ARUA, UGANDA — When Francis Onziga found out he was HIV-positive, he and several friends got together to increase awareness about testing and available antiretroviral medication.
Their organization, Offaka Care for People Living with HIV/AIDS Association, is not run by experts, but rather by community members in the West Nile region of Uganda, who encourage others to get tested, change behaviors that put them at risk of HIV exposure and share stories about how to avoid infecting others.
Uganda is one African country that has dramatically reduced its HIV prevalence, from an average of 18 percent among all adults in the 1990s to 6.2 percent today, according to the Uganda Population-Based HIV Impact Assessment, a Ministry of Health report released in August.
Some parts of the country, like the West Nile region, have persistently had lower HIV/AIDS rates than the rest of the country for years. In the West Nile region, in the far northwest of the country, numbers are some of the lowest in Africa, just 3.1 percent, according to the Ministry of Health’s HIV report.
Onziga attributes the West Nile region’s low HIV prevalence to concerted efforts by local people, who have come together to change everything from wedding ceremonies to market hours to curb behaviors that may contribute to the spread of HIV.
In the region, which trends both rural and poor compared to much of the country, techniques that have been successful in preventing HIV infections are fascinating to researchers because, instead of being government-led or scientifically based, they are community-led and culturally specific.
The West Nile’s low HIV rates can be explained by the strict adherence to a culture that promotes chastity and virginity in the region, says David Talima, program director of the Straight Talk Foundation.
“They uphold traditional values here,” he says. “In West Nile if [a man] is found with someone’s daughter he is made to the pay bride price and legitimize the marriage.”
Traditional marriage ceremonies here used to last for three days, with discos and dancing every night. But when locally-elected community leaders began hypothesizing that wedding celebrations were leading to unsafe sexual activity and the spread of HIV, they voted to shorten the traditional ceremony.
“Sub-county leadership stopped discos before marriage [ceremonies],” Onziga says, adding that it was common for people to have sex with others without knowing their HIV status during these celebrations. Multi-day wedding ceremonies are still common, but discos have been replaced by inter-village football games and other daytime activities.
When Joseph Lakwor, 65, was planning a disco to celebrate his son’s wedding in February 2016, he was barred by the local leadership council.
“We had planned to hold a nighttime disco last year,” he says in a phone interview. “Then we were warned that they were no longer allowed. So we did not have it. The discos were stopped to prevent HIV infections and school dropout rates due to unwanted pregnancies.”
Community leaders, who are elected to implement local policies, also changed market hours to prevent loitering at night and sex work, says James Owacha, a local council leader in Orussi village of the West Nile region.
“We used to go market from 6 p.m. to 10 p.m.,” he says. “But now markets take place during day. People arrive at 10 a.m. and go back home by 2 p.m.”
Talima of the Straight Talk Foundation says there are other family-related reasons for the decrease. He says the nuclear family is also a strong influence here, adding that in some of the urban areas marriage rates are decreasing and more young people live alone and pursue careers.
“They still sit as family and make decisions for young men and women here. [It’s] not the same with other regions that have been opened up,” Talima says, referring to more urbanized parts of Uganda.
Sylvia Nakasi, policy and advocacy specialist for the Uganda Network of AIDS Service Organizations (UNASO), says this region is benefitting from a rare convergence of funding, nongovernmental organizations and concerned citizens.
“There is a concentration of NGOS and funding there,” Nakasi says.
There have been concentrated efforts to decrease HIV infections in the West Nile region for years, says Reuben Twinomujuni, head of communications and advocacy for the Uganda AIDS Commission.
“They had high HIV prevalence, but they have championed behavioral change interventions,” he says.
But AIDS rights activist Flavia Kyomukama, who is HIV-positive, says she doesn’t think the numbers reflect the reality of the West Nile region, suggesting that the behavioral modifications have made people less likely to get tested.
“If more women in the region were being tested, then we would know whether it is actually higher or not,” she says.
The Ugandan government has increased testing and treatment options in much of the country, Twinomujuni says.
“We have also started a test and treat campaign where everyone who tests HIV-positive is started on antiretroviral treatment,” he says. “We also host debates in schools about HIV/AIDS to raise awareness across the country.”