Stigma and discrimination remain widespread across Ugandan communities and continue to undermine efforts to combat HIV, tuberculosis (TB) and malaria, particularly among vulnerable and key populations, a new study has revealed.
The report titled Documentation of Human Rights and Equity Violations: An Assessment of Access to HIV/Aids, TB and Malaria Services by Vulnerable Populations in Uganda, conducted by the Equal Opportunities Commission (EOC) in March, states that stigma remains one of the biggest obstacles to healthcare access across the country.
The study, which covered 40 selected districts and cities, found that discrimination, fear of exposure and social exclusion continue to affect access to essential health services among women, children, youth, persons with disabilities, older persons, people living with HIV, and communities in hard-to-reach and enclosed settings.
‘The findings illustrate how these challenges manifest across diverse contexts and disproportionately affect vulnerable populations,’ the report states.
Beyond stigma, the report highlights persistent systemic weaknesses within the healthcare system, including recurrent drug stock-outs, staffing shortages and inadequate health infrastructure.
These challenges, according to the researchers, continue to compromise service quality and patient confidentiality.
The study documents varying forms of discrimination across districts. In Kasese District, stigma within health facilities, judgmental attitudes from some health workers and poor treatment experiences were found to discourage female sex workers, cross-border traders and young people from seeking healthcare services.
In Busia District, the report notes that truck drivers, female sex workers, men who have sex with men (MSM) and other mobile populations often avoid health facilities due to fear of being identified or targeted.
Meanwhile, fishing communities in Namayingo District face social exclusion and fear of disclosure, factors that have contributed to limited uptake of malaria prevention interventions.
The report notes that fisherfolk, youth and island communities remain particularly vulnerable to infection. In Lwengo and Kalungu districts, fear of disclosure linked to gender-based violence (GBV), household-level stigma and lack of partner support were found to undermine treatment adherence among women, adolescent girls and caregivers.
Speaking about the findings, EOC chairperson Safia Nalule Jjuuko said Uganda has made progress in controlling HIV, TB and malaria, but social and structural barriers continue to hinder efforts to eliminate the diseases.
‘The latest evidence demonstrates that HIV, TB and malaria continue to impose a heavy and unequal burden on different population groups,’ Ms Jjuuko said. ‘Uganda’s greatest remaining challenges are social, behavioural and structural.
Communities still confront stigma, discrimination, mobility constraints, gender inequality, food insecurity, harmful cultural norms, weak social support systems and geographical isolation,’ she added.
The report indicates that TB remains one of Uganda’s leading infectious killers, with an estimated 90,000 new cases recorded annually.
However, more than 30 percent of TB cases remain undetected, raising concerns about continued transmission within communities.
The HIV situation has improved considerably over the years, although challenges persist. According to the Uganda Aids Commission (UAC), the national adult HIV prevalence currently stands at 4.9 percent, with an estimated 1.5 million people living with HIV in the country.
Despite this achievement, the report notes that approximately 100 people still contract HIV every day, translating into nearly four new infections every hour.
Malaria, meanwhile, remains the leading cause of outpatient visits and hospital admissions in Uganda.
According to the report, the disease accounts for about 30 percent of outpatient visits and 20 percent of inpatient admissions nationwide.
Malaria cases
Uganda records between 12 million and 16 million malaria cases annually, with significant variations across districts.
Health advocates say addressing stigma remains critical if Uganda is to sustain gains made in the fight against HIV.
Mr Abdallah Ochoggia, the advocacy and communications specialist at the Aids Information Centre, said many people living with HIV still travel long distances to seek treatment.
‘Many people living with HIV still feel compelled to seek services in distant districts out of fear of being recognised. This disrupts continuity of care and heightens health risks,’ Mr Ochoggia said.
He argued that the Ministry of Health’s strategy of integrating HIV services into general healthcare systems could help reduce stigma and improve access to treatment.
Ms Flavia Kyomukama, the executive director of the National Forum of People Living with HIV/Aids Networks in Uganda (NAFOPHANU), said fear of disclosure remains a major challenge among people living with HIV.
‘Fear of being recognised discourages many individuals from collecting their medication in nearby health facilities,’ she said.