Targeted interventions key to ending AIDS

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OPINION

By Dr Nelson Musoba

Uganda has made significant progress in the fight against HIV/AIDS over the past three decades. New infections and AIDS-related deaths have declined, and the country continues to move toward global targets such as the UNAIDS 95-95-95 goals. The Uganda AIDS Commission report shows that by Dec 2024, Uganda was at 94:90:97. Despite these gains, Uganda still records tens of thousands of new HIV infections each year. Achieving the goal of ending AIDS as a public health threat by 2030 will require confronting a critical reality: the epidemic is unevenly distributed and concentrated among key and vulnerable populations whose needs are not fully met.

The Uganda Modes of Transmission analysis shows that understanding who is getting infected is essential to ending the epidemic. A relatively small number of population groups account for a large share of new infections. Adolescent girls and young women, for example, contribute about 36 percent of new infections among adults aged 15 - 49. When combined with other high-risk groups such as female sex workers, men who have sex with men, and previously married individuals, these populations account for nearly 78 percent of new infections.

This concentration highlights an important public health principle: interventions are most effective when they are targeted. A generalised approach is no longer sufficient to close the remaining gaps. Uganda must now adopt more focused strategies that prioritise those most at risk.

Key populations, including sex workers, men who have sex with men, and people who inject drugs, experience much higher HIV incidence rates than the general population. Female sex workers, for instance, have significantly elevated rates of infection compared to national averages. These risks are not only driven by individual behaviour but also by structural challenges such as stigma, discrimination, criminalisation, and limited access to appropriate health services.

Vulnerable populations such as Adolescent girls and young women face a different but equally complex set of risks. Gender inequality, economic hardship, and harmful social norms increase their exposure to HIV. Transactional relationships, intergenerational partnerships, limited access to education, and gender-based violence all contribute to heightened vulnerability. Addressing these underlying drivers is essential, as biomedical interventions alone cannot fully reduce infection rates.

Stigma and discrimination remain major barriers to progress. Legal and social environments that marginalise certain groups discourage them from seeking testing, prevention, and treatment services. Fear of judgment or legal consequences often drives individuals away from care, allowing infections to continue unnoticed and untreated. Creating an enabling environment where all individuals can access services without fear is therefore critical to ending the epidemic.

Another challenge is the mismatch between resource allocation and epidemiological need. Although Uganda has invested heavily in HIV programs, funding for prevention has declined in recent years, and not all high-risk groups receive adequate attention. Some populations with a high burden of infection still have limited access to essential services such as testing, counselling, and prevention tools. Aligning resources more closely with evidence will improve the efficiency and impact of the national response.

To accelerate progress, Uganda must adopt a more evidence-driven and client-focused approach. This includes scaling up access to pre-exposure prophylaxis (PrEP), condoms, harm reduction services for injection drug users, and community-based testing. For Adolescent girls and young women, interventions must go beyond health services to include keeping girls in school, addressing gender-based violence, expanding economic opportunities, and improving access to youth-friendly services.

Community engagement is equally important. Programs that actively involve affected populations are more likely to succeed because they are better tailored to real needs. Community-led approaches can build trust, increase service uptake, and ensure sustainability over time.

Improving data systems is also essential. Gaps in data, particularly for marginalised populations, limit the ability to design effective interventions. Strengthening surveillance, conducting regular population size estimates, and collecting disaggregated data by age, gender, and risk group will support more precise targeting and better outcomes.

Sustained political commitment and increased domestic financing will be key to long-term success. Uganda’s HIV response has relied heavily on external funding, which is not guaranteed in the future. Strengthening domestic investment and implementing the national HIV sustainability roadmap will enhance ownership, accountability, and continuity of programs.

In conclusion, ending AIDS in Uganda by 2030 is achievable, but only with a sharper focus on those most affected. Key and vulnerable populations must be placed at the centre of the response. By addressing structural barriers, aligning resources with evidence, strengthening community engagement, and sustaining political commitment, Uganda can close the remaining gaps and move decisively toward an AIDS-free future.

The writer is the Director General, Uganda AIDS Commission