6 Combat HIV/AIDS, malaria and other diseases

Where we are?

(UNDP Uganda 2010)
  • Although Uganda has made commendable progress in the fight against HIV/AIDs, there’s a reversal in progress toward achieving this MDG due to a rising number of new infections.
  • New infections are attributed to high population & high levels of risky behaviour with transmission now occurring more commonly in older groups of married or co-habiting members of society.
  • Malaria and tuberculosis also remain issues of concern in the Uganda health sector as they infect and affect various vulnerable groups including children, pregnant mothers and those with HIV/AIDs.

Uganda made commendable progress during the 1990s to reduce the spread of HIV/AIDS. The proportion of pregnant women attending antenatal care clinics who were HIV-positive fell from a high of 18% in 1992 to around 6% in 2000.

The success was due to a variety of measures that enabled changes in sexual behaviour, as well as provision of care and support services. Over that period, the reduction in HIV prevalence was particularly rapid in urban areas and Uganda was one of the first countries in the world to report a decline in the rate of new infections and a contracting epidemic. Prevalence among the youth is the established MDG indicator and, for Uganda, this indicator, measured in the whole population and not just among pregnant women, showed that 2.6% of girls and 0.3% of boys aged 15-19 years were HIV-positive in 2005/2006. Moreover, among those aged 20-24 years, 6.3% of girls and 2.4% of boys were HIV-positive.  The vulnerability of women is most apparent in younger age groups, with young women aged 20-24 almost three times more likely to be infected than young men in the same age group. The main reason for this difference is high-risk behaviour in the sexual relationships between young women and much older male sexual partners, sexual violence and the ability of women to negotiate for safer sex. Unfortunately, there is no comparable data for earlier or later years to provide a picture of how prevalence has been evolving.

Moreover, progress towards halting and reversing the spread of HIV is regarded to be better measured when using data on new infections (incidence). In the absence of direct measures of incidence, the Ministry of Health and its partners rely on epidemiological modelling. However, the data since the late 1990s show a worrying, upward trend in the number of new infections. It is estimated that more than 130,000 people have been infected with HIV so far in 2010.

Hence, while Uganda may earlier on have been well under way to reverse or halt the spread of HIV, the situation today is deteriorating. The overall assessment of progress towards Target 6.A is therefore reversal.

The recent epidemic expansion in the absolute number of new infections is related to high population growth, but indicators also show persistently high levels of risky behaviour (e.g., multiple partners and decreased condom use), and only 32% of young people aged 15-24 have comprehensive knowledge about HIV. The total number of people living with HIV in 2010 is around 1.2 million, which is higher than at the peak of the epidemic in the 1990s. Nationally, the epidemic has also evolved from a mature generalized epidemic, with transmission occurring through casual relationships largely in the 15- to 19-year-old age group, into a heterogeneous epidemic, with transmission shifting to older age groups and among the large group of people who are married or cohabitating. Recent data shows that 43% of new infections occur in this group. Moreover, commercial sex work is thought to be an important bridge of the epidemic into other population groups.

Uganda has made commendable progress in terms of rolling out Anti- Retroviral Therapy (ART), expanding coverage from 44% in 2003 to 54% in 2009. These gains, though, are fragile, as the number of people who need ART grows each year and future financing to expand ART coverage is uncertain. In addition, newly released international guidelines recommend the much earlier initiation of ART; if adopted as government policy, this recommendation would significantly increase the number of people who need ART.

Malaria is responsible for more illness and death than any other single disease in Uganda. People with low immunity, such as pregnant women, young children and people living with HIV/AIDS, are particularly vulnerable to morbidity and mortality associated with malaria. But all people living in Uganda are at risk of being infected with malaria parasites and suffering from resulting illness and potential fatality. In most parts of Uganda, temperature and rainfall are sufficient to allow a stable, year round (perennial) malaria transmission at high levels with relatively little seasonal variability. Only in the high altitude areas of the southwest, west and east is malaria transmission generally low. However, with the increasing threat from climate change, extension of malaria to these highlands could pose a serious challenge. While tremendous progress has been made in the fight against malaria through the improvement of health system performance and increased public knowledge about malaria, increasing resistance to commonly used treatments remains a serious challenge to malaria control.

In 2008, over 110,000 malaria cases were reported, corresponding to 37 per 10,000 in the population. While recent trends have stabilised, rates are high, indeed, significantly higher than in the 1990s, when the number of reported cases hovered around 15,000-30,000 of the population, or 7-14 per 10,000. The rise in the number of malaria cases since 2000 may be related to an increase in health service coverage, improved reporting, the abolition of user fees in 2001, resistance to the commonly available anti-malarial drugs and inadequate coverage of the preventive measures. In recent years, there has been some progress in the implementation of the preventive measures. The share of children under five sleeping under an Insecticide Treated Net (ITN) has increased from 8% in 2000 to 33% in 2009 and access to ITP2 treatment has doubled from 16% to 31% over the three-year period from 2006-2009. However, for both ITN and IPT2+, the achievements fell short of targets. Moreover, still less than 30% of children who needed treatment in 2005/2006 received treatment with appropriate anti-malarial drugs. This had great regional variation, from just over 10% in Kampala to more than 40% in West Nile. One key contributor to the limited access to anti-malarial drugs is the persistently high levels of stock-outs of essential medicines at the country’s hospitals and clinics.

Tuberculosis is another major disease included in the MDG framework and one against which there has recently been much progress. The prevalence of TB has been reduced from 652 per 100,000 in the

population in 2003 to 350 in 2008. Over the same period, incidence has also dropped from 411 per 100,000 in the population to 310. If the current speed of progress continues, Uganda will attain the 2015 goal of a prevalence of 103 per 100,000 in the population. However, TB death rates have stagnated for most of the last decade and so the one-third reduction targeted for 2015 looks unrealistic. Case detection rates have stagnated around 50% in recent years and treatment success rates have fluctuated around 70%. For both indicators, the progress seen since 2006-2007 would have to be sustained if the 2015 targets are to be met. Key challenges in fighting TB include: inadequate financing, lack of qualified laboratory personnel, high HIV prevalence, and the emergence of drug-resistant strains of TB.

Targets for MDG6
  1. Halt and begin to reverse the spread of HIV/AIDS
    • HIV prevalence among population aged 15-24 years
    • Condom use at last high-risk sex
    • Proportion of population aged 15-24 years with comprehensive correct knowledge of HIV/AIDS
    • Ratio of school attendance of orphans to school attendance of non-orphans aged 10-14 years
  2. Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it
    • Proportion of population with advanced HIV infection with access to antiretroviral drugs