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Articles

Renewed War on HIV Pays Off

By Professor Vinand M Nantulya, MD, PhD, FRCPath.

Chairman, Uganda AIDS Commission

Published in the New Vision Newspaper, August 12, 2013, Page 17

Anxiety has been raised recently by the UNAIDS global report on the status of the epidemic which was comparing the number of new infections in 2005 to that in 2013. This analysis clearly showed that in Uganda the number of new infections in 2013 was much higher than that of 2005. This we already knew. Uganda is now dealing with the second wave of the epidemic which started around 2002. However, the report did not go further to look at the progress Uganda has made in tackling the second wave of the epidemic. His Excellency the President commented on the progress we are making in a speech given on Budget Day. The message from His Excellency was that Uganda was beginning to make positive gains in the fight against the second wave of the epidemic as shown below.

Uganda was once the beacon of hope in how HIV/AIDS can be controlled, with a marked decline in the number of new infections recorded each year ranging from as high 230,000 in 1988/89 to around 80,000 by 1996. The key factor for this success was the remarkable decline in the practice, among both the men and women, of engaging in sex with several partners, driven by “zero grazing” campaign. Unfortunately, the epidemic later got out of control and new infections started to rise from 2001, driven by the return of the behavior of sex with several partners. This reversal of sex behaviour, most pronounced among males, was due to the high degree of complacency about HIV infection caused by focus on treatment and the lopsided investment in biomedical interventions to the near-exclusion of sex behaviour interventions. Thus it came as no surprise that the number of new infections rose again, reaching levels observed in 1990.

This situation was extremely worrying. Uganda responded bravely by developing and implementing a new HIV/AIDS Strategic Plan (2011-2015) and an aggressive HIV Prevention Strategy (2011-2015). These efforts have begun to yield positive results. The number of new infections reported for 2013 dropped to 137,000 compared to 170,000 recorded in 2011 (19.4% drop); the number of new babies born with HIV dropped to less than 8,000 in 2013 compared to 26,000 in 2011(69% drop). In some specific programmes such as the HIV/AIDS outreach programme run by the Mbuya Catholic Church in Kampala, no baby has been born with HIV in the last 3 years. I congratulate the gallant mothers for their determination to have their babies born without HIV; the husbands for standing up to support their partners; the supporting mothers for encouraging your colleagues to accept and adhere to treatment; the staff for commitment to serve fellow citizens; to the United States Government for support to this programme; and the First Lady, Hon. Janet Museveni for most ably championing this drive to eliminate, nationwide, transmission HIV to newborn babies.

It is heartening also that the number of people currently enrolled on anti-retroviral treatment has increased dramatically. By end of last year it stood at 577,000. In 2013 alone, 193,000 patients were initiated on treatment. Thus for the first time in our country the number of patients placed on treatment in one year exceeded the 137,000 new infections recorded in the same year. Epidemiologists regard this as the tipping point in our renewed war on HIV/AIDS. Government, our Development Partners and the programme implementers are aiming higher and higher. This year alone we plan to put another 240,000 patients on anti-retroviral treatment.

Enrolling people living with HIV/AIDS on anti-retroviral treatment has three major benefits:

a) for HIV-positive pregnant mothers, transmission to the babies is blocked while the health of the mother is also guarded so she can bring up her baby;

b) for our citizens born with the infection and those who acquire it in adult life, treatment restores their health, allowing them to live a productive life so that they can support themselves and their families;

c) and as we put more people on treatment we shall suppress the volume of virus circulating in the community and thereby protect even more people. Research has shown that if an HIV infected person is put on treatment early and adheres to it, the virus levels in blood can be suppressed to a point that you significantly reduce transmission of the virus to others.

Finally, we have observed also that as we enroll more people on this life-saving treatment, death due to AIDS and related conditions has begun to fall. The number of Ugandans who died of AIDS and related conditions fell from 66,000 in 2011 to 56,000 in 2013. This will go further down as we put more people on early treatment.

In Part II of this article I shall discuss what more we need to do to sustain the decline of new infections.

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