No Degrees of Separation

Great strides have been made against HIV/AIDS in Uganda. But the fight continues in the north, where everyone knows a victim.

KITGUM, Uganda - Immaculate Angom does not move. Not a muscle. Not a twitch. She will look at you but remains expressionless, registering nothing. She is as close to inanimate as a breathing person can be.

She is only five years old, but her grandmother thought she should be tested for

Ezrina has two other reasons for testing Immaculate: the girl's parents. Both died of AIDS -- her mother in July and her father four years ago.

Ezrina prays Immaculate won't become a statistic too. In the early '90s, nearly 20 percent of Uganda's population was infected with HIV. At some medical centers the rate reached 30 percent.

The efforts have not been without controversy. In August, an international consortium named the Global Fund to Fight AIDS, Tuberculosis and Malaria announced it was suspending funding to Uganda after discovering evidence that the Ugandan Health Ministry mismanaged grants.

The progress made in reducing infection doesn't mean the problem has gone away, especially in the conflict-torn north, where the rates of infection are still high. Critics have charged in the past that the area has not received its proper share of resources.

"It's still not under control," says Dr. Chiara Pierotti of the International Service Volunteers Association (AVSI), an Italian non-governmental organization. "There's a great deal of awareness and education, but in some areas we are still getting reports of 30 to 40 percent of the population infected."

Part of the reason for those high percentages is the 20-year war the Ugandan government has been fighting, primarily in the north, with a bizarre and savage insurgent group called the Lord's Resistance Army (LRA).

Its founder, Joseph Kony, claims he wants to establish a regime based on the Ten Commandments, but the LRA has conducted a campaign of killing and mutilation, as well as abducting an estimated 25,000 children.

This has permanently displaced more than 1.5 million people. It also has created a phenomenon called "night commuting," in which women, children and young adults walk nightly from rural areas to sleep in safer urban zones.

At St. Joseph's Catholic Hospital in Kitgum, where Pierotti works, dozens of patients wait outside the AIDS clinic to receive medication as well as follow-up examinations.

For most patients here, the AIDS cocktail of protease inhibitors has been simplified to just two pills: Truvada and Stocrin, both very expensive but supplied through a U.S. government grant made to Catholic Relief Services.

Thirty-year-old Sandra (not her real name) says she's seen a huge improvement since she began taking the drugs three years ago. But they have not, unfortunately, helped reduce the stigma of being HIV-positive in her community.

"People around me are not friendly," she says with a very tired look on her face. "Even my family was not very kind to me, until they saw me begin to improve with the treatments."

Sandra's husband died of AIDS complications last year. She says her four-year-old twins, a boy and a girl, give her hope to keep living. They both have been tested for HIV and are negative.

Jennifer Alur, 39, has been HIV-positive for three years; her husband died from AIDS. But she says she feels no stigma from the disease. "When I first found out I was HIV-positive a few years back people treated me badly, but then so many people became infected -- it's a common thing. People seem to understand now," she says.

Jennifer says the medication has helped her fight off opportunistic infections like skin rashes. She needs to be healthy, she says, to take care of her five children -- none of whom have been tested. But she is thinking about it for the youngest, who is seven.

It is hard to speak to anyone in this community who has not been affected by the AIDS epidemic. It seems literally no one has been spared, that there are no degrees of separation between victims and the virus' larger public consequences.

More than 30 people gather outside near another section of St. Joseph's to get information about the disease and apply to be tested. Results are given three days a week.

I ask one of the counselors here, Ocheng Sidonia, why the infection rates are so high in the north. She ticks off the reasons, as she has probably a thousand times before.

"There are three primary reasons for HIV infections here: insecurity resulting from the war, poverty resulting from the war, and ignorance," she says.

Many here agree that ending the conflict in the north would go a long way toward reducing the AIDS epidemic. Until then, education, testing and treatment have to suffice.

Joseph Olleli, 20, is getting tested for HIV today. He says he wants peace of mind.

"The situation of ours is very bad. I'm a little concerned," he says. When pressed a little, Olleli reveals that his father died of AIDS in 2004.

Rose Alanyo says her husband died from AIDS in 2003. "That's why I'm here," she says while waiting in line for nurses to draw blood. "I need to know about my situation. I have five children to care for and sometimes I don't feel well."

Five-year-old Immaculate emerges from the testing clinic holding a cotton swab to the needle prick on her pencil-thin arm. While many wince at the pain from the test, she remains stoic.

Immaculate is one of the last to be tested. Her grandmother Ezrina steadies her as they walk down the dirt path away from the hospital -- and perhaps steadies herself for the five-day wait to hear the results.

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