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IRIN PlusNews HIV/AIDS News and information service | East Africa | UGANDA: UNGASS - good HIV/AIDS information but too little prevention | Care Treatment, Prevention | Focus
Saturday 16 December 2006
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UGANDA: UNGASS - good HIV/AIDS information but too little prevention


[This report does not necessarily reflect the views of the United Nations]



©  Richard Lough/IRIN

The government maintains that its policy has never shifted from ABC

KAMPALA, 26 May (PLUSNEWS) - Uganda has failed to meet two of the three HIV prevention targets set by the United Nations General Assembly Special Session (UNGASS) on HIV in 2001, according to a UN World Health Organization (WHO) official in the Ugandan capital, Kampala.

"The only one Uganda is hitting is access to information on ways of preventing the transmission of the HIV," said Dr Abdikamal Alisalad, an HIV medical officer with WHO. "According to last year's nationwide sero-status survey, more than 90 percent of Ugandans could identify one or two ways of preventing the sexual transmission of the virus.

Uganda participated in the 2001 UNGASS HIV Declaration of Commitments and has since sought to achieve a 25 percent reduction in the number of HIV-positive people aged 15-24; a 20 percent reduction in infants born HIV positive; and 90 percent awareness among young people of how to stop the spread of the disease. Only the last of these goals has been met.

The country's fight against the pandemic during the 1990s was widely considered a success story, when the country's pioneering 'Abstain, Be faithful, use a Condom' strategy - commonly known as ABC - brought the prevalence rate down from over 20 percent to about six percent by the end of the decade.

Over the past five years HIV prevalence rates have stagnated. The 2004-05 Uganda sero-survey established an overall adult prevalence of 6.4 percent, compared to 6.1 percent in 2000 and 6.2 percent in 2002.

MORE PMTCT NEEDED

The greatest challenge facing Uganda is the bid to curb mother-to-child transmission of the virus. A separate report published by the Uganda AIDS Commission, assessing the country's progress in achieving the UNGASS commitments, found that just 12 percent of HIV-positive pregnant women received antiretroviral [ARV] treatment in 2005, double the figure for 2003.

An HIV-positive pregnant Ugandan woman has a 30 percent chance of passing the disease to her newborn infant. "To lower this figure you need PMTCT [prevention of mother-to-child transmission] services such as testing, counselling and ARV provision at antenatal clinics," said Alisalad. "This is an intervention that we are gradually expanding to rural areas, but it will take years before all health centres can provide this kind of service in Uganda."

There are now PMTCT services in all districts. "Women are receiving HIV tests at antenatal clinics, but many who test positive feel they can't tell their family and community members, and so refuse treatment," said Rosemary Kindyomunda, acting policy director at the Uganda AIDS Commission. "So we are looking to target both husband and wife throughout testing, counselling and treatment process."

The threat of a possible rise in HIV prevalence rates, coupled with a failure to meet the midway targets set by UNGASS, has prompted what health officials are calling a 'rapid assessment' of Uganda's prevention strategy in 2006.

POLICY ADJUSTMENTS

The government has been criticised in some quarters for shifting the emphasis of its fight against the pandemic, under the perceived influence of the United States and evangelical churches, from condom use to abstinence and fidelity, which critics claim is having an adverse impact.

In August 2005 the UN Secretary-General's special envoy for HIV/AIDS in Africa, Stephen Lewis, accused the US of jeopardising Uganda's struggle to curb AIDS by cutting funds for condoms while promoting abstinence. "To impose a dogma-driven policy that is fundamentally flawed is doing damage to Africa," he commented.

Last year, the United States channelled US $148 million through PEPFAR - the US President's Emergency Plan for AIDS Relief - to Uganda; this year the figure is expected to reach $170 million.

The US maintains that any perception of skewing national policy is wrong. "The US government's HIV-AIDS programmes aimed at preventing the sexual transmission of the disease have followed the ABC framework that Uganda established - not the other way around," Alyson Grunder, a Kampala-based US public affairs officer told PlusNews.

American policy, Grunder said, was to mount comprehensive prevention programmes that targeted all three components of ABC.

"The condoms procured for Uganda by the US government increased from seven million in 2001 to 47 million in 2005," the official said in response to suggestions that US policy neglected adequate attention to condoms. "The condom message has not been blunted; it has been targeted at populations most at risk."

Uganda's Ministry of Health maintains that government policy has never shifted from ABC, and says equal weight is given to all three elements of the approach.

Echoing the US government's stance, Alex Kamugisha, Minister of Health in charge of primary health, said Uganda had adopted the ABC strategy more than 20 years ago - long before the US began funding abstinence programmes.

"For younger primary school children, the appropriate thing is to focus on abstinence, but later we teach them all the ways to avoid contracting the disease, including the use of condoms," he said.

Health officials are beginning to wonder whether the recent stagnation in prevalence rates is the result of pouring too much money into HIV/AIDS treatment and not enough into prevention.

Uganda's Minister of Health, Jim Muhwezi, said more than 70,000 HIV-positive people were currently accessing anti-AIDS drugs, surpassing the target of having 60,000 on ARVs by 2005.

Alisalad maintained that prevention has not been forgotten, but attention has been diverted to treatment to achieve the United Nations target of three million HIV/AIDS sufferers globally receiving ARVs by 2005 - known as '3 by 5'.

He feared that focusing too much attention on treatment was akin to closing the stable door after the horse had bolted. "Even with all the money being poured into the treatment of HIV, we still only have half of those who require ARVs in Uganda receiving antiretroviral drugs."

[ENDS]




 
Recent UGANDA Reports
An HIV/AIDS campaign in crisis?,  4/Dec/06
HIV/AIDS rising amid extreme poverty of north's IDP camps,  21/Nov/06
Interview with Maj Felix Kulayigye, defence force spokesman ,  15/Nov/06
Funding shortfall to affect health programmes,  7/Nov/06
Marching for abstinence,  3/Nov/06
Links
· AIDS Media Center
· The Global Fund to fight AIDS, Tuberculosis & Malaria
· International Community of Women Living with HIV/AIDS
· AEGIS
· International HIV/AIDS Alliance


PlusNews does not take responsibility for info in links supplied.


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