By Bazio Doreen.

Authorities in Adjumani District are concerned about the rising cases of HIV infections among young people especially adolescents. Records at the District Health Office reveal a concerning rise in new HIV infections among the population in Adjumani District from 2021 to 2024 with young people disproportionately affected.

New HIV cases among the population in Adjumani district increased from 327 in 2021 to 437 in 2024, marking a 33.6% rise over four years. The young people in Adjumani district account for over 40% of the new HIV infections.

Worse still, according to records District Health Office captured between January and March 2025, six new HIV infections among adolescents (10-19 years) were registered with one yet to be linked to HIV care. This underscores the urgent need for intensified Sexual and Reproductive Health and Rights (SRHR) interventions to curb this trend. 

According to Inyani Mane Dolorence, the District HIV Focal Person, several factors contribute to the rising HIV incidence among youth in the district including: limited access to comprehensive SRHR education; inadequate youth-friendly health services; and socio-economic challenges such as poverty and unemployment increase vulnerability.

He also adds that stigma and misconceptions around HIV and sexual health discourage young people from seeking testing and treatment services.

“Adjumani’s youthful population, coupled with many vulnerabilities, creates a critical environment where HIV transmission can escalate if not addressed promptly. The increase in new HIV infections highlights the gaps in effective outreach, counselling, and provision of preventive tools such as condoms and pre-exposure prophylaxis (PEP),” Inyani observed.

Indeed some of the Adolescent Friendly corners at some health facilities are dilapidated and now other rooms/space is being improvised to encourage young people to access SRHR services. This is concerning because teenage pregnancies in Adjumani increased by 1% in March 2025.

The Teenage pregnancy rate among nationals increased from 15.6% in financial year 2023/2024 to 16.3% in financial year 2024/2025. Data at the District Health Office also indicates that the teenage pregnancy rate in financial year 2020/2021 was 14.4%.

Irama Steven Leku, an Enrolled Nurse and Adolescent Focal Person at Pagirinya I HC III, says that the Adolescent Friendly Corner has become so dilapidated that it can’t accommodate patients and fulfil their needs.

“Our Adolescent Corner has since become so open. It is now the poles that are remaining. There is no privacy. People can see whoever has come in and even sometimes predict what might have brought them to the facility. For now we are improvising the breast feeding corner but this is not sustainable. Most of our clients are refugees. Their culture doesn’t shun teenage pregnancy but they need protection from stigma that can be exerted by the host communities,” Leku explained.

In affirmation, Dipio Frances, Senior Social Welfare and Probation Officer, also observes that having a comfortable space for an Adolescent Friendly Corner is key because many young people are still afraid to speak up about their SRHR problems.

“Many young expectant mothers find it difficult to open up when they are in OPD. They prefer corners. Unfortunately, World Food Program has stopped its NutriCash program, it used to map even those who fear to come to the health facility so as to receive the supplementary feeding support. We are aware that many now have aborted due the halt,” Dipio observed.

The increase in HIV is also being linked to Gender Based Violence (GBV). This is worrying because Sexual violence can lead to HIV infection directly, as trauma increases the risk of transmission. More importantly, GBV increases HIV risk indirectly. Victims of childhood sexual abuse are more likely to be HIV positive, and to have high risk behaviors. This sometimes is due to the SRHR challenges faced by health facilities.

Meanwhile, the district finds it hard to harmonize GBV data. This is because of the multisectoral duty bearers involved; different reporting lines for partners and conflicting GBV registers at the health facility.

Steven Tako, Ofua HC III Facility In charge, says that some implementing partners want the health facilities to capture GBV data in separate registers other than the one provided by government as as a result, some cases remain unresolved.

“We have conflicting registers at the health facility. The partners need to adopt the one of government so that we harmonize our reporting system. It is also worth noting that a lot of GBV cases that are reported to police are not resolved,” Tako explained.

However efforts have been made to streamline interventions on SRHR. The District recently commissioned a 20 member Committee for Adolescent Health (DICAH).  This is in line with a District Local Action plan (2025 -2030) that seeks to reduce GBV from 27% to 17% within the next five years targeting 9,135 beneficiaries. However, the DICAH is also charged with resolving all SRHR issues.

For adolescents and young people specially, some capacity building trainings have been done between January to March 2025. However, the targets are yet to be met. Only 12 out of 60 Primary School teachers trained, 8 out of 21 Secondary School teachers trained, 40 out of 44 Health In charges trained, 40 out of 120 senior men/women teachers trained, 720 out of 1800 in school peer educators trained, and 110 out of 592 out of school peer educators trained. Through these efforts, over 11,851 adolescents and young persons have been reached with SRHR information and referred to the nearest health facilities.

