| Chapter 1: | Introduction |
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such as free provision of anti-HIV drugs, tuberculosis treatment, and counseling—Ugandan centers cannot provide all needed services to clients because of financial constraints. For example, some of the opportunistic illnesses characteristic of individuals with advanced HIV (for instance, malignancies and shingles) are manifested in severe pain, but Ugandan centers can provide for neither their free treatment nor palliative care (USDS, 2007). All clients on HAART also need and are required by health care providers to access good nutrition (Food and Agriculture Organization [FAO], 2002). However, although the majority of individuals under therapy in Uganda cannot afford good nutrition, Ugandan centers cannot provide them with dietary supplements, as is the case in the United States (WHO, 2008b). Additionally, centers in Uganda do not possess laboratory equipment for effective diagnostic tests, such as those required for the CD4 cell count and viral load. The cost for these services is usually so high that those affected cannot afford them. These services are generally carried out by other organizations not affiliated with free HAART-providing centers and usually at a cost.
Despite their differences, Uganda’s and the United States’ HAART-providing centers also show some similarities. For instance, because HIV disproportionately affects those at the bottom of the social stratification in all societies, many of the providing centers both in the United States and in Uganda are nongovernmental organizations that provide free or subsidized services within local communities to those in need who cannot afford them (U.S. Global AIDS Coordinator, 2008). Another similarity is that most of the HIV centers in both countries were founded in the late 1980s or early 1990s. This was partially due to a delay on the part of the U.S. government and the world community to address the AIDS phenomenon soon after the initial HIV diagnoses in 1981 (Bongaarts, 1996; Robbins, 2005; TASO, 2006). Studies blame this delay on the stigma that surrounded the disease and those affected, who were supposedly labeled as homosexuals, prostitutes, sinners, or social deviants. Nevertheless, these nongovernmental programs expanded over time in size and efficiency. For example, all three satellite centers under study in Uganda are part of somewhat large nongovernmental organizations