2 February 2013

Uganda: Why Aids Is Still a Problem

Kampala — Uganda was one of the countries in Africa that were recognized for fighting HIV /AIDS, a disease which was discovered in the early 1980s.

The scourge is one of the deadly diseases that have claimed many lives of people in the last three decades. It's because the country has not carried out enough research on how the disease can be controlled as compare to other diseases.

It is what is attributed to the upward trend in the number of Ugandans suffering from HIV/AIDS. At its highest peak, HIV/AIDS prevalence was as high as 30 percent (adult Ugandans who had the virus) tested at some antenatal sites.

This was driven by bad behaviors like having sex with more than two partners, transmission of the virus from mother to children TMTC and many other factors this led the Government to think twice and comes up with strategic interventions aimed at mitigating the spread of the disease

In 1986, President Yoweri Museveni spearheaded a mass education campaign promoting a three-pronged AIDS prevention message: abstinence from sexual activity until marriage; monogamy within marriage; and condoms as a last resort.

The message became commonly known as ABC: Abstinence, be faithful, use a condom if A and B fail. This message also addressed the high rates of concurrency, which refers to the widespread cultural practice of maintaining two or more sexual partners at a time.

Mass media campaigns also targeting this practice included the "Zero-Grazing" and "Love Carefully" public health messages in the 1990s.

This created good environment for the government to fight AIDS in collaboration with other interventions. According to the World Health Organization (WHO), around 41,000 women received Preventing Mother to Child Transmission (PMTCT) services in 2001.

Uganda was the first country to open a Voluntary Counseling and Testing (VCT) clinic in Africa called AIDS Information Centre and pioneered the concept of voluntary HIV testing centers in Sub-Saharan Africa.

"When the Government introduced such preventive mechanism the number of children born with the virus reduced at good rate.

"Although it still faces a big challenge on the side of communities because many couples still fear to be tested in clinics which can help the medical personnel to monitor the expecting mother" said Annette Nakanwaji a private midwife practioner in Makindye division a Kampala city suburb.

Information available shows that between 2005 and 2007 the number of health facilities providing routine HIV counseling and testing for pregnant women increased, raising the uptake of HIV testing to 80 percent of all women attending antenatal clinics.

By 2010, the proportion of all pregnant women tested for HIV had substantially increased; from only 1 in 5 in 2005, to nearly 2 out of 3 pregnant women.

In a bid also to fight the disease, the government through the ministry of Health rolled out free HIV/AIDS services in almost all parts of the country.

Services like VCT started being offered at all health centers III and IV. This helped Uganda to increase on the number of people accessing services and ARVS which reduced the number of people with HIV virus to develop AIDS.

By the year 2005, the number of Ugandans suffering from HIV/AIDS reduced drastically.

But towards the end of 2010 the Government of Uganda started losing the battle to fight HIV /AIDS which its prevalence among the Ugandan communities stated to rise. Information from the Uganda Aids Commission (UAC) reveals that around 130,000 Ugandans are infected with the HIV virus every year.

The government's new national HIV/Aids strategic plan bleakly predicted that the number of HIV positive Ugandans will rise from 1.1 million in 2006 to 1.3 million in 2012. Dr Kihumulo Apuuli the Executive Director of UAC, blames the problem to the government that is focusing only on treatment at the expense of prevention measures.

"Over the last four years, a mistake was made to shift focus to treatment, rather than prevention. A big chunk of money is allocated to drugs," said Kihumulo who was once quoted in one of the international news papers responding to why the country is going back in the struggle to fight.

This move recently led Uganda's president Yoweri Museveni who suggested that the ministry of health should revise their promotion of "their safe male circumcision" arguing that some of the measures developed by the ministry are simply sparking the spread of HIV/AIDS because they mislead the society.

The President notes that there is need to revisit the earlier strategies of Abstinence, Being faithful and Condom use (ABC) if the current trend of HIV is to be reversed.

According to Rukia Nakamatte, the ministry of health public relations officer explained that they will continue advocating for Safe Male Circumcision because it's one of the strategies they think can help fight the HIV/AIDS scourge.

Nakamatte asked health centres all over the country where Safe Male Circumcision is being carried out to continue sensitizing local communities about the positive effect of SMC towards the prevention of HIV/AIDS. The issue of SMC is not only being promoted by Uganda. International health organizations like World Health Organization support it.

According to information on World Health Organization (WHO) website, Voluntary Medical Male Circumcision (VMMC) becomes a component of a comprehensive package of HIV /AIDS prevention services for men. It is the result of recent studies in African men which demonstrate that VMMC reduces the risk of HIV acquisition among medically circumcised men by 60%.

In addition, male circumcision has shown to reduce the incidence of other Sexually Transmitted Infections (STIs).

The programme has been adopted by many African countries as a component of the comprehensive package of HIV prevention services for men in high HIV-prevalence settings.

According to the 2011 Uganda Aids Indicator Survey figures show that the prevalence of HIV among adults has increased from 6.4 per cent in 2005 to 7.3 per cent in 2011.

However, a Senior Medical Officer in the ministry of health who talked to the EABW on point of anonymity said he supports the president on the ABC strategy because it has enabled the country to register positive results as far as fighting HIV/AIDS is concerned.

"The issue of SMC may mislead the general public because we are seeing even Muslims and the Bamasaba of Bugishu region (Eastern Uganda) getting infected with the virus yet they circumcise, let the ministry stop fooling the public with wrong information, " he said.

Ministry of Health figures also indicate that new infections increased by 11.5 per cent between 2007/8 and 2010/11.

Some scientists urge that Safe Male Circumcision reduces up to 60% of HIV/AIDs reach. A new survey results showed that 6.7% of Ugandan adults aged 15-49 years are HIV positive.

Dr Alex Opio, assistant commissioner, National Disease Control at the Ministry of Health, who was once quoted in local dailies here, says that this is not statistically different from the HIV prevalence of 6.4% five years ago.

But Dr. Benon Biryahwaho from the Uganda Virus Research Institute (UVRI) notes that 6.7% is a large burden of disease to a poor country like Uganda.

"Uganda needs to rethink its Abstinence, Be Faithful and Condom-use strategy." The two Doctors were once quoted in one of the Uganda's news paper as having said.

The survey also shows that prevalence is highest among widows and widowers, followed by divorced and married people, and lowest in the unmarried group. Almost one third of widowed adults are living with HIV.

Dr. Opio said it is not yet known why the widowed and divorced groups have higher HIV prevalence, but the assumption is that their partners died of HIV and that women are divorced after learning their HIV status during routine testing and during antenatal visits.

Why infections are going back?

Sarah Nambale a social worker says that many Ugandans especially married couples no longer want to go for Voluntary Counseling and testing that is why children born when they are HIV positive are also increasing.

"When you do a survey among married couples you will find that men are not supportive. Its only women especially expecting mothers who always go for VCT this becomes challenging to the government to fight the disease.

"Some married men are having more than two women outside their marriage unless government again focuses on educating the general public about the danger of having more than one partner that is when Uganda will achieve its goal in fighting HIV/AIDS, "noted Nambale.

According to the Joint United Nations Programme on HIV /AIDS (UNAIDS), the knowledge of HIV status is the gateway to AIDS treatment and has documented preventive benefits.

However, the current reach of HIV testing services is poor in most developing countries including Uganda because some individuals fear to disclose their status for fear of being stigmatized and discriminated.

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