Uganda’s HIV/AIDS Experience and Interventions

Jesse Kagimba, MD, M.Sc.

Senior Presidential Advisor (HIV/AIDS)

UGANDA

Introduction

Over the centuries disasters and pestilences have been visited on mankind. These have left him baffled asking the question why?

The latest are the Tsunami waves which hit the countries around the Indian ocean, killing so far more than 150,000 people , affecting 5,000,000 and destroying property. All in within 7 hours.

Let us observe a minutes silence for the victims.

Effects of the Asian Tsunami in Aceh

The HIV/AIDS pandemic 1982 Ugandans were confronted with a mysterious killer disease

later called SLIM. As the cause was unknown, speculation was rife as to whether it was

a punishment from God, a curse, or witchcraft.

This was not different from the western Scientists who had narrowed on the “4 Hs” namely Haemophiliacs ,Homosexuals, Heroine and other drug addicts and lastly Haitians!

Since then The disease now called AIDS has claimed more than 23 million lives world wide 3 million in 2003 alone, The equivalent of 133 of the recent Tsunami or 20 Tsunami in 2003 alone.

Questions

Why did Uganda have one of the highest HIV prevalences at the beginning?

Has this prevalence really gone down? If yes, was it due to sexual behaviour change? If yes, was the sexual behaviour change natural or due to

interventions? If yes, what were the interventions? Is this achievement sustainable? Is this modest success replicable elsewhere in Sub-Saharan Africa ?

Why did Uganda have one of the highest HIV prevalences at the beginning?

Epidemiological context• Who, where, when, why and then what? Dealing with the why

The history of sexually transmitted diseases in Uganda• Pre-antibiotic era (1900-1940)• The era of sexual emancipation (1952 -1985)

o The introduction of antibiotics (1940, world war II)o The discovery of the contraceptive pill (1952)

• The HIV/AIDS era (1981-2003).What happened in Uganda

Interventions against HIV/AIDS in Uganda

By the mid 80s almost every adult Ugandan new of someone with AIDS or had lost a friend or relative to it.

Scientists had identified the causative organism and the main routes of transmission, mainly heterosexual sex in Uganda.

The political and Health leadership starting with President Museveni had internalised the problem, opened up and spread the message , “AIDS KILLS BUT IT CAN BE PREVENTED EASILY”

Was the Sexual Behavioural Change Natural or due to Interventions?

Why do people change from risky health behaviour?

Was the Sexual Behavioural Change Natural or due to Interventions?

Why do people change from risky health behaviour?Awareness of the of severity of the disease

Awareness of susceptability to the disease

Awareness of options for positive action

Instilling “Fear” but providing options for survival

the “ABC option” Made it clear AIDS/SLIM is caused by a virus The disease was fatal and had no cure. Its main mode of transmission was sexual, and it was easier

for each individual to avoid quite unlike other airborne, water-borne or vector borne infections.

Two options were available namely Abstaining or Being faithful to one partner “Zero-grazing”, later a third one, Condoms for those continuing with risky behavior.

This is the ABC Model

President Museveni on condoms

“Just as we were offered the “magic bullet” in the early 1940s, we are now being offered the condom for “safe sex.” We are being told that only a thin piece of rubber stands between us and the death of our continent. I feel that condoms have a role to play as a means of protection, especially in couples who are HIV-positive, but they cannot become the main means of stemming the tide of AIDS.”

President Museveni,1991 address VII Int.AIDS Conf.Flore Italy

What were the other interventions?

Treatment of Sexually transmitted infections Public awareness campaigns against stigma and

involvement of PLWA Making blood Transfusion and injections in health

settings safe Establishing of VCT services Empowering women Improvements in the economy and general security

sub-Saharan mine workers in one of the “improved” men’s hostels

Did the Ugandan HIV Prevalence Really come Down?

Was it due to Sexual Behaviour Change?

Sexual partnerships in unmarried by age:% with non-regular partners in last 12 months

0%

20%

40%

60%

80%

100%

Uganda Kenya Zambia Malawi

15-19 20-24 25-29 30+

males

0%

20%

40%

60%

80%

100%

Uganda Kenya Zambia Malawi

females

Uganda has much fewer non-regular partnerships across all ages

DHS data compiled by Stoneburner and Low Beer (2000), contained in “Non-Condom Behaviors and the Reduction of Incidence and Prevalence in Zambia and Uganda: Background Materials for a Discussion on the Future of Social Marketing”(AIDSMARK briefing book

sent to all PSI global field offices May 2002)

Is this Achievement Sustainable?Change of public perception of HIV/AIDS

News of Uganda’s Success, has it gone to our heads? Familiarity with the disease and loss of fear for it. Toning down of awareness campaign messages to

avoid fear. Misunderstanding of ARVs thinking they cure. Exposure of the youth to pornography through the

media. Lack of experience with HIV/AIDS especially among

the new generation.

Complacency/Fatigue has set in among the :

Political and community leadership Public health leadership The general public New public priorities eg. Politics, development

issues and entertainment. The public media concentrating on these. The prevalence has stagnated at 6% last two years,

might be going up some places.

But is Uganda’s modest success replicable elsewhere in sub-

Saharan Africa

?

YES