Suliman Kakeeto, the head of the Ugandan Tablique community, says Islam permits patients not to fast and encourages them to take their medication during the month of Ramadan. He says, however, many Muslims with chronic diseases often insist on fasting, endangering their lives. Dr. Stephen Watiti, a physician, says when a person has been taking ARVs only at night, they can fast if they are stable and not feeling sick, especially since they are on a single tablet regimen. However, those who are not on a convenient regimen need guidance on how to fast. “If such a person is not feeling well and knows that they cannot stick to taking their drugs while fasting, they have to skip the fast,” Watiti advises. He says poor adherence could lead to drug resistance and drug failure. “Even if you feel well and would like to fast while continuing to take your drugs, consult your doctor first,” he says. Mengo Hospital’s Dr. Edith Namulema says: “Take your medication as prescribed and take the correct dose when you are meant to.” She says guidance should be given based on an individual. If one is taking drugs twice a day, one needs to ensure that the time in between is 12 hours. She advises that one drinks a lot at night to avoid fluid imbalance.
Kakeeto says Muslims start fasting during puberty, so long as they are healthy, sane and have no disability or illnesses. “The elderly, chronically and mentally ill are exempted from fasting, although the first two groups must endeavour to feed the poor in place of their missed fasting,” Kakeeto advises He says people who travel long distances do not have to fast. Also exempted are pregnant women, those menstruation and nursing mothers. Watiti says it is necessary to disclose your HIV status to your sheikh or spouse when you decide not to fast and explain that you are on life-long treatment so that you are not misunderstood. Namulema says antiretroviral therapy (ART) givers should adapt to the local, religious and cultural practices like Ramadan and maintain fundamental principles such as adherence to taking medication. She says sustained effectiveness of ART depends on long-term regular, fixed interval and time specific dose schedules. “Sub-optimal adherence not only reduces effectiveness, but is more likely to lead to emergency of resistance and treatment failure.”