HIV infection is the leading cause of death in women of reproductive age. (Photo Courtesy UNAIDS/P.Virot)

Kampala — Complacency, ignorance and indifference are reversing Uganda's gains against the Aids epidemic, a senior government official warned yesterday. Dr Kihumuro Apuuli, who heads the Uganda Aids Commission, the government agency responsible for coordinating the fight against Aids, said the number of new HIV infections is "unacceptably high" and rising.

Golden past

After reducing HIV prevalence from over 25 per cent in the early 1990s to five per cent in 2000, prevalence has crept higher to between six and seven per cent of the adult population. "There are more new HIV infections coming up every year and these are mostly concentrated among the married couples," Dr Apuuli said, speaking on the eve of today's World Aids Day commemorations. In fact, the number of people getting infected every year - 110,000 is higher than the number of people dying of Aids-related illnesses, the official said.

Ironically, Uganda appears to be a victim of its success, officials say. News of the early successes, the comfort given by availability of anti-retroviral therapy that help postpone the onset of Aids among people with HIV have led to complacency and a return to risky sexual behaviour. As a result, fewer people are using condoms regularly and more people - including married people and others in long-term relationships - are taking on multiple sexual partners. "The fear and scare from the drumming and simple messages during the grassroots mobilisation of the late 1980s has waned," Dr Apuuli says, "people have abandoned the 'zero-grazing' and resorted to extra-marital sexual partners."

Outdated model

Uganda's ABC model (which urges people to Abstain, Be faithful or use Condoms) helped reduce prevalence and was adopted by several countries across the world. However, apart from an unnecessary and dangerous debate over which of the three interventions was more useful, experts now warn that the ABC model might be outdated.

While preventive ABC messages have not expanded beyond the 15-to-24 age group, evidence shows that the bulk of new infections are occurring among couples in long-term, marriage-like relationships (in the 30-39 age bracket). The rise in HIV infections among married people is exacerbated by the fact that most of these couples do not know their status, in a country where only one in five people have tested for the virus.

This, Dr Apuuli says, underscores the need to focus prevention efforts at people in marriages or long-term relationships. "HIV counselling and testing is the entry point to accessing HIV services but unfortunately people are not coming up for voluntary counselling and testing," he says. "There is evidence that when individuals test negative for HIV the chances of avoiding Aids are higher than when they don't know their status," Dr Apuuli said.

Dr Alex Opio, an assistant commissioner in the Ministry of Health, agrees that focus should shift to testing for HIV and behaviour change. It is the reason why the theme of this year's World Aids Day - which commemorates those killed by the epidemic - is; 'Access my right, testing my responsibility.' "We hope it will act as a springboard to getting further preventive strategies for those who are negative while those who will test positive will be entered into treatment services," Dr Opio said.