By Esther Nakkazi
Civil society and People living with HIV in Uganda want the Uganda AIDS Commission (UAC) and Ministry of Health to jointly launch a costed national strategy for rolling out a comprehensive HIV prevention and treatment response and correctly advise on messages to the public.
They want the response to have concrete deliverable by 2015 like getting at least 80% male circumcision coverage among adult men, rapid and strategic scale up of ARV treatment to all people with HIV with CD4 cells greater than 350 but even earlier for serodiscordant couples, pregnant women, and other key populations.
The government should increase domestic funding and available funds should be accounted for transparently to ensure that funding is not wasted, diverted, abused or stolen as well as strategic implementation of pre-exposure prophylaxis project in vulnerable populations.
“President Obama just put forward a powerful down payment toward the end of the AIDS crisis,” said Lillian Mworeko, the Executive Director of the International Community of Women Living with HIV East Africa. “But we are deeply concerned that Uganda will not seize this opportunity—Government should also double its investments in life saving treatment to turn the tide of HIV in Uganda.”
U.S. President Barack Obama on World AIDS Day announced that the U.S. would scale up treatment access to reach a total of 6 million people on antiretroviral treatment by 2013 through the President’s Emergency Plan for AIDS Relief (PEPFAR)—doubling the pace of scale up for the programme. Obama committed the U.S. to using emerging science to “begin to end” the global AIDS crisis—a concept unimaginable just a few years ago.
Uganda activists also say, although there is various proven new research showing that expanding access is essential to getting ahead of the epidemic the president, Yoweri Museveni has not been advised correctly, accurately and based on scientific evidence.
For instance Museveni’s World AIDS Day message was negative, inaccurate, harmful and showed the continued lack of political will to revamp the national response to the HIV/AIDS crisis that has gone completely off track.
Ultimately, the message did not promote use of the new approaches to HIV prevention and treatment that scientists and policymakers are describing as key to bringing about an end to the AIDS pandemic, the activists said.
In his 1 December 2011 speech, delivered by Vice President Hon. Edward Ssekandi, the President argued that the country should be “careful” of implementing “new medical tools” against HIV, because such innovations “can lead to laxity in behavior.”
The President argued that “eliminating negative sexual behaviors” should be the fundamental priority in the country. Activists say this message is not only inaccurate but also harmful, and
“Of course reaching communities, particularly most at risk populations, with accurate and high impact behavior-change interventions is important—but it is just not enough,” said Leonard Okello of the International HIV/AIDS Alliance in Uganda. “We want a prevention and treatment revolution.”
Unprecedented new research findings have shown that antiretroviral treatment for HIV not only saves lives, but it also reduces the risk of sexual transmission by 96%- http://bit.ly/uXYm00, making HIV treatment an incredibly powerful HIV prevention tool.
The “Partners PrEP” study, conducted in Uganda and Kenya, also found that antiretroviral drugs reduced the risk of infection by as much as 73% when taken by HIV-negative people in serodiscordant relationships http://bit.ly/u59g3x
Safe medical male circumcision, and access to ARV treatment for HIV positive pregnant women are other crucial biomedical prevention interventions that urgently need to be taken to national scale in Uganda. Expanding investments in these interventions will not only save lives—they will also substantially reduce the costs of the AIDS response over time, according to experts.
“These data have provided hope that through accelerated scale up of treatment, as well as other proven prevention and treatment strategies, the end of AIDS could be possible,” says Richard Hasunira, Coordinator of Uganda Civil Society HIV Prevention Working Group.
According to the activists, technical experts in the Ministry of Health are supportive of these new approaches—but the backward-looking message from the President appeared designed by advisors who are not keen on expanding government investments in the fight against the HIV epidemic.
Uganda’s response to HIV is faltering badly, according to experts. Uganda is one of the few countries in the world with rising HIV infection rates, with an estimated 132,500 infections annually. More than 50% of Ugandans in urgent need of HIV treatment currently do not have access to treatment to save their lives and prevent new infections. One in five new HIV infections in Uganda are from mother to child.
“We have no time for equivocation as a country,” said Dr. Stephen Watiti, Board Chair of NAFOPHANU. “Our people are dying; incidence rates are rising. Shaming people with talk of negative sexual behaviors is not helpful at all, since as we all know many people are getting infected without practicing what the President calls ‘negative sexual behavior.’
At this critical time, no one should be talking as if they have the moral high ground; it is not helpful. Moreover, all Ugandans need access to effective prevention and treatment services—not stigma and exclusion.”
Activists also expressed concern that Uganda was not making use of public health flexibilities that would make it easier for Uganda to gain access to low-cost, generic medicines, particularly in the future.
“Uganda needs to be forward looking—instead of making excuses, the government should take advantage of flexibilities other countries are already using to reduce the price of essential medicines,” said Moses Mulumba, Executive Director of Centre for Health, Human Rights and Development (CEHURD).