Efficacy of Ugandan HIV prevention programs decreasing

The efficacy of Uganda's HIV prevention programs is decreasing because a new generation of young people are no longer receiving the messages of fidelity that helped curb the country's HIV epidemic in the late 1980s and early 1990s, the Washington Post reports.

Uganda previously was successful at curbing the spread of HIV with messages promoting sexual fidelity and a "fear" of the virus rather than through messages promoting condom use, abstinence, HIV testing, drug treatment and stigma reduction, according to the Post.

In the mid-1980s when Ugandan President Yoweri Museveni first became aware of the epidemic, a campaign to urge Ugandans to have one sex partner began. According to World Health Organization, the number of Ugandan men reporting three or more nonmarital sex partners decreased from 15% in 1989 to 3% in 1995.

However, in recent years the percentage of Ugandan men who have multiple sex partners has doubled. In addition, sexually transmitted infections among women have increased, which often is a sign of risky sexual behavior, according to the Post.

New HIV cases in Uganda are being recorded five times faster than physicians are able to provide antiretroviral drug access for newly diagnosed people, the Post reports.

In addition, some Ugandans say that the government's HIV/AIDS programs have become "complacent," according to the Post. Museveni was praised for the country's early HIV/AIDS programs in the 1990s, but the president "has gotten a bit bored with the AIDS story," spokesperson John Nagenda said.

Museveni resisted condom promotion programs in the 1990s, saying that condoms offered false hope that the epidemic could be curbed without reducing the number of multiple sex partnerships, and the government in 1991 banned condom advertising.

Sam Okware, a health official who designed the country's early programs, said Uganda's HIV programs have "adapted too much to international guidelines instead of sticking to our own methods, which were very controversial at first but which worked."

The country later adopted a plan to distribute condoms throughout the country, and the focus of HIV prevention programs shifted from fidelity to condom use, according to the Post. Okware called the shift a "mistake," adding, "That message was loud and clear."

HIV prevalence among adults in the country is about 7%, according to a 2004 study, and AIDS-related illnesses are the No. 1 cause of death among Ugandan adults, the Post reports (Timberg, Washington Post, 3/29).

At least 70,000 HIV-positive people in Uganda who need antiretroviral drugs do not have access to them, Apolo Kansiime, the Ministry of Health's AIDS Control Program officer, said recently, Uganda's Monitor reports.

Speaking at the Eastern Annual Meeting for the HIV Basic Preventive Care Package, Kansiime said that of the 160,000 HIV-positive people who need treatment in Uganda, about 90,000 have access to it. He added that about one million people are living with HIV in the country.

The meeting brought together more than 15 HIV/AIDS care and support organizations to discuss ways to reduce opportunistic infections among people living with the disease.

Kansiime called on the organizations to collaborate with the health ministry to control the spread of HIV in the country, to slow the onset of AIDS among HIV-positive people and delay the need to begin treatment.

According to Kansiime, unless action is taken to prevent new HIV cases, the number of people living with the virus in Uganda could increase from one million to between 1.5 million and two million.

Kansiime also expressed hope that the Basic Preventive Care Program would help to improve the health of people living with HIV/AIDS.

According to program manager Lillian Ssekabembe, more than 49 organizations have partnered to implement the program, which is designed to deliver information and key health interventions, such as condoms and insecticide-treated nets, to those living with HIV/AIDS and their families (Kitimbo, Monitor, 3/26).