The Ministry of Health convened a meeting on 6th February 2020 to celebrate the milestones in the Tobacco control Journey in Uganda.

CEHURD together with other key stakeholders were recognized for their significant contribution towards this cause.

#UgandaVsBAT

#TobaccoControl

Sexual violence is any act which violates the autonomy and bodily integrity of women and children under the international criminal law including but not limited to; rape, sexual assault, grievous bodily harm, mutilation of female reproductive organs among others. It can also be seen as a form of violence against women (and men, who can also be sexually harassed) and as discriminatory treatment.

Legal definition of some types of sexual violence

1. Rape:  is defined as having unlawful sexual intercourse with a woman or girl, without her consent, or with her consent, if the consent is obtained by force or by means of threats or intimidation of any kind or by fear of bodily harm, or by means of false representations as to the nature of the act, or in the case of a married woman, by impersonating her husband, commits the felony termed rape.[1] Once a person is convicted the Punishment for Rape is death.  Attempt to commit rape calls for a maximum sentence of life imprisonment. [2]
2. Defilement: The Ugandan Penal Code Act was amended define defilement as having sexual intercourse with a person under 18 years of age. This means that the current law punishes the defilement of both girls and boys. Such person on conviction is liable to life imprisonment.  The law provides for the offense of aggravated defilement, which makes one on conviction by the High Court liable to suffer death. The circumstances for aggravated defilement are:-
3. Where the person defiled is below the age of 14 years
4. Where the offender is infected with HIV
5. Where the offender is a parent or guardian or a person in authority over, the victim
6. Where the victim of the offence is a person with disability; or
7. Where the offender is a serial one.

Under the law a person charged with aggravated defilement is obliged to undergo a medical examination as to determine their HIV status.

The law on defilement further provides for payment of compensation to victims of defilement in addition to any sentence imposed on the offender. It provides for the offense of child-to-child sex, where the offender is a child under 12 years; and when committed by a male child and a female child upon each other when each is not below 12 years, each of the offenders shall be dealt with as required by the Children Act.

Gravity of the sexual violence state in Uganda

Sexual and gender-based violence offenses are the most common and prevalent offenses committed in Uganda. ^[3]Through 2005-2014, rape fluctuated substantially; it tended to decrease ending at 2.9 cases per 100,000 population.^[i]

Worryingly, the Police Crime report for 2015 indicates that at least 1,419 cases of rape were reported countrywide. This rose to 1,572 in 2016, dropped to 1,335 in 2017, and rose to 1,580 cases in 2018.^[ii]

1 in 3 women are victims or survivors of sexual violence, 1 in 6 men are survivors/victims of Rape and Assault.

The above statistics are appalling and shocking, what aren’t we doing well? Has the law failed in some way or it’s the community that is not doing enough?

Why the increase in sexual offenses in Uganda?

Clearly it is not the absence of the Law that has caused failure to eliminate sexual violence in our society because the different actors under the referral pathway like police, Ministry of Health, Parliament, religious sector, the media, Health and Human rights organizations like CEHURD are the leading institutions in fighting this vice. But it is still an uphill climb,

Some of the possible reasons include;

• The increased drug abuse among the young population
• The delay in the Justice system for rape victims to get justice
• Victims of rape, especially the corporate type, rarely report cases of rape to police due to stigma
• Unemployment, leading to criminal minds
• Media’s constant display of explicit content leading to moral decay

Who is mostly at the risk of sexual violence?

Women and girls experience sexual violence at high rates while men/boys experience it at a low rate. Attacks can happen from anywhere, by anyone at any time. Places like refugee camps, homes, schools, offices, isolated spaces are some of the breeding grounds for rape.

What next after rape?

It is true that there is a gap or little knowledge on what the victims of rape are supposed to do immediately after the unfortunate incident. The public needs to know that comprehensive sexual assault services are available at all levels of the public health care system, from local health centers and clinics to national referral hospitals.

