HIV, AIDS and TB - An essential service for Lukuli and Makindye, integrated with general healthcare
Uganda has the unenviable record of being one of the first countries in Africa to experience and report deaths from a strange wasting disease. Noticeable along the main transportation route from Kenya, through Uganda's towns westwards to Rwanda and Congo (then Zaire), transmission spread among truck drivers and in the towns where they stopped. In 1986, Uganda's civil war ended, five years after US laboratories first reported AIDS, the new government rapidly learned that HIV was widespread throughout Uganda. Thankfully they acted and the once massive rate of 29% infection in urban areas was reduced. www.avert.org has detailed information.

Using play, we inform the very young of general health and how to stay safe.	Experienced, trained counsellors help men and women learn about HIV	PEPFAR, The Global Fund, UNITAID and the Government provide the ARVs

Although Hope Clinic Lukuli began as a site for safe delivery of babies and to manage fevers in adults and children, it was soon apparent that HIV was a huge, and unserved, medical and social issue in Makindye. In the early years of the clinic we could not offer counselling and testing, and with the government facility 3 miles away and donor programmes over 5 miles away, HIV services did not really reach Makindye or our community in Lukuli. By walking into the Ministry of Health, we were able to get help from Dr Akol and Dr Onyango to have HIV testing kits and the drugs for PMTCT at Hope Clinic. The procedure for preventing mother to child transmission (PMTCT) of HIV was planned and tested in Uganda so the least we could do was to bring it to Lukuli.

The early testing results and prevalence
In June 2004 we finally brought the AIDS Information Centre to Lukuli and on their first day they were able to counsel and test 40 people. We continued with that for several months of once a week counselling days at Hope Clinic Lukuli. Looking back, the results of people we tested and found positive as a percentage of the people we tested was alarming, regularly over 15% (when national prevalence was reported as less than 10%, even 6%). We took this to be indicative of a significant un-tested population. With no testing site within 2 miles of Lukuli in any direction, and people unlikely to spend money to travel for potentially bad news, HIV services and knowledge of HIV status were absent from Lukuli. The need for counselling space and to be able to host care and support and treatment services was another spur to raise the money to build the current facilities which opened in July 2005.

Uganda's response to HIV, AIDS and TB
As noted by Avert, Uganda's response to HIV and AIDS was led by government action to see HIV as a real risk to the whole country. "Zero Grazing" to reduce affairs outside the house was a major campaign and in the late '90's posters and billboards explained "the clear link" that alcohol leads to sex leads to HIV. It was not until 2004 that ARVs were available free of charge in Uganda from any site in Uganda. In 2006, Hope Clinic Lukuli was inspected by the AIDS Control Programme, Ministry of Health and accredited as an ART centre - one of the very few non-government organisations to have that status, especially as a community clinic. We remain primarily a general healthcare clinic for fevers, maternity, child health and laboratory testing. This greatly reduces the stigma that people would face if we were solely an HIV clinic or heavily branded ourselves as such. Also in 2006, the Joint Clinical Research Centre began a programme of visiting every two weeks to take blood samples for testing from our patients tested and found positive over the prior two weeks. Most importantly, JCRC brought medics experienced in HIV case management and ARVs and since then we have offered a comprehensive service: awareness, prevention advice, counselling and testing with PMTCT services, care and support, distribution of mosquito nets, clean water systems, condoms, information leaflets and cotrimoxazole (Septrin) to reduce opportunistic infections. Since mid 2011 we have had over 660 HIV positive clients on our register, with almost 300 of them already on ARV.

Hope Clinic Lukuli - discussing the challenges to continued care for those in need
The clinic exists because the community need the services and the overstretched government trusts and supports us to work within their policy framework for the population of Lukuli and adjoining parishes. Our catchment population are not employed at companies that provide medical insurance and their household incomes can not meet the costs of HIV drugs or care and support. In the developed world, health provision has a social safety net - in Uganda, at least in Makindye, Hope Clinic Lukuli is that safety net. We work with government, we liaise with donor programmes inside and outside Uganda and it brings services to our community. In 2008, the international HIV implementers conference was held in Kampala and Ambassador Dybul was interviewed by the BBC on the opening day, with our Angella the other interviewee. In the build up, NTV filmed a story of our work and local newspapers compared our services to the government. Internationally, in 2010 changes in which contractor would administer PEPFAR funds in Uganda led to miss-reporting that patients would be denied care. CNN interviewed our patients and staff. UNITAID, the innovative funding programme and MassiveGood feature our work on their website. We tweet!