Prof Elly Katabira left a well paying job in England in 1985 just as the HIV/Aids crisis was wrecking havoc in war-torn Uganda.

He set up the first Aids clinic at Mulago, which was also the first of its kind in Africa. He is a founder member of The Aids Support Organisation (Taso) and has carried out a lot of research on HIV.

Now, a professor of medicine at Makerere University, he heads the neurology unit at Mulago Hospital. The 55-year-old is the president-elect of the International Aids Society and will assume the presidency after the 2010 18th International Aids Conference in Vienna, Austria. He shared his journey through the Aids struggle with Kakaire A. Kirunda.

You're a neurologist. How did you get into HIV?

When I was in England between 1983-85, the issue of Aids came up and that time we thought this was a disease of homosexuals. And since I did not know of any homosexual activities in Uganda I thought we didn't have a problem. On my return however, I was shocked to find there were many cases of Aids patients and at that time there was so much stigma related to the disease. Very many health workers were reluctant to work in the field, because rightly so, they didn't know how much risk they were taking in working with HIV infected patients. At that time, no body knew how the disease was actually transmitted. I therefore got involved; after all I had come back to treat patients.

With no drugs then, how were you managing these patients?

As time went by, it became apparent that the major problem in HIV was immune depression and when people's defences are torn apart they are prone to numerous infections. Therefore what we did at that time was to treat those infections and also to encourage patients to report any ill health earlier than they would have done if they had a normal immune system. We were basically managing the opportunistic infections and then providing psycho social support either through social organisations or people close to the patient. And that is how TASO came up.

What was the mortality like at this difficult time?

It was very high. The treatment of opportunistic infections delayed the progression of the immune suppression. But eventually it happened and people succumbed either from the various infections or from specific opportunistic infections like tuberculosis, pneumonia, and others.

What did it mean for Africa and Uganda when you started the first Aids Clinic?

There were very few countries in Africa that were willing to admit even at that time that they had the HIV problem. But as a country, we came out boldly and we started strategies to mitigate the impact of HIV. My clinic became pivotal in supporting others. Many people came from within Uganda from other health units and I was encouraging them to start similar services in their hospitals. And I was also involved with World Health Organisation in going around some countries to help them initiate similar services.

Of recent we are seeing a resurgence of HIV. Don't you think we have lost the boldness and HIV leadership?

I think the leadership is still there but like any epidemic, people get used to it and get complacent. That support from the president and the government of Uganda was crucial. It made us health workers do whatever was possible to find solutions to curb HIV infection.

Some of the things we were doing were not right but we were given a free hand to talk about the problem, encourage more health workers and leaders to get involved. Now with the availability of antiretroviral therapy, some people may think that HIV now is treatable or manageable and therefore they don't need to follow what we continue to tell them about prevention strategies. But also the other issue is that in the early days, the face of Aids in Uganda and other countries was an ugly face, a face of suffering and people dying miserably, neglected and so on.

As we campaigned to encourage care of HIV infected patients, this ugly face of Aids was minimised. And there are many people now who have never seen the ugly part of HIV disease. Therefore convincing them that it is a deadly disease may be harder than you would expect now than in those early days when we were doing it. And we have taught healthcare workers, patients and their friends and caretakers on how to manage HIV infected patients. Many patients are aware of how to take care of themselves even without antiretroviral therapy through good nutrition, seeking help much earlier, etc. So again people don't see the realities of people wasting away, skeletons, being bed ridden for years, and dying miserably.

Some people are suggesting that we should go back to using those scary ugly messages to emphasise the need for prevention. Is this viable and ethical?

The issue is not about ethics. We did not go out to look for these ugly messages and pictures. They were there. You would walk on Kampala Road and you would see people who were visibly infected because they looked wasted and so on. But nowadays they are not there. People have learnt to get care much earlier, many of the people with HIV look very healthy; most times you may not know.

And if you think of retrieving the images of the past, most of those people have died. Now to start using their pictures is not only unethical but is illegal because you don't have their permission to use them. So that's not the best way to go. I think we need to continue with messages and strategies but change them from time to time so they look as fresh as possible to encourage people to take care of their own health and avoid HIV infection.

There is talk that researchers like yourself have come up with lots of research on how best to come on top of the situation but most of it is gathering dust. Do you agree?

I don't know where you get that impression. We work very much closely with the government. I have been working with the Ministry of Health since 1986 when the Global Programme of Aids was set up. I am involved in formulating treatment guidelines and all these are based on evidence gathered in our research. For example we have one just released a couple of months ago which was signed by the Director General of Health Services. So if he signs it means he agrees with it. So you cannot say that our research is gathering dust. Some of it the implementation is not an issue of Ministry of Health or anybody else but also by individuals.

For example recently there has been research which has shown that circumcision reduces the chances of HIV infection. Circumcision is not new to us. There are many people who choose to be circumcised for various reasons. And the Ministry of Health has come up and said it supports anyone who wants to be circumcised. To implement it at health unit level is more complicated because it means you need to put in place facilities to ensure that anyone who walks off the street and says they want to get circumcised can be circumcised. It is a matter of health systems being capable of taking on those roles but as far as the ministry agreeing and supporting the finding that circumcision may be helpful, certainly they support it. It one thing to support and it may be another thing to implement.

Testing is the key to care and treatment, how come only 12 to 13 per cent of our population know their HIV status?

One of the reasons why people don't test is because it is human nature. No one expects the bad things. You always expect to be on the good side and many people don't think they are infected and because they don't think they have been at risk lately. But with HIV infection, you may be exposed today but you may not get signs and symptoms in some years to come. People may not remember that risky behaviour they have encountered in the past.

Similarly, there may be a hospital in the community and people are coughing and they don't go to hospital yet they know it is there. But there is this tendency to think that may be this is a mild cough which will go. It is only until sometimes they start wasting away that they go there only to be told they have TB. But they didn't get TB overnight; it is got some months back. So this is human nature but we need to change that kind of behaviour.

What do we expect from your appointment as president of the International Aids Society?

I will be working with the current president and then two years later in 2010, I will become the president of the International Aids Society. I have been involved in the Aids society for almost 18 years and have been a member of their governing council representing the African region since 2000. I think my presidency will put forward members from the African region. It will give me an opportunity to accentuate what I had initiated of training and helping particularly young researchers in the region to be able to be recognised, do their work and provide better services to the HIV infected people in the region.

Our region is one of the most highly affected and I suppose it is high time we are also up front in providing health services for our own patients through better research. I am aware that in the region, there is a lot of research going on but because of the nature of the world today, many of our young researchers are not having their work recognised or noticed. So in the society, we are trying to make sure that we change that. I am a co-editor of the International Aids Society journal which is a free journal and we encourage a lot of these young stars particularly in this region to publish in it. They can be circulated and they are noticed. So I hope the region will benefit from my presidency.