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World Aids Day | Revisiting The HIV & AIDS Story In Uganda

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Posted November 29, 2012 by Ugandan Diaspora News Team in Health ~ 5,484 views

     

Uganda is often held up as a model for Africa in the fight against HIV and AIDS. Strong government leadership, broad-based partnerships and effective public education campaigns all contributed to a decline in the number of people living with HIV and AIDS in the 1990s.

Although there is a lot to learn from Uganda’s comprehensive and timely campaign against the AIDS epidemic, emphasising Uganda’s success story must not detract from the huge consequences that AIDS continues to have across the country.

There are an estimated 1.2 million people living with HIV in Uganda, which includes 150,000 children.1 An estimated 64,000 people died from AIDS in 2009 and 1.2 million children have been orphaned by Uganda’s devastating epidemic.

Why might prevalence have declined?

The number of people living with HIV in Uganda fell dramatically during the 1990s. The interesting questions are what caused this decline, whether other countries can adopt similar methods, and whether the lower rates of transmission are sustainable.

The drop in HIV prevalence in Uganda in the 1990s cannot be attributed to a single factor. It is likely to have been a result of both a fall in the number of new infections (incidence), and a rise in the number of AIDS-related deaths.

Deaths: It has been suggested that the high number of AIDS-related deaths in the 1990s may have been largely responsible for the decline in the number of people living with AIDS in Uganda during this period.11 The reason so many people died in this decade is that there was no available treatment to delay the onset of AIDS, and high numbers of people infected with HIV in the 1980s were reaching the end of their survival period. In 2000 the Ugandan health ministry estimated that 800,000 people had died of an AIDS-related illness since the beginning of the epidemic.12

However, the high death rate alone may not account for the significant reduction in the number of people living with HIV in Uganda. Many other countries in sub-Saharan Africa experienced similar patterns of HIV incidence and death but did not experience a similar decline in prevalence.

New infections: It is likely that the number of new HIV infections in Uganda peaked in the late 1980s, and then fell sharply until the mid 1990s. This is generally thought to have been the result of behaviour changes such as increased abstinence and monogamy, a rise in the average age of first sex, a reduction in the average number of sexual partners and more frequent use of condoms.13 Uganda’s entire population was mobilized in the fight against HIV and everyone was made aware of the consequences that risky behaviour could have for their country.

President Museveni encouraged input from numerous government ministries, NGOs and faith-based organizations. He relaxed controls on the media and a diversity of prevention messages spread through Uganda’s churches, schools and villages.

This frank and honest discussion of the causes of HIV infection seems to have been a very important factor behind the changes in people’s behaviour. Music and educational tours by popular musician Philly Lutaaya (who was the first prominent Ugandan to openly declare he was HIV positive) also spread understanding, compassion and respect for people living with HIV.14

Much of the prevention work in Uganda occurred at grass-roots level. Many organizations were often made up of people living with HIV educating their peers. These groups worked to break down the stigma associated with AIDS, and encourage an open discussion of sexual subjects that had previously been taboo.

The sheer scale of the HIV epidemic in Uganda is also thought to have been a major driver of behaviour change and the reduction in the number of new infections. The epidemic was very visible: in the 1990s the majority of Ugandans knew somebody who had died from AIDS and in 1995, 91 percent of Ugandan men and 86 percent of women knew someone who was HIV positive.15 Many villages experienced high numbers of deaths each month, houses stood empty, funerals were frequent and grandparents were increasingly becoming carers for their orphaned grandchildren. As anti retroviral treatment was not yet widely available in the 1990s, many people equated AIDS with a death sentence and it is believed that fear may have driven change in behaviour.

The current HIV prevalence in Uganda is estimated at 6.5 percent among adults16 and 0.7 percent among children.17 HIV prevalence is higher in urban areas (10 percent) than rural areas (6 percent).18 An estimated 43 percent of new infections occur among people engaged in mutually monogamous heterosexual relationships.19

Women are disproportionately affected, accounting for 57 percent of all adults living with HIV. Ugandan women tend to marry and become sexually active at a younger age than their male counterparts, and often have older and more sexually experienced partners. This (plus various biological and social factors) puts young women at greater risk of infection. AVERT.org has more about women and HIV.

