27 November 2012

Uganda: The Changing Faces of HIV

Photo: Patrick Jaramogi/New Vision
Florence Nansubuga, 43, and Nakku Florence, 45, have been living with HIV for 17 years.

I first came face to face with HIV/AIDS in the late 80s. My aunt was brought home, very sickly and looking like a skeleton. She had wounds all over her body and her hair was falling off.

As children, we were curious about her strange illness and one of my siblings actually asked her why she had wounds all over her body. She just broke down and cried. We were forbidden from going to her room after that. We were also warned against eating her leftovers because, we were told, we would get her wounds and end up like her.

That threat was enough to keep us away. At the time of her death, any attempt to turn her over left her skin on the bedding, so they had to get a polythene sheet to minimise this.

The statistics

Looking back at my aunt and many others who died of HIV/AIDS in the early 80s and 90s, it is hard to believe that the same disease is still among us. In fact, statistics show, the HIV/AIDS prevalence rate has increased in recent years, despite the increased awareness about the scourge.

According to the 2011 Ministry of Health Uganda AIDS survey, the HIV/AIDS prevalence rate among people between 15 and 49 years increased from 6.4% to 7.3% between 2004 and 2011.

It also showed that prevalence is higher among women with 8.3% compared to men who have a 6.1% prevalence rate. When it comes to the younger generation, the survey that was conducted between February and September 2011 showed 4% of 15 to 24-year-olds are living with HIV.

The changing face of HIV

One of the reasons why infections are increasing is because HIV/AIDS has taken on a new face. Whereas it used to torture the patient with wounds, rashes, hair loss and weight loss - popularly getting it's name, slim - many people can now live with HIV/AIDS without a single outward sign that they are infected.

According to Dr. Nicholas Atwine, a physician at The Practice Medical Centre in Kampala, the symptoms of the HIV virus were more severe during the late 70s and early 80s, mainly because people did not know about the disease.

"There was little or no information about the virus, so when one contracted it, they were considered an outcast. Many turned to witchcraft or used local herbs in a bid to cure it," he says. Today, patients are put on antiretroviral therapy (ART) to suppress the virus.

In 2011 alone, a total of 7,852 people were enrolled on ART, according to The AIDS Support Organisation's (TASO) 2011 annual report.

By the end of the year, TASO had a cumulative number of 44,897 clients on ART, which the report notes, represents 47.3% of its total number of 94,842 active clients.

Rubaramira Ruranga is one of the prominent Ugandans who has lived with HIV for years, thanks to ARVs

Changing attitudes

Today, people are less scared about getting HIV/AIDS.

According to Sarah Nalule, a clinical psychologist with Mulago Hospital, people's attitudes toward contracting the virus has contributed to the changing face of HIV today. This is mainly due to the strides made in a bid to control and find a cure.

Scientists continue to do research, consequently, new preventive measures and treatment drugs are introduced. These have guaranteed normal and fulfilling lives for those with the virus, shaming the proverbial dramatic look that HIV wore when it first hit humans.

A drama group makes a presentation about HIV. Sensitisation of the masses helped demystify HIV/AIDS.

Counselling services

Unlike today, where counselling services are availed to those infected, there were none in the early years of the epidemic. Instead, people were stigmatised and considered outcasts.

"The victim suffered emotional stress, which further weakened the body, making the symptoms more evident and bringing quicker death. The major one was rapid weight loss from which the term 'slim' was coined," Atwine explains.

With time, however, the need to provide counselling services to both patients and caretakers gave rise to a crop of HIV/AIDS counsellors, who have done a great job of demystifying issues surrounding the disease.

As Nalule notes, paying specific attention to the emotional challenges influencing HIV infection has contributed a lot to the changing face of HIV/AIDS.


Atwine observes that there were no anti-retroviral drugs back in the day, because there was little research on the virus.

As a result, medical help was limited. Of late though, sensitisation about the disease and its prevention has grown in leaps and bounds.

"There are measures today that help prevent mother-to-child transmission, which means babies whose mothers are HIV-positive can be born HIV-negative.

Preventive measures like the use of condoms and positive living campaigns have also gone a long way in helping people cope," she says.


Though there are different strains, HIV is the same

Q Is the HIV virus still the same as it was back in the day?

A Yes, it is, though there are different strains.

Are there any subtle physical signs from which I can tell that someone has the HIV virus?

It is not possible to tell that one has HIV just by looking at them. It is unwise to conclude, for example, that a rash on someone's skin indicates they have the virus. It could be an allergic reaction or a skin infection. The only way to tell that one is infected is by taking a blood test.

Why do people still get wounds on their bodies even when they are on ARVs?

One might be on ARVs but drinks heavily, smokes, has a poor diet, lives in an unhygienic environment or does not adhere to the routine and dosage of the drugs. This can cause the symptoms to manifest more because the drug may not work as effectively as it should.

Why are there more discordant couples these days?

There were discordant couples even back then, but due to lack of information and awareness, they were not known.

Do ARVs reduce someone's chances of getting AIDS?

No. ARVs do not prevent the spread of HIV and people ought to be just as careful not to get infected as they were before their advent.

ARVs are primarily meant to boost sufferers' immunity so they can fight off opportunistic diseases, not cure them.

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