Kampala, Uganda: Housing for People Living With HIV/AIDS

The HIV/AIDS Epidemic

Approximately 940,000 Ugandans are living with HIV/AIDS. HIV prevalence is 10% in urban areas and 6% in rural areas. The HIV prevalence in Kampala is 8.5%. In Kampala, as in all regions, women have a higher HIV prevalence than men (7.5% compared to 5% for men nationally). Higher HIV prevalence is associated with higher education and wealth levels. The epidemic is now generalized in the general population but particularly in pockets of fishing communities, long distance truck drivers, people 35 to 49 years of age, sex workers, mobile and married populations.

The Housing Crisis

Uganda's population is estimated at 30 million people, 14% of which live in urban areas. Approximately 93% of the urban population lives in slums. Slum dwellers face challenges such as security of tenure, access to affordable and quality education, medical care, energy, and water and sanitation management, along with a high incidence of HIV/AIDS.

Kampala, with a population of over 1.4 million, is surrounded by numerous slum dwellings that constitute the majority of the population's housing. Shelter and Settlements Alternatives, a nongovernmental organization working in five slum communities in Kampala, identified the following problems associated with slum dwellings: quality of affordable housing, evictions by landlords, issues of property inheritance, stigma and lack of health care. Most people in slum communities cannot afford adequate housing because their economic providers have died of AIDS-related causes. Some residents have inadequate incomes, and others are widows who lost their homes following the death of their husbands. It is not culturally acceptable for women to inherit property; widows' only alternative is to find cheaper housing in slums. Other times, those suffering from HIV/AIDS are evicted, either by their own fathers- and brothers-in law, or by landlords due to complaints of other tenants and fear that future tenants will refuse to live in the former home of PLWHA.

HIV-positive slum residents face substantial stigma and discrimination, especially those who sell food or perishables. "The community looks at them as dirty and cannot support them. They avoid buying anything from them," explained a community member in Kisenyi, a Kampala slum. This stigma only increases the economic crisis for positive residents, who are left without enough money to secure their housing, medical bills, school fees and food. Health workers also face difficulties carrying out home visits for slum dwellers, especially during the rainy season when accessibility is very difficult due to flooding, which increases infections and limits patient outreach.

HIV-positive slum residents are more vulnerable to issues of housing instability because they are often unable to work due to their medical condition, and thus cannot save enough money to move into better shelter. Most positive residents save the little money they have for medical treatment and thus the only dwellings affordable are slum dwellings. Some HIV-positive residents fear that they may leave their families in worse housing conditions upon their death, which leads them to remain in the slums in order to save money to leave for their families.

Most HIV-positive slum dwellers, like all slum tenants, lack collateral security. They cannot borrow money from the bank or individual money lenders, and so their hopes of getting better housing are limited. Some cannot join saving cooperatives because they do not have the startup capital. Lack of housing finance and security invokes anxiety, sometimes to the point of suicide: "We have had cases where people have killed themselves because of stress and worrying due to evictions by landlords," explained another Kisenyi resident. Some of the HIV-positive slum residents lost their parents before they were educated and thus cannot obtain well-paying jobs that would allow them to move to better housing conditions.

Institutional Response & Solutions

Governmental programs and strategies to reduce the impact of HIV/AIDS have overlooked violations of women's housing, land and property rights. Various non-governmental organizations are working in the Kampala slums to fix the problems of housing insecurity. Uganda Cooperative Alliance and Slum Dwellers International trains residents to join cooperatives and save for better housing. Uganda Cooperative Saving, Community Initiative for Development International and Credit Union and Act Together train people in information sharing and awareness-raising. The Red Cross has helped in securing alternative settlements, improved diets and access to medication. Concern Worldwide has improved drainage systems along with training communities on improved income-generating activities.

Ugandan laws protecting inheritance and property ownership are rarely enforceable due to corruption. Various governmental institutions, such as the Ministry of Labor and Gender, the local Welfare and Probation Officers, the police Family and Children Unit, and the Administrator General's Office are all centralized and inaccessible to those in need. Several organizations and legal aid projects are in place to fight violations of property and inheritance rights, such as the Human Rights Commission, the Federation of Women Lawyers, COHRE, the Platform for Labor Action, and others, but these are often prohibited by the costs associated with outreach and follow-up.

According to Shelter and Settlements Alternatives and the Global Coalition of Women Against AIDS in Uganda, the solutions for housing HIV-positive people are multifaceted. Key housing issues that are pertinent to positive slum residents can then be brought to light and advocated for, such as mainstreaming HIV and gender in housing movements, with special consideration on how housing impacts HIV/AIDS and gender and how HIV/AIDS and gender impact housing. Clear strategies and policies both for organizations and government can then follow from these discoveries. Capacity building -- training community paralegals to teach positive residents their rights, including anti-discrimination and stigma training for the community, its leaders, and local officials, provide access to emergency support, and improve their economic livelihood skills to encourage financial sustainability and personal empowerment -- will tackle many of the issues associated with housing vulnerability for HIV-positive people.

"My parents died when I was 12 and they left me with their property. After sometime, I was tested HIV positive; I started becoming weak and could not work to earn a living. Lucky enough, I had houses to rent out and the money I got kept me going. One day a relative who stays overseas came in to sell my property after knowing that I was HIV positive. I had no one to defend me and part of my property was sold. Since the houses I was renting were also sold, I was left with no alternative to earn a living. I was left with a small part of land with one poor house where I stay now. Today, I depend on well-wishers since I am already bedridden and cannot go out to make money. All these situations have weakened me to an extent that even the medicine I take cannot improve my health. The house I live is in a bad condition and this does not give me piece of mind at all. I do not have money to improve on my house since every coin I get now is spent on drugs. For now, I do not know what the future holds for me. I depend on friends and do not even think I will have a better house."

Advocate testimony and photos provided by Eunice Kyomugisha of Shelter and Settlements Alternatives and by Flavia Kyomukama of the Global Coalition of Women against AIDS in Uganda.

Sources

Centre On Housing Rights and Evictions, Shelter from the Storm: Women's Housing Rights and the Struggle against HIV/AIDS in Sub-Saharan Africa, 2009.

Government of Uganda, Uganda National Bureau of Statistics and Ministry of Finance, Planning and Economic Development, Uganda Demographic and Health Survey, 2006.

Uganda Ministry of Health / ORC Macro, National HIV/AIDS Sero-Behavioural Survey, 2004-2005.

Uganda Population, Health and Well-being Indicators, 2001.

UNGASS Country Progress Report: Uganda, 2010.

UN-Habitat, Uganda Statistical Overview, 2010.