The HIV incidence in Uganda is on the rise. According to the Ugandan Ministry of Health, the prevalence of HIV has increased from 6.4% in 2005 to 7.3% as of September of last year. As seen in many other countries around the world, the young and single cohort is not the only segment driving the increase. The Uganda AIDS Indicator Survey identifies married individuals as having the biggest increase. Women, traditionally on the sidelines of the HIV conversation, now have a 10 percent chance of becoming infected with HIV before they turn 40.
This comes as a surprise as Uganda was, and often still is, viewed as having one of the most successful HIV prevention responses in Sub-Saharan Africa (SSA). The response from the government and local leaders during the early 1990s allowed Uganda to rapidly decrease HIV incidence and resulted in one of the lowest prevalence rates of HIV epidemic countries in SSA by the late 1990s. From the high of 15 percent in 1991, HIV prevalence decreased to 5 percent by 2001. Not even the United States was able to replicate that drastic of a decrease.
To move forward we must learn from our past. Now is a great time to ask the world and ourselves: what happened to stem the epidemic before?
An estimate by USAID places the peak of the HIV epidemic in Uganda in 1991 – seven short years after HIV was first discovered to be the cause of AIDS and nine years from when AIDS replaced GRID (Gay Related Immunodeficiency Disease) as the official medical term in response to the rapidly broadening epidemic. (The AIDS Institute, 2015). During that time several important processes were started, aimed at reducing the spread of HIV. These included a strong, multi-spectral response from the government, front-line promotion of HIV reduction behaviors by community and religious leaders, and Africa’s first voluntary counseling and testing program. By directly addressing the community’s perceptions and norms on both the national and local levels, the government and community leaders were able to start many behavioral changes that would swiftly decrease the incidence of HIV in a little under a decade.
The change with the most impact, according to USAID and The Synergy Project (an HIV/AIDS technical support group), was the decrease in the number of sexual partners for both men and women. Between 1989 and 1995, the period of greatest decrease in HIV incidence, the percent of males reporting casual sex in the past 12 month decreased from approximately 40 percent to approximately 16 percent. The same is true for women, if to a lesser degree, with a drop from approximately 20 percent to less than 10 percent. The change in both genders directly affects HIV risk and transmission as casual sex is the biggest contributor to HIV infection. Jumping ahead 15 years, the 2011 Uganda AIDS Indicator Survey found that the trend continued; only 3 percent of females and 18.8 percent of men had engaged in casual sex in the last 12 months. If true this is good news for Uganda, though the low condom use (15 percent for both genders) is a warning sign that should not be ignored.
Reducing the number of casual sex partners is a current priority for the government of Uganda, and reflected in the National HIV Prevention Strategy 2011 to 2015. The first desired outcome of the strategy read, “Increased safer sexual behaviour and reduced risky behaviors” which includes casual sex, cross-generational sex, transactional sex, and multiple partnership. The objective is a great start, and hopefully will be included in the new strategy made for 2016 to 2020, but a larger approach needs to be taken. Worldwide, HIV/AIDS is often put on the back burner as a “known and addressed” issue in public health priorities. Without the direct and active involvement of the government combined with community and religious leaders little emphasis is placed on HIV prevention on any level. This needs to change if we hope to contain HIV/AIDS in the future: the battle is far from over.