Browsing by Author "Rujumba, Joseph"

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Experiences of gender based violence among refugee populations in Uganda: evidence from four refugee camps
(Eastern Africa Social Science Research Review., 2018-01) Kwiringira, Japheth Nkiriyehe; Mutabazi, Marion Mugisha; Mugumya, Firminus; Kaweesi, Edward; Munube, Deogratias; Rujumba, Joseph
In refugee generating situations, flight conditions and actual refugee circumstances, Gender Based Violence take different forms like rape, female genital mutilation, physical, psychological and emotional abuse, defilement and bride kidnapping in the name of 'early marriage' and sexual harassment among others. These forms are heightened by the adverse conditions of lack of basic needs, unequal power relations, breakdown of institutions of social control and order, exposure to the dangers of group violence and low capacity of protection agencies both local and international, and the host governments. This study intended to detail refugee experiences of Gender Based Violence among refugees in Uganda as well as the associated factors. We conducted a qualitative study and used content-thematic approach analysis. While there was high GBV awareness; this did not translate into reduced susceptibility. Detection, prevention and response to GBV were curtailed by an intersectionality of unequal power relations, poverty, and a multiplicity of cultures that concealed the nature, extent and reality of GBV. Effective GBV prevention requires an array of interventions and 'capacities' especially access to basic needs for individuals and households. Our findings aver that, gender based violence is endemic in peripheral hard to reach, conflict and post-conflict settings than in more stable communities due to underreporting and concealment that are associated with numerous capacity challenges in access and utilisation of the available services. The extreme conditions that refugees go through during displacement, flight and resettlement tend to exacerbate and sustain GBV.
‘If they beat you and your children have eaten, that is fine…’ intersections of poverty, livelihoods and violence against women and girls in the Karamoja Region, Uganda
(The Palgrave Handbook of Intersectionality in Public Policy, 2019-02-02) Rujumba, Joseph; Kwiringira, Japheth
Violence against women and girls (VAWG) is a common occurrence, but the daily struggles to meet survival needs take precedence over rights, entitlements and freedoms. As such, violence against women and girls thrives on deprivation, poverty, acceptance and concealment coupled with women’s dependence on men and male-dominated decision-making in most spheres of life. Even with increased awareness about VAWG, there was a fear to lose ‘care’ among women and custody over their children, which kept violence unreported and hidden. In practice, for policies and programmes to be effective, the multiple vulnerabilities of being female, mothers, poor, illiterate, married and the limitations on access and control over household and communal resources as intersectionalities need to be addressed. It is important for policy makers and programme implementers to continuously develop and adapt interventions and approaches considering the multilayered lived experiences of women and girls that expose them to and sustain violence.
Interface of culture, insecurity and HIV and AIDS: lessons from displaced communities in Pader district, northern Uganda
(Springer Nature: Conflict and Health., 2010-11-22) Rujumba, Joseph; Kwiringira, Japheth
Northern Uganda unlike other rural regions has registered high HIV prevalence rates comparable to those of urbanized Kampala and the central region. This could be due to the linkages of culture, insecurity and HIV. We explored community perceptions of HIV and AIDS as a problem and its inter-linkage with culture and insecurity in Pader District. Methods: A cross sectional qualitative study was conducted in four sub-counties of Pader District, Uganda between May and June 2008. Data for the study were collected through 12 focus group discussions (FGDs) held separately; 2 FGDs with men, 6 FGDs with women, and 4 FGDs with the youth (2 for each sex). In addition we conducted 15 key informant interviews with; 3 health workers, 4 community leaders at village and parish levels, 3 persons living with HIV and 5 district officials. Data were analysed using the content thematic approach. This process involved identification of the study themes and sub-themes following multiple reading of interview and discussion transcripts. Relevant quotations per thematic area were identified and have been used in the presentation of study findings. Results: The struggles to meet the basic and survival needs by individuals and households overshadowed HIV as a major community problem. Conflict and risky sexual related cultural practices were perceived by communities as major drivers of HIV and AIDS in the district. Insecurity had led to congestion in the camps leading to moral decadence, rape and defilement, prostitution and poverty which increased vulnerability to HIV infection. The cultural drivers of HIV and AIDS were; widow inheritance, polygamy, early marriages, family expectations, silence about sex and alcoholism. Conclusions: Development partners including civil society organisations, central government, district administration, religious and cultural leaders as well as other stakeholders should mainstream HIV in all community development and livelihood interventions in the post conflict Pader district to curtail the likely escalation of the HIV epidemic. A comprehensive behaviour change communication strategy is urgently needed to address the negative cultural practices. Real progress in the region lies in advocacy and negotiation to realise lasting peace.
Livelihood risk, culture, and the HIV interface: evidence from lakeshore border communities in Buliisa district, Uganda
(Journal of Tropical Medicine., 2019) Kwiringira, Japheth Nkiriyehe; Ariho, Paulino; Zakumumpa, Henry; Mugisha, James; Rujumba, Joseph; Mugisha, Marion Mutabazi
While studies have focused on HIV prevalence and incidence among fishing communities, there has been inadequate attention paid to the construction and perception of HIV risk among fisher folk. There has been limited research with respect to communities along Lake Albert on the border between Uganda and the Democratic Republic of Congo (DRC). Methods. We conducted a qualitative study on three landing sites of Butiaba, Bugoigo, and Wanseko on the shores of Lake Albert along the border of Uganda and the Democratic Republic of Congo. Data were collected using 12 Focus Group Discussions and 15 key informant interviews. Analysis was done manually using content and thematic approaches. Results. Lakeshore livelihoods split families between men, women, and children with varying degrees of exposure to HIV infection risk. Sustaining a thriving fish trade was dependent on taking high risks. For instance, profits were high when the lake was stormy. Landing sites were characterized by widespread prostitution, alcohol consumption, drug abuse, and child labour. Such behaviors negatively affected minors and in many ways predisposed them to HIV infection. The lake shore-border heterogeneity resulted in a population with varying HIV knowledge, attitudes, behavior, and competencies to risk perception and adaptation amidst negative masculinities and negative resilience. Conclusion. The susceptibility of lakeshore communities to HIV is attributable to a complex combination of geo-socio, the available (health) services, economic, and cultural factors which converged around the fishing livelihood. This study reveals that HIV risk assessment is an interplay of plural rationalities within the circumstances and constraints that impinge on the daily lives by different actors. A lack of cohesion in a multiethnic setting with large numbers of outsiders and a large transient population made the available HIV interventions less effective.
