HIV highest in adults, marrieds

Jan 05, 2006

SINCE 1992-3, despite the pain and death on a personal level, as a country Uganda has had almost exclusively good news on HIV. First, prevalence declined from about 18% to 6%, the biggest decline of any country ever. Second, in the late 1990s ARVs arrived: We now have more people on ARVs than any ot

By Catherine Watson

SINCE 1992-3, despite the pain and death on a personal level, as a country Uganda has had almost exclusively good news on HIV. First, prevalence declined from about 18% to 6%, the biggest decline of any country ever. Second, in the late 1990s ARVs arrived: We now have more people on ARVs than any other African country and are ahead of our target.

Third, 2004 brought the exciting news that Septrin reduces sickness due to HIV by about 40%. It is now government policy that all people with HIV should take this inexpensive drug daily.

But now we have very bad news. New cases of HIV are increasing, and there is a real possibility that HIV prevalence will increase overall.

At the Joint Annual AIDS Review, just before Christmas, Dr Kihumuro Apuuli, head of Uganda AIDS Commission, summed it up: “The epidemic is getting on top of us.”

What makes us think that the situation is getting worse and not continually better? Some evidence comes from long-term studies of villages in Masaka and Rakai. Other data comes from blood tests of pregnant women in antenatal clinics (ANCs).

About the first, Dr Apuuli said dramatically: “Incidence is increasing for the first time in the population groups we have been studying since the late 1980s”.

About the second, Dr Alex Opio, chief epidemiologist at the Ministry of Health, was more cautious, talking of “one upward bounce” in the figures. Nevertheless he presented data showing “subtle increases” in HIV between 2003 and 2005 in nine ANC sites in Arua, Lacor, Kilembe, Masindi, Mbale, Mbarara, Mutolere, Nebbi and Soroti.

So what is going wrong? The answer is simple. The epidemic has changed but we have not changed our approach to it. In 1988 the average age of a person with HIV was 22, now it is 35. The epidemic is now concentrated in adults.

But we continue to focus our prevention messages almost exclusively on youth. This is a grave mistake. Adults are struggling with their sexual lives and getting infected in very large numbers.

If you do not believe that the problem is adults, look at the data from the 2004/5 Uganda AIDS Indicator Survey which tested 30,000 people aged 15-59 in a representative sample across the nation.
Only 0.3% of boys aged 15 to 19 have HIV and only 2.3% of young men aged 20-24. Which group of men did the study find to be most infected? Those aged 35 to 44, with over 9% having the virus.
Since the average age of marriage for males is 22 in Uganda, most males who get HIV are getting the virus well into marriage.

The picture is similar for females. Their peak age of infection is 30 to 39, with rates of between 9 and 12%. Since the average age of marriage for females is 17.8 years, most women get infected a decade or more into marriage.

At the AIDS Review, Dr Apuuli said: “We are not going to manage this epidemic because we are not focusing on where the problem is.”

When I asked Dr Donna Kabatesi of CDC/Uganda Virus Research Institute if prevalence was going to rise, she said simply: “Yes, because of unfocussed prevention activities. People want to keep doing what they have always done.”

But we cannot keep doing what we have always done: the year 2006 cannot be business as usual. Yes, we need to keep on with the youth, but we urgently need to focus on adults.

Research by Parent Talk found that most couples have never discussed how to protect their marriage from HIV. They live in worry, hoping that their partner is not infecting them.

Since they have had unprotected sex together for years, if their partner has HIV/AIDS, they assume that they do too. They feel it is too late to test. They do not know about discordance – that one partner can be infected while the other is not. Yet in Uganda 50% of married people with HIV have an HIV negative spouse.

In 2006 let us address the epidemic as it really is, not as we would like to imagine it to be. Let us base our work on evidence and begin to address the complexities of adult sexuality.

The writer is Co-Director of
Straight Talk Foundation

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