UG@60: Uganda taught the world how to fight HIV

As Uganda celebrates 60 years of independence, the New Vision highlights the achievements the country has given to the world. Many discoveries, innovations and inventions from Uganda have impacted the lives of citizens and even beyond. Today, Agnes Kyotalengerire explains how Uganda gave the world an AIDS control programme design than became a blueprint for many nations. 

Uganda was the first country in the world to set up the AIDS control programme in 1986, says Prof. Samuel Okware who was then the senior medical officer in charge of epidemics and outbreak control management.

“Everybody was afraid. There was denial coupled with stigma as HIV/AIDS was thought to be strictly sexually transmitted,” Okware says.

As such, when Uganda came out boldly about the existence of HIV/AIDS, it was hailed. And when the AIDS control programme was established, Uganda became the benchmarking model of other countries, which were establishing their own.

AIDS cases were first recognised in Uganda in 1983, with about 900 cases reported by 1986. This had risen to 6,000 cases by 1988.

However, there is evidence that the Government knew about the disease by 1982, but chose to keep quiet for fear of spoiling Uganda’s image and scaring away tourists. 

However, when the bush war ended in 1986 and National Resistance Movement took over power, the Government sent 60 army officers for military training in Cuba. When the soldiers were tested before training, 18 were found to have HIV. The Cuban government raised a flag about this to President Yoweri Museveni.

“This was the first indication of Uganda’s high prevalence rate which was later confirmed in 1989 when a report showed that nearly a quarter of the pregnant women attending antenatal care at sampled clinics were infected with HIV,” Okware says. 

The Government recognised that the magnitude and impact of the HIV/AIDS epidemic cut across all sectors of life. It was then that President Yoweri Museveni took swift action.

In October 1986, the health ministry with the guidance of Prof. Okware set up an AIDS Control Programme (ACP) and the National Committee for the Prevention of AIDS (NCPA).

How it worked

Working with financial and technical support from the World Health Organisation (WHO), in October 1986, the Ugandan government launched the first ACP in Africa, which later became the model after the government launched an aggressive open policy and media freely reported about HIV/AIDS.

“Our ACP effectively co-ordinated the first multi-sectoral mobilization campaign. Through it, HIV prevention messages were widely disseminated in the country at a critical time when there was a dearth of knowledge and information about the epidemic. By the early 1990s, Uganda was among the African countries worst hit by the HIV/AIDS epidemic,” Okware says.

With the Government openly acknowledging the devastating effects of HIV, many partners started coming on board. 

That was the first step in the fight against HIV/AIDS. The biggest hindrance at the time was the traditional healers who claimed that they could heal people.

Through the technical oversight and direction of the health ministry, the first national blood transfusion service; the first voluntary, confidential counselling and testing service; the first HIV&AIDS care and support organisation and the first national sexually transmitted disease control programme were initiated in Uganda. 

These interventions jointly helped to slow down the epidemic.

Policies for comprehensive HIV prevention, care and treatment were developed and updated in response to the emerging global and national challenges.

Later, ACP developed a strategy, based on the ABC – Abstinence, Be faithful and Condom use for those who failed to follow the first two. This yielded results and many countries replicated the strategy. And many NGOs were set up and funded along those lines.

In 2007, the STD/AIDS control programme developed a four-year Strategic Plan (2007-2010) with the primary goal of preventing further transmission of sexually transmitted infections and HIV infection and providing support for the mitigation of the impact of HIV and AIDS on individuals, families and the community. 

The plan sought to scale up proven prevention and care initiatives and ultimately contribute to the realisation of the three health sector objectives and the broad national goals. 

Key among others were the preventing of new infections, mitigation of the impact of the epidemic, and strengthening of the national capacity to coordinate and manage the multi-sectoral response to the HIV and AIDS epidemic.

Health education was the main thrust of the ACP. It entailed making use of all facilities to disseminate health information and education.

It focused on urban dwellers, schools and workers in places of entertainment, who were identified as a special risk group in the most danger.

Messages were put on local television and radio urging people to ‘love carefully’ and to avoid indiscriminate sexual relations.

For rural areas with no access to TV and newspapers in those days, programmes were delivered through cultural, religious and social leaders.

The President incorporated health education in speeches at most of his rallies, which were usually well attended. Resistance committees were responsible for household contacts.

They received elementary, but effective re-orientation about AIDS, which information they eventually passed along from door-to-door.

Blood transfusion, which was another source of HIV transmission, was curtailed right from the beginning. Screening of blood became mandatory. 

It would be gross malpractice to transfuse anyone with contaminated blood. The provisional high rates of infection of donated blood meant that between 5 % and 15% of those transfused could become infected. 

Instituting blood screening had been handled as an absolute emergency. From limited screening facilities in Kampala in 1986, there were, by May 1987, at least 13 readers of enzyme-linked immunosorbent assays (ELISAs) in centres in all the regions, especially in the HIV endemic areas and along the major transport corridors. 

Another sector that received considerable attention was the National Blood Transfusion Service, which was being improved and rehabilitated to cope with the AIDS epidemic.

To protect the public and health workers, several orientation courses in sterile techniques were mounted.

These were purchased in substantial quantities. An additional quantity of gloves, aprons and surgical boots were a must, especially for midwives and traditional birth attendants. The gap between demand and supply remained wide. 

Uganda’s AIDs control programme goes international, used as template 

In 1992, a miracle happened and many were surprised. The antenatal prevalence dropped to 18% and in 2001, to 6.5%.

More significant declines were recorded in urban areas where the average prevalence dropped from 10.9% in 1999 to 8.7% in 2000, compared to declines of 4.3% to 4.2% over the same period.

UNAIDS executive director Peter Piot also presented Museveni with an award of distinguished leadership excellence over the AIDS control programme.

The former general director of Uganda AIDS Commission, Dr Apuuli David Kihumuro, attributes the reduction in HIV prevalence to strong political leadership, an open approach to combating the epidemic and a strong multisectoral, decentralised and community response was a huge success.

In 1992 the Uganda AIDS Commission (UAC) was established by Statute of Parliament, under the Office of the President to ensure a focused and harmonised response towards the fight against HIV/AIDS in Uganda.

Benchmarking ACP

Prof. Samuel Okware says the AIDS Control Programme (ACP) got absorbed by yet another global programme on AIDS that was co-ordinated by Dr Jonathan Mann who was the director at the World Health Organisation. Dr Mann used our ACP to co-ordinate the expansion of the global programme on AIDS to the rest of the world; for all the countries to follow.

Based on that, Okware travelled to different countries, helping them to set up their programmes. He became a consultant on HIV/AIDS management. 

In 1989, Okware started off with Tanzania and later other countries in the East African region. He went to Namibia, Botswana, Gambia, Ecuador and Australia were all ministers of health had gathered.

“As a result, two agencies were formed out of the ACP — Society for AIDS in Africa and the International AIDS Society. In 1995, Uganda hosted a big conference; Internal Conference on AIDS and STDs in Africa, bringing together over 52 countries, with over 7,500 participants. I was the chair.

The society has continued to hold annual conferences in the world,” Okware says.

Additionally, Prof, Okware and Mann mobilised many of the people for their activities. 

Okware was instrumental in explaining the ACP to other experts in Geneva, trying to link up strategies, documents, tutorials and journals globally.