By Esther Nakkazi
The United States Secretary of State Hillary Clinton visit to Uganda did not come with any specific commitment for more funding for its HIV/AIDS programmes even as its disease burden swells.
Clinton said she was alarmed that Uganda, once a world performer that managed to lower its HIV prevalence rates is now the only country in sub-Saharan Africa with a reversal situation.
“I am worried. Uganda is the only country where infections are going up and not going down,” said Clinton visiting the Reach Out Mbuya, an indigenous, faith-based HIV located in a Kampala suburb.
She is not the only one worried it is now an issue of national concern again. For its 90 years of existence, the Makerere University School of Public Health partnered with Centres for Disease Control (CDC) will hold a public debate asking if Uganda is moving in the right direction for its prevention strategy.
Obviously it is not as confirmed by the recent survey, which shows rising HIV infection rates. According to the 2011, Uganda AIDS Indicator Survey (UAIS) results released two months ago, the prevalence rate is now 7.3 from 6.4 percent in the 2004-05 survey. It is even higher among women at 8.1 percent.
While the trend of the number of new infections are also on an upward curve from 124,000 in 2009, 128,000 in 2010 to now 130,000 in 2011, which outstrips the annual enrollment into anti-retroviral treatment by two-folds.
“We are losing the gains we had achieved,” said Dr. Patrick Ndase, an HIV prevention research expert. “We are becoming a country of shame. The situation is going from bad to worse yet we have the tools and we can make them work.”
Health experts have blamed the increase on complacency and a growing dismissive attitude among the public ‘HIV is not cancer’, aggravated by the wellness impressed by anti-retroviral therapy and care.
Rising prevalence rates are also blamed on ‘more patients surviving on anti retroviral therapy’ but this case is also true for even other countries, even with higher and more effective national HIV/AIDS programmes, says Peter Waiswa, a researcher at the School of Public Health, Makerere University College of Health Sciences.
But many also think that Uganda’s National HIV prevention strategy should be reviewed and to find new sources of funding to sustainable levels, issues Clinton said she had discussed with President Yoweri Museveni in the few hours she spent in Uganda.
Uganda’s commitment to putting aside more funds for its AIDS programmes is key to the reversal of its rising infection numbers, many have argued, but also to create a meaningful impact in its prevention strategies.
“We must show that we mean business by examining alternative options for mobilizing additional domestic resources. Current allocations are below what is needed to contain this epidemic!” said Professor Vinand Nantulya, the chairman of Uganda Aids Commission.
Currently, about 95 percent of Uganda’s AIDS programmes are funded by donors, the larger amounts by the American people through the US President's Emergency Plan for AIDS Relief (PEPFAR). Treatment funding in Uganda is almost entirely from development partners.
At the Mbuya Reach Out facility that serves over 5000 active patients, Dr. Stella Alamo Talisuna, the executive director said the US government supports at least 97 percent of all their activities but emphasized finding alternative ways to fund Uganda’s significant disease burden.
Indeed, HIV/AIDS control programmes in Uganda have been left to donors and non-profit organisations. And although these may have good intentions they are not responsible for delivering the ‘public good’ in an equitable manner as only governments can do so.
So as they fill the purse, so do the decisions on where to spend. “We were doing combination prevention, putting equal focus on everything. But as donors decide on what to fund that has changed,” said Julius Lukwago, the director marketing and communications at PACE, an entity that deploys social marketing for innovative health solutions in the private sector.
For instance with a low interest in condom funding now by donors, PACE is now rationing condoms to its clients in the private sector. “Funding for condoms just dwindled,” Lukwago says supporting the cause for the government to prioritize funding for AIDS activities.
It has been observed that condoms, which were initially used as a key tool in the fight against HIV, are only available in a few public health centres, particularly in anti-retroviral therapy clinics and a few non-governmental organisations.
In Kampala for example the condoms are now in super markets – only around the "till" area, which embarrasses most shoppers to purchase them with an ogling queue behind, said Sylvia Nakasi, an Advocacy Officer, Uganda Network of AIDS Services Organisations (UNASO).
“Uganda has just failed to provide HIV prevention strategies to a reasonable scale for any meaningful impact.”
In tacking sourcing of domestic resources to sustain HIV programmes, several ideas have been suggested including an AIDS tax on some items but none has been followed through yet.
At a global level, Clinton during the just ended XIX AIDS conference held in Washington D.C, announced added funding for male circumcision, prevention of mother to child transmission and treatment as prevention with more people on anti-retroviral treatment, an effort towards universal coverage.
As a mother she told Ugandans that she cared that no babies are born anymore with HIV through mother-to-child transmission, with commitment of an additional $80 million for the effort at a global level and to it eliminate entirely by 2015.
Uganda ranks among the top-five highest burden countries, of HIV positive mothers that transmit it to babies. As such more than 100,000 HIV-exposed babies are born each year in Uganda. Clinton can play her part but the greater part should be by Ugandans. Maybe if she had committed some resources during her trip the ‘regression amidst plenty’ syndrome would have continued.
“The government must go back to the drawing board and get back to its stewardship role, and be in charge of implementations. The role of donors and NGOs should be minimised as time goes on,” said Waiswa.