New Vision (Kampala)

10 February 2008

Uganda: Stick to Condom Use - WHO

Kampala — THE Government and medical professionals have raised concern over a report released last week in Switzerland claiming that AIDS patients who take effective anti-retroviral drugs do not pass on the virus even through unprotected sex.

AFP reported last week that Bernard Hirshel of Geneva University's Hospital and a co-author of the report, said on the basis of four different studies, one of them done in Uganda, people on effective ARVs do not transmit the virus.

The report indicated that HIV-positive patients did not need to use condoms, as long as effective anti-retroviral therapy is followed regularly and has suppressed the virus in the blood for at least six months.

The World Health Organisation (WHO) and UNAIDS, responding to the study published by Switzerland's Federal AIDS Commission, said "correct and consistent use of condoms" was the best way to prevent the spread of the AIDS virus between sexual partners.

People taking ARVs can have undetectable amounts of HIV virus in their blood "at certain stages of their treatment", the Geneva-based agencies said in a statement.

"However, it has not been proven to completely eliminate the risk of transmitting the virus," UNAIDS and WHO said.

Dr Pius Okong of St Francis Hospital, Nsambya echoed WHO's stand: "While it is true that if you take effective ARVs, the viral load can get to undetectable levels, in Uganda, not all patients on ARVs are consistently monitored for the viral load because of lack of finances.

Only 1% of the people on ARVs get the tests," he says.

Okong says most of the ARV services in Uganda are dependant on donor support. Estimates in 2007, show that Uganda has about 80,000 people on ARVs, yet there are one million people living with HIV/AIDS. About 250,000 people need ARVs.

Professionals in HIV/AIDS community-based organisations in Rakai also pointed out that ARVs are not complete protection. They say the report could create a false impression among the public.

"What happens is the reduction of multiplication of the virus and the viral load in the blood is low," says David Sedyabule, the coordinator of a Rakai-based AIDS project "This implies that the chances of multiplication are lower than cases where anti retroviral drugs are taken."

Sedyabule says the anti retroviral drugs have the potential to reduce the risk of transmission of the virus. But there are also negative implications from the new report.

"The rate of infection has been stagnating and in some cases, the rate of transmission of the virus is rising, particularly among married couples," says Sedyabule.

"People have started being complacent since there are antiretroviral drugs.

Contracting AIDS is no longer a death sentence. This is likely to increase the transmission rates, which we have been grappling with," Sedyabule says.

He says counsellors have been advising people on antiretroviral drugs to use condoms to reduce re-infection. There are fears that people will stop using condoms if such reports are disseminated.

"They are likely to fall back to their reckless sexual behaviour once they hear that those on antiretroviral drugs do not transmit the virus," Sedyabula argues.

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