By Ronald Musoke
As the world strives to get to zero infections, Ugandans are getting a confusing message on interventions
As World AIDS Day (Dec. 1) was this year marked with increased optimism across the globe, in Uganda a persistent decade-long rise in new infections and prevalence is causing panic among experts.
The United Nations says 25 countries, many in Africa, have at least halved new HIV infections in the past decade and there has been particular progress towards protecting children from the deadly virus.
The Uganda AIDS Indicator Survey report released in mid-2012 notes that although the knowledge level about HIV/AIDS among Ugandans has increased, there has been an upsurge in HIV prevalence rate from 6.4 percent in 2006 to 7.4 percent in 2011. It shows that over 130,000 new infections were recorded in the country the previous year.
Prevalence is highest among women (8.3%) in comparison to men (6.1%). In urban areas, HIV prevalence among women is 10.6% than in rural areas (7.7%) but prevalence is the same (6.1%) for men living in urban and rural areas.
Margaret Happy, the advocacy manager of the National Forum of People Living with HIV/AIDS Networks in Uganda, blames the upsurge on laxity in leadership.
“We need to re-engage leadership for effective HIV prevention in the country,” she says,” we are not looking at the President or ministers but leadership right from the household level, community, cultural institutions, religious and district leaders.”
Marion Natukunda, the Advocacy and Information Officer at the AIDS Information Centre, says the messaging on prevention has changed. “It is less or no longer there and if it is there, it is not clear,” she says.
Joshua Wamboga, the team leader for advocacy and networking at The AIDS Support Organization (TASO) agrees. He says Uganda’s response to HIV is “dramatically off track”.
He says evidence-based interventions that could halt new infections and end the epidemic are getting too little attention and funding, while interventions that are being given priority are not associated with prevention benefit.
“HIV treatment scale up, which saves lives and dramatically reduces the risk of sexual transmission, has been slower in Uganda than in other countries in the region,” Wamboga says.
He adds: “The time for a dramatic change is long overdue—with a focus on interventions that work; including earlier access to HIV treatment to save lives and prevent new infections, safe medical male circumcision (SMC), Option B+ for pregnant women to prevent vertical transmission, and access to male and female condoms.”
To him, in a recent shift of strategy, the ABC model; abstinence, being faithful and condom use, which contributed to HIV/AIDS decline in the past, has unfortunately been given less prominence.
Condom use in particular, has now become a controversial HIV prevention method with stiff resistance from sections of the religious fraternity.
As a result, although the Uganda AIDS Indicator Survey showed both more men and women reporting having more than one sexual partners, only a few reported consistently using condoms.
Among men who had more than one sexual partner in the past 12 months, only 19% were reported to have used condoms in their last sexual encounter. The number for women was slightly higher, at 31%.
Other experts say the reason as to why the HIV/AIDS education campaigns in Uganda are proving to be ineffective is because they depend wholly on donor funds which sometimes do not come on time to finance or insufficient.
The latest UNAIDS report released in November shows that the countries that had the sharpest declines in new HIV infections are countries where the governments assumed a shared responsibility by increasing domestic investment in responses to HIV/AIDS.
New infections were down in Malawi 73%, Botswana 71%, Namibia 68%, Zambia 58%, Zimbabwe 50% and South Africa 41%.
Globally, the report shows that 2011 donor funds for HIV/AIDS were short, but for the first time, domestic investments from low- and middle-income countries surpassed donations.
South Africa increased its scale-up of HIV treatment by 75 per cent over the last two years – ensuring 1.7 million people had access to life-saving treatment – and new HIV infections have fallen by more than 50,000 in just two years. During this period, South Africa also increased its domestic investments on AIDS to US $1.6 billion, the highest by any low- and middle-income country.
In Zimbabwe, 260 000 additional people accessed HIV treatment, registering a 118% expansion rate.
In Uganda, as in another 25 of the 33 countries in sub-Saharan Africa, donor support accounts for more than half of HIV investments. But the global gap in resources needed annually for HIV/AIDS interventions by 2015 now stands at 30 per cent. This means the governments need to invest more domestically.
Happy says there is urgent need for Uganda to scale up treatment since it has been proven that treatment prevents infection by 96 %. For this to happen, the frequent stock outs of drugs and condoms need to be controlled.
“Our country should highly prioritize the scientific prevention methods such as safe male circumcision; scale up treatment for all so that all those who are eligible for ARV treatment can access it.”
But Dr Chris Baryomunsi, an MP who sits on the Parliamentary Committee on HIV/AIDS says better treatment is breeding complacency.
“People have got used to HIV/AIDS and they no longer view the pandemic with the trepidation of the 1990s, rather they think it is a chronic illness which one can live with given proper medication.”
Whatever the intervention, Happy says. there is need to disseminate the same message instead of the Ministry of Integrity pushing a different message from that of the Ministry of Health on circumcision and condom use.