On any given night, you can find volunteers and staff from SHES (Social, Health and Environmental Sustainability) on the streets of Kampala, Uganda, performing nighttime outreach under the moonlight, in an attempt to bring some light to the darkness. SHES conducts outreach to local sex workers and their clients, targeting individuals at high risk for contracting HIV and STIs, both highly prevalent in Uganda.
HIV in Uganda
As we knows, HIV and AIDS has been a threat to public health affecting people of all races, nationalities, sexual preferences, and income and educational levels. More than half of the world population living with HIV is found in Africa, particularly the sub-Saharan region where Uganda is located, accounting for over sixty-nine percent of all HIV cases.
In the eighties and early nineties, Uganda was among the most highly affected countries with thirty percent of its population living with the virus. With death rates soaring, the Ugandan government embarked on a campaign, spearheaded by the President, to fight and respond to the epidemic. Through prevention messages, open group discussions, massive condom use, fidelity and abstinence-based messages, Uganda saw the rate of new HIV infections drop from thirty to fifteen percent in 1991. This earned Uganda early recognition as an African success story in the fight against HIV.
However, through subsequent complacency, high risk behaviors like having multiple partners, lack of condom use and involvement in sex work, the statistics have recently changed, with the highest prevalence among adults (ages fifteen to forty-nine) and with sex workers accounting for about thirty-five percent, which prompted HIV workers to develop strategies to address the rising prevalence rates among this population.
Hence the moonlight activity was born.
The moon lights the path
As the sun goes to sleep, darkness covers the night and all that is left for lighting is the moon. In Uganda, electricity is a luxury that most cannot afford. The moon lights the path, allowing people to conduct their business of the night as well as see and escape danger that may lurk in the darkness. When it comes to HIV/AIDS, the moonlight outreach does precisely the same.
“Since it comes in the night and sometimes doesn’t stay for long, we use the opportunity of the light to carry out moonlight HIV and AIDS-related activities,” states Ofwono Opondo, executive director of SHES. SHES services include HIV testing, STI screening and treatment, condom distribution and enrollment.
Since clinics and facilities are closed during the night, moonlight outreach takes place on the streets, targeting people that work till late but focusing mainly on commercial sex workers easily found on the streets at that time. The moonlight brings services closer to the brothels where they work.
Before conducting outreach, community mobilizers identify the leaders of the sex workers and inform them of the activities and their importance. Together they mobilize sex workers to come and receive services.
During the moonlight outreach, there is a public-address system and a projector screen used to display prevention messages on the importance of testing, safer sex negotiation, STIs, and the signs and symptoms of HIV. These are aimed at helping the ones on site as well as those that may find it hard to come for services but are watching from the streets. This type of education also encourages them to keep an eye out for tell-tale changes that may occur on their bodies indicating infection.
On the moonlight site, there are doctors, counselors, peer educators, and data collection tools, all enabling on-the-spot enrollment that provides for immediate service delivery and information gathering for follow-up.
During moonlight outreach, people who test HIV-positive are enrolled then and there and started on a PCP prophylaxis. They’re referred to the health center where they are later enrolled into the ART program. Those who test positive for STIs are given on-the-spot treatment and referred to the health center for ongoing treatment.
Through moonlight outreach it was discovered that most of the sex workers have permanent partners, who in many cases, are unaware of the kind of work their partners do and what their HIV status is. Through the support program they are encouraged to come together for the next clinic appointment.
It has also been observed that some people prefer being offered these services at night compared to during the day at the health facility. Given the nature of their work, most sex workers sleep during the day and rarely get time to visit the facilities to acquire services.
Two thousand people have been reached through moonlight outreach within the last nine months and the number of clients enrolled onto ART has greatly increased due to on-the-spot enrollment. Moonlight outreach is a concept that organizations and health facilities around the world working with individuals at high risk for HIV and other STIs should incorporate in their fight against HIV and AIDS.
Frank Balamaze is the founder of TRWUganda, a youth activist, and an HIV prevention coordinator with SHES organization.