Zero HIV infections: How far has Uganda gone

HEALTH

KAMPALA - Uganda's fight against HIV/AIDS has been on for almost 30 years.

There was a very high rate of HIV infection experienced in Uganda during the 1980s and early 1990s.

Today, the country has a vision to plummet the infections to zero, using the 90, 90, 90 strategy.

The 90, 90, 90 is an ambitious treatment target that was launched by UNAIDS and other partners.

It is aimed at diagnosing 90% of all people living with HIV, provide antiretroviral therapy (ART) for 90% of those diagnosed, and achieve viral suppression for 90% of those treated by 2020.

Where are we now?

According to Uganda Population-Based HIV impact assessment UPHIA report of 2016, the national prevalence of HIV/AIDS was at 6% as compared to 30% in the early 1980's when many Ugandans were getting to know about the disease.

The report also indicated that the country has made a lot of progress in the national HIV response.

For instance, among women and men, HIV prevalence declined from 8.3% and 6.1% in 2011 to 7.5% and 6% in 2016 respectively.

The history

According to the acting director general of the Uganda AIDS Commission, Dr Nelson Musoba, Uganda was a success story in the early phase of the epidemic.

"We reduced the HIV prevalence from 18% in the 1990s to 6.4% by 2005. The mainstay of our efforts was prevention.

"The President led this fight and at every public function he cautioned the population to protect themselves. All other public leaders did the same and the media also conveyed the same message," he says.

However, between 2006 and 2011, the prevalence rose to 7.3% and new infections rose to 170,000 annually; close to the same levels of the 1990s.

This period coincided with the time most Ugandans with AIDS started accessing anti-retroviral treatment (ART).

Once started on treatment, the health of people with AIDS improved remarkably. The opportunistic infections and other symptoms associated with AIDS, for example skin rash, herpes zoster, skin cancers, weight loss all disappear once started on treatment.

Tackling the risk factors

The commission also considered the risk factors for the new infections in the different groups of Uganda's population and set out to address them.

Young girls

Young girls may not have correct information about HIV and AIDS and they tend to be a target as sexual partners by older men who themselves maybe infected.

The young girls are vulnerable to new HIV infections partly because of biological factors and also for structural reasons. Because of the biological factors they have a larger surface over which the HIV virus can enter their body.

They are also more likely to sustain tears during sex, therefore, more likely to become HIV infected.

The young girls may also be forced to engage in transactional sex to meet their basic needs and yet may not be in position to negotiate for safer sex with their partners who often are older men.

The strategies to protect the young girls include: reviewing the criteria for socio-economic development programmes (for example operation wealth creation, youth livelihood funds, women poverty funds) to ensure a focus on addressing issues that predispose young men and women to new HIV infections, we are designing a social Behaviour change communication campaign targeting young girls, the Ministry of Gender, labour and Social development has developed programmes for Vocational and livelihood skills building for young people through formal and informal educational systems linked to productive occupations, the Ministry of Education and sports together with the Ministry of Gender, labour and Social development are leading the process and have reviewed, updated and will soon implement young people and adolescent relevant policies, including a national sexuality Education framework and the school health policy targeting young people in school and out of school.

An example of a successful program is the DREAMS program supported by PEPFAR that is being piloted in 10 districts of Uganda targeting young HIV-negative girls with a menu of interventions to shield them from acquiring HIV.

Initial results show that this program is working well and the Government is collaborating with partners to see lessons learnt and decide which aspects can be selected and operated at scale.

Young boys

The risk factors for young boys to acquiring new HIV infections are lack of information and poverty.

Women

Similar to young girls, the Government is strengthening Reproductive, Maternal, Neonatal, Child, Adolescent Health services to ensure that all pregnant women and partners, deliver at health facilities, attend postnatal services.

Men

From the program modeling data of the Ministry of Health 2015, 45% of HIV infected men did not know their HIV status and 48% of those who knew their results had not been initiated on treatment, and 60% of the AIDS-related deaths were men. 

The causes are partly due to the patriarchal and societal norms but also associated stigma.

The strategies for men: UAC working with other actors is designing and will roll out training materials for key actors to use to reach men. We are also working with Parliament to design a parliamentary toolkit that will be used by other leaders. Key among the leaders supporting this campaign include: cultural leaders, religious leaders, politicians, business leaders and opinion leaders.

Presidential fast track Initiative to end AIDs as a public health by 2030

In June 2017, the President launched the Presidential fast track Initiative to end AIDs as a public health by 2030.

The initiative highlights five areas of focus: Engaging men in HIV prevention to close the gap on new HIV infections especially among adolescent girls and young women, accelerating implementation of test-and-treat to achieve 90:90:90 especially among men, consolidating progress on elimination of mother-to-child transmission of HIV, ensuring financial sustainability for the HIV response, ensuring institutional effectiveness for a well-coordinated multi-sectoral response.

Uganda is winning the fight

The UNAIDS country director, Dr Karusa Kiragu-Gikonyo says Uganda is doing well in eliminating HIV/AIDS in the country and that with continuous efforts, the epidemic will be history by 2030.

She says that prior to coming to Uganda, she had worked with the UNAIDS headquarters in Geneva, Switzerland.

"As a team, we used to ask ourselves; how come Uganda is doing so well towards HIV/AIDS elimination?" Kiragu-Gikonyo says.

"The truth is; Uganda is on the right track towards achieving the 90, 90, 90 strategy by 2030," she adds.

"You may not realise it because change happens slowly, but Uganda is on the real move, which will bring us to the elimination stage, and many people, including the young ones, are making this happen," Kiragu-Gikonyo says.

Similarly, Musoba says that overall, Uganda is winning the war against HIV/AIDS. The greatest victory has been demonstrated among women and children with elimination of mother-to-child transmission of HIV.

With 95% of mothers accessing prevention of mother to child treatment, Uganda qualifies to be assessed by the World Health Organisation for a pre-elimination certificate.

Musoba also noted that there has been a reduction in HIV prevalence in most regions in the country.

Funding

In April this year, the US government has announced a $408m budget support to Uganda's HIV prevention and treatment effort. The funding was to be disbursed under the US President's Emergency Plan for AIDS Relief (PEPFAR).

An increase from last year's $402m PEPFAR budget for Uganda, the funding will cover a range of HIV/AIDS-related programming for the period October 2018 to September 2019.

The development came at time the Minister for Presidency Esther Mbayo had announced a $918m shortfall (sh3.4trillion) in the government's drive to address HIV/AIDS in relation to care and treatment.

Way forward

Musoba says that Uganda needs the AIDS Trust Fund. The majority of the country's funding for HIV and AIDS still comes from development partners. Most of these organisations involved in HIV and AIDS are not funding sources but rather implementing partners.

"The external funding sources for HIV and AIDS have been reducing and now remain limited. The AIDS Trust Fund will help minimize on the dependency on foreign assistance.

The AIDS Trust Fund (ATF) will soon be operational. The law was passed by Parliament and assented to by the President in July in 2017. The regulations were endorsed by cabinet and forwarded to Parliament for approval.

"The HIV committee of parliament has been scrutinizing them and reported that they lay them on the floor of parliament for approval when during the next session of parliament after recess.

"We are hopeful that soon after that the ATF should be operational," he adds.