28 December 2012

Uganda: Complacency Sacrifices Gains Against HIV/Aids

Photo: Aphaluck Bhatiasevi/WHO
The health sector played a key role despite numerous challenges in the year 2012.

After years of pace-setting in the fight against the HIV/AIDS pandemic globally, Uganda is losing her footing, with government statistics pointing to a surge in new infections.

A national demographic and health survey conducted in 2011 shows that the national HIV/AIDS prevalence has hit a seven-year high of 7.3%, up from 6.4% in 2006, according to the Minister of health, Dr. Christine Ondoa.

"We (Uganda) have relaxed a bit and (national) prevalence has gone a bit high," she says. "It is high among married couples and lowest through mother-to-child transmission."

The news is a set-back to the country after years of vigorous, sustained and fight against the dreaded pandemic, catapulting Uganda to global stardom largely due to strong government leadership, broad based partnerships and effective public education campaigns.

HIV statistics

The first 10 years of Uganda's real 'war' on HIV recorded tumultuous successes, with the health ministry's fear model that worked wonders as it shocked people into changing their sexual behaviour. The national prevalence rate fell from 30% in the early 1980s to 6.4% in 2006, according to the Uganda HIV and AIDS Sero-Behavioural Survey.

This, however, followed a string of up and down-turns. By the end of 1992, for example, the prevalence rate was estimated at 18.3%, with some centres registering rates above 30% but fell from 15% in the early 1990s to 5% in 2001.

In 2002, the prevalence rate rose to 6.2%, rising to 6.5% in 2004 but dropping to 6.4% in 2006. New HIV infections, meanwhile, were estimated at 70,170 cases, with AIDS cases at 73,830 and AIDS deaths at 75,290 in 2002 alone.

From 1982 when the country's first cases of HIV were detected on the shores of Lake Victoria in Rakai district, cumulatively an estimated 2.6 million Ugandans were infected while 1.6 million lost their lives to HIV/AIDS related illnesses including 76,000 in 2005 alone.

To date, a total of 1. 2 million Ugandans are living with HIV/AIDS and, while 577, 000 of them are in need of ART only 310, 000 access treatment.

Why the prevalence rate reduced

Prevention work at grassroots level began in this era, with a multitude of organisations educating people about HIV. The first communitybased organisation formed being was The AIDS Support Organisation (TASO). The Aids Information Centre and the Uganda Aids Commission (UAC) also emerged.

TASO later became the largest indigenous AIDS service organisation providing HIV/AIDS services in Uganda and Africa, and providing emotional and medical support to thousands HIV positive people.

"Back then, Government prioritized the health sector," says Dr. Ben Khingi, a consultant surgeon. "This is no longer the case as seen from human resource development, remunerations and health facilities.

We have good policies, but we come short of implementing them," he observes. The 1990s was also the time popular music icon, Philly Bongole Lutaaya openly declared his HIV positive status, becoming the first Ugandan to do so.

Through his popular music and educational tours, the hero Lutaaya used music and a brave face at a time when it was almost 'treasonable' to be HIV positive.

Lutaaya's vocal endowment helped spread understanding, compassion and respect for people living with HIV.

There was also the wide view that the fall in the number of new infections and a rise in the number of AIDS-related deaths played a part in the eventual drop in national threshold.

It must be remembered that 1990 was a cruel year as many people died of HIV since there was no treatment to delay the onset of AIDS.

As such, many people who were infected from the 1980s were reaching the end of their survival period. In 2000, the Ministry of Health estimated that 800,000 people had died of an AIDS-related illness since the beginning of the epidemic.

New infections

However, the colossal gains Uganda has made in reducing HIV prevalence, granting her a model status in Africa, seems to have been sacrificed on the alter of complacency.

The last five years have seen an increase in the HIV infection rate. Apparently, over 65% of infections occur amongst the married!

A total of 135,000 new infections are registered annually, with children accounting for 30,000 and 70,000 being women. "One big problem we have, is multiple partners," says Ondoa.

"Zero-grazing is no longer a norm, with some HIV positive men infecting their wives and children." Free antiretroviral (ARVs) drugs have been available in Uganda since 2004. It is thought that the introduction of the HIV drugs led to complacency about HIV as AIDS is no longer an immediate death sentence.

However, the biggest problem in the fight against HIV is that of babies born with the virus 20 years ago. These have matured and engage in sexual intercourse with those who are HIV negative, consciously or otherwise infecting them in the process.

The other problem is that amongst young girls, it is pregnancy and not HIV, that is dreaded most. "I was taken aback when a girl told me if I didn't use a condom, I would make her pregnant," says Musa Kato, a university student. "I don't know why she never mentioned HIV!"

In its fight against HIV, Uganda has used the ABC strategy that emphasizes Abstinence, Being faithful and, at most, Condom use.

Condoms remain the widely available and cheap means in the fight against HIV. However, false confidence is growing among new couples who give-up their use before they know their sero-statuses.

"Poverty is also contributing to new infections," says Ondoa. "Our funding is not high, but it is also due to low tax collections and low production."


With Quality Chemical Industries (QCIs) now manufacturing ARVs, experts believe this is easing the red-tape of procuring the drugs from abroad and reducing the cost of treatment that stands at between sh300,000 to sh800,000 annually.

Government officials estimate that the generic drugs will cut the price from $9-15 to between $2-9 per patient per month.

The health ministry plans to use a policy of rapid testing and diagnosis of communicable and non-communicable diseases which will also be incorporated into HIV.

The ABC strategy used over the last five years, is no longer effective as new infections soar. "HIV is a behavioural issue," says Ondoa. "Fighting HIV starts with an individual's change in sexual behaviour."

Experts believe that complacency may be leading to an increase in risky behaviour.

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