AIDS: Uganda’s success story could be erased
Dec 02, 2007
DESPITE the pain and death, Uganda has had almost exclusively good news on HIV since 1992. First, prevalence declined from about 18% to 6%, the biggest decline of any country ever. <br>
By Fred Ouma
DESPITE the pain and death, Uganda has had almost exclusively good news on HIV since 1992. First, prevalence declined from about 18% to 6%, the biggest decline of any country ever.
Second, in the late 1990s, antiretroviral drugs (ARVs) arrived — Uganda now has more people on ARVs than any other African country and is ahead of her 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 possibility that HIV prevalence will increase overall, say health officials.
Dr Kihumuro Apuuli, the head of the Uganda AIDS Commission, sums it up: “The epidemic is getting on top of us.â€
But what makes experts think that the situation is getting worse and not 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 says: “Incidence is increasing for the first time in the population groups we have been studying since the late 1980s.â€
About the second, Dr Alex Opio, a senior epidemiologist at the Ministry of Health, is more cautious, talking of “one upward bounce†in the figures. Nevertheless, he cites data showing “subtle increases†in HIV between 2003 and 2005 in nine ANCs in Arua, Lacor, Kilembe, Masindi, Mbale, Mbarara, Mutolere, Nebbi and Soroti.
What is going wrong?
The answer is simple. The epidemic has changed, while the approach to it has not. In 1988, experts concur that the average age of a person with HIV was 22, now it is 35. The epidemic is now concentrated in adults.
The data from the 2004/5 Uganda AIDS sero survey, which tested 30,000 people aged 15-59 in a representative sample across the nation, show that the problem is adults. For example, only 0.3% of boys aged 15 to 19, have HIV and only 2.3% of young men aged 20-24 were infected. The most affected were those aged 35 — 44, with over 9%.
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 — 39, with rates of between nine and 12%. Since the average age of marriage for females is 17.8 years, most women get infected a decade or more into marriage.
To-date, over 800,000 adults in Uganda are infected with HIV, which is about 7% of all adults, according to the 2004-2005 Uganda HIV/AIDS Sero-Behavioural Survey. There has been an overall declining trend of HIV infection from 18% in 1992 to the current figure of 7%.
Urban versus rural
The survey reveals regional, rural/urban and gender variations in HIV prevalence. Overall infection rates in urban areas were at 10.7% compared to 6.4% in rural areas, while the infection rate among urban women was almost twice as high (13%), compared to women in rural areas at 7%. The trend is attributed to a more tempting social life in towns.
Region
The HIV prevalence is highest in Kampala at 9.2% where education about the scourge is high, compared to rural areas like Karamoja with the least education at 2%. The north-central and central regions follow with infection rates above 8%.
The West Nile and the north-east regions have the lowest infection rates — 2.5% and 4.3%, respectively.
The western region is at 7% and is closely followed by east-central (Busoga) region at 6.5% and south-west at 6%. The eastern region, comprising Busia, Kapchorwa, Mbale, Pallisa, Sironko and Tororo, is at 5.3%.
Ethnicity
There are large differences in HIV infection by ethnic groups. The Batoro are most affected with 15%, followed by the Langi (9%) and Baganda (8%). The Karimojong and the Lugbara/Madi have least infection levels at 2% and 3%, respectively.
Despite two decades of war in northern Uganda, The Acholi level off with the Banyankole in HIV prevalence at 6.9%. Others in the highest prevalence category include Banyara (7%), Bakiga (6.5%), Alur/Japadhola (6.3%), Basoga (5.6%), Bagisu/Sabiny (5.4%), All others (5%) and Iteso (5%).
Education and wealth
The HIV prevalence is highest among the rich and educated. Comparing the uneducated, it indicated 8.1% prevalence among men and 6.6% among women.
On the other hand, the prevalence varied from 4% among the poor to 9% among the wealthy. Although the increase occurred in both sexes, women have the highest rate at 11% compared to men at 6%.
Employment
Both men and women currently working have a higher prevalence than those not working, partly because of their economic muscle.
Religion
Differences are minimal with the Protestants in the lead at 7%. They are followed by Catholics (6.3%) and other Christians (6.3%) while the Muslims have the least rate at 5% and the rest are at 5.5%.
Marital status
For both women and men, HIV infection is higher among the widowed, divorced or separated, than those currently in union or who have never been in union.
