The Role of the Medical Military Senior Command in Mobilization for HIV/AIDS Prevention Interventions: A Case for Uganda Peoples Defense Forces (UPDF) ICASA 2015 Presenting Author: Lutimba Benjamin RTI International, UPDF/US Department of Defense (DOD) Project 29 November – 4 December 2015 RTI International is a registered trademark and a trade name of Research Triangle Institute.

UPDF HIV Magnitude and Risk Uganda HIV prevalence is estimated at 7.3% (AIS, 2011) HIV prevalence among the UPDF population is not well documented, but is believed to be higher than the general population The UPDF population are at a higher risk of HIV infection because, generally, they are:  Young, highly sexually active, and take risks  Highly mobile – away from family for long periods  Operating in areas with high HIV prevalence UPDF is a priority population in the Uganda national HIV prevention strategy

UPDF HIV/AIDS Program: Leadership and Strategy Chieftaincy of Medical Services (CMS) heads medical services in UPDF Directorate of HIV/AIDS (D/HIV/AIDS) is one of 9 directorates under UPDF; CMS is responsible for the HIV program UPDF HIV program’s mission is to increase the accessibility, uptake, and provision of quality care HIV prevention services in the military UPDF prevention strategy aligned with the national strategy – promotes a comprehensive package of combined prevention interventions HIV services are delivered within institutional, command-led structures

Issues: HIV/AIDS Prevention Strategy UPDF is supported by partners to increase access to and uptake of quality HIV prevention, care, treatment, and support services  42 static and 1 mobile HCT units; 17 ART centers; 10 static and 3 mobile VMMC units  Services are more accessible, but there has been relatively low uptake, sub- optimal use and coverage due to target population complexities UPDF is very structured and organized. Commanders are always in charge and listened to by the personnel they lead The program adopted the command-led mobilization to increase use and, ultimately, coverage of given interventions

Description: Commander-led Mobilization Mobilization approach is top-down (from larger units to smaller units) CMS and the D/HIV/AIDS officers meet unit commanders at various military bases CMS field visits are biannual and D/HIV/AIDS visits are quarterly, or as needed Mobilization approach existed, but was rejuvenated in 2011

Description: Senior Command Field activities During the periodic field visits, senior officers: Share basic tips on HIV prevention with field unit commanders, including advancements related to HIV and AIDS Sensitize and discuss implementation plans with unit commanders Conduct targeted dialogue with all unit health workers Occasionally champion interventions, such as participation in HTC to lead by example Carry out targeted health dialogue meetings with available UPDF officers and men

An Officer Engaged in an HIV Prevention Dialogue meeting in Mubende Barracks.

Achievements Over the Years Lower unit commanders have been reached with HIV/AIDS sensitization by the senior officers as peers and over the last four (4) years, the following results were achieved:  171,258 individuals reached with HCT  8,820 enrolled in HAART  30,236 men circumcised  14,222 reached with PMTCT services  66,242 individuals (38,450 men and 27,792 women) reached with sexual and behavioral change messages delivered through small group dialogue

VMMC Achievements with Continuous Commander Mobilization

Small Group Dialogue Meeting Achievements with Continuous Commander Mobilization

Next Steps Consolidate achievements by making the commander-led mobilization a routine activity Dedicate additional resources to allow deeper commander involvement in mobilization through field visits Equip more lower unit commanders with basic current information on HIV and AIDS Ensure deeper commander engagement in HIV and AIDS activity at planning phase

Acknowledgements US-DHAPP(Department of Defense) UPDF Chieftaincy of Medical Services UPDF Directorate of HIV/AIDS RTI International, UPDF project team RTI International, Home Office UPDF staff, their families, and surrounding communities Co-authors: John Bosco Ddamulira, Nobert Mubiru, Cassette Wamundu, Davis Rwangoga, Stephen Kusasira, and Juliet Akao

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