Ugandan clinics selling bogus HIV certificates
Private clinics in Uganda's capital, Kampala, are selling fake HIV negative certificates to help people get jobs, an undercover investigation by BBC Africa's Catherine Byaruhanga has revealed.
It is the tail-end of the morning rush-hour when I meet Sarah outside a popular supermarket in a suburb of Kampala.
She is a young woman in her 20s, with dreadlocks. She is anxious, and can hardly look me in the eye.
So I am careful not to push her too hard.
I, along with my BBC colleagues, spent several weeks trying to track down someone who had paid for a fake HIV-negative certificate.
Most of the people we spoke to were too scared to be interviewed. Sarah isn't her real name - she would only talk to us if we hid her identity.
We visited 15 clinics - 12 were willing to give us a fake negative result”
"I had to get the fake negative results because if I gave the company my positive results I was not going to get employed," she told the BBC.
"I'm a single mother. I'm struggling. I need this money. I need this job for my child."
We heard several accounts of people buying bogus HIV-negative results in order to get a job, to travel abroad or to lie to sexual partners because of the huge stigma against people with HIV here.
We went undercover to several clinics in Kampala, pretending to be HIV-positive job-seekers in need of a negative certificate to show prospective employers.'Global leader'
These were small private clinics - there are hundreds of them all over Kampala. Inside, there were a handful of staff, a doctor maybe but usually a nurse and a laboratory technician who carries out the testing.
We visited 15 clinics - 12 were willing to give us a fake negative result.
One laboratory technician said it was very risky for him to give a fake certificate and he could be arrested. After some negotiations, he agreed to write it for around $20 (£12).
The certificates have everything to make them look official, including the clinic's official stamp and the health worker's signature.
This evidence comes at a time when many people here are taking a critical look at Uganda's HIV policies. For years, the country was seen as a global leader in the fight against the disease.
Ugandans with HIV
- 7.2% in 2012
- 6.3% in 2005
- 18.5% in 1992
- 60% face stigma
Sources: Ugandan government; Nafophanu
Twenty years ago, around one in five Ugandans had the virus, the government quickly got behind Aids campaigns and by 2005 the rate was brought down to 6.3%.
But in recent years the number of people with HIV has started to rise again, to 7.2% in 2012.
Once again, the government and activists are fighting to turn things around.
The message is: "Get tested". Everywhere you go in Kampala there are billboards and posters urging people to find out their status.
Even President Yoweri Museveni and his wife have taken public tests.
The idea is once people find out they are HIV-positive they can get onto anti-retroviral medicines and be counselled so they don't spread the disease.
But the massive social stigma means many are just too scared.'They don't know'
Last year, a survey of more than 1,000 Ugandans living with HIV/Aids was carried out by the National Forum of People Living with HIV/Aids Networks in Uganda (Nafophanu). It found that more 60% of them faced stigma; either being shunned by relatives or friends or losing a job.
Many people in Uganda still see it as a disease of the immoral, those who have led a promiscuous life.
The HIV-positive people we have spoken to add that employers are not willing to hire them because they think the disease will make them less efficient at work.
Nafophanu head Stella Kentutsi says this stigma leads some HIV-positive people to avoid accessing health services.
This then leads to more people dying of the disease and passing it on to their partners.
Nicolette Uwimana has chosen to be open about being HIV-positive but, she says, that has made her life difficult.
She is a beautiful young woman, welcoming and very confident. Her purple extensions match her bright pink top with the printed slogan: "HIV stops with me".
Ms Uwimana contracted the virus at the age of 10 after being raped. Her family initially took care of her but eventually kicked her out because her treatment became expensive. She now lives in a cramped room with four others.
End Quote Ruhakana Rugunda Uganda's health minister
It does not shock me Nevertheless, it's a challenge for government and the country to pull up its socks and squarely face this problem”
"My friends don't even want to associate with me, those who are not positive," she said.
"And when they hear my story they tend to point fingers - 'You went looking for it,' because they don't actually know, they don't understand what somebody goes through.
"And for quite some time now I haven't been working because everywhere I go to look for a job the first thing they ask me is my status."
Nonetheless, Ms Uwimana is adamant that sharing her story will give her peace of mind and help her come to terms with her ordeal.
For now, she earns some money by making jewellery and speaking at HIV events.'Going to die'
We showed our undercover footage to Uganda's Health Minister Ruhakana Rugunda. He admits the government could do more to stop the issuance of fake HIV-negative results.
"It does not shock me [that people are buying bogus negative results] Nevertheless, it's a challenge for government and the country to pull up its socks and squarely face this problem," he told the BBC.
He said the police had handled some cases, but it is not a problem for them to solve.
Instead, companies should stop stigmatising job seekers who are HIV-positive, Mr Rugunda said.
"I think that's discriminatory. I think that's pushing people to tell lies and to fake certificates," he told the BBC.
But there are no laws to protect HIV-positive people against discrimination. At the same time, the government is proposing legislation that activists fear will increase stigmatisation.
The HIV and Aids Prevention and Control Bill 2010 has clauses that aim to punish people who transmit the virus.
Health-workers will also be obliged to divulge the status of anyone they think could pass on HIV to their partner.
The US funds the majority of Uganda's HIV programmes, mainly through non-governmental organisations. In the past decade, it has contributed more than $2bn.
US ambassador to Kampala Scott DeLisi told the BBC he could not guarantee that US money had not gone to clinics giving out fake HIV-negative certificates.
But he says the responsibility to monitor programmes lies with Uganda.
"When they find these problems, they have to prosecute people. They have to show they're serious about it."
Sarah says she takes responsibility for breaking the law and lying about her HIV status but says she would do it again for the sake of her child.
"Why should I sit back and say: 'Let me do the right thing'. At the end of the day, it's me who's going to suffer. It's my child," Sarah told the BBC.
"No-one is going to listen to me. I'm going to die and if I die just like that, who's going to speak out for me?"