Uganda’s integration of HIV services into outpatient departments (OPD) raises hope and human rights concerns.

18 February 2026, 4:53 pm

Byamukama Alozious

Following recent funding cuts to vertical HIV programs, the Government of Uganda moved to integrate HIV and HIV-related services into general outpatient departments (OPDs), a decision that has been broadly welcomed as a strategy to sustain the national response while strengthening the broader health system. The shift means patients now access HIV prevention, treatment, and care alongside other services such as sexual and reproductive health and non-communicable disease management under a single service delivery point. While many Ugandans see the integration as practical and efficient, civil society organizations say important human rights safeguards must be strengthened to ensure that integration reduces stigma rather than deepening it.

Uganda has made notable progress over the past two decades in expanding access to antiretroviral therapy and improving viral suppression rates. Yet stigma, discrimination, and structural inequalities continue to undermine equitable access to care, especially for women and girls, adolescents and young people, persons with disabilities, refugees, rural communities, and key populations. Civil society groups argue that integration must be examined not only as a health systems reform but as a human rights issue.

Speaking at a civil society engagement on integration, Nyasha Chingore, Regional Advisor on Human Rights and Law at UNAIDS, emphasized that integration must be people-centered. “Integration is a health systems conversation, but it must first and foremost pick people at the center,” she said. “We do not exist for systems; systems exist for people. The first principle that must guide integration is non-discrimination and equity. We cannot ignore the fact that stigma and discrimination remain real. People living with HIV still experience criminalization. Young women and adolescent girls face harmful social norms. Persons with disabilities, refugees, and rural communities face geographic and financial barriers. Integration must recognize inequality and transform it not hide it.”

Chingore stressed that participation and community leadership are non-negotiable. “Communities have shown leadership through peer navigation and differentiated service delivery. They must remain central to the design, monitoring, and evaluation of integration. If privacy, dignity, data protection, and patients’ rights are not built into training curricula and implementation, then integration risks eroding trust.”

Community voices echoed similar concerns Nusbuga Moses, a national advocate often referred to as “Super Charger,” described long waiting hours and service fatigue. “People come to clinics at 8am and are not served until lunch,” he said. “Health workers then go for lunch when patients have not even taken anything. Medication refills sometimes cover more than three months, but the time spent waiting is exhausting. Health workers need empowerment and better facilitation to manage this workload.”

Concerns about congestion were reinforced by Dr. Augustine Kubanga, National Medical Director of AHF Uganda Cares. “There is a lot of congestion in our hospitals, and less has been done to address it,” he said. “In some facilities, meetings are held in the morning as the first activity while patients are already waiting. That is not fair. We must reorganize service flow so patients are prioritized.” Dr. Kubanga also noted that broader structural and legal barriers continue to affect access to services, including reproductive health care. “Many people who need safe abortion services are misinformed or constrained by cultural beliefs and restrictive interpretations of the law. These realities intersect with HIV and must be addressed holistically.”

At district level, implementation gaps are also raising alarm. Azizuyo Brenda, Program Officer at International Community of Women Living with HIV Eastern Africa (ICWEA), called for stronger supervision and accountability mechanisms. “We need to strengthen district health systems.

Some facilities in hard-to-reach areas receive little supervision,” she said. “Patient community advisory boards exist in some places, but not consistently. There are cases where patients are asked for money unofficially. That undermines trust.”

One participant cited an incident where a facility hired a loud slashing machine that operated near a patient ward. “Patients were covering their ears. These are small things, but they show a lack of patient-centered planning.”

Civil society organizations argue that breaches of confidentiality remain one of the biggest risks under integration. When HIV services were delivered in specialized clinics, privacy protocols were clearer. Now, shared queues and common dispensing points can lead to involuntary disclosure if not carefully managed. Participants recommended discreet numbering systems for medicine collection and stronger data protection practices.

To address these gaps, a coalition led by the Centre for Women’s Justice and supported by partners convened 20 national and local CSOs in a structured process to document rights violations, analyse policy gaps, and propose minimum human rights standards for integrated HIV service delivery.  Immaculate Owomugisha stated that the engagement brought together representatives of people living with HIV, adolescents, key populations, persons with disabilities, and community-based providers to generate evidence-informed recommendations.

“Our goal is to ensure that integration aligns with dignity, confidentiality, gender equality, and meaningful community participation,” one organizer said. “We want to build consensus and speak with one voice so that minimum human rights standards are clearly defined and implemented.”.