1.5 million Ugandans killed by Aids since 1982

It is World Aids Day, an important occasion to reflect on how much the scourge has ravaged Uganda.
According to the Ministry of Health, between 1.5 million and 2 million people have died of HIV/Aids-related ailments since 1982.

When the disease started to ravage humans, Ugandans mistook it for witchcraft or some misfortune because medical science then had no answers to it.
As a result, the Health Ministry reports, an estimated 1.8m children have been orphaned by the disease.
In the earlier years, the places which were first hit, especially Rakai and greater Masaka area, saw a surge in child-headed families, eventually attracting international attention.
Aids tends to mostly kill people in their most productive years, who leave behind young children that tend to increase the dependency burden on relatives who adopt them. This has serious implications for economic growth.
The open approach to HIV/Aids prevention, powered by the injection of billions of dollars by international players into the anti-Aids effort, has seen new infections drop to 60,000 per year as of 2017, down from more than 130,000 in 2012.
But, Dr Joshua Musinguzi, the head of HIV programme at the Ministry of Health, warns that, millions are still at risk of getting infected and the infection rates could balloon further.
He says the most vulnerable group to new infections at the moment are young women and adolescent girls, particularly those who engage in sexual activities with older men.
He says older men are hardly testing for HIV and/or enrolling on medication, yet the girls who engage in sexual activities with them are barely empowered to insist on protected sex. This year, the World Aids Day is marked under the theme, “Know Your Status”. The aim is to get everyone to test for HIV so that treatment options can be availed to those who are positive while those who are negative may be encouraged to keep that way.
Research findings released in 2013 by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, USA, indicated that HIV/Aids-related deaths in Uganda slightly increased between 2005 and 2010 when the disease was responsible for 16.6 per cent of Ugandan deaths and 17.2 per cent, respectively.

Drop in deaths
The findings, published in the peer-reviewed journal AIDS, however, noted that there had been a drop in the deaths by 2010, where less than 48,250 died of the same per year.
By last year, the number of people who die of HIV-related illnesses had dropped further to 26,000, according to the Ministry of Health.
Dr Musinguzi says: “Uganda has had strong programmes on HIV treatment and prevention over the last decade with more people being enrolled for antiretroviral (ARV) treatment, counselling and testing, male circumcision and others.”
But with ARVs in place, it would be expected that the number of deaths would be much lower.
Dr Jaqueline Balungi, the clinical manager of Baylor-Uganda, a not-for-profit organisation providing HIV healthcare treatment for children and adults, says many of the HIV-related deaths lately result from delayed diagnosis, especially among babies who are born with the virus.
“People are still dying of HIV because they don’t know. You can not be out there sexually active and you do not know your status,” Dr Balungi says.
Other HIV/Aids death occur due to issues such as drug fatigue owing to side effects, depression and stigma, which she says forces some people to give up on medication and resign to death.
HIV-infected individuals are supposed to take one big tablet daily for those on the first line of treatment. If that fails, they are switched to the second line requiring one to take up to six tablets a day. The third line treatment course may require one to take up to nine tablets a day.

Mental stress
Once one tests HIV-positive, they are destined to take medication every day for the rest of their lives, or else submit to an early death.
The shock of the HIV positive diagnosis, combined with the drug load, stigma and things such as relationship breakups usually lead to mental health problems like depression, anxiety and substance abuse disorders.

These also expose HIV patients to early death since they cannot ably adhere to their medication.
A study by Dr Eugene Kinyanda of Uganda Virus Research Institute (UVRI) Aids research unit on HIV-positive adults in Entebbe found that 8.1 per cent of people had major depressive disorder. Of these, 7.8 per cent of people were at moderate to high risk of suicide.
There is, however, no documented number of people who die of HIV-related mental illness in Uganda annually accept the few researches that explore the relationship between the two.

The cancer scourge

Exposure. HIV/Aids has also exposed more infected people to non-communicable diseases, especially cancer given the fact that it weakens their immunity more so for those who delay to start taking their drugs. Cancers, including cervical and Kaposi Sarcoma, are the commonest among people living with HIV/Aids.
For example, 10 per cent cases of Kaposi Sarcoma cases are reported by people living with HIV/Aids, according to the Uganda Cancer Institute (UCI). Kaposi Sarcoma is a cancer type that causes patches of abnormal tissue to grow under the skin, in the lining of the mouth, nose, and throat, in lymph nodes, or in other organs, Dr Fred Okuku, a consultant Oncologist at UCI, says Kaposi Sarcoma is one of the cancers that had been dormant but the number of people suffering from it started going up on the coming of HIV/Aids in the early 1980s.
“The immunity against cancer is usually destroyed by HIV. In other cases it’s because the virus that causes cervical cancer is spread in the same way as HIV,” Dr Okuku explains.
As a result, cancer usually quickens the death of people living with HIV given the fact that 80 per cent of cancer patients in Uganda die within five years after diagnosis.
Also pointing at late diagnosis as the major factor that exposes people living with HIV to cancer, Dr Okuku says most patients with cancer usually don’t know they are HIV-positive until they are diagnosed.
Not in active care.

According to Ministry of Health at least, 180,000 infected people are not in active care of HIV/Aids despite the increased testing services and free access to medicine across the country.
The ministry has also not given a clear reason why the numbers are not on treatment yet government has since started a test and treat policy that leaves no one out as long as they test positive.
The country is also still grappling with the challenge of retention of expectant mothers living with HIV/Aids on treatment as statistics have indicated that majority stop coming for treatment after their first antenatal visit. As a result, they transmit the disease to the babies who die after birth due to late treatment
“Countrywide, about 94 per cent of pregnant mothers come for the first antenatal visit, but this drops to only 40 per cent of pregnant women who attend all the four previously recommended visits during pregnancy,” a ministry of Health document of elimination of mother to child transmission services states
Reduction in transmission.

Uganda has since registered a reduction in the transmission of HIV from mother to child from 25,000 babies in 2009 to 4,000 in 2016.
Absconding of HIV-positive mothers from health facilities during is still hindering the country’s target to eliminate mother-to-child transmission which exposes many babies to death.