The first step is to report the assault/ incident at the nearest police station. After the complaint has been lodged at the Police Station and a statement recorded, the victim is subjected to a medical examination to ascertain the authenticity of the rape, assault and gravity of the incident to inform the nature of the case and evidence to support the case.  Before a victim lodges a compliant at a Police Station and undergoes a medical examination, they are advised to avoid activities that could potentially damage evidence such as bathing, showering, using the restroom, changing clothes, combing hair, and cleaning up the area.

Rape survivors are most often in a compromised and highly vulnerable position when they seek for help. Attendants ought to recognize the vulnerability of these clients and ensure that treatment does not cause further trauma or secondary victimization. The treatment should be sensitively given, with confidentiality and informed consent.

Rape / sexual assault victims are advised undergo Medical Examination. DNA evidence from the crime scene should be collected from the crime scene, but it can also be collected from the body of the victim, clothes, and other personal belongings. In most cases, DNA evidence needs to be collected within 72 hours from the occurrence of the incident.

Effects of The Rape Trauma

Rape and Sexual Assault cases may come and go, but they leave  grave, life-long effects on victims., Their psychological health and physical well-being are usually adversely affected; some of these effects include; sexually transmitted infections (diseases), depression, low self-esteem, mental illness, suicidal thoughts, insecurity, poor performance, isolation, pregnancy, post traumatic disorder etc.

Way forward

• Having more relevant and updated policies will ensure safety for all. As seen in Section 123 of the Penal code Act of 1954, only girls and women are considered to be victims, but time has shown that men and boys are also at risk.
• Justice delayed is Justice denied, assailants should be brought to book as soon as possible and uncalled for delays in the Justice system should be eliminated.
• Rehabilitation centers for Rape and Sexual Assault victims should be publicized more to support survivors emotionally and mentally
• Men should be involved at ground level because they are extremely important in breaking the rape culture.
• Government should step up mobilization, sensitization and education. Follow up referral pathways, investigate every single case reported quickly and effectively.

---

[1] Section 123 of the Penal code Act.

[2] Section 125 of the Penal Code Act,

[3] The presiding High Court Judge, Justice Gadenya Paul Wolimbwa, much attention is drawn towards Sexual Gender Based Violence cases such as defilement, rape and domestic violence, because they constitute 62 percent of the cases in the High Court of Uganda.[3]

---

[i] https://knoema.com/atlas/Uganda/Rape-rate

[ii] https://www.monitor.co.ug/Magazines/PeoplePower/Do-we-have-rape-crisis-country/689844-5415522-13yl07n/index.html

By Jacqueline Twemanye and Nakalembe Judith -CEHURD.

We at Center for Health Human Rights and Development (CEHURD) are excited to welcome and introduce to you our new Deputy Executive Director, Ms. Fatia Kiyange. Having Fatia at CEHURD is such a great honour!
Ms. Kiyange brings with her 19 years of work experience in the areas of programme development; leadership and management in the health and social justice sectors at the national, regional and global level. READ MORE..

In 2014, Uganda adopted the Industrial Property Act, with a landmark clause excluding pharmaceutical products from patenting at least until 1st January 2033.

Despite this positive move, pharmaceutical patents continue to be a barrier. The Africa Regional Intellectual Property Organization (ARIPO) administers the filing and grant of patents for 18 countries in sub-Saharan Africa including Uganda and annually churns out hundreds of pharmaceutical patents that apply to Uganda inconsistent with its national law.

The exclusion of pharmaceutical patents in the 2014 Act is aimed at addressing the massive challenge of access to medicines in Uganda. Notably it is also to promote its potential as a manufacturer of generic medicines, following in the footsteps of countries that developed a robust pharmaceutical sector due to the absence of pharmaceutical product patents.

India, excluded pharmaceutical product patents in 1970, creating the pathway to be a leader in the manufacture and export of quality affordable generic medicines. Nations globally are dependent on India as the “pharmacy to the world”. Bangladesh, a least developed country, suspended the granting of pharmaceutical product patents in 2008, a key factor in its emergence as a significant player in the global generic pharmaceutical sector. Historical development of the pharmaceutical sector in the rich countries is also instructive as the origins may be traced to the lack of pharmaceutical patent protection.