Understanding implementation barriers in the national scale-up of differentiated ART delivery in Uganda
(Springer nature: BMC Health Services Research., 2020-03-17) Zakumumpa, Henry; Rujumba, Joseph; Kwiringira, Japheth; Katureebe, Cordelia; Spicer, Neil
Although Differentiated Service Delivery (DSD) for anti-retroviral therapy (ART) has been rolled-out nationally in several countries since World Health Organization (WHO)‘s landmark 2016 guidelines, there is little research evaluating post-implementation outcomes. The objective of this study was to explore patients’ and HIV service managers’ perspectives on barriers to implementation of Differentiated ART service delivery in Uganda. Methods: We employed a qualitative descriptive design involving 124 participants. Between April and June 2019 we conducted 76 qualitative interviews with national-level HIV program managers (n = 18), District Health Team leaders (n = 24), representatives of PEPFAR implementing organizations (11), ART clinic in-charges (23) in six purposively selected Uganda districts with a high HIV burden (Kampala, Luwero, Wakiso, Mbale, Budadiri, Bulambuli). Six focus group discussions (48 participants) were held with patients enrolled in DSD models in case-study districts. Data were analyzed by thematic approach as guided by a multi-level analytical framework: Individual-level factors; Health-system factors; Community factors; and Context. Results: Our data shows that multiple barriers have been encountered in DSD implementation. Individual-level: Individualized stigma and a fear of detachment from health facilities by stable patients enrolled in communitybased models were reported as bottlenecks. Socio-economic status was reported to have an influence on patient selection of DSD models. Health-system: Insufficient training of health workers in DSD delivery and supply chain barriers to multi-month ART dispensing were identified as constraints. Patients perceived current selection of DSD models to be provider-intensive and not sufficiently patient-centred. Community: Community-level stigma and insufficient funding to providers to fully operationalize community drug pick-up points were identified as limitations. Context: Frequent changes in physical addresses among urban clients were reported to impede the running of patient groups of rotating ART refill pick-ups. Conclusion: This is one of the first multi-stakeholder evaluations of national DSD implementation in Uganda since initial roll-out in 2017. Multi-level interventions are needed to accelerate further DSD implementation in Uganda from demand-side (addressing HIV-related stigma, community engagement) and supply-side dimensions (strengthening ART supply chain capacities, increasing funding for community models and further DSD program design to improve patient-centeredness).
Understanding the persistence of vertical (stand-alone) HIV clinics in the health system in Uganda: a qualitative synthesis of patient and provider perspectives
(Springer nature: BMC Health Services Research., 2018-09-05) Zakumumpa, Henry; Rujumba, Joseph; Kwiringira, Japheth; Kiplagat, Jepchirchir; Namulema, Edith; Muganzi, Alex
Although there is mounting evidence and policy guidance urging the integration of HIV services into general health systems in countries with a high HIV burden, vertical (stand-alone) HIV clinics are still common in Uganda. We sought to describe the specific contexts underpinning the endurance of vertical HIV clinics in Uganda. Methods: A qualitative research design was adopted. Semi-structured interviews were conducted with the heads of HIV clinics, clinicians and facility in-charges (n = 78), coupled with eight focus group discussions (64 participants) with patients from 16 health facilities purposively selected, from a nationally-representative sample of 195 health facilities across Uganda, because they run stand-alone HIV clinics. Data were analyzed by thematic approach as guided by the theory proposed by Shediac-Rizkallah & Bone (1998) which identifies; Intervention characteristics, organizational context, and broader environment factors as potentially influential on health programme sustainability. Results: Intervention characteristics: Provider stigma was reported to have been widespread in the integrated care experience of participating health facilities which necessitated the establishment of stand-alone HIV clinics. HIV disease management was described as highly specialized which necessitated a dedicated workforce and vertical HIV infrastructure such as counselling rooms. Organizational context: Participating health facilities reported health-system capacity constraints in implementing integrated systems of care due to a shortage of ART-proficient personnel and physical space, a lack of laboratory capacity to concurrently conduct HIV and non-HIV tests and increased workloads associated with implementing integrated care. Broader environment factors: Escalating HIV client loads and external HIV funding architectures were perceived to have perpetuated verticalized HIV programming over the past decade. Conclusion: Our study offers in-depth, contextualized insights into the factors contributing to the endurance of vertical HIV clinics in Uganda. Our analysis suggests that there is a complex interaction in supply-side constraints (shortage of ART-proficient personnel, increased workloads, laboratory capacity deficiencies) and demand-side factors (escalating demand for HIV services, psychosocial barriers to HIV care) as well as the specialized nature of HIV disease management which pose challenges to the integrated-health services agenda.