This post is by the Global Center’s Rabita Aziz
Musa Bugundu, the UNAIDS country coordinator for Uganda, spoke with global HIV/AIDS advocates yesterday at an event sponsored by the Global Health Council about the current HIV situation in Uganda, making several suggestions about the best ways to move forward.
Bugundu spoke at length about successes in the fight against HIV thanks to political leadership and commitment and funding from PEPFAR and other sources. However, he stressed that much more needs to be done, as there are hundreds of thousands of HIV infected individuals who have no access to treatment. Bugundu warned that with the recent flat-lining of funding and the proposal of harmful legislation in Uganda like the Anti-Homosexuality Bill, the progresses made against the epidemic may be reversed.
At the peak of the AID crisis in Uganda in 1992, HIV prevalence was 18 percent among adults. This number has now stabilized to 6.4 percent. At present, over 350,000 persons are in need of care, with just over half of the infected population receiving treatment. Twenty two percent of HIV infected pregnant women are transmitting the disease to their newborns, and the prevalence rate among children is .7 percent.
Bugundu stressed that reducing mother-to-child transmission rates is a critical component of the HIV response because vertical transmission can easily be prevented given that the right resources are present. In addition to applying resources to such concrete endeavors, Bugundu stressed that attitudes toward women and children must be changed. There should be a renewed focus on treating women and young girls more equitably, he said, and the well-being and development of young girls should be a priority. He said it is deplorable that people do not see any negative impacts of the practice of child marriage and consequently, child pregnancy. He said the culture must be changed so women and girls are not like treated like second-class citizens, which places them at a higher risk for contracting HIV.
Bugundu went on to say that “a combination of culture and religion makes things difficult.” He said that the messages sent to young people to abstain from sex and to be faithful are ineffectual, and that people need to face reality of the numbers: 43 percent of new infections occur in monogamous, heterosexual couples. This is one reason why the Anti-Homosexuality Bill, proposed by MP David Bahati last October, is so appalling, he said. In 2008, less than 1 percent of new infections occurred in same-sex couples.
In 2007, Parliament had criminalized homosexuality. The new bill goes further and aims to prosecute not only HIV infected individuals who transmitted the disease, but also to punish individuals who fail to report another person’s homosexual orientation to authorities. This would mean that doctors, religious leaders, teachers, and others must turn in a gay or lesbian person, or face three years in jail.
Bugundu said if adopted this provision would have a very negative impact on the HIV situation in Uganda, as those infected with HIV would stop seeking help for fear of being imprisoned, which in turn would result in more people becoming infected. Bugundu credited pressure from the international community as playing a key role now in watering down the scope of the bill.
But he said the entire bill must be removed as a way to deal with the HIV situation. In addition, there must be renewed commitment from political leaders, who must take more ownership of the HIV response, he said.
Along with more financial support, African leaders should be held more accountable by donors for their actions. In addition, he said, there should be more integration of services as the fragmentation of services has proven to be detrimental.
He gave several suggestions on the best ways ahead, including the scale up of male circumcision, the scale up of ARV treatment, and more efforts put towards reducing stigma and discrimination against those who are infected.