Results from the 2004/5 Ugandan Behavioural Sero Survey, the latest and most robust country-wide population level HIV prevalence study indicated an adult prevalence of 6.4 per cent, a figure far lower that the over 15 per cent prevalence registered in 1991/92.

This drastic improvement was a result of visionary leadership and efforts towards prevention and treatment. With improvements in HIV/Aids treatment and support systems, people living with HIV do not only live longer but also enjoy better quality of life.

Today, only 54 per cent of the 350,000 people requiring ARVs are on these much needed drugs. Over the years, increased attention to HIV/Aids treatment overshadowed prevention efforts leading to increased numbers of new infections country wide. The strategy of Abstinence, Faithfulness and Condom use worked well in the early days of the epidemic but now seem inadequate to curtail new infections.

Why do we continue to experience increase in new HIV infections? An appropriate response to this question is not simple and can't come from a single 'expert'. We have a tested and workable means already but two serious issues have not been decisively addressed.

While complacency is not easy to define in terms of developing new prevention strategies apart from the existing ones, humanity must find a way to deal with intentional spread of the virus. In virtually all the 112 districts, there are people who boast of having successfully lured 20 plus people into unprotected sex knowing they are HIV positive (refer to the Daily Monitor story of June 12, about an HIV infected business man in Mbarara who had unprotected sex with over 100 university ladies).

Let us make a modest assumption that each district has an average of eight similar minded people; we are talking of 896 beasts and 17,920 victims country wide. Unfortunately, such abuse is often meted against weaker members of the society by people who are fit to be their parents and guardians-talk of inter-generational sex and sexual networks. If these 17,920 at risk people each have two other sexual partners, we are now talking of 35,840 new infections! Should we live things the way they are?

Beyond the routine ABC strategy, there is need to define new and workable HIV prevention modalities including a legal framework. The draft HIV/Aids Bill has generated lots of discussions with opponents arguing that in its current form, it's counterproductive and will only serve to fuel new infections as people will shy away from testing and or disclosing their status. It's also true that operationalising this legal approach that's based on evidence of one's intension to infect is very difficult.

I believe the concept of positive prevention where people living with HIV are considered as the primary stakeholders in prevention of new infections has worked in some areas. Now that a few of them are behaving rather criminally, should we not legally or socio-culturally deal with them? I therefore challenge the opponents of the new HIV/Aids Bill to provide alternative prevention strategies rather than concentrating on presenting likely reasons for failure of the proposed Bill.

The gist of the matter is that we have reached crossroads as vaccines for HIV prevention still seem far and donors are already cutting their contribution to this fight. It's therefore imperative that we stop basking in the glory of having generated some of the best practices currently being used in HIV prevention around the world. I would like to see more support for research in these areas rather than relying only on laboratory or industry based solutions. Questions such as, how should the family, society and the country handle people who intentionally spread HIV could be adequately addressed.

Dr Ayiko is a maternal and child health specialist