Uganda continues to fall short of achieving its goal of ensuring that 80 percent of people living with HIV receive antiretroviral drugs (ARVs) by 2015, according to the Uganda AIDS Commission (UAC).
Some 62 percent of those needing HIV treatment were on ARVs in March 2012, up from 50 percent in 2010. Uganda managed to enrol an estimated 65,493 new HIV cases on life-prolonging ARVs in 2012, bringing to 356,056 the number of those receiving ARVs, according to UAC statistics.
But just 8 percent of these cases were children. A recent government survey has revealed that just 49 percent of infants in need of treatment are receiving it. (The government recommends that all HIV-positive infants under age two receive ARVs.) Some 20,000 to 24,000 children are infected with HIV each year, according to the Ministry of Health.
To improve the prevention of mother-to-child transmission of HIV, the government launched in September 2012 the UN World Health Organization's "Option B+" strategy, which involves giving HIV-positive mothers triple-therapy ARVs as soon as they are diagnosed, and continuing treatment for life, regardless of their CD4 count.
Call for treatment scale-up
Civil society groups have called on the government to scale up treatment and halt new infections.
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“We need to put all the people who are eligible on treatment, and move quickly to provide early treatment for those who are not eligible yet for prevention benefit,” Richard Hasunira, HIV/AIDS adviser for the health rights group Coalition for Health Promotion and Social Development (HEPS)-Uganda, told IRIN/PlusNews.
Recent statistics show that Uganda's HIV prevalence has risen from 6.4 percent to 7.3 percent over the past five years.
Health facilities face frequent drugs stock-outs, inadequate CD4 count machines and understaffing. Additionally, Uganda’s HIV programmes have been hit hard by a funding crunch limiting its ability to operate HIV programmes.
Of the 700 health facilities listed as offering antiretroviral therapy (ART), only 532 were doing so by end of March 2012.
The government acknowledges more must be done, saying it will focus on HIV prevention and allocate more funds to fighting the disease.
“The majority of accredited sites [administering ART] are higher-level facilities such as hospitals and Health Centres IV [county level], while [ just] 8 percent of Health Centres III [sub-county] are active, thus limiting access for rural communities. The situation is worse in hard-to-reach areas, such as the fishing islands,” noted UAC in a recent report.
“There is need to accelerate accreditation of Health Centres IV and III to enable access of ART for eligible individuals, including pregnant women, and health facilities that are accredited and are not functional should be supported to become functional,” it said.
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“We are going to initiate some 214,000 individuals on ART by 2013,” David Apuuli Kihumuro, UAC’s director-general, told IRIN/PlusNews, “We have set an annual target of enrolling a minimum of 100,000 patients on ART.”
“We are going to emphasize prevention in order to reduce new HIV infections. We are embarking on male circumcision, condom distribution and rolling out Option B+,” said Health Minister Christine Ondoa. “The government will continue to allocate funds to fight the epidemic. We shall also mobilize funds from our development partners for universal access, prevention, treatment and care.”
The government has been urged to set up an “AIDS levy” to generate additional revenue for HIV prevention, treatment and care.
“Budgeting by government for the AIDS response must increase as a matter of urgency for the financial year 2013-14 and beyond, prioritizing recurrent costs such as health worker recruitment and retention and procurement of essential commodities rather than trainings, workshops and seminars,” civil society groups said in a statement.
The Ugandan government recently developed a draft working paper on establishing a US$1 billion HIV fund to explore alternative and sustainable sources of funding for its HIV/AIDS programmes.
Sources of funding listed in the paper, released in September by the Uganda AIDS Commission, include levying taxes on bank transactions and interest, airplane tickets, beer, soft drinks and cigarettes, as well goods and services traded within Uganda.
Small fees would also be levied on civil servants' salaries. Corporate and withholding taxes would be increased slightly, and a small tax would be added to telephone calls and to each kilowatt of electricity consumed.