Uganda’s AIDS success risks sliding backwards
Feb 22, 2010
FOR more than 20 years, Uganda has been fighting the valiant fight on AIDS. Looking back, I recognise that prevalence dropped from more than 20% in 1990 to around 6.4% today. Awareness is high. Strong messages, from “AIDS kills†in 1989 to today’s “get off the sexual network†are well-kn
By William Salmond
FOR more than 20 years, Uganda has been fighting the valiant fight on AIDS. Looking back, I recognise that prevalence dropped from more than 20% in 1990 to around 6.4% today. Awareness is high. Strong messages, from “AIDS kills†in 1989 to today’s “get off the sexual network†are well-known.
Effective preventive medicines are available to dramatically reduce transmission of HIV from a mother to her child. And antiretroviral therapy is now available for women, men, boys and girls. Yet, despite these many victories, today we are in danger of losing this fight.
At the heart of any prevention effort is testing — knowing your status. Yet even today, with all the preventive services available, too many individuals in Uganda still do not know their HIV status.
Couples are marrying and having children and grandchildren, and do not know their status — and as a result, the incidence of new cases of HIV infection is on the rise.
When the AIDS Information Centre started 20 years ago at Baumann House in downtown Kampala, our first clients were two young patients. They were counselled, their blood was drawn, put in marked vacutainers, packed into a cold box, and then strapped to the back of a bicycle and taken to the Nakasero Blood Bank.
After two weeks, the results came back and the patients received more counselling — as well as receiving the news that they were HIV-negative. Support for these early interventions was funded by the American people, from USAID through World Learning.
Today — two decades later — we have rapid tests and can provide results quickly, but the key is that we still need people to come for testing in the first place and to make better and full use of the available facilities.
The best example of beating new infections is prevention-of-mother-to-child transmission services (PMTCT), which is the drug equivalent of a vaccine to prevent an HIV-positive mother from transmitting the disease to her child.
In 2007, just 35% of HIV positive pregnant women received PMTCT services, but today, we are reaching more than half countrywide, with the goal for the health ministry to reach at least 80% of all HIV positive pregnant women by the end of 2010.
The critical point here is that PMTCT not only fights new infections, but that the cost of delivering PMTCT is clearly far less than the costs of providing life-long care and treatment to children who become infected.
PMTCT is our key to winning this ultimate fight in Uganda against new infections.
However, we all fall far behind in the overall infection rate in Uganda: only half of Ugandans who currently are in need of treatment are receiving it, about 200,000 out of 400,000.
The majority of these patients have their costs covered by PEPFAR, and the US government has committed to maintaining its level of funding to Uganda at its peak for the foreseeable future. While this is good news for all those who are continuing on treatment, the critical question is: Who will pay for the treatment of the estimated 130,000 newly HIV-infected individuals each year that will eventually require treatment?
The truth is, the only way we can be victorious over this epidemic is to prevent new infections altogether — not just to provide care and treatment after people get sick. It is just too costly — both in dollars and in lives.
We need hope, but we also need a strong collective commitment from everyone — individuals, Government, donors and corporations — to commit to a long term strategy of prevention to win this war on AIDS, and to create a generation free of HIV.
The writer is the country director for the Elizabeth Glaser Pediatric AIDS Foundation, Uganda
FOR more than 20 years, Uganda has been fighting the valiant fight on AIDS. Looking back, I recognise that prevalence dropped from more than 20% in 1990 to around 6.4% today. Awareness is high. Strong messages, from “AIDS kills†in 1989 to today’s “get off the sexual network†are well-known.
Effective preventive medicines are available to dramatically reduce transmission of HIV from a mother to her child. And antiretroviral therapy is now available for women, men, boys and girls. Yet, despite these many victories, today we are in danger of losing this fight.
At the heart of any prevention effort is testing — knowing your status. Yet even today, with all the preventive services available, too many individuals in Uganda still do not know their HIV status.
Couples are marrying and having children and grandchildren, and do not know their status — and as a result, the incidence of new cases of HIV infection is on the rise.
When the AIDS Information Centre started 20 years ago at Baumann House in downtown Kampala, our first clients were two young patients. They were counselled, their blood was drawn, put in marked vacutainers, packed into a cold box, and then strapped to the back of a bicycle and taken to the Nakasero Blood Bank.
After two weeks, the results came back and the patients received more counselling — as well as receiving the news that they were HIV-negative. Support for these early interventions was funded by the American people, from USAID through World Learning.
Today — two decades later — we have rapid tests and can provide results quickly, but the key is that we still need people to come for testing in the first place and to make better and full use of the available facilities.
The best example of beating new infections is prevention-of-mother-to-child transmission services (PMTCT), which is the drug equivalent of a vaccine to prevent an HIV-positive mother from transmitting the disease to her child.
In 2007, just 35% of HIV positive pregnant women received PMTCT services, but today, we are reaching more than half countrywide, with the goal for the health ministry to reach at least 80% of all HIV positive pregnant women by the end of 2010.
The critical point here is that PMTCT not only fights new infections, but that the cost of delivering PMTCT is clearly far less than the costs of providing life-long care and treatment to children who become infected.
PMTCT is our key to winning this ultimate fight in Uganda against new infections.
However, we all fall far behind in the overall infection rate in Uganda: only half of Ugandans who currently are in need of treatment are receiving it, about 200,000 out of 400,000.
The majority of these patients have their costs covered by PEPFAR, and the US government has committed to maintaining its level of funding to Uganda at its peak for the foreseeable future. While this is good news for all those who are continuing on treatment, the critical question is: Who will pay for the treatment of the estimated 130,000 newly HIV-infected individuals each year that will eventually require treatment?
The truth is, the only way we can be victorious over this epidemic is to prevent new infections altogether — not just to provide care and treatment after people get sick. It is just too costly — both in dollars and in lives.
We need hope, but we also need a strong collective commitment from everyone — individuals, Government, donors and corporations — to commit to a long term strategy of prevention to win this war on AIDS, and to create a generation free of HIV.
The writer is the country director for the Elizabeth Glaser Pediatric AIDS Foundation, Uganda