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Uganda stuck in HIV/Aids slow track

By Flavia Nassaka

As world marks AIDS day, the country struggles to fast-track treatment for all

On Dec. 01, the world marked this year’s World AIDS Day under the theme:`Fast track-ending the AIDS epidemic by 2030’.

A week before the event, a United Nations Agency UNAIDS released a new report showing remarkable progress in the fight against HIV globally. It showed, there were 2 million new HIV infections around the world in 2014 the lowest since 2000, when 3.1 million people worldwide were diagnosed with HIV. Deaths from AIDS also came down from the highs of 2 million in the early 2000s to 1.2 million this year. Much of that success is being attributed to improved access to life-saving treatments with anti-retroviral drugs (ARVs).

As a signatory to the United Nations, says Dr. Nelson Musoba, the Director of Planning and Strategic Information at Uganda Aids Commission (UAC), Uganda like other member countries agreed to end the epidemic by 2030.The UAC is the government institution that oversees implementation of programmes aimed at combating the disease.

Dr. Musoba says Uganda has had some success in reducing new infections.He says the country has seen a reduction in the number of new infections from 137,000 per year in 2013 to 99,000 in 2014. He says this has mainly been brought about by mainly the decrease in mother to child transmission.On the adult front, the news is not as good.  Even as the world celebrates successes, the prevalence rate in Uganda remains high at 7.3%. The country once known as the beacon of hope in how HIV/AIDS can be controlled is floundering.

Musoba says the prevalence rate shot up from 6.4% in 2005 to 7.3% currently because of one positive reason;- that those infected are not dying because of the drugs. Combined with any new infections coming up, this means that the prevalence rate remains stubbornly high and poses a challenge of offering treatment. Musoba says managing these numbers to undetectable levels would not be a problem if only the health sector had the resources to initiate everyone on treatment.

As the country struggles to enroll those who urgently need treatment on ARVs, there’s also more evidence coming up that it is best to put patients on drugs as soon as they test positive rather than waiting until their immune systems weaken.

Dr. Andrew Kambugu, the head of Research at the Infectious Disease Institute (IDI) of Makerere University says delay to start patients on treatment leads to opportunistic infection. Kambugu lists fungal meningitis, a condition caused by inflammation of the protective membranes covering the brain and spinal cord as a major nervous system problem among HIV patients. The infection can kill a person with low immune system in just a matter of days. “If one starts ARVs when the immune system is still high, it’s hard for such infections to take advantage of them and they will continue being productive,” he says. He says, unfortunately, it is largely ignored. As a result, every month, an average of 15 patients report to Mulago with fungal meningitis.

“Most of these patients are those receiving ARVs but are not doing well on them,” he says adding that this can be controlled by ensuring that whoever tests positive for HIV is immediately tested for the fungal infection.

Though government has been working on enrolling everyone who needs treatment on ARVs and also preventing infection through programmes such as prevention of mother to child HIV transmission, voluntary male circumcision and other behavior change campaigns, the money is still inadequate.

Several development partners have intervened to supplement government efforts. From October 2014 to September 2015, US$387 million was spent on tacking HIV related problems in Uganda under the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). The contributionwent into improving access to treatment and prevention of mother-to-child transmission (PMTCT). Also, in June 2015, the country got a Global Fund grant of US$176 million for HIV treatment and prevention.

Even with this help, many health centers are still reporting drug stock outs. In November, patients had their doses disrupted when the Ministry of Health could not avail drugs due to late delivery by donors. In the case of HIV/AIDS, such breaks in treatment lead to resurgence of opportunistic infections, drug resistance, and avoidable deaths. The latest figures, from 2013, indicate that 56,000 Ugandans died of conditions related to HIV.

The AIDS Commission has set a target that by 2020, 90% of the people will be knowing their status, 90% of those living with the virus to be on treatment and 90% of those on treatment will have their virus maintained at undetectable levels. But, as it is now, it’s quite unclear that we will have achieved that in the remaining five years as of about 1.4 million Ugandans living with the virus, only 750, 896 had access to treatment by March this year. This shows the country still has a long way to go especially after the World Health Organisation recently released new guidelines requiring patients to be initiated on treatment immediately after testing positive for the disease.

To attempt to beat the epidemic, according to Dr Musoba, the AIDS Commission together with partners are implementing an aggressive communication campaign for behavioral change. As a result, giant roadside billboard have been springing up across the country; along town streets, major highways, and near schools and populated urban neighbor hoods. “I am faithful. That’s my way of fighting HIV,” proclaims one along Kira road, a road that links Kamwokya and Ntinda, two of the most populated residential suburbs of Kampala city. “Our messaging has different components depending on who we are targeting.

You will find that billboards near a school will carry an abstinence message. For married couples, we will tell them to be faithful whereas in other instances we will tell them to use condoms,” says Musoba. He adds that targeting the messages to the right audiences is quite challenging because they have to craft messages for different people differently. A similar campaign was used to bring prevalence numbers down in the late 1980s and 1990s. There was a marked decline in the number of new infections recorded each year ranging from as high 230,000 in 1988/89 to around 80,000 by 1996. This was attributed to aggressive grassroots behavioral change campaigns. Unfortunately, the epidemic later got out of control and new infections started to rise from 2001, driven by the return of the behavior of sex with several partners.

“Initially, the decline was because of the campaigns we did that discouraged people from having multiple sex partners. After a while people started engaging in risky behavior again leading to the numbers shooting up,” says Musoba. He is hoping to change that.

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