By Joel Ogwang

UGANDA has, over the years, emerged as a role model in the fight against HIV/AIDS in Africa and globally. This can be attributed to the Government’s effort, broad-based partnerships and effective public education campaigns.

HIV statistics
The HIV prevalence rate has reduced from 30% in the early 1980s to the current 6.4% threshold, according to the Uganda HIV and AIDS Sero-Behavioural Survey.

This, however, followed a string of up and down turns. For instance, by the end of 1992, the prevalence rate was estimated at 18.3%, with some centres registering rates above 30%.

This figure fell from about 15% in the early 1990s to 5% in 2001. In 2002, the prevalence rate rose again to 6.2%.

New infections
New HIV infections were estimated at 70,170 cases, with AIDS cases at 73,830 and deaths at 75,290 in 2002.
Since 1982 when the country’s first cases of HIV were detected on the shores of Lake Victoria in Rakai district, cumulatively an estimated 2.6 million Ugandans were infected, while 1.6 million lost their lives to HIV/AIDS-related illnesses including 76,000 in 2005 alone.

Health experts say the last five years have seen an increase in the HIV infection rate. Ironically, the 67% rise of HIV infections occurs among marrieds.

Currently, there are over 1.2 million Ugandans living with HIV/AIDS, but only 400,000 access anti-retroviral drugs (ARVs). A total of 135,000 new infections are registered annually, including 30,000 children and 700,000 women.

“People have become complacent,” says Akol. “It is now like hand-washing. People know they can catch diseases if they don’t wash their hands, but they evade it.”

What causes complacency?
Free ARVs have been available in Uganda since 2004. It is believed that the introduction of the drugs led to complacency about HIV as it is no longer an immediate death sentence.

Why don’t HIV-positive people start using ARVs imediately?
In the developed world, a person starts using ARVs as soon as they test positive. This is not the case in Uganda where ARVs are recommended only when the CD4 count falls below 250.

Akol says when ARVs are taken when the CD4 is over 300, they do not have an effect on a person. “People shouldn’t be exposed to ARVs too early,” she advises.

“One ends up feeling the same way he did before taking the drugs. Many people have complained about this.”
Apparently, ARVs also cause diabetes because they cause high appetite which results in obesity and high blood pressure.

“Even children on ARVs are ending up with diabetes,” Akol says. The health ministry plans to use a policy of rapid testing and diagnosis of communicable and non-communicable diseases.

“We want a person to go to a health centre and get their results in less than 12-hours,” says Kakooza. “Not the three days one needed to know their HIV in the past.” In a rallying call, Akol urges couples which are HIV-positive to give up having children.

“Only do this if the CD4 count level has risen. Otherwise, we shall lose you and your baby.”

Key players in the fight
On realising the high HIV infection rate in Uganda, a combination of factors took centre stage, however, none of them worked in isolation.

Dr. Zainab Akol, the AIDS Control Programme project manager, says at the health ministry, the first 10 years of ‘war’ against HIV recorded tumultuous successes in Uganda.

“We (the health ministry) used the fear a model that worked wonders,” she says. “People were shocked and changed their sexual behaviour accordingly.”

Prevention work at grass-roots level also began in this era, with a multitude of tiny organisations educating their peers about HIV, with the first community-based organisation formed being The AIDS Support Organisation (TASO).

Others are the Aids Information Centre and the Uganda Aids Commission, partly run by paid workers and volunteers who had either been personally affected by HIV/AIDS, or had professional training in fighting it.

TASO later became the largest indigenous AIDS service organisation providing HIV/AIDS services in Uganda and Africa, providing emotional and medical support to many thousands of people who are HIV-positive.

The 1990s was also the time popular music icon, Philly Lutaaya openly declared his HIV status, becoming the first Ugandan to do so.

Through his music and educational tours, Lutaaya used music and a brave face at a time when it was almost treasonable to be HIV-positive.

Nonetheless, Lutaaya’s vocal endowment helped spread understanding, compassion and respect for people living with HIV.

There was also the wide view that the fall in the number of new infections and a rise in the number of AIDS-related deaths, played a part in the eventual drop in the national threshold.

The year 1990 was cruel as many people died of HIV since there was no available treatment to delay the onset of the disease.

Many people who had been infected in the 1980s were reaching the end of their survival period.

In 2000, the health ministry estimated that 800,000 people had died of an AIDS-related illness since the beginning of the epidemic.

This was believed to have resulted from behaviour change such as increased abstinence and monogamy, a rise in the average age of first sex, a reduction in the average number of sexual partners and more frequent use of condoms.

Uganda’s entire population was mobilised in the fight against HIV and everyone was made aware of the consequences that risky behaviour could have for their country.

This was also the anti-promiscuity period, says James Kakooza, the state minister for primary healthcare.

He says the traditional African values were still strongly held. “There was not promiscuity in communities. This is different today. People live in comfort even when they lack latrines.”

HIV PREVENTIVE METHODS THAT HAVE BEEN EMBRACED
In the fight against HIV, Uganda has emphasised the Abstain, Be faithful and Condom-use (ABC) strategy. Condoms remain the widely available and cheap means in the fight against HIV.

Millions of the rubber sheaths continue to be imported by the Government and private enterprises.

The condoms come in different batches of 270,000 to 300,000 pieces, labelled according to the lot of manufacturer under the same conditions and assembly line.

There are over 30 condom brands in Uganda, says Vastha Kibirige, the condom focal person at the health ministry.

“We look at colours, names, flavours, sensation, length, amount of lubrication, thickness and package when branding condoms,” she says.

Much as the ABC worked wonders in 2000, people are going away from it.
“People know that HIV kills, but they live reckless lives,” says Kakooza.
“Telling them the same thing would not yield any success.”

However, their use gains momentum at the earliest stages of new relationships.
A baseline survey by the Uganda Network for Law and Ethics (UGANET) in five districts found condom awareness at 80%.

When 600 men and women between 20 and 29 years were interviewd, 20% said they used condoms with a new partner, 25% only used them once they had sex with people they did not trust.

About 60% said they used condoms in the past, while 28% said they seldom used condoms.

“There is need to popularise condoms and design strategies that address negative perceptions held about condom use, given the central role they play in the prevention of HIV,” says Beatrice Were, the UGANET executive director.