Uganda will join the rest of the world in commemorations on World AIDS Day under the theme Getting to zero new HIV infections. The day serves to elevate awareness of the HIV pandemic. It also provides a chance to remember those people who have died as a result of HIV.
HIV was first reported in Uganda in 1982 in two fishing areas, Lukuya and Kasensero in Rakai District. By the end of 1980s the virus had spread to all parts of the country and Uganda was faced with a severe generalized epidemic, affecting different population groups with a higher toll in the urban areas.
Despite of higher levels of knowledge on HIV, unprotected sex and fear to disclose, especially between married couples, remains the main driver of the HIV epidemic in Uganda.
Unprotected sex may involve inconsistent condom use or no condom at all and may involve sex with multiple partners. Some will be engaging in sex for survival or with someone whose status one does not know. It is argued that many Ugandans are having higher risk sex but may not realise their behavior puts them at risk.
A key factor influencing the continuation of high risk sex despite higher levels of knowledge about HIV transmission is a lack of personalization of HIV risk. What’s more, in Uganda some are beginning to view HIV as no longer a death sentence, thinking of it as ‘life as normal’. This is referred to as ‘HIV normalization’.
The transmission of HIV from an infected mother to a child is the second most common means of transmission of HIV in Uganda. Mother to child transmission of HIV has driven the epidemic despite the availability of an effective and affordable prevention of mother to child transmission (PMTCT) intervention, the drug Nevirapine.
This is linked to the fact that many mothers give birth at home, attended to by tradition birth attendants. Although more than 80% of pregnant women attend antenatal care at least once during pregnancy, only around 30% deliver in health facilities.
The social cultural factors for the low numbers of women attending maternal healthcare services includes a lack of or limited male involvement in these programs and stigma surrounding HIV. The quality of services offered by service providers compared to traditional birth attendants is also a factor.
Faltering response
Uganda was previously known as a successful country in dealing with HIV as it reduced HIV prevalence from 18% in 1992 to 6.2% in 2002 but recently its response to the virus has been faltering.
Uganda is one of the main countries receiving funding from major donors, including the US and UK.
In September, Jerry Lanier, US ambassador to Uganda, challenged the government to take the lead in tackling HIV. He said the US will keep its commitment to Uganda to fight the virus but cannot do this alone and needs greater commitment from both the Ugandan government and civil society to do so.
He pledged $25 million by 2012 for funding towards stopping pediatric HIV in addition to the $15 million already already budgeted for to support national PMTCT services. The goal of this second pot of funding is to reduce by 2015 the number of HIV positive women that are dying as a result of giving birth.
In October, the UK announced it is to reduce its global AIDS funding by nearly one third.
“90% of the HIV budget is donor funded, yet the Ministry of Health set up to 2015 to eliminate the virus. Prevention of mother to child transmission of HIV has reduced to 6% from 19% although new infections in children are still prevalent,” said the head of prevention of mother to child transmission programs at the Ministry of Health.
Of the 127,000 people newly infected with HIV each year, 25,000 are children. Of these infections, 95% are the result of mother- to child transmission.
Drug and food shortages
This year Uganda has been crippled by drug shortages. In September, more than half of those living with HIV who need antiretroviral (ARV) treatment could not access it due to these chronic shortage.
This alarming situation was announced by Robert Ochai, the head of the Aids Support Organization (TASO), who confirmed that only 6% of the children that need ARVs can get it.
Food shortages also contribute to HIV prevalence. Famine in the Eastern Uganda has led people to refuse to take ARVs due to their side effects when taken on an empty stomach.
Out of Katakwi’s population of 153,700 people, 2,678 have tested positive for HIV and 458 are enrolled on antiretroviral therapy (ART). According to Idholoi Okia, Katakwi District’s health inspector, the unit has stop distributing ARVs to HIV patients for fear of the side effects the drugs may have for those unable to eat as well as required. Okia is worried the HIV situation will get worse, especially when UKAid reduces its funding.
The legal context
Another issue facing people living with HIV in Uganda is the HIV/AIDS bill, which calls for ‘willful or intentional transmission’ of HIV to lead to life imprisonment. This could mean life imprisonment for a mother who has HIV but doesn’t get PMTCT, causing her baby to get infected, or a man who has HIV and infects his wife. Yet the mother may not be able to access PMTCT and the man may be overwhelmed by fear and stigma.
The bill states that anyone living with HIV must disclose their status to their sexual partners. This sounds easy but disclosure is hard. The government has not empowered people with HIV to be able to disclose without fear of being stigmatized and discriminated against.
Married couples
The National HIV/AIDS strategic plan says 65% of new HIV infections occur in established couples. According to Kihumulo Apuuli, Director General of the Uganda AIDS Commission, HIV is now spreading faster among married people than in any other group in Uganda. This is because many married people have sex outside marriage often without a condom, which creates a large network of sexual relationships. When one person in a network gets HIV, everyone is at risk of getting it.
In preparation for World AIDS Day (1 December 2011), the Ministry of Health, together with Health Communication, launched HIV testing for all married couples in Uganda. This is done every year to reduce HIV prevalence in married couples and to enable more couples to disclose and take ART.
World AIDS Day provides an opportunity for all of us individuals, communities and political leaders to take action and ensure human rights are protected and global targets for HIV prevention, treatment and care met. African governments are committed to tackling HIV but how will they manage to reach zero level in the wake of global funding cuts? The fight is far from over.
- women waiting for immunising their bchildren
- Father had come for child day plus for his newborn child
- Mother weighing her child at kawempe health centre