Uganda’s precedent setting pharmaceutical waiver clause is consistent with the requirements of the World Trade Organization’s Agreement on intellectual property commonly known as the WTO-TRIPS Agreement and international expert recommendations. The WTO-TRIPS Agreement features special rights for countries designated as least developed country (LDC) by the United Nations.  Recognizing that LDCs have economic, financial and administrative constraints, and need policy flexibility to create a viable technological base, in 2015, the WTO granted all LDCs the right to refuse the granting of pharmaceutical product patents at least until 1^st January 2033, with the option to renew it in the future.

The effect of patents on the affordability of medicines is an international concern. When a medicine is patented, it grants the patent holder a monopoly for at least 20 years. In 2000, patent holders of life-saving antiretroviral treatment charged $10,439 for a year’s supply of the treatment. The high price tag meant patients living with HIV/AIDS were mostly condemned to death. Entry of affordable generic versions of the treatment dropped prices significantly over time to less than US$100 crucial factor in the global scaling up of HIV/AIDS treatment.

Impact of patents on access to affordable treatment is likely to be more acutely felt with the rise of non-communicable diseases such as cancer and the prohibitively high cost of treatments. A 2018 technical report of the World Health Organization notes “Cancer medicines under the protection of intellectual property are unaffordable to patients and health care systems in low- and middle-income countries” and recommends that countries use flexibilities provided by the WTO-TRIPS Agreement to address the patent barrier. In this context, the flexibility of exemption of pharmaceutical product patents granted by the WTO and adopted by Uganda’s patent law is the right step forward. Apart from Uganda, several other African LDCs such as Rwanda, Liberia and Zanzibar have implemented this flexibility nationally. 

In 2012, the Heads of States of Africa adopted a Road-map on Shared Responsibility and Global Solidarity for the AIDS, Tuberculosis and Malaria Response in Africa: treating prevalence of infectious diseases “as an emergency for the region”, raising concern also that national responses to AIDS, TB and other infectious disease are highly dependent on external financial and foreign produced medicines and that this “dependency poses grave risk to the Continent”. The Road-map zoomed in on the LDC pharmaceutical waiver as a crucial policy tool to create a sound and viable technological base in the pharmaceutical sector in the region.   

Similarly, the African Union Pharmaceutical Manufacturing Plan for Africa and the East African Community Pharmaceutical Manufacturing Plan of Action for 2017-2027 identifies the under utilisation of TRIPS flexibilities as one of the major obstacles to the development of a viable pharmaceutical manufacturing on the African continent; stressing on full exploitation of WTO-TRIPS flexibilities including the LDC pharmaceutical waiver.

Uganda is well-placed to exploit these opportunities to promote its nascent generic manufacturing capacity as evidenced by the partnership between Cipla a well-known Indian generic company and Quality Chemicals, a local Ugandan company formed which continues to date as CiplaQCIL. This partnership is borne out of concern that countries with established generic manufacturing capacity will be barred from supplying generic versions of patented medicines, and to exploit Uganda’s status as an LDC with freedom from patent protection.  

While forward steps are taken at the national level, little has been done to ensure consistent implementation by ARIPO at the regional level. Since 2014 countless pharmaceutical patents have been granted by ARIPO that apply to Uganda.

According to the Ugandan patent office authorities, ARIPO has been notified of its national law, however this has done little to prevent ARIPO from granting pharmaceutical patents that extend to Uganda.

A similar situation prevails in other LDCs that are ARIPO members such as in Rwanda and Liberia whereby ARIPO patents are being granted inconsistent with national legislation. This situation creates legal uncertainty that could hinder the manufacturing or importation of affordable generic medicines.

