8 January 2009

Uganda: New HIV Cases Alarm Doctors

Kampala — DOCTORS have raised a fresh alarm over the rate at which Ugandans are becoming infected with HIV, especially married people.

The Director General of Uganda AIDS Commission (UAC), Dr. David Kihumuro-Apuuli, said Uganda was facing a fresh crisis that required overhauling her HIV prevention programmes.

Kihumuro-Apuuli said HIV infection rates were rising again yet most of the funding was going into treatment rather than prevention.

"We have done well to put more than 150,000 people on anti-retroviral treatment, an increase from 15,000 three years ago, but that means we have shifted our priority from prevention," he said.

"For every two people you put on anti-retroviral treatment, five others are becoming infected. If you wait for people to become infected and you continue treating them, you are missing the point."

Kihumuro-Apuuli was referring to the results of a study done by Makerere University experts on behalf of the UAC and the United Nations AIDS programme, UNAIDS.

The Modes of Transmission study revealed that whereas most infections are occurring among married people aged 30-40, the prevention programmes are focusing on younger, unmarried people.

Prof. Fred Wabwire-Mangen, who led the study, noted that whereas many organisations have programmes to promote abstinence among the youth and condom use, few are focusing on faithfulness among married or those co-habiting.

He said about 650,000 Ugandan men and women are unknowingly living with HIV positive sexual partners. If nothing is done to enable these people become aware of the risk, about 13% of them (close to 85,000 individuals) will become infected this year, Wabwire-Mangen warned. This partly explains why Uganda's HIV infection rate is going up.

"The proportion of people who know their HIV status is low. That is why we have many couples where one person is living with HIV while the partner is not (discordant couples). Many of them do not know it and, therefore, they are not doing anything about it. This could explain why we see a lot of new infections every year," said Wabwire-Mangen, an associate professor of epidemiology at the Makerere University School of Public Health.

He called for a massive campaign to encourage couples to test for HIV together and plan for better health.

Kihumuro-Apuuli said they would use the evidence from the study to re-programme the fight against HIV/AIDS. In particular, they will push for widespread HIV testing, especially among married couples and those intending to marry.

"Here is a changed face of the epidemic. Here is the evidence that we have to emphasise different areas of prevention from what we emphasised in the 1990s," he said.

He added that unnecessary conflicts between promoters of different HIV prevention strategies had confused the public. "There was a time when ABC (abstinence, being faithful or using a condom) was like an anthem. Today there are people opposing A, others opposing B, and so on. The messages are confusing."

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