prevalence rate among 13-19 year olds in Masaka, Uganda
Uganda reverses the tide of HIV/AIDS
Uganda's success in reducing high HIV infection
rates is the result of high-level political commitment to HIV prevention
and care, involving a wide range of partners and all sectors of society.
Same-day results for HIV tests and social marketing of condoms and self-treatment
kits for sexually transmitted infections, backed up by sex education
programmes, have helped reduce very high HIV infection rates.
Uganda, one of the first countries in sub-Saharan Africa to experience
the devastating impact of HIV/AIDS and to take action to control the
epidemic, is one of the rare success stories in a region that has been
ravaged by the HIV/AIDS epidemic. While the rate of new infections continues
to increase in most countries in sub-Saharan Africa, Uganda has succeeded
in lowering its very high infection rates. Since 1993, HIV infection
rates among pregnant women, a key indicator of the progress of the epidemic,
have been more than halved in some areas and infection rates among men
seeking treatment for sexually transmitted infections have dropped by
over a third.
In the capital city Kampala, the level of HIV infection among pregnant
women attending antenatal clinics fell from 31% in 1993 to 14% by 1998.
Meanwhile, outside Kampala, infection rates among pregnant women under
20 dropped from 21% in 1990 to 8% in 1998. Elsewhere, among men attending
STI clinics, HIV infection rates fell from 46% in 1992 to 30% in 1998.
Success in reducing the prevalence of HIV in Uganda is the result of
a broad-based national effort backed up by firm political commitment,
including the personal involvement of the head of state, President Yoweri
Museveni. From the outset, the government involved religious and traditional
leaders, community groups, NGOs, and all sectors of society, forging
a consensus around the need to contain the escalating spread of HIV
and provide care and support for those affected.
Sex education programmes in schools and on the radio focused on the
need to negotiate safe sex and encouraged teenagers to delay the age
at which they first have sex. Since 1990, a USAID-funded scheme to increase
condom use through social marketing of condoms has boosted condom use
from 7% nationwide to over 50% in rural areas and over 85% in urban
areas. The social marketing scheme involved sales of condoms at subsidized
prices or free distribution by both the government and the private sector.
The scheme was also backed up by health education and other public information.
Meanwhile more teenage girls reported condom use than any other age
group -- a trend reflected in falling infection rates among 13-19 year
old girls in Masaka, in rural Uganda. And among 15-year-old boys and
girls, the proportion who had never had sex rose from about 20% to 50%
between 1989 and 1995.
Condom use is also being encouraged among men who seek treatment for
sexually transmitted infections. A new innovative social marketing scheme
to promote the use of an STI self-treatment kit ("Clear Seven") has
proved to be successful in treating STIs and preventing HIV infection.
The kit, which contains a 14-day course of tablets, condoms, partner
referral cards, and an information leaflet, is designed to improve STI
treatment rates, prevent over-the-counter sales of inappropriate treatments,
encourage partner referral, and reinforce condom use. The distribution
system relies on the use of small retail outlets which are normally
licensed to sell over-the-counter drugs but not antibiotics. The Ugandan
Government has waived these restrictions to promote sales of Clear Seven,
marketed at the subsidized price of US$ 1.35, and trained shopkeepers
in the management of STIs. As a result, cure rates for urethritis have
increased from 46% to 87% and condom use during treatment has more than
doubled (from 32% to 65%).
Another innovation in Uganda was the launch in 1997 of same-day voluntary
counselling and testing services. Up till then, clients had to wait
two weeks for their HIV test results and up to 30% failed to return.
Thousands of people who have taken advantage of same-day testing have
since been recruited and trained as peer educators. So far, 180 000
people have been reached by the scheme and over a million condoms distributed.
In Uganda, as elsewhere in sub-Saharan Africa, AIDS has caused immense
human suffering over the past two decades -- setting back development
and reducing life expectancy. Over 1.5 million children have been orphaned
since the epidemic began -- losing their mother or both parents to AIDS.
Today there is hope that the tide can be turned at last.