The number of new infections (an estimated 120,000 in 2009) exceeds the number of annual AIDS deaths (64,000 in 2009),20 and it is feared HIV prevalence in Uganda may be rising again. There are many theories as to why this may be happening, including the government’s shift towards abstinence-only prevention programs, and a general complacency or ‘AIDS-fatigue’. It has been suggested that anti retroviral drugs have changed the perception of AIDS from a death sentence to a treatable, manageable disease; this may have reduced the fear surrounding HIV, and in turn have led to an increase in risky behaviour.21 There is also a need for greater education among the younger generation, with only 39 percent of young people aged 15 to 24 knowing all the necessary facts about how HIV can be prevented.

The current HIV prevalence in Uganda is estimated at 6.5 percent among adults16 and 0.7 percent among children.17 HIV prevalence is higher in urban areas (10 percent) than rural areas (6 percent).18 An estimated 43 percent of new infections occur among people engaged in mutually monogamous heterosexual relationships.19

Women are disproportionately affected, accounting for 57 percent of all adults living with HIV. Ugandan women tend to marry and become sexually active at a younger age than their male counterparts, and often have older and more sexually experienced partners. This (plus various biological and social factors) puts young women at greater risk of infection. AVERT.org has more about women and HIV.

The current situation

The number of new infections (an estimated 120,000 in 2009) exceeds the number of annual AIDS deaths (64,000 in 2009),20 and it is feared HIV prevalence in Uganda may be rising again. There are many theories as to why this may be happening, including the government’s shift towards abstinence-only prevention programmes, and a general complacency or ‘AIDS-fatigue’. It has been suggested that anti retroviral drugs have changed the perception of AIDS from a death sentence to a treatable, manageable disease; this may have reduced the fear surrounding HIV, and in turn have led to an increase in risky behaviour.21 There is also a need for greater education among the younger generation, with only 39 percent of young people aged 15 to 24 knowing all the necessary facts about how HIV can be prevented.22

AIDS has had a devastating impact on Uganda. It has killed approximately one million people, and significantly lowered life expectancy.23 AIDS has reduced the country’s labour force, reduced agricultural output and food security, and weakened educational and health services. The large number of AIDS related deaths amongst young adults has left behind over a million orphaned children.24

The impact of AIDS on Uganda

People living with HIV and AIDS in Uganda not only face difficulties related to treatment and management of the disease, but they also have to deal with AIDS related stigma and discrimination. Stigma and discrimination towards those affected by AIDS are visible at all levels of society from families and local communities to the government. President Museveni himself supported the policy of dismissing or not promoting members of the armed forces who test HIV positive, and in 2001 he suggested that a rival presidential candidate was unsuitable for office because he was allegedly infected with the virus. Discrimination has also been reported in the private sector, including mandatory HIV testing for new employees. As well as discriminating against those living with HIV, such attitudes are a major hindrance to prevention and treatment efforts.25

The way forward

Uganda is at an important crossroad in the history of its AIDS epidemic. After a dramatic reduction in HIV prevalence following an early comprehensive HIV prevention campaign, there are signs that the number of people living with HIV in the country may be starting to rise again. The Ministry of Health has predicted that the current rate of new HIV infections is seriously impeding economic growth and will continue to do so, particularly as HIV and AIDS is affecting people in their most economically productive years.79

In order to avoid this, Uganda needs to take a serious look at infection trends and behaviour to identify why this rise may be occurring and how to remedy it. Experts believe that complacency and the ‘normalisation’ of AIDS may be leading to an increase in the risky behaviour that early prevention campaigns sought to reverse.

“People now think that because we have had HIV for so many years, it is a normal condition among the population.”Kihumuro Apuuli, director of Uganda Aids Commission (UAC)80

Uganda clearly needs to revive and adapt its HIV prevention programme, moving away from abstinence-only initiatives to a comprehensive programme that incorporates not only abstinence, fidelity and condom use, but also HIV testing and the prevention of mother-to-child transmission of HIV. Source — Avert.org


About the Author

Ugandan Diaspora News Team

Ugandan Diaspora News Online is an independent, non political news portal primarily aimed at serving Ugandans who work and reside outside Uganda. Our aim is to be a one stop shop for everything Ugandan and the celebration of our Ugandan heritage.

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    Rivak Punchoo

    The HIV epidemic rages in South Africa and I think the use of a comprehensive programme of primary prevention borrowing on grass roots interventive strategies especially, changes in lifestyle factors, emphasised in Uganda’s initial effort for curbing HIV infection, critical to an optimally successful South African health care practice.





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