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After 14 years, the Aids ‘commissioner’ retires

With satisfaction, Kihumuro Apuuli tells of a journey that started with tears

President Museveni has long been hailed for leading the fight against HIV/Aids, but that war has had many other devoted warriors. Among them is Dr David Livingstone Kihumuro Apuuli, who has retired after 14 years as director general of the Uganda Aids Commission (UAC).

He has built hope for people living with HIV/ Aids and under his watch the annual additional number of HIV-positive patients on anti-retroviral (ARV) treatment (193,000) has surpassed the number of those catching the virus annually (140,000). For Kihumuro, getting to what he calls the tipping point of the epidemic has not been easy.

He says the country has now reached a point where it has started breaking the epidemic, because more people are receiving treatment than those getting infected. New infections have dropped from 160,000 in 2011 to 140,000 in 2012. Of the 800,000 people who need treatment, the country has put nearly 600,000 people on treatment.

“This is an important point in science because it has been shown that when you take treatment, it reduces the chances of transmitting the virus to another person. This reduces the viral load in the community and in turn reduces the infection rate. The target is that by mid-2014 we should have put 240,000 new people on treatment,” Kihumurosays.

This can only be achieved if donor countries like USA don’t cut their funding budget to Uganda following the signing of the Anti-Homosexuality Bill into law. Donor funding covers nearly 80 per cent of HIV treatment in Uganda.

When Kihumuro took over from Omwony Ojok on December 1, 1999, he literally cried on his first day at work.

“I asked God, why me? The offices were in such a poor state. That day it had rained and there was mud everywhere. It was a house in a matooke plantation on Sentema road. I found only five members who were demoralised because they had not received a salary in six months.

There was no vehicle, no systems. I asked them what had happened and they said ‘we have no funding’. I asked them why and they said the commission is part of the ministry of Health and they decide what to give us?” Kihumuro recalls.

He knew he had a tough job ahead of him. If he was to convince anyone to sink funding into the fight against HIV, he needed better systems – in a better facility. At his inauguration, there were only 50,000 people receiving anti-retroviral treatment; today, that number is 600,000. Funding for HIV/Aids activities stood at $50 million; today it is $450 million, although the Uganda government puts in barely $40 million.

The number of people who know their HIV sero status has increased and now 67 per cent of women and 55 per cent of men have tested for HIV and know their status. The number of children born HIV-positive has also dropped from 28,000 in 2010 to 25,000 in 2011 to 15,000 in 2012 and it is estimated to have dropped even further to 10,000 in 2013. – the evidence of progress seems boundless.

UAC’s revival started in earnest in 2001, when the World Bank committed $580,000 to renovate its dilapidated buildings in Mengo. But this careful spender dreamt bigger, using that money to build new structures.

“You see now the whole place is staffed with highly-qualified people. Our donors and partners have confidence in the commission and it is an example for many people who come here to learn and copy the structures of what we have done here.”

Yet it has not all been rosy. It was also under Kihumuro’s watch that the HIV prevalence rose from 6.4 per cent to 7.2 per cent. He suggests that although ARVs have been part of the solution, they also ushered in a dangerous problem – complacency.

“People thought that drugs have come and there is nothing to worry about,” Kihumuro says of his lowest point in his tenure at UAC. He says the country has drawn a plan and if it is not followed, by 2020, 2.8 million people will be living with HIV. Today 1.5 million Ugandans are living with the virus.

“We must be bold on what must be done to save 700,000 to 800,000 people from getting infected,” Kihumuro says.

Part of the plan is to enrol all people living with HIV on ARVs to reduce their viral load and infection rate. But what is most important is for the country to know that sexual behaviour is the cornerstone of a country’s HIV/Aids backbone.  People must be tirelessly mobilised to know their status, avoid risky behaviour and protect themselves and their loved ones.

Royal struggle

Kihumuro remembers waking up at 3am to walk 11 miles through a thick forest canopy filled with wild animals to Kabalega Junior Secondary school in Masindi district, where he was born on July 27, 1948. His father, Canon Swithin Nyarubona, was a very religious man and one of the founders of Uganda’s Pentecostal movement.

“This experience shaped my life as somebody focused and determined. If I decide to do something, I must finish it. I grew up in a poor background and I have learnt that money does not drive what I do,” Kihumuro says.

His great grandfather was Omukama Kabalega’s brother and that makes Kihumuro a member of the royal family. His decision to take up a career in medicine was made by his father and uncle Dr Ivan Majugo.

“Nobody in the royal family was a doctor except my uncle Ivan. If he passed away, they wanted another person; so, they chose me,” he recalls.

He joined Makerere University and qualified in medicine in 1973. His first posting was at Iganga hospital, where he worked as a medical officer and rose through the ranks to become district medical superintendent.

This did not go down well with former President Idi Amin and his soldiers. Kihumuro got wind of a plan to kill him and on December 31, 1975, when everybody was in a celebratory mood, he got on the first plane out of Uganda to Nairobi, Kenya.

“At that time, when State Research Bureau looks for you, you know your time to die has come,” he said.

The Kenyan government received him with open arms and immediately gave him a job as medical superintendent. In the 70s, most of the doctors and teachers in Kenya were Ugandans in exile.

“In Kenya, if you do a good service, you wake up in the morning and find your compound filled with sacks of food, chicken, goats. I remember a rich businessman offered me a blank cheque to buy my first car; so, I bought a Mark II,” Apuuli recalls.

His most memorable day in service as a doctor was when he was at home resting and an emergency call came in. A woman in the labour ward was on the brink of death due to excess bleeding. Yet the baby was not coming out. There was no blood in the hospital.

“I asked the husband to donate one pint but he refused. I couldn’t believe that he would let his wife and child die. So, I asked the nurse to take blood from me and give her. I then operated her and mum and baby left the hospital alive,” Apuuli says.

In 1980, he returned to Uganda and was immediately posted as deputy medical superintendent of Mulago hospital. He was then appointed director of Mulago, where he moved from to join the ministry of Health as director of Medical Services in 1993. In 1999, he became the director general of Uganda Aids Commission.

He continued to work closely with his kingdom and because of his royal ties, this inspired him to write his book; A thousand years of Bunyoro-Kitara Kingdom. He retires into private business but says he is available whenever his country needs his input.

smwesigye@observer.ug

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