The HIV prevalence in the general population
The number of Ugandans dying from HIV/AIDS-related illness has reduced by 50.7% in one year, according to the new report from the Ministry of Health. This,according to the Minister of Health, Dr Jane Ruth Aceng, is “great progress” in Uganda’s quest towards containing the HIV/AIDS scourge.
According to Dr. Aceng, 31000 people with HIV died in 2014, down from 63,000 in 2013, a reduction of 32,000 deaths. AIDS-related deaths were 67,000 in 2010 and over 75,000 in the late 1980s and early 1990s.
World Wide, AIDS-related deaths have fallen by 45% since the peak in 2005. In 2015, 1.1 million people died from AIDS –related causes worldwide, compared to two million in 2005 according to the joint UN programme on HIV/AIDS (UNAIDS).
Addressing a press conference at Hotel Africana in Kampala on Friday 15/07/2016, Dr. Aceng attributed the success to the increased number of HIV patients accessing anti-retroviral (ARV) drugs, which has also resulted in the stagnation of HIV prevalence.
The Hon. Minister was briefing the media about the forthcoming nationwide survey to generate new data on the HIV prevalence and infection rates.
The $5m (Ug shs 16.6b) Uganda Population HIV Assessment (UPHIA) which starts next month, is being funded by the US Centers for Diseases Control and Prevention(CDC) and the International Center for AIDS Care and Treatment Programs(ICAP) at Columbia University .
The survey targets 33,642 children and adults in at least 13,000 households across the country. Issues such as access to prevention, care and treatment services will also be evaluated.
The Ministry of Health estimates that by the end of 2015, about 1.46 million people in Uganda were living with HIV. The HIV prevalence in the general population increased from 6.4% in 2005 to 7.3% by 2011.
The number of people enrolled on antiretroviral therapy (ART) increased from about 330,000 in 2011 to about 750,896 in 2014.
Standard antiretroviral therapy consists of the combination of the ARV drugs to maximally suppress the HIV virus and stop the progression of HIV disease.
“ART also prevents onward transmission of HIV. Huge reductions have been seen in rates of death and infections when use is made of a patent ARV regimen, particularly in early stages of diseases,” according to the World Health Organization (WHO).
Florence Buluba, the executive director of the National Community of Women Living with HIV in Uganda (NACWOLA), said over half of the 100,000 members of her organization have lived with HIV more than 20 years.
“Only those who get infected with other diseases like cancer and those who do not adhere to treatment have died; those who went on treatment before getting so sick and have adhered , have survived,” she explained.
She, however, decried the intermittent ARV shortages experienced in the country over the years , saying it hampers adherence to treatment .” poor adherence enables the virus to multiply, lowering the patient’s immune system and increasing their chances of infecting others. The Government should expedite the proposed national health insurance scheme to cover ART”, said Buluba.
WHO recommends ART for all people with HIV as soon as possible after diagnosis without any restrictions of CD4 counts. It also recommends giving ARVs to people who do not have HIV, but are at high risks of infection as an additional prevention strategy.
In Uganda, the policy is that HIV – positive people are enrolled on ARVs when their immune system declines to 500 CD4 cell amount or below.
However, the Government rolled out option B programme in 2013 aimed at eliminating mother-to-child HIV transmission. According to the programme, all pregnant women who test HIV positive are put on treatment straight away, irrespective of their immune system as measured by the CD4 cell count.
HIV-positive partners in discordant couples (where only one has HIV and the other is negative) are also put on treatment irrespective of their CD4 cell count.
“This is done first of all to improve their health and protect the other partner who is HIV-negative from getting infected. It has been proved that effective treatment of a person living with HIV suppresses their chance of passing on the virus to their partners by over 96%,” Prof. Vinand Natulya the chairperson of Uganda AIDS Commission, commented.
Other people who qualify for ARVs, irrespective of their CD4 cell counts, are those co-infected with tuberculosis, children under 15 years of age, and most-at-risk populations, such as prostitutes.
“We are slowly moving towards the WHO recommendation of treating all people who test HIV-positive without any restrictions of the CD4 counts. This is important if we are to reach the UN 90-90-90 target,” Nantulya said.
UNAIDS programme has set an ambitious treatment target requiring that by 2020, 90% of all people living with HIV will know their HIV status ; 90% of all people with diagnosed HIV infection will receive sustained anti-retroviral therapy and 90% of all people receiving anti-retroviral therapy and 90% of all people receiving anti-retroviral therapy will have viral suppression.