Love Restores Teen’s Health
Emmanuel Asiimwe, 16, is an active teenager living in Kibisho, a farming village in southwestern Uganda. But he was not always so full of life. Often, over the past eight years, he has struggled with health complications, due to problems taking his antiretroviral treatment (ART) regularly.
When Emmanuel was diagnosed with HIV at the age of 8, he was immediately enrolled in ART. However, viral load tests over the years continued to show that he was not suppressing HIV in his body. When the viral load is low (suppressed), a person living with HIV can lead a normal life, without the health risks related to AIDS.
Through a focused effort to reach children and adolescents with high viral loads, health workers at Mitooma Health Center IV followed up with Emmanuel in early 2023 and found out he is an orphan and had no one at home to help him follow his treatment protocols.
“His immediate family abandoned him in the home,” reports Mary Kyomugisha, the nurse-in-charge of the ART clinic at Mitooma Health Center IV. “Sometimes he would not get meals, which caused him to miss his medications.”
Antiretroviral medication should be taken with food to avoid unpleasant side effects. The medication also increases appetite, which is a problem when there is no food. It is not uncommon for people experiencing food scarcity to miss doses of antiretroviral medication for these reasons.
A Community Health Worker to the Rescue
Staff at Mitooma Health Center IV asked Patience Atuhwerire, a community health worker and peer educator, to identify a secondary caretaker in the community to support Emmanuel in treatment. With Emmanuel’s consent, Patience found a relative, Specioza Kyosiimire, who said that she would be glad to look after the boy. Patience educated Specioza regarding Emmanuels’ needs, such as making sure that he gets regular meals to help him take his medication as prescribed—under her direct observation.
Emmanuel says he feels loved and secure under Specioza’s watch. “Life became much better because I no longer missed meals and drugs, and nobody mistreated me,” he says.
After taking custody of Emmanuel, Specioza encountered stiff resistance from his extended family. For example, they did not allow her to grow food on their land to feed Emmanuel and demanded that she let the boy go back to their home.
“They thought I was plotting to take their land under the pretext of caring for the boy. They were very aggressive and determined to get Emmanuel out of my care.” Specioza recounts. It took the intervention of the community development officer for Mitooma Sub-County and the village’s council chairperson to safeguard Emmanuel’s plight.
“We already knew that the family had abandoned the boy, and we could not allow him back in their hands. It would mean we have surrendered the boy to die. “We used our mandates as community leaders to overrule the family members,” says Byemushika Steven, the chairperson for Kibisho.
Under the Eye of a Caring Guardian
Emmanuel’s viral load began to decline after two months of consistent adherence to treatment. A repeat viral load test in March 2023 showed that his viral load had decreased from 2,330 copies/ml to 675 copies/ml—an incredible achievement in a short time!
Emanuel is just one of the many children around the world who face the risk of death due to a high viral load. Health centers like Mitooma Health Center IV have taken on the task of following up to make sure that every young client living with HIV is getting the care they deserve.
Mary says that she and her team learned that 14 of the 106 children and adolescents on ART were not virally suppressed, despite being enrolled in long-term treatment and psychosocial support.
“We got concerned because this number was so high and would undermine our commitment to achieve the global target of having 95% of people on ART achieve viral suppression by 2025,” Mary recounts.
She says that some of the children and adolescents living with HIV experience stigma from family members who believed they would die soon. Or children may have multiple caretakers who give minimal attention to medication schedules and treatment challenges. In other cases, children may find themselves with caregivers that are either elderly or illiterate and cannot ensure that children take their medicine as prescribed.
To address such issues, Mitooma Health Center IV began implementing a community engagement approach in January 2023, identifying secondary caregivers from communities—with the consent of their families—and enlisting community leaders. Hospital staff trained guardians on HIV fundamentals and psychosocial support. By involving secondary caregivers and community leaders—who are often familiar with the cultural and social contexts of the children they support—case management is more holistic and effective.
Emmanuel is one of the 10 children who have suppressed their viral load following the implementation of the community engagement approach. Mary Kyomugisha and her team are working with the remaining four to also achieve viral suppression.

EGPAF-Uganda appreciates the support of ViiV Positive Action that has made this work possible.
Richard Mayanja
Uganda
Adolescent Identification, Care & Treatment; Pediatric HIV Diagnosis, Care & Treatment