Uganda confronts AIDS complacency

But that attitude is dangerous in a country that still has rising rates of new annual infections and where at least half of the people who need ART still don’t have access to it.

That’s why public health officials used World AIDS Day – and the days leading up to it – to sound the alarm. To encourage people to remain vigilant in confronting the disease and caring for themselves and their families.

Uganda’s much-heralded success in confronting the spread of the epidemic relied on a two-pronged strategy: a policy that directly confronted the behaviors that were leading to the spread of the disease and the involvement of local spiritual and political leaders in encouraging people to take action. Both of those elements have, to some extent, dissipated.

In his World AIDS Day speech, the Chairman of the Uganda AIDS Commission Vinand M. Nantulya, cited a “deterioration” in the sexual behavior of Ugandans. The reduction in multiple sexual partners – a key driver in reducing Uganda’s prevalence rate –“is no more,” he said.

He also said that “leadership in the fight against HIV/AIDS has remarkably gone missing.” Spiritual and religious leaders, he said, need to reassume their role in helping lead the fight against the spread of the virus.

Uganda’s call echoes a message for United States Secretary of State Hillary Clinton, who announced in the weeks leading up to World AIDS Day that the United States – for the first time – has adopted an official policy of helping produce an “AIDS-free generation.”

“Thanks both to new knowledge and to new ways of applying it, we have the chance to give countless lives and futures to millions of people who are alive today, but equally, if not profoundly more importantly, to an entire generation yet to be born,” she said.

As she rightly pointed out – all of the tools are there: treatment that can virtually eliminate transmission of the virus from mother to child or between discordant couples; male circumcision; and ongoing voluntary counseling and testing programs.

Dr. Richard Nduhuura, the minister of state for health, applauded Clinton’s speech in a press release from the Ministry of Health. He said the speech “has re-energized us in Uganda to work even harder to enhance the implementation of important new scientific findings.”

But just because the science is there, doesn’t mean the money is. The recent announcement that the Global Fund had suspended all new grants until at least 2014 underscores a problematic worldwide trend.

The amount of money available for HIV/ AIDS prevention and treatment simply is not there. So it’s hard to imagine how Uganda, which is already unable to get ART to everyone who needs it, will implement the expanded treatment that new science calls for, specifically among HIV-positive pregnant women and discordant couples.

The government is launching a rapid scale-up of a new PMTCT program, with support from the United States’ President’s Emergency Plan for AIDS Relief. But there are still plenty of gaps in both prevention and treatment.

In this environment, civil society groups are calling on government to ensure that the money Uganda does have is being spent as efficiently as possible. Officials say it is. An ongoing National AIDS Spending Assessment will determine who is right.

In the absence of enough funding, government and health officials are falling back on what worked the first time: Creating an energized and informed public who, through their actions, can keep prevalence down.

And that is certainly important. The problem, of course, is that the situation has changed from the late 1980s and early ’90s. Back then, there were no good answers to give HIV-positive pregnant mothers who were worried about transmitting the virus to their children. Now there are. But if the solutions are not implementable, then how do you convince her to keep her morale up?

by Andrew Green