Juma Bwanika

Juma Bwanika was confused. In late January, he started hearing on the local television and radio stations that all HIV services had been shut down for 90 days. He didn’t understand why. Something about the United States cutting its funding to Uganda.

I got frightened. My heart sank in deep sorrow. They were saying there would be no more treatment for us.

Bwanika is HIV-positive and has been taking daily anti-retroviral therapy, paid for by the U.S. government, for 13 years. He has never missed a dose. As a result, the virus has stopped showing up in his regular blood tests. It is undetectable.

When news of the stop-work order came, he didn’t have enough treatment to last him through the 90-day pause.

I was prescribed to take a tab per day. But I started taking a tab every three days, so that the medicine can take me for the three months the HIV work was supposed to stop. I never got interruption before this type of trauma.

He had an appointment scheduled to get his ARVs refilled at Kiboga General Hospital in late February. He wasn’t sure if the services would be available, since the 90 days were not yet over. But since he started rationing his medicine, he was growing more and more anxious that it would give the virus a chance to return. So he kept his appointment.

It turned out that the clinic had remained operational despite the order from the U.S. government. The process of getting ARV refills had never been interrupted.

When his clinician found out Bwanika had been rationing his medicine, she immediately ordered a viral load test to see if the virus had taken advantage of the diminished treatment in his system to rebound.

If it had, there is a chance it has also mutated to become resistant to the treatment he was taking. In that case, there would need to be more tests and intensive monitoring to find a different ARV regimen to keep the virus in check. It would be a long, stressful process for Bwanika and an expensive one for the clinic.

If the viral load results come out with high copies, I will need to stabilize. I will need to sit down and swallow the medicine.

Now, at the start of April, he is back at the clinic to find out the results of the viral load test. As the health worker goes through his digital files, there is relief. A small celebration. The virus has remained undetectable.

Then the health worker notices a problem. The testing dates don’t match Bwanika’s. It turns out, he has given her the wrong patient number. He has to provide the number at every visit and he knows it by heart, but this time he just can’t remember it. He is too nervous. He calls his wife and asks her to look it up. As she reads it off to him, he repeats it to the health worker.

This time there is no celebration.

The test has detected copies of the virus in his blood. He is no longer suppressing the virus.

I was so scared to have copies. I didn’t want to have any.

Bwanika retreats to a corner of the office to call his wife back. He is upset and starts pacing as he shares the news with her.

When he is done, the clinician starts laying out the next steps. There will be more frequent appointments and tests to make sure he has not grown resistant to the current treatment. He will no longer be able to get three-month refills of ARVs until the virus is fully undetectable again.

Bwanika is anguished, but also frustrated about the uncertainty that made him think he needed to conserve his ARVs.

Ever since this order from Trump, I am seeing death near me.