Notably twelve out of the eighteen ARIPO members are LDCs: entitled to the pharmaceutical waiver. Exploitation of the LDC waiver is globally supported for its role in promoting access to medicines, and improving self-reliance through local/regional production. Yet ARIPO persist in granting pharmaceutical patents that extends to all LDCs, hindering manufacture, export and import of affordable generic medicines. 

Public health and legal experts say that ARIPO’s legal framework, the Harare Protocol requires urgent review and change in that it should be implementing the pharmaceutical waiver so that pharmaceutical patents do not apply to LDCs.

In 2017, the High-Level Meeting on Promoting Policy Coherence on Health Technology Innovation and Access in the ARIPO Region organized by the Government of Malawi as well as the 16^th Session of the Council of Ministers of ARIPO also considered it to be critical to improve legal and policy coherence at the Regional level.

Accordingly, civil society across ARIPO Members have repeatedly called for implementation of public health sensitive TRIPS flexibilities in ARIPO. In June 2019, to move the issue forward, detailed proposals were presented to the ARIPO Secretariat.   

Despite this and the numerous promises made to civil society by the ARIPO Secretariat that it will engage on this matter, discussion on this important subject has been conspicuously absent. 

Given what’s at stake in Uganda, it should take leadership at the upcoming Administrative and Ministerial Meetings of ARIPO beginning next week to initiate a credible, transparent and inclusive process that includes civil society to review the Harare Protocol from a public health perspective and to explore implementation of WTO-TRIPS flexibilities in particular the pharmaceutical waiver that is imperative for public health.

THERE IS NO WAY ANYTHING IS GOING TO BE DONE FOR THE YOUNG PEOPLE WITHOUT THEM BECAUSE IT WILL BE AGAINST THEM! (THE IMPORTANCE OF MEANINGFUL YOUTH PARTICIPATION)

I agree with World Contraception day ambassador Nana Abeulsoud when she states that today there are more young people than before and therefore youth voices matter because no one is more convincing to define the future through innovation but the largest population. It is common knowledge that Uganda has the second youngest population in the world with about 78% below 30 years and half of that below 15 years. We should also note the alarming growth rate which is 3% per annum, the unemployment rate of the youth which is 38% and the rate at which teenagers are getting pregnant has increased from 24% to 25%. It is on this premise that I focus on Adolescent girls and young women.  Adolescent girls and young women (AGYW), especially in sub-Saharan Africa, are highly vulnerable to HIV. In 2015, up to an estimated 450,000 new infections occurred among AGYW aged 15-24 years globally, translating into approximately 1,229 new infections per day.^[1] In Uganda, where AGYW are estimated at 6,569,000 or 16% of the population, up to 29,640 infections occurred in 2015.^[2] In 2014, HIV prevalence among young people aged 15-24 years was estimated at 3.72% for women and 2.32% for men.^[3] New HIV infections among AGYW are substantially higher than among males of the same age because HIV is more commonly acquired from male sexual partners who are a few or several years older.^[4] Findings from the Uganda AIDS Indicator Survey conducted by Ministry of Health revealed that 3% of adolescent girls 15-19 years live with HIV, and that prevalence doubles (7.1%) by the time they are 24 years.^[5] Estimates for 2015 show that the country registered an estimated 83,000 new HIV infections, 22% of them among AGYW, among whom an average of 50 infections occurred on a daily basis.^[6]

While carrying out research on integrating Legal Empowerment and Social Accountability (LESA) for Sexual Reproductive health and HIV services for Young People in Kibwa and Kireku slums, I realized that the biggest challenge these adolescent girls and young women face is lack of information. After being assured of confidentiality, some of them who had had children before 18 and had gotten infected wished they had known of contraception, what to do in case of coerced sexual activity and infection, redress mechanisms and what their rights as individuals are. INFORMATION. That’s what they basically wished they had. Most of them are brilliant with a lot of potential but have been derailed from what they could have been simply because they didn’t have this information.

