Dental Methods to Improve Health Care Introduced on Lake Victoria Island with High HIV/AIDS Rates

HIV/AIDS in Lake Victoria, Uganda: Lake Victoria is home to the Ssese Island chain, which comprises 84 small islands off the coast of Uganda (1). Kimi is the smallest and most densely populated of these, with a transient population of 4,785 people (as of 2018), one public toilet, one health clinic, and low rates of education. These are all factors in the staggering rise in the HIV rate on Kimi compared to the national average and even to some other islands in Lake Victoria.

Between 2011 and 2016, the national HIV prevalence in Uganda declined from 8.3% to 7.5% in women and 6.1% to 4.3% in men (2). This means that over 1.4 million of Uganda’s 43 million residents live with HIV/AIDS, but rates are concentrated geographically, particularly in the Lake Victoria region (3). Today, the HIV epidemic on Kimi Island is characterized by a sustained high prevalence (22–29%) in a relatively small population (4). Prostitution, rape, high mobility of people, drug and substance abuse, and myths and misconceptions about condom use are all major contributing factors to the HIV rates (3). Kimi is home to many AIDS widows, high promiscuity rates, and women who find it difficult to negotiate safe sex with their partners.

Role of Dentistry in HIV/AIDS Health Care: People living with HIV/AIDS (PLWHA) have a higher risk of developing dental caries. This is likely due to reduced saliva flow rate that stems from infiltration of HIV, proliferation of CD8 lymphocytes in salivary glands, and antiretroviral medications that result in changes in the normal microbial flora of the oral cavity (5). PLWHA also have a significantly higher rate of oral manifestations including, but not limited to, oral thrush, oral cancer, Karposi’s sarcoma, oral hairy leukoplakia, and necrotizing ulcerative periodontitis. While addressing these issues does not reduce the risk or improve the prognosis of HIV/AIDS directly, it can significantly improve patient comfort and overall well-being as it would for any person dealing with these oral issues.

Medical-Dental Collaboration Project: The only health clinic on Kimi island is run by TASAAGA with the fundraising support of a U.S. arm, Friends of TASAAGA. The mission of TASAAGA is the reduction of HIV/AIDS via education for children and adults, and to accomplish this, they have built primary and secondary schools and health clinics in three villages across south central Uganda. At their clinics, including the one on Kimi Island, TASAAGA provides regular and emergency medical checkups and prescriptions from its internal pharmacy.

Once a year, they arrange local clinics for the dental teams organized by A Reason to Smile (ARTS). ARTS’ volunteer teams include general dentists, dental hygienists, dental assistants, and other volunteers who travel to multiple sites, including Kimi Island, to provide dental education, cleanings, emergency extractions, and oral hygiene supplies. Each year, ARTS has worked with TASAAGA to determine the best way to support sustained improvements in oral hygiene in Uganda through the empowerment of community leaders. For the first three years, this took the form of bringing local leaders together for brief oral hygiene seminars, enabling these leaders to continue sharing the importance and technique of proper oral hygiene throughout the year when ARTS volunteers are not present.

In 2018, the fourth yeara of ARTS and TASAAGA’s collaboration, TASAAGA recruited a medical physician, Dr. Tegume Leonard, to live and work on Kimi Island for six months. During ARTS’ trip to Kimi Island that October, dentists worked alongside Dr. Leonard, treating patients and educating them on medical and dental health. This project was part of ARTS’ general mission to provide sustainable oral health care, but its impact was even greater due to the high prevalence of HIV/AIDS in Kimi island.

During this collaboration, Dr. Leonard was taught how to identify carious lesions, periodontal abscesses (sinus tract infections with oral fistulas) as well as to identify abnormal pathology and situations requiring antibiotics. This committed physician was also given instruction and supervision on how to provide local anesthesia to alleviate pain. ARTS dentists guided him on how to extract periodontally involved teeth which had extremely poor prognoses as well as teeth that were infected and non-salvageable. He shadowed ARTS dentists’ extraction procedures and learned basics of oral surgery.

Oral health care, education, and promotion for all ages and genders are needed but unavailable in most of Uganda. Political and social changes are urgently required to remove the fundamental obstacles that are plaguing these islands and to control the rising rates of HIV and consequently oral diseases in Kimi. Basic oral health education in schools and dental collaborations with health clinics can reduce the risks of oral diseases and HIV. Having been trained by U.S.-trained dentists, Dr. Leonard will be better equipped to locate, identify, and treat dental infections on these islands and elsewhere in Uganda. With this additional knowledge, he will be better able to manage patients’ pain and suffering and to raise awareness of the oral consequences of HIV/AIDS and improper hygiene.

HIV puts the entire body at risk, and many people do not realize this includes oral health. While addressing oral health does not directly mitigate the symptoms and risks of HIV/AIDS, it is crucial to maintaining the best overall health possible in both PLWHA and the general population. Proper oral hygiene keeps toxic bacteria out of the body and helps to avoid other issues, such as diabetes and arterial plaque buildup, which can complicate the prognosis for PLWHA. Through continued partnership with TASAAGA, ARTS hopes to continue training local health care providers on these important issues, empowering more Ugandans to live healthier lives.

ARTS empowers communities without access to dental professionals to achieve and maintain a higher level of oral health by providing hygiene education, dire