For instance, one in every three women and men widowed are HIV-positive as compared to around 6% of those currently married.
DESPITE the pain and death, Uganda has had almost exclusively good news on HIV since 1992. First, prevalence declined from about 18% to 6%, the biggest decline of any country ever.
Second, in the late 1990s, antiretroviral drugs (ARVs) arrived — Uganda now has more people on ARVs than any other African country and is ahead of her 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 possibility that HIV prevalence will increase overall, say health officials.
Dr Kihumuro Apuuli, the head of the Uganda AIDS Commission, sums it up: “The epidemic is getting on top of us.â€
But what makes experts think that the situation is getting worse and not 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 says: “Incidence is increasing for the first time in the population groups we have been studying since the late 1980s.â€
About the second, Dr Alex Opio, a senior epidemiologist at the Ministry of Health, is more cautious, talking of “one upward bounce†in the figures. Nevertheless, he cites data showing “subtle increases†in HIV between 2003 and 2005 in nine ANCs in Arua, Lacor, Kilembe, Masindi, Mbale, Mbarara, Mutolere, Nebbi and Soroti.
What is going wrong?
The answer is simple. The epidemic has changed, while the approach to it has not. In 1988, experts concur that the average age of a person with HIV was 22, now it is 35. The epidemic is now concentrated in adults.
The data from the 2004/5 Uganda AIDS sero survey, which tested 30,000 people aged 15-59 in a representative sample across the nation, show that the problem is adults. For example, only 0.3% of boys aged 15 to 19, have HIV and only 2.3% of young men aged 20-24 were infected. The most affected were those aged 35 — 44, with over 9%.
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 — 39, with rates of between nine and 12%. Since the average age of marriage for females is 17.8 years, most women get infected a decade or more into marriage.
To-date, over 800,000 adults in Uganda are infected with HIV, which is about 7% of all adults, according to the 2004-2005 Uganda HIV/AIDS Sero-Behavioural Survey. There has been an overall declining trend of HIV infection from 18% in 1992 to the current figure of 7%.
Urban versus rural
The survey reveals regional, rural/urban and gender variations in HIV prevalence. Overall infection rates in urban areas were at 10.7% compared to 6.4% in rural areas, while the infection rate among urban women was almost twice as high (13%), compared to women in rural areas at 7%. The trend is attributed to a more tempting social life in towns.
Region
The HIV prevalence is highest in Kampala at 9.2% where education about the scourge is high, compared to rural areas like Karamoja with the least education at 2%. The north-central and central regions follow with infection rates above 8%.
The West Nile and the north-east regions have the lowest infection rates — 2.5% and 4.3%, respectively.
The western region is at 7% and is closely followed by east-central (Busoga) region at 6.5% and south-west at 6%. The eastern region, comprising Busia, Kapchorwa, Mbale, Pallisa, Sironko and Tororo, is at 5.3%.
Ethnicity
There are large differences in HIV infection by ethnic groups. The Batoro are most affected with 15%, followed by the Langi (9%) and Baganda (8%). The Karimojong and the Lugbara/Madi have least infection levels at 2% and 3%, respectively.
Despite two decades of war in northern Uganda, The Acholi level off with the Banyankole in HIV prevalence at 6.9%. Others in the highest prevalence category include Banyara (7%), Bakiga (6.5%), Alur/Japadhola (6.3%), Basoga (5.6%), Bagisu/Sabiny (5.4%), All others (5%) and Iteso (5%).
Education and wealth
The HIV prevalence is highest among the rich and educated. Comparing the uneducated, it indicated 8.1% prevalence among men and 6.6% among women.
On the other hand, the prevalence varied from 4% among the poor to 9% among the wealthy. Although the increase occurred in both sexes, women have the highest rate at 11% compared to men at 6%.
Employment
Both men and women currently working have a higher prevalence than those not working, partly because of their economic muscle.
Religion
Differences are minimal with the Protestants in the lead at 7%. They are followed by Catholics (6.3%) and other Christians (6.3%) while the Muslims have the least rate at 5% and the rest are at 5.5%.
Marital status
For both women and men, HIV infection is higher among the widowed, divorced or separated, than those currently in union or who have never been in union.
For instance, one in every three women and men widowed are HIV-positive as compared to around 6% of those currently married.