Report lists hurdles in HIV/Aids fight

Officials at the Uganda Aids Commission (UAC) have said they are registering stagnation in HIV/Aids figures and a decline in condom use, contrary to the country’s ambition of ending the disease by 2030.

According to the information contained in the Annual Joint Aids Review Report released in Kampala yesterday, a total of 51,516 new HIV infections were registered in the 2022/2023 financial year, a figure which is more than double the government’s target of reducing annual HIV infections to around 20,000.

In the same report, the number of Aids-related deaths was 17,337 in the 2022/2023 financial year, a figure which is also very high when compared to the government’s target of reducing annual Aids-related deaths to at least 10,000.
Dr Daniel Byamukama, the UAC head of HIV prevention, while commenting on the progress in the HIV/Aids fight, said there is an urgent need for all citizens to increase effort in the fight.

“We notice that the rate of reduction in the number of new HIV infections is not good enough to enable us to attain our commitment of ending Aids as a public health threat by 2030,” Dr Byamukama said.

“If we were on track to end new HIV infections by 2030, we should be having less than 20,000 new HIV infections per year by now, but we now have more than 51,000 new HIV infections per year, which is still very high,” he added.

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The HIV prevention boss blamed the high rates of infection on risky behaviours and the refusal of some persons on Anti-retroviral drugs (ARVs) to adhere to medication.

He said low adherence to medication causes an increase in viral load and risk of transmission during sexual intercourse, and a high death risk for the patient.  

“We notice the negative high-risk behaviour, including multiple sexual partners, a significant number of men are leaving their spouses and engaging in sexual activities with other women. An ever-increasing number of women are engaging in extramarital affairs,” Dr Byamukama said.

“We are seeing an increasing number of young people initiating sexual activity as early as 15 years. We charge the parents not to abandon their responsibility of parenting and guiding their children –children are now initiating their sexual activity very early,” he added.

According to the Uganda Demographic and Health Survey (UDHS) report for 2022, 31 percent of adult men and 10 percent of adult women reported having sexual intercourse with more than one partner in the last 12 months.

Still in the UDHS report, for young people aged 15-24 years, 32 percent of males and 24 percent of females reported having sexual intercourse before the age of 15.

Dr Vincent Bagambe, the Uganda Aids Commission (UAC) director of planning and strategic information, said condom use in the country also reduced.

“One of the observations was that the number of condoms that we used in the country this year is lower than what we have been using in the past. For example, in 2022, we used 189 million condoms but based on this report, this number has now reduced to 141 million,” he said.

“This is a serious drop because condoms are a key tool in the prevention of HIV/Aids. If people are not using condoms but at the same time are engaged in risky sexual behaviour, that increases the risk for new HIV infection.

“Use of a condom is a very tricky indicator to measure because when people are using condoms, you are not there to count. So we use a proxy indicator. Every time people have used a condom, they ask for more. So, if we have distributed 141 million, the assumption is that only 141 million have been used. The distribution is based on the need, when they want more, then we distribute,” he added.

However, in the Annual Joint Aids Review Report, the number of new HIV infections reduced slightly from 52,000 in the 2021/2022 financial year to 51,516 in the 2022/2023 financial year.

Dr Peter Wakooba, who heads monitoring and evaluation at UAC, said there are more interventions other than condoms that are used to curb infections.

“You cannot use one intervention to explain the number of infections. We had abstinence, being faithful to sexual partners, and condom use (ABC) which worked before ARVs came. Now, we are talking about more than one million people on ARVs,” he said.

“And we have 94 percent viral suppression which means the risk of transmission has reduced. The gaps in condom distribution may be in the last mile, but the problem is not so dire that it is going to affect the number of new infections. But we want a Uganda where if you want a condom, you can access it and afford it,” he added.

Condom distribution
However, in the copy of the report, through the “Total Market Approach (TMA), a total of 210,060,121 condoms were distributed in the 2022/2023 financial year, an increase of 16 percent compared to 181,574,979 distributed in the 2021/2022 financial year.” This is higher than the figures given by Dr Bagambe.

The TMA, according to the Global HIV Prevention Coalition, refers to “the three sectors- public, social marketing and commercial sector – working together to “grow the condom market” and meet the needs of the different segments of the population.”

However, in the report, the Aids-related deaths increased slightly from the 17,000 reported in the 2021/2022 financial year to 17,337 in the 2022/2023 financial year.

“Regarding the number of Aids-related deaths, in our plan, we had estimated that if we implement the interventions, we put people on treatment, these people adhere to their medication then we will see the number of deaths by people due to HIV/Aids-related illnesses reducing to less than 10,000 per year,” Dr Bagambe said.

“But we are seeing in our report that the number is still at 17,000 cases (deaths) per year. We think that the reason why we are not seeing that decline as expected is the delay in seeking treatment and they start their treatment late.
“If you start your treatment late, the risk is high that you are more likely to die even when you have just started your medication. But there is also another group of people, who have started their medication, especially among adolescents and young people, and then they abandon their treatment. Which means the virus then relapses and then it affects their health and they can die,” he added.

Dr Bagambe also said there are still many opportunistic infections that kill HIV patients.

“We have tuberculosis (TB), the biggest killer of people living with HIV/Aids. They are not checking for TB. We have people on Anti-retroviral drugs who have diabetes, so if they are not taking their medicines for diabetes and they are not holistically being checked, all those are risks that can put their lives in danger,” he added.