Although this is encouraging, Inyani, observes that the district and its SRHR partners still have more to do to empower young people through socio –economic programs that can help them overcome risky behaviors.

“We must create an enabling environment where young people feel supported and informed to make safer sexual health choices. We need to strengthen youth-friendly health services to offer confidential, stigma-free HIV testing, counselling, and treatment,” said Inyani.

The DICAH was commissioned with support from Right to Play (RTP) under the Sexual Health and Reproductive Education (SHARE) program. Funded by Global Affairs Canada, the SHARE project is being implemented by a consortium led by Right to Play, in partnership with WaterAid, the Forum for African Women Educationalists (FAWE) and FHI 360. The 5 year program ending in March 2026 seeks to empower 325,000 adolescents and youth aged 10-24, particularly girls and young women, both in and out of school, to demand better sexual and reproductive health care through a gender-transformative and rights-based approach.

In Adjumani, the SHARE Project is being implemented in 66 Primary schools, 8 Secondary Schools, 43 Health Centres and through four 30 member mentorship cohorts. These all target young people between 10 -24 years.

END.

Access to medical care at Arua Main Prison Health Center III is now being hampered by the increased security measures at Arua Main Prison.

The Arua Main Prison Health Center III has long offered vital medical services, having been established as a public health center to assist both prisoners and the local population soon after Arua Main Prison was built in 1930.

However, regular security measures, a lack of public knowledge of the facility’s existence, and other circumstances have led to the public’s underutilization of it.

Authorities implemented stricter security measures throughout the prison grounds in response to growing concerns about smuggling and disturbances. These included heightened patrols, stringent limitations on movement, and thorough security inspections at every point of entry.

Although these precautions were taken to keep the staff and prisoners safe, they unintentionally interfered with the health center’s regular operations because they are housed in the same property.

According to conversations with medical staff at Arua Main Prison Health Center III, the facility is completely functional, stocked with enough medications, and outfitted with diagnostic equipment for conditions like diabetes, HIV, TB, malaria, ulcers, and more. The usage is still low in spite of this.

According to Sharon Munduru, who at the time of writing brought her child with a fever, cough, and illness, the facility’s services are quick and easy to access, and the medical staff is friendly and accommodating to patients.

Because we live close to prisons, Munduru explained, “you find a lot of people at Police Health Center III. For us, we just come here and it’s just a matter of carrying your national ID to enter from the gate. Their services are very fast, easy, and you can’t go without having your medication.”

Records from the facility reveal that, on average, about 700 patients with various illnesses are registered weekly. Of these, approximately 100 patients come from outside the prison community this is primarily due to fears related to data collection and security checks conducted by security personnel.

The most common ailments seen at the outpatient department include respiratory tract infections, peptic ulcers, tuberculosis, malaria, and diabetes.

Hellen Dejang, Enrolled Nurse at the facility they conduct variety of services including immunization campaigns, Nutritional assessments, General body checkups Antenatal Serveries though they don’t conduct deliveries due to inadequate space, other services including Family planning and Reproductive Health services, Maternal Child Health services and emergency care.

The facility receives supplies from National Medical Stores, Joint Medical Stores and equally from General stores of Uganda Prisons Services in Luzira. It has variety of equipments in the laboratory including the Gene expert Machines, SD4 count Machines, Microscopes, Diabetes Machine, Afino Machine with exception of the CBC-Complete Blood Count Machine and Chemical Analysis Machine whose services are sort from either Oli Health Center III or Arua Regional Referral Hospital.

SP Herbert Muhangi, the Officer in Charge of Arua Main Prison, stated that the security protocols are designed to maintain order and safety, given that the health facility is situated within a secure installation.

“The nature of the Health Facility is situated under a Security institution, so perhaps you have to adhere to the security protocols that are in place, we only require proper identification,, and we register you, usher you in, and serve you. The challenge we have is when you ask some people about their national Identity Cards for identification, they don’t just turn away any other identification, so we get challenged on how to really manage security and this person who is a stranger. If the general public could carry any form of identification, we are good to go.” Muhangi said

The facility is staffed by 16 personnel and primarily serves the catchment areas of Kenya and Awindiri Wards in Arua City.

By Bazio Doreen.

About 85 selected health workers in Adjumani District have been trained on a Water, Sanitation and Hygiene (WASH) improvement tool for Health Facilities.

The training was to enhance the knowledge and skills of the health workers to effectively collect, analyze, manage and utilize infection, prevention and control (IPC) data to identify trends and assess the efficacy of interventions to make informed decisions to contribute to enhancing public health and safety through improved WASH.

