New Fears in Uganda's Fight against AIDS

New Fears in Uganda’s Fight against AIDS
By Ellen Schnier

The number of new HIV infections worldwide in 2007 was 2.7 million people, and of those, 1.9 million live in Sub-Saharan Africa, according to the UNAIDS Outlook Report for 2009. Two thirds of all people living with HIV/AIDS are in Africa. The crisis in Uganda reaches nearly every family and orphans many children. According the World Health Organization in 2008, AIDS is the leading cause of death in Africa. After aggressive efforts to stop the spread of the disease, Ugandan officials have been very successful in reducing the infection rate in Uganda from 30% in the 1980s and ‘90s to around 6%.

Campaign to Reduce HIV Infection
Sandra Kiapi, Executive Director of the Action Group for Health, Human Rights, and HIV/AIDS (AGHA), says the Uganda government sponsored a massive campaign through the media and schools to educate people about how HIV is contracted and to promote behavioral change and abstinence. One of the reasons Uganda has been successful, she says, is because some people living with AIDS came out openly, declared their status and served as living examples. “If the public is aware about the facts, they will know how to deal with it,” says Kiapi.

According to Dr. David Serwadda, Dean of Makarere University School of Public Health in Kampala and specialist in AIDS research, political leadership has been the key to Uganda’s success. Other African countries, like Swaziland, Zimbabwe, and South Africa, have much higher rates of infection and have not been as successful in reaching all areas of Uganda.

Weary of seeing many people infected, Kiapi says, “We need to ensure that future generations are HIV free.” While HIV/AIDS is a relatively new disease, young people in Uganda have been touched by the virus their whole lives. They cannot remember a time when there wasn’t AIDS. To eradicate the deadly virus, messages of prevention target the younger generation.

Seth Kibet Kigen, a Kenyan who studies Computer Science at Makarere University, says there are several campaigns aimed only at young people. Organizations use peer counseling groups because young people are more receptive to their peers. Government-sponsored sporting events reach out to the youth to educate them about the virus, and some music and films encourage young people to practice ABC (Abstinence, Be faithful, and use a Condom).

A New Group is Affected
When HIV became an epidemic, the demographic with the highest infection rate was single adults. In the past few years, the pendulum has swung, and the prevalence of new infections of HIV is highest for married couples and people in long-term relationships. According to the Uganda AIDS Commission, approximately 43% of new infections are occurring in these groups, which were once considered “low risk.”

Dr. Serwadda says this is rooted in the cultural expectation that married couples will be unfaithful, and this demographic is not being targeted with educational messages. “The messages and the programs are not keeping pace with the changes, and in the process, a lot of people are getting infected.”

There is a stigma associated with contracting HIV, according to Florence Ntakarutimana, who is a counselor for the African Great Lakes Initiative (AGLI) and works with East African women with AIDS. “Many people have fear to do the blood test because once they are known as HIV positive, they are rejected by their families, communities, and jobs. They are hated.” Even married people shy away from being tested, for fear of the implications of their results.

New Fears
Awareness campaigns have been extremely successful in reducing the infection rate of HIV in Uganda. There are new fears that the virus could become more widespread. With the development of antiretroviral drugs (ARVs), people who contract HIV today live longer and more comfortably than those living with the disease in previous years. The drugs are now widely available in Uganda and other African countries, meanwhile decreasing some of the fear associated with getting AIDS.

“[Fear] was one of the factors that contributed to the reduction of the infection rate because people were frightened by the effects of the disease,” says Kigen. Without that fear, many Ugandans have relaxed their practices of prevention.

“There are people who say HIV is no longer a problem since there are the ARVs. They say to have HIV is a way of being rich,” comments Ntakarutimana. The health care system in Uganda is insufficient, and many people cannot afford to get treatment. People with HIV receive basic care (along with AIDS treatment) from aid associations.

In addition to the increased use of ARVs, the message of prevention has been replaced by information about getting tested and treated. Dr. Serwadda says, “As more financial resources have become available [from the United States and other nations] to treat HIV, less is available for HIV prevention.” The focus of the message has shifted, which leaves many fearful there will be a new surge of infections. Without the knowledge of how HIV is contracted and effective measures of prevention, Ugandans are at greater risk of infection.

Many scholars, including Dr. Serwadda, point to political intervention as an explanation for this shift in focus. For example, PEPFAR, The U.S. President’s Emergency Plan For AIDS Relief, was established in 2003 and is the largest monetary commitment by any nation to combat a single disease. This money has been used successfully to treat people living with HIV/AIDS, including access to ARVs. Funds are specifically allocated to the Uganda government to promote abstinence, and some fear the message of prevention has suffered. In response to this controversy, many non-governmental organizations, religious organizations, and researchers have focused on treating the disease instead of prevention to avoid political interference.
HIV/AIDS is still a very serious health risk in Uganda, and most people who research or treat patients believe the government has weakened their message of prevention.