Uganda must close tap on new HIV infections
UPHIA is not a verdict of failure. It is a call to sharpen our response. Uganda has overcome far worse circumstances before. If we strengthen abstinence messages among school-going youth, faithfulness in relationships, testing, treatment and accountable leadership, we can close the tap on new infections and sustain progress towards ending AIDS by 2030, writes Dr Vincent Bagambe
Dr Vincent Bagambe. (File)
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OPINION
By Dr Vincent Bagambe
The latest Uganda Population-based HIV Impact Assessment (UPHIA 2025) reminds us that progress against HIV is real, but cannot be taken for granted. The preliminary findings released on October 1 show adult HIV prevalence at 5.9%, largely unchanged from the previous survey. Uganda must protect its achievements while renewing efforts to end AIDS as a public health threat by 2030.
UPHIA is a nationwide household survey that measures how many people are living with HIV, how well treatment is working, and who is being reached by prevention and testing services. It matters because reliable evidence shows government, districts and partners where to concentrate resources, instead of relying on guesswork.
Prevention progress
What does 5.9% mean to an ordinary Ugandan? Put simply, out of every 100 people aged 15 and above, about six are living with HIV. This is prevalence: the proportion already living with the virus, not the number newly infected each year. Because people on successful treatment live longer, prevalence may remain steady even when treatment improves. We therefore need new-infection figures alongside prevalence to judge prevention progress.
Our history gives reason for hope and caution. During the early 1990s, HIV devastated families and communities. Surveillance among pregnant women in some major urban areas recorded levels as high as 25 to 30%. Those figures were not nationwide household estimates and cannot be compared directly with today’s 5.9%.
Today, strong treatment results are encouraging. Among adults living with HIV who know their status, 99.1% are receiving treatment, and 96.5% of those on treatment have suppressed the virus. But only 85.3% of adults living with HIV know their status. We must reach those who have not tested while preventing more infections.
Our first priority must be to close the tap on new infections, consistent with the first pillar of the Presidential Fast Track Initiative launched in 2017. Prevention must begin with young people, those still in school. Abstinence is a clear, practical choice for young people who are not ready for sexual relationships.
Parents, teachers, religious leaders and peers should confidently encourage them to delay sexual debut, concentrate on education and protect their future. This message must be delivered respectfully, alongside accurate health information and access to support.
Young people
The survey also shows why adolescent girls and young women need special attention. Poverty, pressure from partners, misinformation and fear of judgment can undermine healthy choices.
Families should offer guidance and protection rather than silence. Schools should support age-appropriate prevention education, while health facilities remain welcoming to young people who need confidential advice or services.
Faithfulness is equally important for married couples and people in long-term relationships. Being faithful to one mutually faithful partner helps reduce HIV exposure. Partners should communicate openly, test together where appropriate, and avoid multiple sexual relationships. Marriage by itself is not protection; trust must be supported by honesty and knowledge of each other’s HIV status.
ABC message
Alongside these choices, people should access HIV testing and proven prevention services, including medicines that prevent HIV where appropriate. Prevention messages should equip people to make informed decisions, not shame those seeking help.
Collective responsibility
Leadership must also become everyone’s responsibility. Religious and cultural leaders, elected officials, local government teams, teachers, employers and media personalities have audiences that health workers cannot always reach. They should use meetings, places of worship, classrooms, workplaces and public events to encourage testing, responsible behaviour, treatment and an end to stigma.
District leaders should act on local data and support communities with the greatest gaps.
Every Ugandan should know their HIV status. Men must overcome reluctance to test; couples should seek counselling and testing; and anyone diagnosed should start and continue treatment.
People who maintain an undetectable viral load do not transmit HIV sexually. Government and partners must protect testing, medicines, health workers and services that prevent transmission from mothers to babies, even as financing becomes tighter.
UPHIA is not a verdict of failure. It is a call to sharpen our response. Uganda has overcome far worse circumstances before. If we strengthen abstinence messages among school-going youth, faithfulness in relationships, testing, treatment and accountable leadership, we can close the tap on new infections and sustain progress towards ending AIDS by 2030.
The writer is the senior manager — planning, policy and strategic information — Uganda AIDS Commission