Uganda is on track to attaining the Millennium Development Goal Target 6 (MDG 6) on universal access to treatment of HIV/AIDS.
Under MDG Target 6, all 189 United Nations member states (currently 193) and at least 23 international organizations that are signatories to the UN Millennium Declaration 2000 have a commitment to combat HIV/AIDS, malaria and other diseases.
And, whilst signatories should have halted by 2015 and begun to reverse the spread of HIV/AIDS under Target 6A, which Uganda is not any close to achieving, it is Target 6B- where UN member states vowed to achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it- where 'The Pearl of Africa' has made gains.
2010 target failed, 2015 on course
But, also, whilst the 2010 target was not achieved, Uganda is on course to attaining her national target of ensuring that 80% of the people who need ante-retroviral therapy (ART) access it by 2015.
According to a progress report- Millennium Development Goals Report for Uganda 2013, the share of the population with advanced HIV receiving ART increased from 44% in 2008 to 54% (2009), 50% (2010) and 62% in 2012.
This progress, the report says, prompted the ministry of health to expand ART eligibility in 2011- under the new criteria, adults with HIV can initiate treatment much earlier while all children below two years of age and TB sufferers are automatically eligible.
“Even with expansion in the eligibility population, Uganda is on course to achieve the national target of providing antiretroviral drug to 80% of those in need by 2015,” it reads in part.
MoH statistics show that Uganda has 1. 2 million people living with HIV/ AIDS (PLHA) and, while 577, 000 of them are in need of ART, only 310, 000 access treatment.
Apparently, people with mild HIV (stage 1 and 2) may not require ART, but are recommended to start when it is severe (stages 3 and 4). WHO recommends ART when CD4 is at 350.
The first-line generic treatment of AIDS comprises Zidovudine or Tenofour alongside 3TCY Efaviranz (Lahuvidine) but, through the Prevention of Mother to child HIV Transmission (PMTCT) scheme; mothers take Neverapine to prevent them from infecting their unborn babies, although there are fears that Neverapine may expose babies to HIVDR.
To reverse the spread of HIV/AIDS, the government is revitalising the preventions strategies that accounted from the significant decline in new infections during the 1990s.
The Uganda Aids Commission (UAC) estimates that 37% of new infections are among persons reporting multiple sexual partnerships, 35% occur within discordant monogamous couples, 18% are due to Mother To Child Transmission (MTCT) while 9% arise from commercial sex networks.
“There has been no significant improvement in condom use for higher-risk sexual activity- around half of the youth population engaging in sexual intercourse with a non-marital or non-cohabiting partner still do not use a condom,” it continues.
Access to affordable essential drugs through public health facilities and treatment of HIV/AIDS for those who need it has also improved significantly, with improvements in child health outcomes registering a marked acceleration recently as under-five mortality rate falling by 34% between 2006 and 2011.
Uganda’s national HIV Prevention Strategy, launched in 2011, prioritises behavioural change to reduce high-risk sexual activity through HIV counselling and education and information campaigns.
To prevent MTCT, the Ministry of Health is rapidly rolling out revised WHO guidelines to ensure HIV infected mothers and their infants receive triple ARV prophylaxis during labour and through breast-feeding.
“In addition, the MoH has launched Safe Male Circumcision (SMC) programme. Around a quarter of the male population was circumcised in 2011, but the SMC programme targets this to reach 50% by 2015. While beneficiaries must be aware that this is not 100% effective, a randomised trail found the procedure reduces the risk of HIV infection in men by approximately 60%,” says the report.
Increase in infections
However, amidst acceleration in the provision of ART, past gains in the fight against HIV/AIDS have not been sustained, with disturbing recent increase in new infections.
Via a combination of strong government leadership, broad-based partnerships and effective public education campaigns, Uganda caught global attention when she scaled down the national HIV prevalence rate from 30% in the early 1980s to 6.4% by 2005.
It fell to 15% in the early 1990s to 5% in 2001. In 2002, the prevalence rate rose to 6.2%, oscillating between 6% and 6.5% five years on.
New HIV infections, meanwhile, were estimated at 70,170 cases, with AIDS cases at 73,830 and AIDS deaths at 75,290 in 2002.
However, a national demographic and health survey conducted in 2011 showed that the national HIV/AIDS prevalence has risen to 7.3% (up from 6.4% in 2006).
Ironically, the rise-67% of all HIV infections- occurs amongst the married! As well, there are over 1.2 million Ugandans currently living with HIV/AIDS.
A total of 135,000 new infections are registered annually, with children accounting for 30,000 and 700,000 being women.
Rubaramira Ruranga, an anti-HIV activist, notes that complacence and risky lifestyles were to blame for new infections.
“When I was growing up, there was another bad epidemic called yoas,” he says. “It was worse than HIV. If a victim had injuries and passed through any footpath, coming into touch with dew, it would infect another person who followed. It was also sexually communicable.
“People were able to fight it by telling their children not to marry from a family where someone had yoas. People made it known. We need to take HIV into human behavioral construct and ensure right from the family, parents and leaders are told to avoid risky behavioral right from the outset.”
In the past, unlike today, HIV control and prevention was an issue for all in the past, notes Prof. George Kirya, the former chairman of the Health Service Commission (HSC).
“We were also the first country to declare HIV infections and come-up with the ABC strategy to control its spread. Now we need to increase HIV/AIDS awareness and the health budget otherwise, we are in trouble again!”