A brighter future awaits

John Waswa, a long distance truck driver, is a well of information on how each and every one of us can curtail the spread of HIV: By maintaining one partner and using protection when he has more. But Waswa cannot say he practices any of what he preaches.

He says the notion that those of his ilk and multiple sex partners are not separated for long, is true for most in his profession.
“I cannot say I use a condom all the time I have sex. Sex with a condom does not feel good. It is the reason many of us will go ahead without even when we know the risk,” he said.

That would be his business were Uganda not in the middle of combating the HIV/Aids pandemic. But Waswa and his fellow drivers fall in the category of most at risk groups, along with commercial sex workers, fisher men, gay men and recently added, boda boda cyclists. He is also young, not yet 35, and married.

Results of the last indicator survey were a jolt of reality, a reminder that the prevalence rate which had been steadily going down since 1991 had crept back up. It is not as bad as the double digit days. Still, it was enough to raise questions on where we are in the fight against HIV/Aids.

The most at risk groups may not be blamed for all the spread of HIV, though more than once, allusions have been made to the same, but they are an integral part of the story of prevalence on HIV and the progress made on the fight. Prevalence rates among these groups remains worryingly high. They are the reminders of areas where there are still gaps, like low condom use despite improved accessibility and information on the same. UNAids puts condom use in Uganda at a paltry 13 per cent. This is in a country with over one million adults living with HIV.

And risky sexual behaviour seems to continue with reckless abandon among these groups. What is more, behavioural change seems a long way off and it appears misinformation is still rife.
You only have to hear the questions at an HIV sensitisation workshop to understand that half-truths and myths on HIV are still making the rounds. “What if I shower with soap immediately after?” “I heard if the woman is properly lubricated then you cannot contract HIV.”
What this means to Dr Joshua Musinguzi, the programme manager of Aids Control Programme at the Ministry of Health, is more intense efforts are needed to bring intervention closer to these groups.

“As you know, there are efforts through partners to reach these groups, and the response is already good,” he said.
There is an ambitious plan to raise the reach of interventions, structural, behavioural and bio-medical to 80 per cent. And with plans like these, he insists the future still looks bright, all things considered.

“The indicators are up and targets set for 2015 are within reach. Those that do not look achievable next year have been deferred to 2018.
“By then we hope to have increased universal access to care and reduce new infections by 50 per cent,” said Musinguzi. There is also a plan to roll out care to people in most at risk communities who test positive irrespective of CD4 count as was the practice before. And the renewed push for safe male circumcision is an effort to reach a target of four million men. So far 1.5 million men have gone through the process, according to Musinguzi. The hope is that this will definitely have an effect on the overall HIV prevalence rates in the future.

Some successes
What you cannot tell, by focusing on how the prevalence rate seems to have gone up between 2006 and 2010, is that Uganda is still registering successes on other fronts.

A good example is the Prevention of Mother To Child Transmission (PMTCT) which is now Elimination of Mother to Child Transmission (EMTCT).
If the figures from the Ministry of Health are to be believed, Uganda is within sight of its goal of reducing the incidence of HIV positive mothers passing on the virus to their babies to just five per cent.

This means that by 2015, the expectation is that of all children born of HIV positive mothers, 95 per cent will not contract it. New treatment guidelines like putting all HIV positive children from 15 and below under treatment irrespective of CD4 count could mean a rosier picture in the future. This indicates that for Uganda, the success against HIV lies in a series of small victories in all the fronts of intervention, from behavioural to structural, as opposed to one big win. But even in the unlikely event that all efforts pay off and all the goals are achieved within the allocated time frames, he who expects a sharp drop in the prevalence rate is in for a disappointment. At least in the short run.

According to Dr Musinguzi, the success also means that more people will live longer quality lives with HIV. “People will not be dying off. Even when change comes to the figure, it will not be precipitous,” he said. This will impact on the final figure output as HIV prevalence rates.
The number to watch then is the new incidence rate, that is the rate of new infections per annum.
“It is the clearest indicator of how the future looks like for Uganda,” he says. The numbers are promising. 130,000 new cases last year, from 145,000 in 2012, according to...

Still, with the world aiming for zero infections, deaths, and stigma, even a single new infection is one too many. Uganda may be succeeding in keeping those infected with HIV alive for longer which can explain the prevalence rate. But the new incidence rates mean that the battle is far from over.
It is proven that majority of new infections is from risky sexual behaviour. Hence, what Waswa does during his stopovers on the road, behind locked doors, is of utmost importance. It eventually reflects on a national scale.

THE NUMBERS
13
The percentage of condom use in uganda, according to UNaids

2015
The year in which it is expected, that of all children born of HIV positive mothers, 95 per cent will not contract it.

130,000
The number of new infections recorded in 2013 according to Uganda Aids Commission.

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