About 200,000 more Ugandans will require antiretroviral therapy by 2015 but a looming funding crisis makes it unlikely that they all will receive the life-saving treatment, an official has said.
That projection, coming on the World Aids Day, poses an enormous challenge for the country, says Dr Kihumuro Apuuli, the head of the Uganda Aids Commission. The number of new infections is increasing every year, but funding is leveling off. The only solution, he argued, is for Uganda to become much more serious about preventing spread of the disease in the first place.
“The challenge is already huge, and if we don’t change course and address the problem of HIV/Aids prevention, then it’s going to be hard to sustain the free treatment programme in the years ahead,” he warned. “The resources are already limited so we should start looking at the biggest source of new infections and target them.” Noting that most new infections are occurring in people aged 30-40, he added that “current strategies may not work for them. We must change”.
Dr Apuuli’s comments come on the heels of a new report by UNAIDS, the joint United Nations Programme on HIV/Aids, that said Uganda has stopped making gains against the disease. Instead, more Ugandans are becoming infected every year.
Currently, about 1.2 million Ugandans are HIV-positive, and 540,000 are eligible for treatment under current treatment guidelines, which were developed by the World Health Organisation. But only about 240,000 actually receive treatment.
Funding is not the only reason that many go untreated. Many HIV-positive people do not know their HIV status, and others begin therapy but fail to remain on treatment. One thing is clear, though: with 110,000 new infections occurring per year, Uganda will not be able to treat everyone who needs medication. “Your problem is getting bigger, while our budget is about the same,” said Lynne McDermott, the spokesperson for PEPFAR, the US HIV/AIDS programme. PEPFAR provides about $300 million for HIV/AIDS programmes in Uganda, about 70 per cent of the funds spent to fight the disease here. Other countries contribute an additional 15 per cent. HIV/Aids activists believe the Ugandan government should contribute more. While acknowledging that its contribution did rise from about Shs69b to Shs277b in the past year, they say much more is needed.
“The donors will most likely eventually tire of supporting a community whose government doesn’t seem to care that much, even though they evidently have the capacity to contribute more, given the Pajeros and four-wheel cars they are purchasing,” said Dr Stephen Watiti of the National Forum of People Living with HIV/AIDS Networks in Uganda.
Mr James Kigozi, the Uganda Aids Commission spokesperson, believes donors’ past largesse made Ugandans complacent.
“HIV was considered as priority but not one requiring immediate government attention as it was initially viewed to have tremendous donor support,” he said. But now, he acknowledges, Uganda faces a funding crisis unless the government assumes more responsibility.
Most experts agree that more money alone will not solve the problem, though. They say more attention needs to be paid to prevention. US President Barack Obama himself made that point in a meeting with African leaders in August. “We’re never going to have enough money to simply treat people who are constantly getting infected,” Mr Obama said. “We’ve got to have a mechanism to stop the transmission rate.” McDermott put it more bluntly. Noting that condoms are cheaper than drugs, she said: “You have got to do a better job at prevention. You can’t treat your way out of this problem.”