International Rescue Committee UK

The IRC's Julia Peppiatt discusses the challenges facing IRC staff fighting HIV/AIDS in northern Uganda.

The good news is that the number of people in low and middle-income countries receiving anti-retroviral therapy (ART) for HIV/AIDS increased ten-fold over the past five years to 4.03 million, according to the United Nations. The bad news is that an additional 5 million people needing ART are still unable to access it.

Take Uganda, for instance. "Ideally, we would like to be able to give treatment to every patient who tests positive for HIV, but this is a problem," says Stanley Bailey Angiyu, an IRC health officer in Kitgum and Lamwo districts. "This is sometimes because of drug shortages, but more often it's because of the absence of qualified staff with the knowledge to dispense these drugs."

Angiyu tells me that the majority of large health centres in Uganda should have staff who are officially accredited to administer ART, according to 2008 Ministry of Health standards. But here in the far north of Uganda, only 11 out of 41 such facilities have accredited staff.

Kitgum and Lamwo - in northern Uganda - were devastated by protracted conflict between the Ugandan government and rebel group the Lord's Resistance Army. Health centres were destroyed or fell into disrepair, medical supplies were ransacked and key health staff fled. While the conflict may have ended in 2006, the process of rebuilding public services is still ongoing and patients are bearing the brunt.

Mary (not her real name) is one of the lucky ones. She sits in a tiny office in Padibe Health Centre IV with her son, his hand resting supportively on her shoulder. District health clinician Gustave Opoka talks to her for nearly half an hour about ART, how the drugs will help, and how Mary must take them correctly.

Finally, Opoka passes Mary a few small plastic bags of pills, and her face breaks into a wide smile. After months of suffering from intense chest pain and a nasty cough, today she has received her first round of ART.

But trained and dedicated clinicians like Opoka are few and far between. So the IRC is supporting national Ministry of Health officials to educate district health clinicians, counsellors and midwives. The national officials conducted a five-day intensive training in June 2008, and refresher courses in July and November 2009.

"We teach the district health officials to educate patients - about the importance of taking their medication every day, reporting any side effects, and paying attention to good nutrition and safe water," says Angiyu. The district counsellors also learn how to combat social stigma that surrounds HIV, and how to deliver group counselling sessions to ease patients' anxiety.

Mary certainly seems confident when she leaves the health centre. She says: "I've learned the facts about HIV and positive living. I know to eat eggs, greens and meat to stay healthy, and I'm going to take this medicine for life."

Given that there are currently 135,000 new HIV/AIDS cases reported each year in Uganda, and that country-wide prevalence rates have risen to almost 7%, such initiatives are crucial.