Need for fresh prevention strategy to tackle 'evolving' epidemic

As Uganda's AIDS epidemic matures, bringing altered behaviour patterns, prevention messages must be adjusted to reflect the new dynamics of the pandemic, senior health officials have said.

"The landscape has changed; it's important to understand what is driving the epidemic," Dr David Apuuli Kihumuro, director-general of the Uganda AIDS Commission, told IRIN/PlusNews. "We have carried out a detailed analysis and found that while the biggest number of new infections used to be in the 20 to 24 age bracket, it is now in the 30 to 40 bracket."

He said women aged 30 to 35 were now the group at greatest risk, while among men it was those aged between 35 and 40; married people were now at greater risk of contracting HIV than previously.

"Studies show that a significant number of new infections through marital sex are because, over the past four years, men have increased their number of sexual partners, be it wives or girlfriends," he commented.

The uptake of voluntary counselling and testing has also remained low, with only 20 percent of the population aware of their HIV status, despite the fact that more than one million people are thought to be infected.

Uganda's previous reliance on the ABC - Abstinence, Be faithful and use a Condom - approach to prevention, saw HIV prevalence decline from over 20 percent in the early 1990s to six percent in 2000.

However, the country's fight against HIV has since been dogged by controversy, with a nationwide condom shortage after the government imported defective ones in 2004, and allegations that the authorities have placed increasing emphasis on abstinence and faithfulness over condoms as a prevention strategy.

A recent upward curve in the infection rate - it now stands at 6.7 percent - has alerted policymakers to the need to modify prevention strategies to fit the changing face of the epidemic. "We are in the process of developing a communication strategy that will address the new dimensions of HIV," Kihumuro said.

Declining to give details of the new strategy, Kihumuro said more information would be available before the end of the year.

Uganda also has a less-than-satisfactory record in the prevention of mother-to-child transmission (PMTCT), with only 30 percent of pregnant women being tested for HIV and just 38 percent giving birth in health centres.

"There is almost universal attendance at antenatal clinics but, when it comes to delivery, women prefer to use traditional birth attendants," Kihumuro said. "These women are the ones we need to target in the new strategy."

Justine Nankinga, programme officer for PMTCT in the Ministry of Health, told IRIN/PlusNews that while the demand for HIV testing among pregnant women was high, there had been a shortage of testing kits.

"Sometimes women live far from the health centres and find it difficult to walk there when their pregnancy is advanced," she said. "We are incorporating traditional birth attendants into our programme; they encourage women to go to the centres, and are also trained to administer Nevirapine [an antiretroviral (ARV) drug that reduces the risk of mother-to-child transmission] to mothers and babies."

Kihumuro said the introduction of ARV treatment had altered people's perception of their HIV risk, a factor that also needed to be taken into consideration for prevention purposes.

"Recently, there has been more emphasis on treatment than on prevention," he said. "Statistically, however, for every one person enrolled on an ARV regimen, there are six new infections - we cannot afford to ignore prevention."

At a recent stakeholders meeting in the capital, Kampala, Kihumuro said the country would need more than US$300 million to reverse the spread of HIV.

The task of raising money has been made more difficult by the decision of the Global Fund to fight AIDS, Tuberculosis and Malaria to exclude Uganda from its current round of grants after the discovery that previous funding had been misused.

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