Uganda tops East Africa in HIV

KAMPALA - Uganda has the highest HIV prevalence in East Africa, according to a new UNAIDS Country Report 2023/2024. 

The epidemiological data estimates for December 2023 indicate that HIV prevalence among the adult population (15-49 years) has continued to decline, now standing at 5.1%, down from 5.5% in 2020. 

However, the prevalence remains higher among women (15-49 years) at 6.6% compared to men in the same age bracket at 3.6%, according to the annual Joint AIDS Review Report 2023/2024. 

Comparing Uganda with peer countries in the East African region, Tanzania ranks second with a prevalence of 3.8%, followed by DR Congo and Kenya at 3.2%, Rwanda at 2.2%, South Sudan at 1.6% while Ethiopia at 0.7%, according to the same report.
 
Overall, there has been a declining trend in new HIV infections, with Uganda registering a 61% reduction since 2010 to 38,000 new infections in 2023, ranking fourth in the region. 

Kenya leads in reductions at 78%, followed by Ethiopia at 72% and Rwanda at 71%. 
Latest data shows that in 2023, a total of 38,000 people acquired HIV, a slight reduction from 46,000 in 2020, with the majority being adolescent girls and women, who contributed about 30%.

AIDS-related deaths 

By June last year, nearly 20,000 people in Uganda had died of AIDS-related illnesses, marking a slight decline from 21,000 deaths in 2023. The majority of these were men (8,700), followed by women (8,200) and children (3,200). The 2025 target is 10,800 deaths. 

Dr Vincent Bagambe, the director of planning and strategic planning at the Uganda AIDS Commission, said nearly half of those dying from AIDS-related illnesses are men, indicating limited access to HIV/AIDS services for men compared to their female counterparts. 

Response from ministry  

Dr Robert Mutumba, the manager of the AIDS control programme at the Ministry of Health, acknowledged the HIV indicators but emphasised the need to appreciate Uganda’s progress in the HIV fight. 

He said Uganda’s HIV prevalence was as high as 18% in the 1980s before gradually reducing to 11%, then 7%, and now 5.1%. 

To further reduce infections, Dr Mutumba stressed the need for a multi-sectoral approach focused on behavioural change interventions, including reactivating awareness campaigns and sensitising communities, as HIV is predominantly a behavioural disease. 
He called for targeted interventions for high-risk populations, particularly young people who did not witness the first HIV epidemic. 

Dr Mutumba acknowledged the neighbouring countries’ downward trend in HIV new infections. 

“We are in the same region, so we have a lot in common. But once we implement the already highlighted the interventions to full scale across the entire country, we will get there.” 

The report findings were released during the recent three-day training on Adaptive Leadership Framework for key stakeholders with a focus on the adolescent girls and young women (AGYW) HIV response programme in Uganda at Imperial Resort Beach Hotel in Entebbe. 

The training was organised by Uganda AIDS Commission together with development partners. Other high-risk groups receiving pre-exposure prophylaxis include commercial sex workers, fishing communities, people living with HIV who are not suppressing their viral loads and sero-discordant couples. 

Additional interventions include scaling up safe male circumcision, which reduces transmission by 60%, increasing condom distribution, ensuring that those who test positive for HIV are started on treatment as well as eliminating mother-to-child transmission. 

Can Uganda hit its target? 

For Uganda to achieve epidemic control, new HIV infections should equal or be lower than AIDS-related deaths. 

Dr Bagambe said while Uganda has reduced new HIV infections, the decline is not fast enough for the country to reach zero new infections by 2030 — a key target. 

Failure to attain this goal could lead to a resurgence of new infections, triggering a second wave of the HIV epidemic, worsening Uganda’s situation. 

“We need to achieve the desired epidemic control, where people are no longer dying of AIDS and new HIV infections have dropped below the number of AIDS-related deaths,” he said. 

In 2020, Uganda recorded 21,000 AIDS-related deaths, which slightly reduced to 20,000 by June last year. 

However, new infections remain high at 38,000, according to the annual Joint AIDS Review Report 2023/2024. In contrast, Rwanda has managed to bring down new infections to 5,400 annually. 

Persistent challenges 

HIV prevalence remains higher among women at 6.5% compared to men at 3.6%. 
Additionally, young people, particularly adolescent girls and young women, account for 30% of new infections. 

This means that young females are acquiring HIV at four times the rate of their male counterparts. Dr Ruth Ssenyonyi, the board chairperson of the Uganda AIDS Commission, stressed the need to protect young people, as they represent the future generation. 

“Our strategic focus is on this young group, and we must provide them with HIV messages and effective communication,” she said.

Gender inequality also fuels the HIV epidemic. Dr Bagambe explained that if women cannot negotiate for safe sex, they are at a higher risk of acquiring HIV. 

He added that unless economic and educational opportunities for women improve, Uganda will continue to register more HIV infections among women than men. 

“There is an urgent need to change cultural beliefs at the household level and empower women so their rights are not violated,” Dr Bagambe said. 

He added that shifting the balance of power in favour of women would ultimately protect them against HIV. 

Identifying hotspots 

Prof. Pontiano Kaleebu, the executive director of the Uganda Virus Research Institute (UVRI), said that if everyone living with HIV knew their status and started treatment [ARVs], it would significantly reduce infections. 

He emphasised the importance of identifying hotspots for new transmissions, such as fishing communities, to implement intensive measures. 

Additionally, the introduction of injectable ARVs will help reduce the pill burden and improve adherence. Prof. Kaleebu said the USAID funding freeze is likely to impact progress, urging the Government to bridge the funding gap.

Increasing HIV mainstreaming 

There is a need to increase HIV mainstreaming to optimise limited resources. 
HIV mainstreaming requires every government entity to allocate 0.1% of its budget to HIV-related interventions. 

Dr Bagambe acknowledged challenges in monitoring these funds but confirmed that most entities are making the necessary allocations. 

The annual Joint AIDS Review Report 2023/2024 indicates that in one year, 4,700 children (aged 0-14) acquired HIV from their positive mothers, translating to a 5.04% infection rate. 

This marks a reduction from the 5,900 new infections recorded among children in 2023.

Case: Rwanda

Last year, Rwanda’s HIV prevalence among adults aged 15-49 stood at 2.7%, with women having a higher prevalence (3.7%) than men (1.7%). 

The prevalence is slightly higher in urban areas (3.7%) compared to rural ones (2.5%). 

Rwanda has achieved the UNAIDS 95-95-95 targets: 95% of people living with HIV know their status, 95% are receiving antiretroviral therapy and 95% have achieved viral load suppression. 

The government actively distributes condoms and donor-funded efforts align with its priorities. 

In contrast, in Uganda, donor funding often determines priorities, which can sometimes create gaps in addressing the country’s specific needs. 

For Uganda to follow Rwanda’s example, a strong government-led approach, combined with increased local funding and targeted interventions, will be essential in effectively controlling the HIV epidemic.