The Struggle Against HIV/AIDS In Uganda

visit web geneva;”>The findings of an Institute of Medicine (IOM) study panel noted that the campaign has “met or surpassed” many of its goals to expand treatment to people living with HIV, about it give care to those with AIDS and provide prevention options to those at risk of infection.

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PEPFAR is striving to reach 6 million people with HIV antiretroviral treatment (ART), while the current scope of the program reaches some 5 million persons with the lifesaving medications.

Panel members announced their conclusions at a briefing held at the National Academy of Sciences, IOM’s parent institution, in Washington. Panel member Jennifer Kates said PEPFAR’s efforts to care for people with AIDS and their dependents are exceeding the goals.

The program target is to reach 12 million people with care services, Kates said, while PEPFAR is now “supporting care for nearly 15 million, including more than 4.5 million” orphans and vulnerable children.

The care of children — hundreds of thousands orphaned after their parents died of AIDS — was an urgent priority when the program began in 2003, and PEPFAR has “provided unprecedented support” for that vulnerable group in subsequent years.

Conceived during the administration of President George W. Bush, PEPFAR was the largest effort ever made by a government to address a single health problem. The concept was new and untested, but the IOM report validates the approach and the results it has achieved: millions of lives saved and improved.

“I think essential to those working in HIV, [PEPFAR has] provided proof of principle that you can do this,” said Kates. “You can successfully scale up a large program in countries with high disease burden.”

Significant doubt existed in the early years of the last decade that such an endeavor was possible, Kates said. PEPFAR began in 2003 as a $15 billion program, but U.S. investments in AIDS relief have now grown to more than $37 billion in bilateral aid. The United States has also donated more than $7 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

“We are proud that the IOM stated that PEPFAR has played a transformative role in the global response to HIV,” said Eric Goosby, the U.S. global AIDS coordinator who oversees PEPFAR. “We stand ready to continue to play this role as we work with our partners across the globe to create an AIDS-free generation.”

The Obama administration announced its intent on World AIDS Day 2012 to work toward an AIDS-free generation, a strategy based in part on more effective prevention methods.

“That’s the only way to get ahead of this epidemic,” said Ann Kurth, a committee member from the New York University College of Nursing. An AIDS-free generation can only be achieved when prevention efforts are so expansive that new infections are minimal and are exceeded by the number of new people receiving ART therapy.

The IOM committee worked four years to develop the report, which is about 700 pages long. Panel members conducted more than 400 interviews with people working in PEPFAR activities and made trips to 13 countries in South America, Africa and Asia to study implementation of the programs in stricken regions.

PEPFAR was evolving while the study was in the making, so a number of actions it recommends are already being undertaken. Long-term success in keeping disease at bay, the report says, will depend on countries making a transition.

Rather than recipients of emergency assistance, they must become stewards of health care systems that routinely provide the services of treatment, care and prevention.

A report summary indicates that process is well under way. “Already PEPFAR has improved the function of health systems. It has strengthened laboratories [and] bolstered the reliability of supplies and essential medicines.”

The training of hundreds of thousands of health care workers achieved under PEPFAR is another step in this direction, the report says.

Now that the urgency of the AIDS crisis has ebbed slightly, Kurth said, countries receiving PEPFAR assistance must place a greater focus on outcomes, such as reducing infections, reducing deaths, helping patients adhere to a care routine and increasing access to HIV testing.

“While our work is far from finished,” according to Goosby, “we believe our best days lie ahead as we work with the global community to help countries reach the tipping point in their epidemics, and sustain their AIDS responses over time.”

Ugandan context

However, in November last year, health experts raised a red flag over the recorded increase in HIV/AIDS prevalence in Uganda from 6.4% in 2004 to 7.3% in 2011.

The alarming results were tabled before legislators at a dialogue organized by the Parliamentary Committee on HIV/AIDS to address the resurgence of the pandemic in Kampala November 26.

Dr. Joshua Musinguzi, the Programme Manager of the AIDS Control Programme in the Ministry of Health said the recent statistics indicate a reversal in the gains the country had attained during the last three decades.

He confirmed that the HIV/AIDS burden stood at 1.3 million people with 145,294 new infections recorded in 2011. Uganda lost 62,365 people to HIV/AIDS in 2011 according to statistics released by the Ministry of Health.

Research conducted by Global Health Action in 2010 showed that majority of students at the prestigious Mbarara University of Science and Technology in southwestern Uganda were “sexually active.”

“1,179 students (60.3% of the study population) reported that they were sexually active,” the organisation reported in their findings.

Of these, 199 (18.6%) did not use contraception in their last sexual encounter. Students currently not in a relationship had higher odds of non-use of contraception (odds ratio 1.8, 95% confidence interval 1.2–2.7).

The objective of the study was to determine the relationship between non-use of contraception and socio-demographic factors, alcohol consumption, and types of partner(s) among Ugandan university students.

In 2010, 1,954 students at the campus participated in a cross-sectional study whereby a self-administered questionnaire was used to assess socio-demographic factors, alcohol consumption, and sexual behaviour including the use of contraceptives.

More than half of the world’s population is less than 25 years old and approximately 85% of this demographic segment lives in low- or middle-income countries.

The sexual behaviour of such young people has become a crucial social and public health concern, especially with regard to unintended pregnancies.

Attending the 5th Joint AIDS Review/7th Partnership Forum Conference at Imperial Royale Hotel in Kampala in October Ethics and Integrity, Minister Simon Lokodo, said government had increased its contribution in the HIV/AIDS response to $65 US dollars in the financial year 2012.

He further said government would add more 100,000 HIV patients on the service of ARV’S so as lives of Ugandans are not left to perish.

Prof. Vinand Nantulya, Chairman Uganda Aids Commission (UAC) also recently called upon leaders at all levels to play their role in sensitizing HIV/AIDS in Uganda.

“I urge cultural, religious and political leaders to get back in the field because there is a new HIV battle that has increased the rate of HIV/AIDS prevalence in Uganda,” he said.

“We need to strengthen the health systems in Uganda by focusing on all the districts especially the remote villages where there is still a high rate of HIV/AIDS,” he added on.

Shocking findings

It is estimated that 41% of all pregnancies globally are unintended and 39% occur in Africa.

According to World Health Organization (WHO), the lifetime risk of death due to pregnancy is 1:22 in sub-Saharan Africa, with adolescents facing a higher risk of morbidity and mortality than older women.

The bio-social gap, explained as the early onset of puberty and increasing age of marriage, has widened in most low-income countries.

This has led to an increase in pre-marital sexual activity, which exposes vulnerable youth to the risk of unwanted pregnancies and sexually transmitted infections (STI).

“Pre-marital sexual activity seems to be increasing among university students in Asia and Africa as a result of many factors, such as rapid urbanisation and exposure to mass media (5–8),” said Global Health Action.

“Nearly half of Uganda’s inhabitants are below the age of 15, and 20% are between 15 and 25 (9). Poor mental health, sexual coercion, low trust in others, and increased university enrolment are associated with risky sexual behaviour among university students (10–12).” Non-regular partners, unprotected sex, and cross-generational sex among university students were reported for this group in a recent study.


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