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Uganda reverses the tide of HIV/AIDS
Uganda’s success in reducing high HIV infection rates is the result of high-level political commitment to HIV prevention and care, involving a wide range of partners and all sectors of society. Same-day results for HIV tests and social marketing of condoms and self-treatment kits for sexually transmitted infections, backed up by sex education programmes, have helped reduce very high HIV infection rates.
Uganda, one of the first countries in sub-Saharan Africa to experience the devastating impact of HIV/AIDS and to take action to control the epidemic, is one of the rare success stories in a region that has been ravaged by the HIV/AIDS epidemic. While the rate of new infections continues to increase in most countries in sub-Saharan Africa, Uganda has succeeded in lowering its very high infection rates. Since 1993, HIV infection rates among pregnant women, a key indicator of the progress of the epidemic, have been more than halved in some areas and infection rates among men seeking treatment for sexually transmitted infections have dropped by over a third.
In the capital city Kampala, the level of HIV infection among pregnant women attending antenatal clinics fell from 31% in 1993 to 14% by 1998. Meanwhile, outside Kampala, infection rates among pregnant women under 20 dropped from 21% in 1990 to 8% in 1998. Elsewhere, among men attending STI clinics, HIV infection rates fell from 46% in 1992 to 30% in 1998.
Success in reducing the prevalence of HIV in Uganda is the result of a broad-based national effort backed up by firm political commitment, including the personal involvement of the head of state, President Yoweri Museveni. From the outset, the government involved religious and traditional leaders, community groups, NGOs, and all sectors of society, forging a consensus around the need to contain the escalating spread of HIV and provide care and support for those affected.
Sex education programmes in schools and on the radio focused on the need to negotiate safe sex and encouraged teenagers to delay the age at which they first have sex. Since 1990, a USAID-funded scheme to increase condom use through social marketing of condoms has boosted condom use from 7% nationwide to over 50% in rural areas and over 85% in urban areas. The social marketing scheme involved sales of condoms at subsidized prices or free distribution by both the government and the private sector. The scheme was also backed up by health education and other public information. Meanwhile more teenage girls reported condom use than any other age group — a trend reflected in falling infection rates among 13-19 year old girls in Masaka, in rural Uganda. And among 15-year-old boys and girls, the proportion who had never had sex rose from about 20% to 50% between 1989 and 1995.
Condom use is also being encouraged among men who seek treatment for sexually transmitted infections. A new innovative social marketing scheme to promote the use of an STI self-treatment kit (“Clear Seven”) has proved to be successful in treating STIs and preventing HIV infection. The kit, which contains a 14-day course of tablets, condoms, partner referral cards, and an information leaflet, is designed to improve STI treatment rates, prevent over-the-counter sales of inappropriate treatments, encourage partner referral, and reinforce condom use. The distribution system relies on the use of small retail outlets which are normally licensed to sell over-the-counter drugs but not antibiotics. The Ugandan Government has waived these restrictions to promote sales of Clear Seven, marketed at the subsidized price of US$ 1.35, and trained shopkeepers in the management of STIs. As a result, cure rates for urethritis have increased from 46% to 87% and condom use during treatment has more than doubled (from 32% to 65%).
Another innovation in Uganda was the launch in 1997 of same-day voluntary counselling and testing services. Up till then, clients had to wait two weeks for their HIV test results and up to 30% failed to return. Thousands of people who have taken advantage of same-day testing have since been recruited and trained as peer educators. So far, 180 000 people have been reached by the scheme and over a million condoms distributed.
In Uganda, as elsewhere in sub-Saharan Africa, AIDS has caused immense human suffering over the past two decades — setting back development and reducing life expectancy. Over 1.5 million children have been orphaned since the epidemic began — losing their mother or both parents to AIDS. Today there is hope that the tide can be turned at last.
-who.intl