As the country races to end HIV/Aids as a public health threat by 2030, new figures from the Uganda Aids Commission (UAC), show there has been a slight decline in HIV prevalence from 5.1 percent in 2023 to 4.9 percent in December 2024.
The new data also shows that the HIV epidemic is geographically diverse. The prevalence ranges from 7.5 percent in South Buganda Sub-region to 1.4 percent in Karamoja. Details in the report further indicate that South Buganda has the highest HIV prevalence, followed by Acholi, Ankole, Lango, North Buganda and Kampala. The prevalence is generally higher in fast urbanising areas than in rural areas, according to the Commission.
During a press conference at the Uganda Media Centre yesterday, Dr Nelson Musoba, the UAC director general, explained that this is partly driven by high rates of risky sexual behaviour such as not using condoms, having multiple sexual partners and prostitution. There were 1,527,238 people living with HIV (PLHIV) by the end of 2024, with 37,000 people contracting the virus in 2024. There were also 20,000 Aids-related deaths reported in the same year. Despite the high numbers of new infections, Dr Musoba believes the country is making meaningful progress towards the 2030 goal of eliminating the disease as a public health burden.
He said over the past two decades, the increased efforts on prevention, ensuring access to Anti-retroviral therapy (ART) and promoting adherence to medication, have caused a significant decline in HIV prevalence. ‘HIV prevalence is at 4.9 percent from a double-digit figure of 18 percent in the late 1990s,’ Dr Musoba noted. ‘Uganda is winning the war in the fight against HIV/Aids.’
Dissatisfied Canon
Dr Ruth Senyonyi, the chairperson of the UAC Board, observed that the Commission is always looking out for the gaps that can hamper the attainment of the 2030 goal. ‘When we say we are ending Aids by 2030, there are three things we are looking at. We don’t want new infections, and the 37,000 new infections last year are a big number; we should not have that number,’ she said in her remarks at the Uganda Media Centre. She added: ‘We want to go towards zero, making sure we are suppressing the viral load and making sure we don’t have new infections. Then, we also don’t want Aids-related deaths. We don’t want anybody dying from Aids. And it is possible.
People who are living with HIV are on medication, and they are not dying of Aids, and they will not die young. They will die of old age.’ Dr Senyonyi said the other roadblock to achieving the goal is stigma. ‘When there is stigma, people do not go for treatment. People do not go to find medicine. People do not go for tests because they are being stigmatised. Or they don’t say they are living with the virus if they find out they are,’ she explained. ‘Therefore, they don’t go for medication. They still pass on this infection. Therefore, they still have children who are born with HIV,’ she added. Dr Musoba explained why the HIV prevalence appears to have reduced just slightly or even stagnated. He said the prevalence measures the number of people living with HIV (PLHIV) within the general population.
‘So, if the PLHIV are on treatment and treatment is working and they are not dying, that number will be there. If you are having very high new infections, then that number of PLHIV might slightly go up, but if you are doing well in terms of managing new HIV infections and they are going down, then you see a reduction in prevalence,’ he said. ‘Ideally, the prevalence should either remain the same or decrease slightly. If the prevalence decreases significantly, it might be a result of deaths,’ he added. On why the 2023 and 2024 figures both show the Aids-related deaths of 20,000, Dr Musobsa said it means ‘we neither improved nor deteriorated.’
Is the 2030 target within reach?
However, Dr Vincent Bagambe, the head of planning at the UAC, said in an interview earlier that hitting the 2030 target requires increased efforts and adoption of new technologies to improve prevention and treatment. ‘We need to do more to bend the curve of new HIV infections to go down, and of course, also the curve of Aids-related deaths to go down. Our target was that by 2030, we would see less than 10,000 new HIV infections and less than 10,000 Aids-related deaths,’ he explained. According to our analysis of government data, new HIV infections have fallen from 53,000 to 37,000 over the last five years – a drop of 16,000, or about 3,200 each year.
