Every year, 130,000 new infections are reported, and donors are growing weary and restless, as they consider the prospect of an ever-rising cost of keeping thousands of infected people alive. The national HIV strategic plan, for instance, targeted a 40 per cent reduction in new infections by 2012. This would be 100,000 infections annually.
According to Ministry of Health estimates, the country is still registering close to 130,000 new infections every year—a surplus of over 30,000 new cases above the target, causing leading experts to warn that unless critical interventions are put in place, the epidemic could be moving in a reverse direction.
So, what has gone wrong with Uganda’s anti-HIV campaign?
Speaking at a public forum on HIV/Aids, as part of Makerere University’s 90th anniversary celebrations, Dr Alex Coutinho, who heads the Infectious Diseases Institute, said multiple factors were behind the rise in Uganda’s HIV prevalence.
While there was a time when the government made HIV a major national concern, it is no longer the case among the political leadership.
Dr Coutinho says the leaders have not been speaking enough about HIV/Aids. Their support for the campaign is not as visible and vocal as it used to be in the early years of the epidemic.
“Often times, leaders don’t do by example. When was the last time you saw leaders coming forward to be publicly tested for HIV/Aids? When have we seen leaders—the men coming out publicly to be circumcised,” he asks.
Although President Museveni has played a key role in leading the fight against HIV/Aids, Dr Coutinho says Uganda has several other leaders the people listen to, but who are not contributing much to the campaign against the scourge. He also accuses the government of having failed to direct programmes to the rural areas, which are a key driver of the epidemic.
“In fact, most of the movement (of HIV/ Aids) in the wrong direction is coming from rural areas. There are some programmes that we are not putting particularly to rural populations that are accounting for this rise from five to seven per cent,” he asserts.
There is also the question of double-standards. Married women can’t abstain and are expected to be faithful, so they can’t use condoms. But many men are not faithful or even expected to be. What’s more, the economic and social disempowerment of women forces them to remain in high-risk relationships, making it hard to achieve much progress.
On the other hand, Uganda also appears to be a victim of its own success, officials say. News of the early success and the comfort created by the availability of antiretroviral drugs that help postpone the onset of Aids have led to complacency and a return to risky sexual behaviour.
As a result, fewer people are using condoms regularly and more people, including married people in long-term relationships are taking on multiple sexual partners.