Fighting HIV requires a new way of thinking
Feb 01, 2009
A recent article entitled “Is Uganda losing grip on the changing face of HIV?†(The New Vision, January 9, 2009) lists multiple concurrent sexual partnerships and being in a marital relationship as some of the key risk factors for HIV infection in Uga
By Joseph Matovu
A recent article entitled “Is Uganda losing grip on the changing face of HIV?†(The New Vision, January 9, 2009) lists multiple concurrent sexual partnerships and being in a marital relationship as some of the key risk factors for HIV infection in Uganda today.
This article, which draws heavily from a recent Modes of Transmission study, indicates that 46% of new infections in 2005 were among persons involved in multiple sexual partnerships (that is those reporting two or more partners), while 43% were among married people. That 43% of new infections occur among married people is not only self-defeating but also discouraging, given the earlier focus on sexual abstinence until marriage as the best HIV prevention strategy.
In encouraging people to abstain from sex until marriage, the perception then was of marriage being a “safe havenâ€.
However, the findings reported in the above-mentioned article show that marriage is no longer as safe as it used to be, calling for a need to focus on married people as one of the risk groups in need of urgent attention.
Findings from a recent Modes of Transmission study also suggest that available HIV messages have tended to focus much more on young people at the expense of the older age groups.
This created an impression that older age-groups were at a low risk of HIV infection. Unfortunately, however, in this situation of low perceived HIV risk, HIV transmission continued unabated among older age groups.
Evidence suggests that up to 75% of HIV-infected Ugandans are aged 25 years and above.
It is, therefore, not surprising that married individuals (in the 30-39 age bracket) and individuals reporting multiple sexual partners (majority of who are aged 25 years and above) have the highest prevalence of HIV.
A focus on married individuals and persons reporting multiple sexual partners would thus be a timely intervention given what we now know about the transmission dynamics of HIV. This does not and should not, be interpreted to mean a shift away from HIV prevention interventions targeting young people who continue to be at increased risk for HIV infection. However, since we know where the next 1,000 infections will come from, it is imperative that we design interventions that target the source of these infections.
At the end of the day, evidence-informed interventions targeting different most-at-risk populations will help to bring down the prevalence of HIV that seems to be on the rise in a country that was declared a rare success story in the fight against HIV just a few years ago.
The first step towards reinvigorating our HIV/AIDS prevention efforts will be to utilise the findings of the Modes of Transmission study in designing appropriate target-specific interventions as well as allocating adequate resources to those interventions. We should be able to scale-up HIV prevention interventions that have proven successful in reducing HIV risk in those population segments that are most affected, including nationwide promotion of joint counselling and testing.
Recent findings in Kumi and Bushenyi districts, for instance, suggest that door-to-door counselling and testing approaches can help couples to learn their HIV status within the confines of their homes, as well as identify many HIV-discordant couples.
It is time to aggressively promote such approaches that can help couples learn about their HIV status since this has been shown to reduce transmission risk particularly in those couples where one of the partners is infected with HIV.
As a matter of urgency, the Uganda AIDS Commission should convene a national HIV/AIDS stakeholders’ meeting with players at different levels to discuss the implications of these findings and decide the next course of action for HIV prevention efforts in Uganda.
The writer works with Makerere University School of Public Health
A recent article entitled “Is Uganda losing grip on the changing face of HIV?†(The New Vision, January 9, 2009) lists multiple concurrent sexual partnerships and being in a marital relationship as some of the key risk factors for HIV infection in Uganda today.
This article, which draws heavily from a recent Modes of Transmission study, indicates that 46% of new infections in 2005 were among persons involved in multiple sexual partnerships (that is those reporting two or more partners), while 43% were among married people. That 43% of new infections occur among married people is not only self-defeating but also discouraging, given the earlier focus on sexual abstinence until marriage as the best HIV prevention strategy.
In encouraging people to abstain from sex until marriage, the perception then was of marriage being a “safe havenâ€.
However, the findings reported in the above-mentioned article show that marriage is no longer as safe as it used to be, calling for a need to focus on married people as one of the risk groups in need of urgent attention.
Findings from a recent Modes of Transmission study also suggest that available HIV messages have tended to focus much more on young people at the expense of the older age groups.
This created an impression that older age-groups were at a low risk of HIV infection. Unfortunately, however, in this situation of low perceived HIV risk, HIV transmission continued unabated among older age groups.
Evidence suggests that up to 75% of HIV-infected Ugandans are aged 25 years and above.
It is, therefore, not surprising that married individuals (in the 30-39 age bracket) and individuals reporting multiple sexual partners (majority of who are aged 25 years and above) have the highest prevalence of HIV.
A focus on married individuals and persons reporting multiple sexual partners would thus be a timely intervention given what we now know about the transmission dynamics of HIV. This does not and should not, be interpreted to mean a shift away from HIV prevention interventions targeting young people who continue to be at increased risk for HIV infection. However, since we know where the next 1,000 infections will come from, it is imperative that we design interventions that target the source of these infections.
At the end of the day, evidence-informed interventions targeting different most-at-risk populations will help to bring down the prevalence of HIV that seems to be on the rise in a country that was declared a rare success story in the fight against HIV just a few years ago.
The first step towards reinvigorating our HIV/AIDS prevention efforts will be to utilise the findings of the Modes of Transmission study in designing appropriate target-specific interventions as well as allocating adequate resources to those interventions. We should be able to scale-up HIV prevention interventions that have proven successful in reducing HIV risk in those population segments that are most affected, including nationwide promotion of joint counselling and testing.
Recent findings in Kumi and Bushenyi districts, for instance, suggest that door-to-door counselling and testing approaches can help couples to learn their HIV status within the confines of their homes, as well as identify many HIV-discordant couples.
It is time to aggressively promote such approaches that can help couples learn about their HIV status since this has been shown to reduce transmission risk particularly in those couples where one of the partners is infected with HIV.
As a matter of urgency, the Uganda AIDS Commission should convene a national HIV/AIDS stakeholders’ meeting with players at different levels to discuss the implications of these findings and decide the next course of action for HIV prevention efforts in Uganda.
The writer works with Makerere University School of Public Health