But Uganda now has only five years left to reach the 2030 target. At the current pace of decline, the country could still have about 20,000 new HIV infections in 2030. This also means Uganda may need an extra four years after 2030 to reach the goal of reducing new infections to below 10,000. This means Uganda may require a total of nine more years to hit the elimination target, when counting from 2025. The new data shows that 930,000 females are living with HIV, compared to 570,000 males. New infections are also higher among young people-especially young women and adolescent girls-as well as in urban areas. Ms Jacqueline Makokha, the country director of the Joint United Nations Programme on HIV/Aids (UNAIDS), noted the ‘commendable progress’ in the HIV/Aids fight, but said to attain the 2030 target, there should be a keen interest in addressing the high rates of infections among adolescent girls and young women.
She noted that in 2024, young women aged between 15 and 24 made up 78 percent of new HIV infections among adolescents, while boys in the same age group accounted for only 20 percent. ‘In no way does it mean that young girls have more frequent sexual interactions than boys. We should interpret this in terms of their biological vulnerability in terms of the likelihood of young girls facing sexual and gender-based violence and also in terms of intergenerational sex, where older men are having sex with our young girls, and so these intergenerational sexual encounters expose them to HIV infections,’ she added.
She said their findings show that gender inequality, poverty, and limited access to sexual and reproductive health services continue to increase the vulnerability of young girls. In the 2024 data, young people aged between 15 and 24 alone contributed 14,000, which is more than a third of the 37,000 new HIV infections. Another 4,700 infections in children aged between zero and 14 years were due to mother-to-child transmission of HIV. The two contribute about half of the total new infections.
Innovations
Ms Makokha said Uganda can do better in reducing the rates of new infections and deaths by embracing these five strategies. The strategies greatly focus on young people who are the leading contributors to new infections. ‘The first strategy is that we must scale up sexuality education and empower young people with accurate information,’ she recommended. She said in most countries, knowledge of comprehensive HIV information is only at about 70 percent, a level requiring improvement. ‘Secondly, we have to expand access to HIV prevention tools for young people, including Pre-exposure prophylaxis (PrEP)and condoms, and we must provide testing not just in health facilities, but also in communities and in places where young people are such as schools, higher institutions of learning and others.
We are also encouraging countries to give young girls a choice,’ she advised. ‘In the HIV sector, we have a lot of interventions that young people can use to prevent HIV infections. Let’s give them a choice. There is lenacapavir (an injectable drug for HIV infection given twice a year). This is available,’ she added. Dr Musoba said the government expects to start administering lenacapavir next year. But he said the doses, around 36,000 expected from donors through the Global Fund, will prioritise the high-risk groups, including young women, those in transactional sex and those in discordant relationships. Dr Musoba also revealed that the government is completing estimates for the number of beneficiaries before making an official request for the drug. He said they also expect the private sector to start purchasing the drug, whose cost per person per year has been reduced to $40 (Shs142,000), after the approval by the National Drug Authority (NDA).
But Ms Makokha said the existing interventions shouldn’t be overlooked. ‘We also have condoms. We have the oral PrEP, we have the vaginal ring. Let them get a choice and choose what best suits them to prevent HIV infection,’ she said. She also called for strengthening community-led initiatives that address stigma and discrimination and gender-based violence and ensure young people who face gender-based violence are referred for services, including HIV prevention. ‘Fourthly, we have to invest in economic empowerment programmes for young women and girls to reduce their vulnerability and ensure they remain in school and complete secondary school education,’ she said.
‘Finally, we have to ensure youth participation in policy making and programme design because young people are not just beneficiaries of services; they are leaders, they have knowledge, they know what works, and we have to give them the space to do what best suits them,’ she added. Dr Senyonyi said they are increasing interventions to address stigma and barriers that contribute to the 4,700 new infections in babies through mother-to-child transmission of HIV. She also said they are engaging men, who are the main negotiators for sexual activity, so that they lead in the HIV prevention drive.