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HIV tests will soon become compulsory for all expectant mothers as the Health Ministry carries out a Shs 2.3 billion merger of Sexual Reproductive Health (RH) and HIV programmes this fiscal year.

According to Dr. Collins Tusingwire, a Senior Medical Officer in-charge of integrating RH and HIV services, the integration has reached 80% of all health facilities in the country.

These include regional referral hospitals, district health centres and Health Centres (HC-3s). But he says the coverage at HC-3 is lower due to staffing and budgeting constraints.

The integration process started in 2005 with the arrival of ARVs, and Mpigi and Soroti districts were elected as pilot centres for this programme. In the past, RH services were run parallel to HIV, but the arrival of ARVs has made it difficult to run the services separately as they are both administered by the same medical officers.

According to Dr. Betty Kyadondo of the Population Secretariat, in the past tests were carried out but results were only disbursed to patients who wanted to know. When the tests become mandatory, the patient must be counselled, informed and put on the PMTCT scheme if they test positive.

“In the past, not everyone wanted to test; many women didn’t want to know their status. Also, husbands were afraid of the results as the stigma remains high,” Kyadondo said. She adds that the emphasis now is on providing preventive and treatment measures at both antenatal and postnatal check-ups.

However, the integration process is not without its challenges. For starters, the integration is carried out by two separate departments in the Ministry of Health; the National Disease Control and the Community Health Department, which has brought about a duplication of duties, where some of the activities at the Village Health Centres (usually carried out by the Community Health Department) are also reflected in the National Disease Control department.

Secondly, when the ministry also introduced the Prevention of Mother to Child Transmission of HIV (PMTCT) in 2005,it came as a parallel programme instead of feeding into the existing anti-HIV programmes, resulting in the alienation from other programmes, with many thinking that it only benefits mothers, rather than women and their children in general.

Thirdly, the programmes rely mostly on donor support and doctors are worried that without state in-put these programmes could die in the long run.

However, the Health Ministry has admitted that the frequent shortages of drugs and staffing constraints remain serious challenges to the integration, according to the director of clinical services, Dr. Nathan Kenya Mugisha.

“Both RH and HIV programmes are run by medical officers who are in short supply so we are resorting to the temporary solution of training non medical staff such as traditional birth attendants to run them,” he said.

The move to speed up the integration is in line with the Kampala Declaration of the recent Partners for Population Development (PPD) Conference held in Kampala 2008. That meeting called for the merging of measures against HIV and RH programmes, as a way of lowering infection levels and enhancing preventive measures.

The move would see patients who seek reproductive health services such as antenatal checks getting HIV-AIDS services under the same premises.  But to make it work, the government will have to make available, a substantial portion of the $151million sent annually for HIV-AIDS and RH services.

PPD Executive Director, Harry Jooserry, acknowledged that the merger would help deprived young women.

“We hope this [merger] will reduce the already excessive disease burden of HIV in PPD countries on the economy,” he said.

PPD African Regional Director, Jotham Musinguzi, explained that HIV-AIDS represents 5.3% of the global disease burden, but it receives inadequate support from African governments, contrary to the resolutions of the Abuja Plan of Action of 2001.

The resolution charged African nations to contribute 15% of their national budgets to health services, including treatment for HIV/AIDS. But Musinguzi is not happy with the results to date. Uganda contributed just 7% of the budget this financial year.

A report titled Assessing the macroeconomic impact of HIV/AIDS in Uganda states that unless something is done to curb HIV/AIDS “rolling effect” across the country, Uganda’s economy could shrink by 39% by 2025.