Almost three decades of HIV in Uganda and still unwavering, what is the future like?

 

“The challenge is already huge, and if we don’t course and address the problem of HIV/AIDS prevention, then it’s going to be hard to sustain the free treatment programme in the years ahead” – Dr. Kihumuro Apuuli, the head of the Uganda AIDS Commission. And McDermott, the spokesperson for PEPFAR warned through a media report: “Your problem is getting bigger while our budget is about the same.” 

 

 As we prepare to mark World AIDS Day on1st December 20011, I would like us to reflect on almost thirty years of HIV in Uganda, the struggles, the successes and the future. What have we done better and what do we still need to do or perfect?

Since it was first diagnosed almost three decades ago, the dreaded HIV has had a devastating history. But President Yoweri Museveni, his government and Organizations like UAC, TASO, ICOBI, Mildmay, RACOBAO, JCRC, Baylor Uganda, AIC, World Vision etc. are credited for their openness and efforts to fight it with hope to eradicate it. 

 

However, the stagnating prevalence rates recorded in recent years suggest that this may remain a vain wish if we do not change strategy. HIV prevalence has been stuck between 6% – 7% for the past few years. Prevalence is the ration of infected persons against the total population. Several interventions have been put in place to mitigate the spread and impact of the HIV and AIDS scourge or at best completely wipe it out of Uganda, but with little success. HIV attacks mainly the youth in their prime years of production. The youth are a hope for the future of a nation.

 

In Uganda, the first AIDS cases were diagnosed in 1982 in Rakai district, at Kansensero landing site. It started as a rumor but soon spread like a wild fire with prevalence rates as high as 18% in 1992, and then dropped significantly to 6.1% in 2002. Generally, there has been three phases in the last three decades: Rapid increase between 1989 and 1992 (18%); Rapid decline between 1992 and 2002 (6.1%); Period after 2002 characterized by stagnation between 6-7% prevalence on average.

 

Please note that the figures provided are only average representatives of people who have tested for HIV or sought medical care and other care services over a period of time but not all Ugandans have tested for HIV, know their HIV status or have sought care and management services of the pandemic. These facts, therefore, are mere estimations of the status quo. 

Since1982 to date the following observations have been made: approximately 2.6 million Ugandans have cumulatively infected by the virus; more than one million Ugandans have died of HIV and AIDS related illnesses; 2 million Ugandan children have been orphaned due HIV and AIDS. 

 

The current facts are worrying: 1.2 million Ugandans are HIV Positive; the National Prevalence Rates stand at 6.4% and 0.7% for adults and children respectively; HIV prevalence by region is: Central and Kampala stands at 8.5%; North central (especially Gulu) is 8.2%; West Nile - 2.3%; Western - 6.9%; South Western - 5.9%; Busoga region 6.5%; Eastern - 5.3%; North Eastern - 3.5%.

 

Media reports have continued to yield both hope and uncertainty about the future of Uganda. For example, one newspaper reported that “about 200,000 more Ugandans will require antiretroviral therapy by 2015 but a looming funding crisis makes it less likely”. But US President, Barack Obama, warned: “We’re never going to have enough money to simply treat people who are consistently getting infected…We’ve got to have a mechanism to stop the transmission rate”.

The New Vision of Thursday, July 14, 2011 reported that an HIV drug trial done in Uganda and Kenya showed impressive protection from HIV infection. The trial was carried out among discordant couples found that negative partners who took certain ARVs daily received up to 73% protection from infection from their partners. The study was coordinated by The International Clinical Research Centre, US, and funded by The Bill & Melinda Gates Foundation. 

 

Still, Dr. Zainabu Akol, the Programme Manager of National AIDS Control Programme commended the results. The ARVs taken by HIV – negative persons to avoid infection from their partners are called PRE-EXPOSURE PROPHYLAXIS (PrEP).

According to UNAIDS, over 30% of married couples in Uganda have a negative partner. Many continue sex without knowing each other’s status or in the belief that one is resistant. Others just want a child. Within time, infection occurs. In Uganda, about 60% of new infections occur in discordant couples.

 

Prof. Connie Celum, the principle investigator from the International Clinical Research Centre – University of Washington, said: “These findings are evidence that this new HIV prevention strategy, called PrEP substantially reduces HIV infection risk”.

 

In the New Vision of Friday July 22, 2011, a new study carried out in orange farm – South Africa by Makerere University by interviewing 316 men, average age 22 who had been circumcised between February and September 2009, showed that new cases of HIV among men fell by an astonishing 76% after a circumcision programme.

 

The New Vision Monday September 26, 2011 reported that Uganda had recorded a 30% reduction in deaths related to HIV/AIDS in the last 10 years, according to the Ministry of Health release. Dr. Zainabu Akol, said: “The number of Ugandans dying from AIDS – related infections is about 50,000 per year, down from 750,000 in th