Asiimwe Evarlyne Buregyeya

"The DSDM model involves reaching out to communities directly, where we maintain contact with our clients. We find it more convenient to deliver medication to our clients rather than asking them to travel to health facilities, as many lack transportation or are too ill to make the journey. We identify key points where a large number of clients gather, and that’s where we deliver the medications. This model proved particularly effective during the COVID-19 outbreak. While it existed before COVID, the restrictions during the pandemic helped us organize and streamline the process. It was originally implemented by health workers in remote areas where our soldiers are stationed, and we would gather medical records for certain groups, refill prescriptions, and deliver the medication to those locations. The pandemic only amplified the scope of this initiative, and it continues to function effectively today. We’ve since expanded the model. Now, a multidisciplinary team goes to specific locations to offer a variety of services, rather than just delivering medications. In addition to dispensing drugs, the team conducts disease monitoring, TB contact tracing, and even viral load testing. Essentially, we’re bringing the entire healthcare facility to the community. People now know that on specific days, they can access healthcare services right in their own neighborhood, instead of having to travel long distances to find a clinic. As long as a battalion is stationed in a particular area, we will continue to offer services to both the soldiers and the surrounding communities."

"HIV has profoundly impacted many aspects of our military culture. In the past, soldiers often had a different mindset, including behaviors like sharing women, as reflected in the Kiswahili saying, "we eat from the same saucepan." There was little jealousy among soldiers, and solidarity was the norm. However, the HIV epidemic has forced a cultural shift. With a better understanding of how the virus spreads, soldiers have realized that maintaining these behaviors could be deadly—not just for them, but for their families and communities. Continuing to live by the old practices of sharing everything could have fatal consequences. HIV has pushed soldiers to rethink their approach to relationships and health, emphasizing personal responsibility and caution."

"Yes, it is. One of our key achievements is the introduction of the mobile approach for Voluntary Medical Male Circumcision (VMMC). I believe the UPDF was the first to implement this model, and now it has been adopted widely. It’s not just about pioneering these initiatives, but also about responding to the unique needs of the situation. We realized that establishing a traditional health facility to serve our troops would be impractical—when would we ever complete a whole battalion? And with soldiers often deployed to remote locations, getting them to a fixed facility would be challenging. This is why our funding model is so distinctive. Current funding focuses on high-incidence areas, but often, these areas don’t have our troops. Instead, our soldiers may be stationed in regions where the HIV prevalence is lower, but they still require services. In some of the most remote locations, the prevalence might not be high, but access to healthcare is extremely difficult. Its not just about providing services to soldiers, but also to the surrounding communities who live in these hard-to-reach areas. We must ensure that people in these regions have access to care. It’s been valuable that PEPFAR has recognized the unique challenges of military health needs and routed funding through URC-DHAPP, an organization that understands military logistics and can effectively negotiate at that level. When mapping HIV distribution across Uganda, the scientific approach is logical, but it doesn’t account for the large group of people—soldiers and civilians alike—who still need care, whether it’s treatment or prevention services. Without a tailored approach, these individuals might be overlooked."

"By the way, we aim for 99:99:99—our targets are always set higher than the national ones."

"Our partners provide two key contributions. First, they bring in technical expertise that is not readily available within the military, allowing us to access specialist healthcare workers. Second, they ensure that resources are used efficiently, ensuring that funds allocated to programs are spent effectively and achieve their intended outcomes. They report both to the funders and to the military for program implementation. Partners help by hiring skilled professionals on a short-term basis, such as physicians, to carry out specific tasks. Additionally, they ensure that all activities align with the guidelines set by their funders while also delivering services to the military."

"We are making progress and staying on track."

"Our figures tend to be higher than those of the Ministry of Health, but as I mentioned earlier, it’s not just the soldiers. We serve soldiers, their families, and the surrounding communities. In fact, in many of our service areas, civilians make up the largest percentage of our clients. We often hear feedback from people who prefer the services provided by military facilities. In fact, we are performing exceptionally well in most of the programs we run."

"The primary challenge remains reaching soldiers stationed in very remote areas, especially since, during wartime, they are not allowed to move freely or travel alone. It’s not feasible to send just one soldier for testing; instead, we must move them in groups. To address this, we established teams equipped with security escorts to carry testing kits and reach soldiers in their deployed locations. Whether in a room, an open space, a tent, or even under a tree, these teams would set up a secure and professional environment to conduct testing. They ensured that the space was spacious and maintained confidentiality, even in such remote settings. Initially, we conducted one-on-one counseling and testing, but over time, as stigma decreased, we shifted to group counseling and testing, making the process more efficient and inclusive."

"Setting higher targets motivates us to work harder to achieve them. I remember when the government first focused heavily on eMTCT, we were still far behind. But we always strive to do our best."

"Everything has its pros and cons. From a practical standpoint, the military encourages open discussions about any issue. However, this approach can sometimes mean that deeper, personal matters are not fully addressed. People may downplay their true concerns and hesitate to share issues that deeply affect them. Despite this, we have well-established psychosocial services, including trained counselors and psychologists. The uptake of these services has been encouraging, with many soldiers actively seeking help. Today, almost every division has a psychologist. Initially, psychologists were brought in to address HIV-related issues, but their roles have since expanded to cover a broad range of psychosocial concerns, offering holistic and multidisciplinary support."

"Some of the challenges we face involve "pulling ropes," especially when it comes to context. In today’s world, global factors affect nearly everything. Implementing programs in a unique environment can be difficult because it’s challenging for partners or donors to fully understand and perceive the situation as you do. For example, with HIV mobile testing, some may find it difficult to accept the idea of bringing services directly to people, which can seem unusual. Global programs often come with challenges in creating interventions that truly address the specific needs and realities on the ground."

"In the structured environment of the military, we are better equipped to identify when a colleague is struggling. Peers play a key role in providing psychosocial support, as they are often the first to recognize when someone needs help. The peer support model is effective because of the strong bonds formed in the military. Soldiers quickly become like family, living and working together closely. If someone is affected, their peers are likely to notice, sometimes even through the chain of command."