Upon arrival at Mpuga Island, visitors are greeted by substandard lodging, shanty kiosks, fish stalls, and small shops. Notably absent are any drug shops or clinics. Under normal weather conditions, a boat ride from Kiyindi Landing Site to Mpuga Island in Bweema Sub-county, Buvuma District, takes 30 minutes. Mpuga Island is one of the 52 islands in Buvuma, covering four miles and housing approximately 150 people.
Recent statistics reveal that Buvuma has 236 cases of HIV, with 132 women and 104 men affected. This is a significant improvement from the 693 cases reported in 2023 and 806 in 2022. Residents believe divine intervention plays a role in their fight against HIV.
Moses Kivumbi, who has lived on Mpuga for over 20 years, notes that health officials seldom visit the island, sometimes taking up to a year between visits.
Makeshift Protection
“We don’t have condoms on this island,” says Kivumbi. “We use polythene bags (kaveera) to protect ourselves from HIV. You must ensure the kaveera is clean and has no holes. Then, you tie it with a rubber band to secure it. You also have to be gentle during intercourse to avoid tearing it.”
A kaveera costs Shs100 in shops, but not everyone can afford it. Paulo Katoringa explains that he buys a mandazi (snack) wrapped in a kaveera, which he then uses during sex. “Sometimes it tears, and those who don’t know how to use this method are dying of AIDS.”
Some men carry polythene bags in their pockets like condoms. One man explains, “Some women insist on using condoms, but we can’t access them. The only way to make them comfortable is to show them the kaveera.”
Transport Costs and HIV Infection
Resident Anna Nekesa highlights the prohibitive transport costs, making it difficult for people to leave the island for condoms. “Men here share the few women on the island, often booking them in advance to avoid conflicts.”
Mpuga Island’s location between Kiyindi Landing Site and Namatale Island makes travel costly. A trip to Kiyindi costs Shs150,000, and a round trip to Namatale costs Shs100,000.
The Ministry of Health established Village Health Teams (VHT) to bridge the gap in healthcare access. However, Peter Kamya Tumusiime, the district councillor, points out that most government projects go to Namatale Island, leaving Mpuga underserved.
The VHTs’ role includes educating residents about condom use. However, as Tumusiime notes, “How do you tell someone to use something they don’t know how to use?”
Paul Ssempijja, the village chairperson, concurs that VHTs rarely provide health services to the islanders. “VHTs are volunteers who also need to work for a living, so they rarely attend to their health duties.”
Lifestyle and HIV Risk
A 2021 study highlights that fishing communities have limited knowledge of HIV/AIDS, contributing to risky sexual behaviour and high HIV incidence. Ssempijja adds that the Marine Unit of the Uganda People’s Defense Forces (UPDF) has reduced the number of infections by curbing illegal fishing, causing many fishermen to flee the island and potentially spread HIV elsewhere.
Without a health centre on Mpuga, residents must travel to Namatale Health Centre III. Doreen Alupo, an enrolled midwife, says that outreach campaigns and VHT efforts have reduced new HIV infections.
Pregnant women like Rose Akello face difficulties accessing antenatal care and HIV treatment. Akello, who is four months pregnant, has not taken antiretroviral drugs (ARVs) in three months and worries about her unborn child’s health.
Post-exposure prophylaxis (PEP) is crucial for preventing HIV after exposure, but its availability on the island is limited. Musa Bukumunhe, an enrolled nurse, notes that the migratory nature of islanders complicates consistent HIV medication access.
Integrated health outreaches, including immunisation and antenatal services, are often hindered by Lake Victoria’s unpredictable weather, affecting transportation.
Isa Mbooge, the district chief administrative officer, emphasises the need for improved transportation and health facilities on Mpuga Island. He acknowledges support from organisations like the Makerere University Walter Reed Project (MUWRP) and The AIDS Support Organisation (TASO) in providing testing and treatment.
HIV Prevalence
A 2021 study indicates that HIV prevalence in fishing communities is significantly higher than the national average due to factors like frequent mobility, multiple sexual partners, and limited health services. The Uganda AIDS Commission estimates that HIV infection rates in these communities are about five times higher than the national average for adults aged 15 to 49 years.
