Renewed spiraling of HIV infections in Uganda needs double efforts

According to the Ministry of Health, Uganda is currently facing a renewed spiraling of HIV infections. Studies show that HIV infections which had stagnated at 6% have climbed again to 6.7%.

Uganda HIV epidemic has gone through three distinct phases characterised by high HIV prevalence and later stagnation especially among young people. After 1996, the trend shifted to adults above 25 years with peak HIV prevalence in the reproductive age groups including the marrieds.

Since 2008, more than three quarters of a million people are living with an HIV positive partner unknowingly and 13% of these people get infected each year.

Most of the causes to this shift in HIV prevalence remain unknown but all indications point to behavioural tendencies. Today the HIV/AIDS response has not kept pace with the epidemic because new infections have been increasing in recent years and the situation is not letting down.

Previously people in marriages or long term relationship were thought to be safe and therefore HIV/AIDS fight efforts concentrated on the youth and unmarried but recently studies have shown that condom use in marriage is low, multiple sexual partnerships are on an all-time high and, therefore, this derails the benefits of prevention efforts through increased HIV infections among the previously safer section of the population.

Still coupled with the above, People living with HIV and AIDS in Uganda not only face difficulties related to treatment and management of the disease, but they also have to deal with AIDS related stigma and discrimination. Stigma and discrimination towards those affected by AIDS are visible at all levels of society from families and local communities to the government.

Discrimination has also been reported in the private sector too. As well as discriminating against those living with HIV, such attitudes are a major hindrance to prevention and treatment efforts.

This has eventually led people declining to go for treatment or testing leading to increase in general national infection.

There are number of reasons for the current HIV prevalence decline. It has been observed that   behavioural changes such as change in age of sexual debut, casual and commercial sex trends, partner reduction and condom use have played a key role in the continuing decline in HIV prevalence here.

The good news is that Uganda government and development partners are keen to see a positive change from this spiraling, so far there is a renewed committement to fight against HIV and AIDS.

The strategies such as   fostering sexual behavioural change, increased critical coverage and combined prevention response at all levels have been mentioned in the national HIV prevention strategy.

In the national HIV prevention strategy for instance, there are interventions such as increasing the number of people on ARV. This in away will lead to reduction of HIV and AIDS.

Uganda has also started to implement combination of prevention interventions, such as implementing multiple HIV prevention strategies comprising of comprehensive package of bio medical, behavioral and structural interventions.

The interventions focus on delayed sexual debut, elimination of unsafe safe and reduction in multiple sexual partners and promotion of correct and consistent condom use, among others. It also addresses prevention of harmful social cultural practices, sexual and gender based violence and discrimination.  

The major outcomes from operationalising this prevention strategy are increased safe adoption of safer sexual behaviours and reduced risky behaviours. We will also witness a strengthened and sustainable enabling environment that mitigates underlying factors that drive the HIV epidemic, among others.

Thus we need to enhance the combined prevention by strengthen systems at all levels so that, together, we can collectively address the increasing HIV/AIDS infections.

The writer works with Program for Accessible Health, Communication and Education