Community sex education among adolescents in rural Uganda: utilizing indigenous institutions.

Although adolescent girls in Uganda are particularly vulnerable to HIV infection, providing relevant sexual health education to them is problematic. The senga (father's sister), is the traditional channel for socializing adolescent girls into sex and marriage among many ethnic groups in Uganda. This paper discusses the implementation and community acceptability of 'modern' sengas who were trained to provide HIV-related counselling to adolescent girls. Fourteen sengas were trained in two villages and, in the course of the 1-year study, 247 individuals made a total of 403 visits to them. By including both traditional services (such as advice on and assistance with labial elongation) and modern health and sex education, the sengas provided a 'middle road' between tradition and modernity. As a result, despite initial suspicion by the community, their activities were supported by the community generally and effective as intervention.

Harnessing the senga institution of adolescent sex education for the control of HIV and STDs in rural Uganda.

Senga (father's sister) is a traditional channel of communication about sexual behaviour for adolescent females in rural Uganda. We evaluated a modification of this approach as an intervention for HIV and STDs in a pilot study in two intervention villages and one control village over 12 months. Eleven adult women and three adolescent girls were chosen and trained to become sengas. Adolescent girls were encouraged to visit the sengas for sexual health information. Adult sengas saw an average of 21 clients; adolescent sengas saw five. Adolescent girls made 45% of visits. The expected reasons for attending the sengas accounted for 51% of visits. Knowledge about HIV/AIDS, sexual communication skills, consistent condom use and family planning service use increased in the intervention group of girls over the study period and compared to control girls. Symptomatic STDs decreased in the intervention group. This intervention was readily accepted by the community; members of all ages and both sexes attended for a wider variety of reasons than anticipated. Adolescent girls in the intervention group showed improved knowledge, attitudes and practices related to HIV and STDs. This promising intervention warrants further testing in larger studies and other settings.

The quality of care by private practitioners for sexually transmitted diseases in Uganda.

One of the limited number of strategies available to reduce the spread of human immunodeficiency virus (HIV) infections in sub-Saharan Africa is the effective treatment of other, curable, sexually transmitted diseases (STDs). At present, a large proportion of people with STDs either treat themselves at home or seek treatment from private sector practitioners (PSPs) rather than use publicly funded services. A randomized controlled trial of the efficacy of a behavioural intervention with or without improved STD services is being carried out in Masaka, a rural area of south-western Uganda. The trial involves three groups, each covering six parishes. People living in one group of parishes receive information, education and communication activities (IEC) to increase public awareness regarding STDs and HIV/AIDS. The second group receives the same IEC interventions with improved treatment of STDs by both public and private service providers. The third group receives community development activities unrelated to HIV. In order to improve our understanding of how the quality of care provided by PSPs might be ameliorated, we interviewed 36 PSPs in the trial area, and made an assessment of the care they were providing. We also carried out six focus group discussions with patients to obtain their opinions on private services. PSPs in the intervention arm of the trial, who had attended meetings dealing with the syndromic management of STDs, referred to syndromes 82% of the time compared with 12% in the control arms, a mean difference of 70% (p < 0.001); stocked locally appropriate antibiotics 76% of the time compared with 52%, a mean difference of 24% (p < 0.001); and are more likely to prescribe appropriate drugs 82% of the time compared with 27%, a mean difference of 55% (p < 0.001). This small study suggests that PSPs can help improve the management of STDs.

Social aspects of AIDS-related stigma in rural Uganda.

In the process of collecting sexual behaviour data through in-depth interviews, 24 respondents offered information on stigma related to HIV-1 infection. Observations of social relations in public places and families of infected individuals were made. The findings suggest that although HIV/AIDS-related stigma has had adverse effects on treatment seeking behaviour of PWAs and coping mechanisms of their families, a more tolerant attitude is starting to emerge in this area. Probably, due to improvements in counselling services and home care schemes for those with AIDS. This supports the call for increased investments in counselling and community development aimed at caring for people with AIDS (PWAs).

Disabilities: incomplete immunisation can be a danger to your child

Causes of disability. The main causes of physical disability are polio (67 per cent); birth defects (37 per cent) and accidents 35. Interestingly; there are fewer diasabled girls than boys (females:males 29:43; 1:1.5). It is not clear if this is an artifact as a result of any gender-based difference in risk; or an issue of selective survival (Schepes-Hughes; 1991). There are relatively few disabled children below the age of five years (22 per cent); the major cause of disability is polio even among these young children (69 per cent). The target proportion of disabled children by age is 10-14 year old group (49 per cent) which reflects the cumulative risk of polio and accidents over time