What you need to know:
- That means investing in affected communities in Uganda to enable them to organise and make their voices heard...
By addressing HIV/Aids related stigma and discrimination, we aim to reduce the risk and the negative impacts on the world’s poorest and most vulnerable people.
In the fight against HIV/Aids , Uganda is at a crucial stage. With the massive scale-up of anti-retroviral treatment, we are saving millions of lives, but the total number of new HIV infections is still unacceptably high.
In addition, despite the success of getting people onto life-saving medication, many people are diagnosed with advanced disease. There have been many successes, but Uganda will not meet the targets of fewer people infected per year by 2025.
As well as saving lives, providing those infected with HIV with anti-retroviral treatment is an essential part of the strategy to reduce new HIV infections. Effective treatment that achieves viral suppression results in “U equals U” — undetectable equals untransmittable. But to cut new infections as a country more swiftly we must tackle the stubbornly high rate of new HIV infections among adolescent girls and young women, and the extremely high prevalence of HIV among key populations.
These two are driven by persistent gender and human rights-related barriers in Uganda.
When women’s rights are violated and when key populations such as sex workers live in a climate of fear, they are unable to access HIV treatment and care services they need.
Uganda will only beat HIV if we acknowledge and take action on the all too pervasive gender-based violence, educational disadvantages, and economic disempowerment that face so many girls and young women.
Likewise, we will only end HIV if we dismantle the human rights barriers faced by key populations. Those barriers, often related to criminalisation and high levels of stigma, simultaneously increase their vulnerability to infection and impair their access to health services.
People from such key populations and their partners now account for over half of all new infections.
We will also only beat HIV if we continue to innovate and accelerate the pace with which successful innovations are scaled up to benefit all those who need them. Bio-medical innovations such as self-testing kits or prep/contraceptive combinations are potentially powerful tools to help reduce new infections in Uganda. Better treatment regimens, longer-lasting, and with fewer side effects, can help improve treatment efficacy in this country.
Just as important are innovations in delivery models and service platforms such as pop-up testing stations at long distance truck stops, differentiated treatment models tailored to the needs of the different key populations, community led services, or social marketing strategies to increase usage of familiar, but still highly effective tools like condoms in most rural and urban areas in Uganda.
To tackle gender inequities and dismantle human rights-related barriers, and to maximise the impact of innovation, we need those directly affected by HIV deeply involved in the design and delivery of products and programmes.
That means investing in affected communities in Uganda to enable them to organise and make their voices heard, to ensure that services are designed for their needs, implemented at their convenience and monitored with community lead monitoring.
We also need to step up investment in capturing and interpreting data. Too often, the data we use in Uganda is out-of-date, insufficiently granular, or based on unreliable or biased estimates; the number of people who inject drugs sometimes reflect policymakers’ wishes about what they would like to be true, rather than the reality. Without accurate, fresh and detailed data, we are flying blind.
Overloaded and weak health systems in Uganda often rely on either paper or fragmented or disjointed health management information systems.
Our investments in data systems as a country need to be accelerated and viewed as part of data systems for health in the era of universal health coverage. Those methods of capturing data, particularly where it relates to key and vulnerable communities, should be built within communities themselves.
Dr Ambrose Byamugisha Muhoozi is the
managing director, Ambrosoli Consult Uganda Limited.