Despite the massive HIV response by the Ugandan government and its partners, 380 people still get infected with HIV every single day. The new infections are threatening Uganda’s success story in responding to HIV in the late 1990s.
Speaking at the 2015 Western Regional HIV and AIDS Scientific Conference, Dr Zepher Karyabakabo, director of policy, research and programming at Uganda AIDS Commission, said Uganda has 1.6 million people living with HIV who need care, treatment and support. He added that 56,000 people die every year of HIV-related illnesses.
“HIV/AIDS poses a very big socio-economic challenge to the country,” he said. “In 2013 we had 137,000 new infections meaning that every single day 380 persons get infected. HIV prevalence is high in urban areas which stands at 8.7 per cent compared to the rural areas where prevalence stands at 7 per cent. This is extremely high and we have to do something about it.”
The conference, which took place at Lake View Hotel in Mbarara on 12 May, had the theme Getting to Zero with Evidence. Its aim was to receive research-based evidence that will influence the future direction of the HIV response and share the post-2015 national HIV and AIDS priorities.
Response has stagnated
Dr Joshua Musinguzi, AIDS control programme manager at the Ministry of Health, said the significant strides Uganda made in addressing the problem, with reported epidemic contraction and sexual behaviour change in the 1990s, has now stagnated.
“The Ministry of Health is focused on the public health response, mainly behavioural and biomedical interventions. We are also working hard to prevent transmission of HIV to reduce incidence and mortality,” he said.
The 2011 AIDS Indicator Survey revealed an increase in HIV prevalence among adults aged 15-49 years, from 6.4 per cent in 2004/05 to 7.3 per cent in 2011. Women are more affected than men, with an overall HIV prevalence of 8.3 per cent among women compared with 6.1 per cent among men.
According to the Ugandan Government’s 2013 HIV and AIDS progress report: “Although Uganda continues to experience a high rate of new HIV infections; the trend over the last three years shows a decline, from an estimated 162,294 in 2011 and 154,589 in 2012, to 140,908 in 2013. However, HIV incidence increased in adults from 134,634 in 2011 to 139,178 in 2012, and only declined to 131,279 in 2013.”
“The country continues to experience many new HIV infections,” Dr Musinguzi said. “By end of 2014, there were 1,631,828 people living with HIV.”
Adherence challenges
David Bangsberg, director of Massachusetts General Hospital Global Health, said the potential short-term gains from reducing individual morbidity and mortality may be far outweighed by the potential for the long term spread of drug resistance.
He said that in Africa, a higher proportion of patients are likely to fall into the category of potential poor adherers (unlikely to stick to treatment) unless resource intensive adherence programmes are available.
He said that another thing that has made adherence fail is when people living with HIV feel well and abandon the drugs, while others refuse to be enrolled.
“An attitude of feeling healthy is the most common reason for antiretroviral refusal, which has increased the infection rate and also drug resistance,” he said.
Where did Uganda go wrong?
Dr Chris Baryomunsi, minister of state for health, general duties, said: “Uganda went wrong when we became complacent. As a result, we have reverted to the pre-epidemic HIV-risky lifestyles of unprotected sex with anyone, anytime without regard to their HIV status. We went wrong when we took our foot off the pedal.
“We also went wrong when we began to communicate messages to the public which do not make sense to them as to what action they are expected to take,” he said. “Take for example the miracle cure of AIDS claimed by some people and aired through different media channels to the community. Some messages are outright wrong.
“If we don’t control our new HIV infections the treatment costs may overstretch national and global resources. I call upon all partners to design innovative approaches and scale up effective interventions using the research shared in this conference to meet the vision of zero new HIV infections.”
Read about Malawi inmates living with HIV appealling for supplementary food
Uganda is going backwards in regard to the gains that were achieved in reversing the HIV burden before.
We need a paradigm shift in planning and programming at the national level.
Concerted advocacy communication and social mobilization efforts are pertinent.The population after this laxity,needs massive and fresh sensitization and awareness about the dangers of opting out while on treatment and the repurcussions. Interventions should focus on adherence to treatment and preventive messages for those who are still HIV negative as a means of overcoming the escalating drug resistance and controlling new infections.