I have interacted with these young people in our legal aid tents in a number of community outreaches and health and youth camps under different projects and the need cuts across. Some of the cases they report and some of the legal advice they seek is in regards to situations that would have been easily been avoided if they had the information they needed. At one of the most recent community outreaches in Mayuge district, I encountered a 21 year old girl who had had six children in six consecutive years simply because she did not know that she could say no to an early marriage as she was not coerced into it but also because she didn’t know of any family planning methods. This information should also be given to the parents of these young people as I have encountered parents that encourage some of this behavior by giving away their own children to be ‘married’ at a young age which is not right even if they have been defiled.

We therefore have to ensure that all the sexual reproductive health rights information is disseminated to the youth specifically in the hard to reach areas like the rural and slum areas but also involve them in decisions related to and for them. Also, young people need models and not critics like John Wooden said. Criticizing them for the past will not help improve the present and future situation. We should also have confidence in them and give them a chance to work with duty bearers as partners. Meaningful Youth Participation (MYP) means that young people work in all stages of decision-making and can participate on equal terms with adults at a number of levels, or alternatively work independently from adults and make decisions solely with the involvement of youth voices. MYP is a right that all young people have according to the Convention on the Rights of the Child. According to this UN Convention, young people have the fundamental right to participate and access information related to decision-making processes that affect their life and well-being. There is clear evidence that MYP benefits society, has positive effects on their development, strengthens organizational capacity and is key to achieving Sexual and Reproductive Health and Rights (SRHR) program outcomes. The youth should be encouraged to take charge of their lives by addressing their situation and then taking action in order to improve their access to resources and transform their consciousness through their beliefs, values, and attitudes. Policy and decision makers should also appreciate the benefits to the country of sufficiently investing in the young people and the risk/consequences to the country of not investing in their empowerment. Advocacy for SRHR enabling policy and social environment for adolescents and young people and empowerment of adolescents and young people to voice their rights and SRHR challenges that affect them should be intensified.

Since Adolescent girls and young women are the mostly affected as earlier illustrated, the Gender Transformative Approach (GTA) which actively strives to examine, question, and change rigid gender norms and imbalances of power as a means of achieving SRHR objectives, as well as gender equality objectives should also be applied. Male involvement and movements such as the ‘she decides’ movement which I am part of should also be encouraged so that we can have a world where every girl and woman can decide what to do with her body, her life and with her future WITHOUT QUESTION. And just Antonio Guterres (former secretary general of the United Nations) said, we need to place a special focus on young women and girls. So many futures are derailed when young women are pushed out of school, subjected to child marriage or have poor access to education and health care. When we empower Africa’s young women and girls, everyone wins.

The legal Empowerment and Social Accountability (LESA) approach will also go a long way in equipping the young people with the information they need and strengthen the capacity of Adolescent Girls and Young Women (AGYW) and their communities to demand for improved quality of SRH services for AGYW, including protection from sexual and gender-based violence (SGBV).

In a nutshell, youth voices matter because it is through that they can become fully empowered to become leaders in their own right. And for those in the struggle in the fight for the rights of the young people, there are times when you will see results in ten seconds and there are times you won’t see any for ten years. Either way, keep planting those seeds of character, eventually they will bloom.

Kyagera Nairuba Angella

Community Empowerment program (CEHURD)

---

[1] UNAIDS 2016 Estimates. Geneva: UNAIDS; 2016. (http://www.unaids.org/en/resources/documents/2016/HIV_estimates_with_ uncertainty_bounds_1990-2015 )

[2] PEPFAR. Uganda: DREAMS overview. https://www.pepfar.gov/documents/organization/253961.pdf

[3] Uganda AIDS Commission (2015). 2014 Uganda HIV and AIDS Country Progress Report

[4] UNAIDS 2016. HIV prevention among adolescent girls and young women: Putting HIV prevention among adolescent girls and young women on the Fast-Track and engaging men and boys. Guidance

[5] Ministry of Health (2011). Uganda AIDS Indicator Survey. http://health.go.ug/docs/UAIS_2011_REPORT.pdf

[6] Office of the President of Uganda (2017). Presidential fast track initiative on ending AIDS as a public health problem in Uganda; a five-point plan