The training featured 2 health workers from each of the 44 health facilities in Adjumani and took place at Dubai Resort from Monday 28^th July 2025 to Friday 8^th August 2025. Each weekly cohort had at least 40 health workers – a move that was done so as to minimize Human Resource gaps at the Health Centres during the training period. The health workers included: Facility in charges, nurses, Clinical Officers, Doctors, mid wives, Health Assistants and Health Inspectors.  

Participants are now expected to bi-annually assess, identify and evaluate WASH gaps at their facilities and thereafter develop or update their WASH improvement plans until such a time when all the gaps have been fixed.

According to Onen David Livingstone, the SHARE Project Officer – WaterAid, the facilities are supported to categorize their gaps according to risk and resolve them conclusively and sustainably in the long run.

“We want them to have a WASH improvement plan with a clear strategy showing those that pose either high or low risk. Some of the issues can be easily resolved using PHC or RBF dependent on capacity. We support the facilities to track progress and consolidate sustainability of their prevention and control measures,” Onen explained.

Onen also said that this is done to ensure that patients get the highest possible quality of care and an enabling environment for recovering when they visit health facilities. Onen also said that WASH is not only critical in Infection Prevention and Control but also health care in general including Sexual Reproductive Health Rights (SRHR).

 “When you go to a health facility and there is no water, as a client, you will run away. We want the right holders like Adolescent to feel comfortable when they visit the medical facility. For example a girl should be able to comfortably change her sanitary towel,” Onen explained.

The WASH improvement tool focuses on seven domains of: water, hand hygiene, management, sanitation, energy, waste management, and environment. Participants in each cohort visited selected 8 health facilities chosen on random, which were used as reference points for making draft WASH improvement plans and group presentations.

In his presentation, Dima Felix, the Health In charge at Ajugopi HC II, also observed that some of his counter parts were just acting negligent as some of the gaps or challenges didn’t need a training or a meeting to resolve.

“At some of our facilities, we have these WASH equipment but we are reluctant to utilize them. Some of the challenges don’t need a lot of money to resolve for example lighting in our WASH facilities, installing mosquito nets, cleaning our toilets and doing peer to peer training,” Dima advised his fellow participants.

In affirmation, Okia Bosco, the Public Health Inspector at the Ministry of Health, who was the lead trainer, urged the participants to constitute a WASH Facility Improvement Team so that the task becomes a shared responsibility.

“It shouldn’t be business as usual. This is serious. We have identified our own challenges and we should commit to resolve them. 80% of the challenges we have identified don’t even require money. You just need to have in place a WASH FIT team that is clear of their roles and responsibilities,” Bosco said.  

On his part, Edema Richard Draciri, the Principal Chief Administrative Officer, emphasized disease prevention observing that it is more sustainable than cure/treatment. He explained that the medical supplies and drugs given by the Ministry of Health are inadequate and thus rallied the Health Inspectors and Health Assistants to double their efforts.

“What the Ministry of Health gives us is just a drop in the ocean. People now think that health workers steal drugs because of the frequent drug stock outs and high disease burden. So prevention is more sustainable. We need to reduce the number of people lining up for medicines. It is unfortunate that we have recruited more health assistants but the performance of WASH keeps deteriorating,” Edema observed.

Edema also informed the participants that resources to local governments are now allocated based the annual National Assessment by the Office of the Prime Minister adding that under Health, the WASH component is assessed and facilities to be visited are selected on random.  

Meanwhile, Onen, was concerned that most of the motorized water systems constructed with funding from UNICEF are now non-functional. He urged the district leadership to carry out a comprehensive assessment on the challenges and together with partners resolve them as some of them are beyond the capacity of the health facility managers.

The training also had the following recommendations: participants should mentor other staff and sensitize the Health Unit Management Committee on the WASH Facility Improvement Tool; integrate WASH and IPC committee for joint interventions; and task the District Health Team to use the tool in their periodic monitoring and support supervision.   

WaterAid is currently implementing the Sexual Health and Reproductive Education (SHARE) project in Uganda, with support from the Government of Canada through Global Affairs Canada. Water, sanitation, and hygiene (WASH) play a critical role in achieving Sexual and Reproductive Health Rights (SRHR) for women and girls, especially as it relates to personal health.

The five-year SHARE project that ends in 2026 seeks to advance gender equality and increase the enjoyment of health-related human rights by vulnerable right-holders, particularly adolescent girls and young women. Through SHARE, WaterAid has been partnering with the district to rehabilitate WASH systems in healthcare facilities including: installing hand washing units to prevent the spread of disease; restructuring sanitation facilities to ensure that toilets are inclusive and gender sensitive; training healthcare workers in healthcare facilities and in the community on WASH infection prevention and control; installing safe waste disposal systems; and training healthcare workers on proper waste management. 

END.