Caroline Hurford in Nairobi
Ever since the 1980s, when HIV/AIDS started taking a heavy toll among Ugandans, the country's Red Cross Society has been trying various ways of fighting the deadly virus. With blood donor recruitment as a core activity (first established in 1954) it was logical to build on the existing partnership with the Ministry of Health, responsible for blood collection and processing, by encouraging new blood donors and simultaneously ensuring uncontaminated blood supplies.
In 1987, the Uganda Red Cross (URCS) began its HIV/AIDS control activities by working alongside the late rock musician, Philly Lutaya - the first famous Ugandan to go public about his HIV status. Using messages such as Lutaya's, the URCS volunteers concentrated on recruiting donors.
But finding donors involves much more than just standing on a street corner - hoping people will come forward, as the Uganda Red Cross senior health coordinator, DR Harriet Kivumbi Nkalubo, readily acknowledges: "Children in some areas run away when they see our Red Cross vehicles - because they think we are bloodsuckers!" She laughs. Attracting blood donors requires extra sensitivity - especially when people don't know their HIV status. With HIV rates in Uganda spiraling, the Red Cross added pre and post donation counseling to the recruitment process.
Volunteers do intensive health education and counseling; they deliver explicit messages on the safety of blood transfusions to large groups in schools, markets and work places, addressing an average 200,000 people annually. When 20 or more voluntary blood donors are identified, they are encouraged to form Blood Donor Clubs.
Members of the clubs become URCS volunteers who commit themselves to donating blood to save the lives of the most vulnerable. Club members not only recruit more blood donors, but conduct peer education on HIV/AIDS. As a group, they are encouraged to maintain safe sexual behavior to retain their blood donor status. The Clubs - the biggest of which has 500 members - are a regular and valued source of safe blood for transfusion.
Since 1990, blood donations have increased from 7,000 units a year to 72,000 in 2000. "We're still working on increasing the availability of blood and decreasing the level of HIV in collected blood," explains DR Nkalubo. "We've managed to do this by moving from replacement donors (who are called in by relatives to supply blood) to forming these voluntary blood donor clubs from a population with a lower percentage of HIV."
The programme exists in Kampala, Mbarara, Mbale, Fort Portal, Gulu, Arua and Masaka with 181 clubs outside schools in 26 branches and nearly 6,000 members.
There is still a small risk that someone who is HIV positive gives blood (before detection and during the infection window period). However, the HIV rate among youth club donors fell from a high of 5.2% in 1989 to 1.9% in 1999. On the other hand, replacement donors, who are being phased out, represented a high HIV rate of 7.6% in 1999.
If there is a shortage of blood, mobilising donors is easier through the clubs. The Uganda Red Cross donor recruitment programme, which currently has 100 Blood Donor Clubs hopes to have at least 5 clubs per branch - reaching a total of 215. These and other health programme activities are conducted in partnership with the Danish and American Red Cross.