You are viewing : Vol. 5, Issue 3 Oct - Dec, 2008

HIV infection rates still a puzzle in Uganda

Christopher Agaba

Following the years of near miraculous reversal of HIV/AIDS prevalence that won Uganda many international accolades, there is general fear that the country is slowly but steadily slipping back into the danger zone. The country is no longer being cited as the HIV/AIDS success story it once was.

Rather, the mention of Uganda in international HIV/AIDS circles is followed by statistics that show a country whose HIV prevalence rate has stagnated at about 5.4% in the last three years, according to the latest combined UNAIDS, UNICEF, WHO HIV Epidemiological fact sheet. There are many theories as to why the HIV prevalence in Uganda is rising again. These include the donor-prescribed shift from ABC-based prevention programs to abstinence only prevention programs. Antiretroviral drugs seem to have changed the perception of AIDS from a death sentence to a treatable, manageable disease, consequently reducing the fear surrounding HIV, and in turn leading to increase in risky behavior.

There is the general complacency that comes with demystification of the infection. The young generation seems not to remember the extreme illness and death caused by AIDS in the early years of the epidemic. We therefore need to recognize that the medical advances do not negate the need for preventing the disease. While it is generally accepted that the ABC policy works, the Uganda government has been blamed for its recent emphasis on Abstinence and Be faithful as the lead methods of prevention. Many experts have speculated that Uganda’s shift in prevention policy away from ABC towards abstinence and be faithful programs may also be responsible for an increase in risky behavior.

The censorship of information about condoms in government funded programs; myths about condoms and restrictions spread by religious leaders also hamper the fight against the AIDS pandemic. Despite the public generally having adequate information about the importance of condoms, their use in the country has remained markedly low. Worse still, it has been difficult to achieve widespread, consistent and correct use of condoms in any high-risk sexual relationship other than commercial and casual sex. Economic pressures caused by among others widowhood and orphaned-hood by the disease has led to risky forms of earning a living. Abstinence is the most controversial area of Uganda’s HIV prevention campaign. Dozens of billboards around the country have sprung up promoting only abstinence to prevent HIV infection.

Emphasis on abstinence above condom distribution and use is a distortion of preventive apparatus and, some experts suggest, is resulting in great damage and unquestionably will cause significant numbers of infections, which should never have occurred. Be faithful to your partner or ‘zero grazing’ was the dominant message preached in the early HIV prevention campaigns. Unfortunately, early emphasis on avoiding casual sex appears to have lost its impact in recent years. Many studies find that high-risk behavior, especially un-protected sex, are continuing at far too high a rate. A 2006 HIV sero behavioral survey by the Uganda Ministry of Health found an apparent increase in multiple partnering.

The proportion of sexually active Ugandans who reported having had two or more sexual partners in the previous 12 months increased from 2 to 4 percent between 2000-01 and 2004-05 among women, and from 25 to 29 percent among men. This suggests that the newer preventive messages are not sufficient to discourage risky behavior. This is true even for people who have been counseled and tested for HIV, including those found to be infected. Effective prevention messages must therefore emphasize that despite the medical advances, HIV remains a serious and usually fatal disease that requires complex, costly, and difficult treatment regimens. These treatments may not work for everyone and sometimes when they work they have unpleasant or intolerable side effects.Substance abuse is becoming a big problem in this country especially among the youth. The intersection of substance use and sexual HIV transmission cannot be overlooked. Prevention messages need to focus on the role of alcohol and drug abuse in HIV risk.

This is because substance abuse can facilitate risky behavior among persons who might otherwise protect themselves and others from HIV. Preventing substance abuse and substance abuse treatment are examples of effective interventions that could be used for reducing HIV transmission.Experts argue that the pandemic will never be defeated without effective prevention. Not mere prevention but combined prevention. This approach would see biomedical strategies such as circumcision, prevention of mother-to-child transmission, behavioral change such as reducing concurrent relationships and using condoms, all promoted to the public in the same message. An editorial in a special edition of the prestigious Lancet medical journal concluded that from the very beginning of the global response to AIDS, prevention has been marginalized and treatment has dominated. And it was argued that this imbalance is largely responsible for the new infections each year.Uganda is at an important crossroads in the AIDS epidemic. Despite the past successes the country has attained, there is a need to re-focus the prevention strategies in order to address the current trends of the epidemic. This calls for more vigilance in observation of infection trends to identify why the number of infections is no longer going down and how to remedy it.