By Ronald Musoke
As stakeholders gathered on the morning of Sept. 19 in Kampala to engage with the government in regard to the annual national review of the AIDS response – now in its sixth year – a group of over 20 civil society organizations at the forefront of the HIV/AIDS fight called for the acceleration of responses to end the AIDS pandemic in the country.
During the release of the shadow report, the group said although they are happy with the government’s achievements, they still want it to give priority action to earlier treatment and viral load monitoring to be in line with new global guidelines.
In addition, they are advocating for improvement in quality of treatment programmes by expanding investments in the most at risk populations such as sex workers, fisher folk and long distance truck drivers.
The civil society is also urging the government to initiate an AIDS levy.
While the group agrees that progress towards reduction of HIV infections has been made by the government and its partners over the years, they said more bold action is still needed to increase high impact prevention and treatment coverage over the next one year.
They say there has been substantial acceleration in the treatment enrollment and national implementation of “Option B+”—treatment for all HIV positive pregnant mothers regardless of their CD4 count.
“[The] Government and all partners made important progress in 2012/13, for example, more than 190,000 new patients have been enrolled on treatment,” said Joshua Wamboga from The AIDS Support Organization (TASO) Uganda.
“Now we have confirmed that what civil society called for one year ago—a surge in HIV treatment scale up—was possible,” he said.
However, Wamboga argued that one year of progress is not enough.
“This pace of treatment acceleration must be intensified, and Uganda must adopt all aspects of the new World Health Organization (WHO) treatment guidelines, including earlier treatment for people who have a CD4 count of less than 500.”
He added: “We know that this is feasible, affordable and critically needed to save lives and slash rates of new infections.”
But although treatment enrollment has expanded, some members of the civil society are gravely concerned by signs of declining programme quality.
Margaret Happy of the National Forum of People Living with HIV/AIDS Networks in Uganda (NAFOPHANU) said persistent stock outs and shortages of medicines, alongside procurement of unacceptably bitter formulations of the ARV combination of tenofovir and epivir is undermining the impact of treatment expansion.
“Stock outs and shortages must not be tolerated, and people with HIV should be at the heart of programme design and implementation including through the generation and dissemination of real time evidence of programme weaknesses,” she said.
The group also called for the government to increase its national investment in HIV, including implementation of an accountable, transparent AIDS levy to generate additional revenue for priority investments—particularly provision of HIV treatment.
The group pointed out that in 2012/13 Uganda committed to making progress in implementation of an AIDS levy, however, no progress had been made.
The civil society concerns come at a time when Uganda is attracting criticism following a resurgence of the HIV/AIDS pandemic.
The most recent Uganda AIDS Indicator Survey released last year showed that prevalence had risen from 6.4 to 7.3 over the previous six years.
Condom use by men and women declined starkly over the same period with reported condom use during sex with a non-cohabiting partner declining significantly between 2005 and 2011 from 47% to 29% and from 53% to 38% among women and men respectively.
More puzzling was the revelation that while her peers had reported consistent declines in incidence as well as prevalence in recent years, Uganda was the only PEPFAR focus country that reported rising HIV incidence.