Monday, December 3, 2012

Status of HIV in Uganda

By Esther Nakkazi

This year, Uganda marks World Aids Day under the same theme as last year, ‘Re-engaging Leadership for effective HIV prevention’ but with the slogan: ‘Accelerating HIV prevention for Zero new infections.’

Indeed, with 130,000 new infections in 2011 according to the National AIDS Indicator Survey (UAIS) released mid this year, from 128,000 in 2010 and 124,00 in 2009, the status of Uganda’s HIV is alarming and at a critical crossroads.

Dr. Christine Ondoa, the minister of Health says the focus on zero new infections once re-energised by leadership at all levels and using the new available prevention tools in combination, would eventually lead to zero new HIV infections in Uganda.

The science is clear. These new HIV infections can be entirely eliminated using combination prevention tools like giving treatment to all the 1.3 million Ugandans currently infected and living with HIV, offering voluntary Medical Male Circumcision (VMMC), prevention of Mother-to-Child transmission of HIV (PMTCT) and use of condoms.

But all these prevention tools have to be implemented at the same time and scaled up to higher proportions, about 80 percent, that can create a dent on the epidemic. 

“We need a comprehensive response- with behaviour interventions backed by biomedical and social-cultural interventions at a scale that generates impact. We have been spreading ourselves at low levels on the ground,” said Dr. Joshua Musinguzi the HIV/AIDS control programme manager at the Ministry of Health.

The 2011, HIV/AIDS indicator survey, exposes Uganda’s current status of the epidemic showing a rise in prevalence after enjoying global yardstick status in the late 1990’s when the HIV/Aids prevalence was brought down to 5 from 18 percent in the 1980’s.   

The UAIS report shows that the prevalence still remains significantly high, currently at 7.3 percent for Ugandans aged 15-49 years from 6.4 percent in the 2004/05 survey. 

Like elsewhere in the world where women bear the burden of the disease, women in Uganda are disproportionately infected with the prevalence higher among women at 8.3 percent than among men at 6.1 percent from rates of 7.5 and 5.0 percent in 2004/05.

Currently, two-thirds, 66 percent of women report ever being tested for HIV and received their results, a marked increase from 13 percent in 2004-05.  HIV testing among men has increase four-fold, from 11 percent in 2004-05 to 45 percent in 2011.  

Overall, 72 percent of pregnant women reported prior testing and receiving their results during antenatal care. 

According to the most recent data, HIV prevalence is highest among the Most at Risk Populations including commercial sex workers, fishing communities and mobile populations.

Government statistics have put HIV prevalence in fishing communities at 28 percent, although there are fears that it could even be higher and 10 percent of all new infections are from sex workers.

Dr. Fred Wabwire-Mangeni, a public health specialist and medical researcher says it is these drivers of the epidemic that need to be focused on to bring a change in the tide of the HIV/Aids in Uganda now.

Moreover, in Uganda now, more urban dwellers are HIV-positive than those living in rural areas 8.7 percent versus 7.0 percent but even here the disproportional rates for women is significant.

Women living in urban areas have a prevalence rate of 10.7 percent and those in rural areas is 7.7 percent, there is not much difference among the men who live in either places as the prevalence is 6.1 percent.

HIV/Aids infection is highest among those who are widowed, high among divorced and separated men and women and least for those who have never been married.

Elsewhere in the world, the area where perhaps most progress is being made is in reducing new HIV infections in children. Half of the global reductions in new HIV infections in the last two years have been among newborn children.

Studies show that there are more than 50 percent reduction in the rate of new HIV infections has been achieved across 25 low- and middle-income countries––more than half in Africa, the region most affected by HIV.

But in Uganda 25,000 children get infected annually and 0.6 percent of the children under age five are HIV-positive.  There is no variation in HIV prevalence among children by gender or urban-rural residence.

“These results demonstrate indisputably that HIV/AIDS remains a significant health problem for Uganda and should serve as a call to action for us all,” said Ondoa.

“The Ministry of Health along with our dedicated international partners takes this as an opportunity to recommit ourselves to continued scaleup of proven HIV interventions, to the goal of universal access to ARV treatment, and to our shared vision of a future free of HIV.” 

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