State of the World's Minorities and Indigenous Peoples 2013 - Case study: Batwa - sexual violence and lack of health care spreads HIV/AIDS

Displacement and loss of access to ancestral territory has had devastating effects on indigenous peoples, including on their health status. Arguably, those most severely affected have been the Batwa communities of East and Central Africa. With recent news about increases in HIV infection rates in Uganda, MRG interviewed Faith Tushabe, Executive Director of African International Christian Ministry, an NGO that works closely with Batwa communities on the impact of HIV/AIDS and other health concerns for Batwa in Uganda.

MRG: What are the major health issues for Batwa communities you work with?

FT: For Batwa, health concerns are directly linked to their displacement from the forest, to social discrimination and to their extreme poverty. Traditionally, Batwa depended on forest products to provide medicines and food products for the community. In addition, their isolation inside the forest reduced their exposure to many illnesses. Today, as a result of their eviction, they have lost access to many traditional forest products that contributed to their health. They also have difficulty accessing health services provided by the Ugandan government. For example, in order to access antiretroviral treatment and other care and support services for men and women living with HIV, Batwa have to walk approximately five kilometres.

Batwa resettlement never provided sufficient land to ensure food security, so, particularly for those living with HIV/AIDS, the inability to provide sufficient food has a negative impact on their health status. Discrimination also hinders Batwas' ability to access health services, as many health workers perceive them negatively.

Shelter and sanitation is another major health concern. Poverty and lack of land makes it extremely difficult for Batwa families to build sufficient shelter with adequate sanitation. As a result, babies and young children are at high risk of pneumonia during cold seasons and hygiene-related diseases spread easily through the community.

MRG: What is the prevalence of HIV/AIDS in Batwa communities?

FT: The high level of stigma and discrimination has affected access to HIV/AIDS services, reducing the number of Batwa men and women who go for counselling, testing and other care services. This has affected the data analysis on the prevalence rates, so it is difficult to know the actual rate of HIV in the community. Despite the difficulty in gathering data, it is clear that HIV is having negative effects in the community, including decreases in productivity because of illness and an increase in orphans and vulnerable children because of the death of parents as a result of HIV. Couples' counselling and testing have also been hard to conduct, which has led to high risk of HIV infection and other sexually transmitted infections like syphilis. There are very limited HIV/AIDS services, including basic education information, as well as care and support, in the Batwa resident centres.

MRG: Does HIV/AIDS affect Batwa men and women differently? How?

FT: Batwa women are affected differently from men for a number of reasons. Some Batwa women have been subjected to rape and also are coerced into sexual relationships in exchange for basic goods, which because of poverty they cannot afford. Sexual assaults and sex for goods/money is generally as a result of interactions with other neighbouring ethnic communities. Other ethnic communities have discriminatory perceptions about Batwa women, believing that having sex with a Mutwa will cure diseases such as backache or HIV. Also, Batwa women often are believed to be HIV-free, which paradoxically has led to the spread of HIV.

MRG: What health services in general are available in areas where Batwa are currently living?

FT: Batwa reside in eight centres in the four sub-counties of Muko, Ikumba, Bufundi and Butanda in the Kabale District. Primary care, reproductive health, HIV/AIDS care, water and sanitation services are generally available from the regional hospital and other local health centres. However, fees for service are a major barrier for Batwa accessing care. Also, Batwa sometimes have negative perceptions of the health care system, as they often experience discrimination, which reduces the likelihood that they will seek out health services.