UGANDA: Questions over government's ability to cut new HIV infections
A red ribbon, the symbol for the global fight against HIV/AIDS
KAMPALA, 12 September 2012 (IRIN) - In response to rising HIV prevalence
, Uganda's government has announced a strategy to reduce new HIV infections by up to 30 percent by 2015, but activists have cast doubt on its ability to achieve this ambitious goal.
Uganda's HIV prevalence has risen from 6.4 percent to 7.3 percent over the past five years. In August, the Uganda AIDS Commission (UAC) released a revised National HIV Prevention Strategy aimed at "increasing the adoption of safer sexual behaviour and reduction of risk-taking behaviour, attaining critical coverage of effective HIV prevention service, creating a sustainable enabling environment that mitigates the underlying structural drivers of the epidemic, re-engaging leadership and energizing coordination of HIV prevention, and improving strategic information on HIV prevention".
The Ministry of Health also plans to improve the quality and coverage of HIV counselling and testing, increase condom use, fast-track the rollout of safe male circumcision to reach 4.2 million men by 2015, expand antiretroviral treatment as HIV prevention, and increase the coverage of prevention of mother-to-child transmission (PMTCT) services from 52 percent to 75 percent.
"We must rise up now. The HIV prevalence in Uganda is not good. The new infections are rising. We are determined to implement all the proven biomedical and behaviour HIV prevention strategies to combat the virus," David Kihumuro Apuuli, director general of the UAC, told IRIN/PlusNews. "We are mobilizing more funds for treatment, care, prevention and strengthening health systems."
However, HIV experts are sceptical about the government's ability and commitment to achieve these ambitious goals. For instance, a voluntary medical male circumcision programme
launched in 2010 is moving slower than anticipated due to funding and health system challenges
"In Uganda, we are experts at preparing very good and wonderful plans. But we are not executing them with speed and direction. The strategy must be linked to the implementation," Alex Coutinho, executive director of Makerere University's Infectious Diseases Institute (IDI), told IRIN/PlusNews. "As a country, we are not heading in the right direction in HIV prevention. We are moving too slowly to achieve the national goals to reduce HIV incidence by 2015. We need to improve and double our efforts."
A problematic programme
Government officials have blamed the rise in prevalence to complacency in the population and poor coordination in the fight against HIV.
"The major cause of the rising HIV prevalence in Uganda is complacency and multiple sexual partnerships. People are engaging in risky behaviours... They no longer fear HIV; they say it's like any other disease and that the drugs are available," Samuel Enginyu, a senior health educator at the Ministry of Health, told IRIN/PlusNews. "We have gone down in public campaigns against HIV. There is also lack in coordination between the government and civil society organizations in the response to contain the virus. However, we are working on it."
According to Stella Alamo-Talisuna, the executive director of the NGO Reach Out Mbuya Parish HIV/AIDS Initiative, one of the main problems with Uganda's HIV prevention strategy is its neglect of the most vulnerable populations. "We have not focused on high-risk groups. As a country, we don't have programmes that are targeting sex workers, homosexuals...so how can we achieve the target?"
The Crane Survey
, a 2008/2009 study of high-risk groups in Uganda, reported that the HIV prevalence among men who have sex with men
(MSM) respondents was 13.7 percent, significantly higher than the national average. A 2011 study
published in the Journal of the American Sexually Transmitted Diseases Association, found 37 percent of sex worker respondents from Kampala's red light areas to be HIV-positive. The government's HIV prevention programmes do not make provisions for sex workers or MSM.
Experts say the country's failure to fund healthcare will also hurt the plan, and criticized the continued reliance on foreign funding for HIV/AIDS.
"Uganda needs to have the better ownership of the epidemic, including designing programmes that are relevant to the population. We need to fight corruption and mismanagement of HIV funds," said Alamo-Talisuna. "We can't also discuss issues of HIV prevention without addressing the issues of the economy. We still need to eradicate poverty and empower these people."
IDI's Coutinho questioned the political commitment of the country's leaders. "We have a challenge to get leaders to get engaged in the fight against HIV/AIDS. Many leaders don't live by example. They are not visible, vocal," he said.