HIV: Emphasising evidence-based prevention technologies a better deal

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By Alice Kayongo

During the World AIDS Day celebrations in Fort Portal on December 1, President Yoweri Museveni made several important reassurances we all applaud him for. However, for purposes of this article, I will focus on the most troubling issues that stood out.

The President told Ugandan youth to fight AIDS by not having sex and blamed evidence-based prevention interventions, in particular, condoms and medical male circumcision on Uganda’s troubled AIDS response. He also said becoming HIV-positive brings shame to a family.

These off-the-cuff comments by our leaders may be their honest feelings about HIV, which they should be helped to change. But when communicated in public, they cause more harm than good. Uganda’s AIDS response should keep in touch with reality, science and available evidence.

Science shows us that it is actually possible to end the scourge by dramatically scaling up testing and access to treatment, which assures suppression of the virus in our bodies, thus saving lives and reducing the risk of further transmission. However, the views highlighted in the President’s speech on December 1 raise the question: Why are we still belittling the evidence that has actually been proven by science most of which derived from Uganda?

For instance, let us start with abstinence, the insistence that Ugandans should stop having sex. First, there is no evidence that telling people not to have sex has worked in the fight against HIV transmission. Secondly, some people can abstain but the reality is, many Ugandans are having sex! And no amount of moralising will change this. Meanwhile, sexual transmission of HIV continues to surge.

But scientifically proven evidence has revealed what does work: Combination prevention. This is an approach that accepts reality and helps people abstain if they can, but ensues that everyone has access to condoms, testing and information about how to stay safe from HIV if they are having sex. Importantly, treatment access for all is crucial: treatment saves lives and prevents new infections, because scientific research has shown that the risk of transmission of HIV is reduced by up to 96% when people are successfully maintained on quality ARV treatment.

What about male circumcision? Well, evidence shows, it works — in fact, Ugandan research, from Rakai, proved medical male circumcision results in a 60% reduction in risk of infection for the man.

And condoms? Research has revealed that when used correctly, condoms are incredibly an important prevention tool. Unfortunately, rates of condom use in Uganda have declined sharply between 2005 and 2011; self-reported condom use during sex with a non-cohabitating partner declined from 47% to 29% and 53% to 38% among women and men, respectively. Instead of reigniting the fire, the President’s comments further stigmatise and undermine effective condom use.

Are our leaders unaware that this evidence exists, some of which has been derived from within, or are the advisors and the responsible people tasked to lead the fight against HIV/AIDS unable to bring this evidence to the Presidents attention. The lives of countless numbers of Ugandans — and the economic development those lives represent—are at stake!

Let us get to funding for the AIDS response in Uganda. To succeed, the fight against the epidemic needs full funding — with a real increase from the Ugandan government in 2015. An increased allocation for HIV, in particular for testing and treatment, should come from the health sector budget, and immediate operationalisation of the AIDS Trust Fund.

I must thank the President for assuring the nation that the Government will take over the AIDS response if donors exit. However, what is equally important is a concise, time-bound.

Finally, one of the objectives of the HIV fight is towards zero stigma and discrimination. The President may hold a personal view that an HIV-positive diagnosis brings shame to a family, but bringing it out in the open encourages a culture of shame and stigma.

It will make people less likely to disclose their status, and more afraid of testing, because they fear the shame that could result. Which will in turn increase avoidable HIV transmission. Most people with HIV in Uganda are unaware of their status, won’t this view make it much harder to reach people with testing and effective combination prevention?

New data released by UNAIDS show that Uganda lags far behind the region in reduction of AIDS related deaths, and contributes substantially to new infections across sub Saharan Africa. Uganda is one of three countries that accounted for an estimated 48% of new infections in sub Saharan Africa in 2013.

We have not reported the major reductions in rates of new infection that our neighbours have. And it’s simply because they are much quicker to reach all people with HIV treatment and effective prevention.

Uganda’s lagging performance is precisely because of lack of emphasis on evidence based interventions, in particular, earlier access to HIV treatment to save lives and reduction of new infections.

We need to prevent and treat targeted at risk populations in greatest need, including young women aged 15-24, sero-discordant couples, and truck drivers; fisher folk as well as criminalised groups like men who have sex with men and sex workers.

We will succeed if we accept reality, evidence and respect the rights of all people to live in dignity, including people with HIV.

The writer is a regional policy and advocacy manager, East/West Africa Bureau, AIDS Healthcare Foundation