Uganda is in dire need of a rethink as its HIV/Aids fight reels from a significant scale back of funds from development partners, the country’s spearhead that runs point on HIV prevention and treatment programmes has said. The Uganda Aids Commission (UAC) told the House Committee on HIV/Aids this past workweek that it is sufficiently concerned with the rise in life-threatening infections. The latest statistics show that as of December 2024, Wakiso District had the highest number of new HIV infections. It registered 3,950 new infections, with Kampala’s tally of 1,840 leaving the capital in second position. Buikwe (600), Luweero (560) and Mubende (540) follow in that order.
‘HIV is a complicated disease because it involves sexual pleasure, things that people don’t normally talk about in public. It involves things that happen in the bedroom where you have no control over whether you are a political leader,’ Ms Ruth Ssenyonyi, the UAC board chairperson, said. ‘Even police cannot go in to stop you. That is why it is taking us so long. It is not because we are not doing what we are supposed to do, but it is a very secretive disease.’ While Obongi District from West Nile and the Karamoja districts of Kabong and Nabilatuk registered only 10 new infections, the picture the UAC has painted is suggestive of lost ground.
This, it added, is because of multiple sexual relationships; inconsistent condom use; transactional sex; and low uptake of safe male medical circumcision services.
Other drivers are cross-generational sex involving sugar mummies and sugar daddies; sub-optimal scale-up of Antiretroviral Therapy (ART); poverty; and gender inequalities, including gender-based violence.
‘The communities are not supportive. So, you have young people having jobs, they are living with HIV, but if they ask for a day off to go and line up for antiretroviral drugs, they will lose their jobs,’ Dr Daniel Byamukama, the head of HIV prevention at the UAC, said. ‘You have housemaids; they are in a home, they are scared of telling their employers that they are living with HIV. So, the communities are stigmatising people.’ The freeze on donor funding has also pulled the plug on facilities that initially served as standalone outlets dedicated to extending medical redress to persons viewed as minorities. These facilities handled transgender persons, sex workers, among others.
‘There are many HIV clinics which were standalone outside government hospitals and these were fully staffed by development partners’ support,’ Dr Vincent Bagambe, the director of Planning and Strategic Information at UAC, said. ‘When that support ceased, that is where we experienced the greatest gaps because people who were receiving services from there initially got lost on where they could continue to get these services.’
Stumbling block
The impact of aid cuts has been most felt at the grassroots, where people are skipping vital doses, raising the risk of drug resistance. ‘Donors would support up to the community level with community resource persons, who were either following up patients to ensure they adhere [to treatment] or they help in identifying those who need to be assisted,’ Dr Bagambe said. Post-Exposure Prophylaxis (PEP), a 28-day course of HIV medication that can be started within 72 hours of a possible exposure to the virus to prevent infection, is now out of the reach of many.
‘There are so many challenges to accessing PEP. Our people who get violated, the girls who get sexually abused, people who have had accidents with condom bursts, by the time they get to a health facility, [it is late]. So, we notice that 48 percent of our people who come for PEP arrive after three days [and yet] after three days, it is no longer helpful,’ Dr Byamukama said. ‘So almost 50 percent come too late and the other 30 percent come when it is almost too late. It would be ideal for PEP to be initiated as early as possible.’
Not easy as ABC
Ms Ssenyonyi disclosed that she received reports from a team implementing the HIV/Aids containment measures that the UAC strategies were struggling to fit into the changes occasioned by the technological advancements. ‘Technology has come in, therefore, so many of the methods that were used 10 or so years ago are not as effective,’ Ms Ssenyonyi said. Also pillars upon which the HIV/Aids fight was built appear to be an afterthought for many. ‘When the ABC [Abstinence, Be faithful, use Condoms] was the only backbone of our response [to HIV/Aids], people really abstained, especially the youth; they delayed to initiate sex,” Dr Byamukama noted, adding: ‘People who had already initiated sexual activity became faithful and the number of people using condoms increased significantly. There was no condom before but it had then increased to over 30 percent.’
He further noted: ‘The other challenge is that when donors came in and they were the ones bankrolling our response, they were sceptical. They didn’t believe our story. We brought it up in strategic meetings, but they refused to fund. So, it became silent a bit but as Ugandans, we still believe it works because of the evidence we have.’ He added: ‘Now that the donors have taken away the funding, some of the funding we lost significantly, was funding for prevention and, especially for commodities. Now prevention commodities will not be freely available, we believe it is time to go back to our campaign, the way we did it. We know it worked and we believe it can still salvage the situation.’
What next?
After donors folded the purse, the UAC has been sent back to the drawing board, with majority of the boardroom discussions strongly proposing that the ABC strategy be re-popularised. Mr Tom Etii, the Director of Partnerships at the UAC, now wants the Committee on HIV/Aids to persuade the House to ensure extra funding is availed for the Commission in the Financial Year (FY) 2026/2027 Budget. ‘We have started the budgeting process and we will be bringing to our needs. Thank you for supporting us in the budgeting process for FY2025/2026, we received about Shs4b but it is not enough. The problem is enormous. So we are going to come up with the need that can really substantially address this problem,’ Mr Etti said.
Once sufficient funding is availed, Mr Etii said most effort will be directed towards prevention considering treatment bites tougher on the UAC meagre budget.
‘According to the National Aids spending Assessment (NASA) report of 2023, care and treatment services consumed the biggest budget of 60 percent, while prevention related interventions consumed only 13 percent,’ Mr Etti said, adding: ‘There is need to spend more on prevention services so as to close the tap on new infections.’