkumba University. "I worked briefly at Kyambogo but in 2008, I resigned and started my own VCT centre.

Kawuma has attended conferences in DR Congo, Nairobi and Canada to sensitize people on HIV/AIDS. At her centre, she employs a doctor, a nurse and a laboratory assistant. It is here that she is serving a population of 180,000 in three sub-counties, whom she sensitises about HIV prevention, counselling and treatment at no cost.

"My heart bleeds when I see people dying because they fear to test. People should know their status so they can get help and live responsibly," she says.

Do you know anyone who has played an important role in the fight against HIV/AIDS in their communities? Nominate the person, indicating name, phone contact and what the person has done in his/her community. Also give your name and phone number.

FACT FILE

Name: Miriams Kawuma Occupation: Executive director, MICHI VCT Centre

Age: 35

Location: KiwangaûMawotto, Mukono District

Impact: Has managed to get over 10,000 people tested and is providing free ARVs and food to over 500 clients.

Contact: 256772491274 +256757491274 or email: michi_organisation@yahoo.com

Write to: The Features Editor, New Vision, P.O. Box 9815, Kampala or email: features@newvision.co.ug

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