The Human Immunodeficiency Virus (HIV) is a retrovirus that infects cells of the immune system, destroying or impairing their function. As the infection progresses, the immune system becomes weaker, and the person becomes more susceptible to infections. The most advanced stage of HIV infection is acquired immunodeficiency syndrome (AIDS). It can take 10-15 years for an HIV-infected person to develop AIDS; antiretroviral drugs can slow down the process even further.
An estimated 36.9 million people have HIV. More than 34 million people have died from the virus, making it one of the most destructive pandemics in history in Africa.
HIV is transmitted through unprotected sexual intercourse (anal or vaginal), transfusion of contaminated blood, sharing of contaminated needles, and between a mother and her infant during pregnancy, childbirth and breastfeeding.
HIV and AIDS responses should be integrated into all aspects of Concern programmes. By addressing HIV related stigma and discrimination, we aim to reduce HIV risk and the negative impacts of AIDS on the world’s poorest and most vulnerable people.
Now we must maximize the impact of these extra resources. We owe it to the taxpayers behind them. Even more, we owe it to those affected by and vulnerable to HIV, TB and malaria to grab this opportunity to achieve a decisive shift in the trajectory of the epidemics.
In the fight against HIV, Uganda is at a crucial stage. With the massive scale-up of anti-retroviral treatment, we are saving millions of lives, but the total number of new HIV infections is still unacceptably high. In addition, despite the success of getting people onto life-saving medication, many people are diagnosed with advanced disease. There have been many successes, but Uganda will not meet the targets of fewer people infected per year by 2025.
As well as saving lives, providing those infected with HIV with anti-retroviral treatment is an essential part of the strategy to reduce new HIV infections. Effective treatment that achieves viral suppression results in “U equals U” — undetectable equals untransmittable. But to cut new infections as a country more swiftly we must tackle the stubbornly high rate of new HIV infections among adolescent girls and young women, and the extremely high prevalence of HIV among key populations. These two are driven by persistent gender and human rights-related barriers in Uganda.
When women’s rights are violated and when key populations such as sex workers and men who have sex with them live in a climate of fear, they are unable to access HIV treatment and care services they need. These people are also unable to adhere to treatment in Uganda.
Uganda will only beat HIV if we acknowledge and take action on the all too pervasive gender-based violence, educational disadvantages, and economic disempowerment that face so many girls and young women. Girls and young women age 15-24 in Uganda are twice as likely to be HIV-positive compared to young men of the same age, and in the hardest-hit districts adolescent girls’ account for more than 80% of new HIV infections in their age group. This is a result of the stark structural gender inequalities that make girls and young women so vulnerable to infection, inhibiting young women from seeking health services and from making informed decisions about their sexual and reproductive health and lives, affecting their ability to protect their health and prevent HIV in Uganda.
Likewise, we will only end HIV if we dismantle the human rights barriers faced by key populations and other men who have sex with prostitutes, people who inject drugs, sex workers and transgender people. Those barriers, often related to criminalization and high levels of stigma, simultaneously increase their vulnerability to infection and impair their access to health services. People from such key populations and their partners now account for over half of all new infections. Recently, countries such as Russia and the Philippines are seeing the incidence of new infections increasing at an alarming rate driven by policy and service access barriers and the persistent stigma and discrimination this generates. Additionally, we must address the challenge of late access to services for many heterosexual men.
We will also only beat HIV if we continue to innovate and accelerate the pace with which successful innovations are scaled up to benefit all those who need them. Bio-medical innovations such as self-testing kits or Prep/contraceptive combinations are potentially powerful tools to help reduce new infections in Uganda. Better treatment regimens, longer-lasting, and with fewer side effects, can help improve treatment efficacy in this country.
Just as important are innovations in delivery models and service platforms such as pop-up testing stations at long distance truck stops, differentiated treatment models tailored to the needs of the different key populations, community led services, or social marketing strategies to increase usage of familiar, but still highly effective tools like condoms in most rural and urban areas in Uganda .
To tackle gender inequities and dismantle human rights-related barriers, and to maximize the impact of innovation, we need those directly affected by HIV deeply involved in the design and delivery of products and programs. That means investing in affected communities in Uganda to enable them to organize and make their voices heard, to ensure that services are designed for their needs, implemented at their convenience and monitored with community lead monitoring.
We also need to step up investment in capturing and interpreting data. Too often, the data we use in Uganda is out-of-date, insufficiently granular, or based on unreliable or biased estimates; the number of people who inject drugs sometimes reflect policymakers’ wishes about what they would like to be true, rather than the reality. Without accurate, fresh and detailed data, we are flying blind. Overloaded and weak health systems in Uganda often rely on either paper or fragmented or disjointed health management information systems.
Our investments in data systems as a country need to be accelerated and viewed as part of data systems for health in the era of universal health coverage. Those methods of capturing data, particularly where it relates to key and vulnerable communities, should be built within communities themselves.
Investing in communities and in data systems are two examples of where the fight against HIV necessarily involves strengthening overall systems for health. Another is supply chain: having the capacities and infrastructure to ensure consistent supply of the required medicines — avoiding out-of-stocks or overstocks — is a vital part of any antiretroviral program, but also essential for the primary health care system as a whole.
Dr. Ambrose Byamugisha Muhoozi
The Author is a Managing Director, AMBROSOLI CONSULT UGANDA LIMITED.
Email: ambrosoli.consult@gmail.com
