Increasing HIV Incidence in Uganda – Education Efforts Aimed Towards Women

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The HIV incidence rate in Uganda was the third highest in Sub-Saharan Africa in 2014.  There are 1.5 million people living with HIV and a 7% HIV prevalence. uganda-2015

As is shown in the graph below, HIV prevalence decreased in the 1990s; however, since the introduction of anti-retroviral drugs, HIV incidence has been increasing.  People have become more careless in their sexual practices as they now believe that if they contract HIV, they can simply take anti-retrovirals and live a long and prosperous life.

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HIV is transmitted through body fluids to include blood, semen and breast milk.  The main interventions have previously focused HIV transmitted through sexual contact and educating on condom use and condom distribution.  However, the key drivers of HIV incidence are the following: 1.) high risk sexual behavior, to include early sexual debut, multiple sexual partners, and inconsistent condom use; 2.) low individual level risk perception; 3.) high STI prevalence; 4.) low utilization of antenatal care and breast feeding education; 5.) safe male circumcision services; 6.) sub-optimal scale up of ART; and 7.) gender inequalities including gender based violence.  Further, the rate of HIV is higher in women (8.3%) than in men (6.1%).

A comprehensive policy that attempts to address the many issues that face women would greatly assist in lowering the incidence rate in Uganda.  In an effort to stay aligned with President Museveni’s National HIV and AIDS Strategic Plan 2015/2016 – 2019/2020, President Museveni should also write and enforce an education policy to be implemented in the local hospitals around the country.  (See link for more information on the National HIV and AIDS Strategic Plan 2015/2016 – 2019/2020 nsp2015.)

This education policy should attempt to deliver key health messages specific to the key drivers that affect HIV incidence in women and children, specifically early sexual debut, multiple sexual partners, antenatal care, and gender inequalities.

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5 Responses to “Increasing HIV Incidence in Uganda – Education Efforts Aimed Towards Women”

  1. sbfphc Says:

    The authors note that, “since the introduction of anti-retroviral drugs, HIV incidence has been increasing.” The graph shows the beginnings of a decrease in 2013 and Avert.org states that, “The number of new HIV infections in Uganda increased by 21% between 2005 and 2013. However, infections are now reducing and fell from 140,000 in 2013 to 83,000 in 2015.” Ideally the graph should be updated to include 2014 and 2015 to show current trends. https://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/uganda. The number in 2014 was 95,000 http://www.unaids.org/sites/default/files/country/documents/UGA_narrative_report_2015.pdf. The basic premise of the Blog that health education must continue is very important and Avert.org identified several key groups for such education: MSM, Sex Worker and Adolescent girls and young women. Unfortunately stigma remains a problem. Other interventions must continue to grow including medical male circumcision, PMTCT and condom use.

  2. lpc2972 Says:

    I stand with sbfphc’s comment/reference on the facts. Certainly majority of the new HIV infections occur among adolescent girls in HIV epidemic areas, but worldwide in the past 20 years, the percentage of HIV+ people who are female has stayed the same.

    According to the WHO data, worldwide (global) percentage of adults (15+) living with HIV who are female (high-risk) since 1996-2016 has not changed much.

    “Two regions have experienced slight increases in the proportion of women among people living with HIV in the past decade or more: Latin America (35% [29–41%] in 2010 versus 32% [26–41%] in 2001) and North America and Western and Central Europe (26% [23–33%] in 2010 versus 25% in 2001 [22–28%]). Elsewhere the proportion has hardly shifted.”
    http://apps.who.int/iris/bitstream/10665/44787/1/9789241502986_eng.pdf

    This is not to say that the persistence of HIV in countries like Uganda should be ignored, but this issue should be addressed from an education, policy, accessibility, and social perspective. Before we discuss increasing the use of condom use, PMTCT, or other resource intensive interventions, it will be crucial to assess the country’s willingness and financial allocation priorities, and help them understand how HIV has been impacting the country (financially, socially, and politically) in the past years.

  3. asmajhu Says:

    I strongly believe, effort to the women education and women empowerment can reduce the increasing incidence of HIV in Uganda. The current HIV prevalence in Uganda is estimated at 6.4% among adults, and women are disproportionately affected, accounting for 57% of all adults living with HIV. The factors increase women’s vulnerability to HIV acquisition, including, biological, behavioral, socioeconomic, cultural and structural risks. Considerable progress has been made in biomedical, behavioral and structural strategies for HIV prevention with attendant challenges of developing appropriate HIV prevention packages which take into consideration the socioeconomic and cultural context of women in society at large. In Uganda, the Health community empowerment organization named “Gweeri” has taken some action with collaboration of women leaders at different levels to reduce the HIV among women
    • Solicited support from community resource persons like church leaders, local leaders, and youth leaders.
    • Held weekly interviews and discussion groups.
    • Referred members for HIV testing and anti-retro-viral therapy
    • Held daily counseling sessions.
    • Created a partnership with youths to lay a foundation for progress in HIV Counselling.
    The mission of the organization is to promote group work through team building and empower the community with knowledge and skills on HIV /AIDS prevention and control. Moreover, sustainability of these work could bring success.

  4. hannahhhan Says:

    This is a very interesting but important posting about challenges that arise in addressing the burden of HIV in Uganda. I am not sure if I agree with the author’s interpretation of the increasing trend in HIV incidence in this community: “People have become more careless in their sexual practices as they now believe that if they contract HIV, they can simply take anti-retrovirals and live a long and prosperous life.” Is it really the expansion of availability of ARVs that is causing the increased risk compensation behaviors in this community? As noted in several studies, risk compensation behaviors often occur when people believe that they are not going to contract HIV because they are either circumcised or on pre-exposure prophylaxis (https://link.springer.com/article/10.1007/s11904-007-0024-7, http://search.proquest.com/openview/d36ac3bba2f1d55b02119dee8b73ed31/1?pq-origsite=gscholar&cbl=2040978). HIV is still a highly stigmatized disease and many are concerned about CONTRACTING HIV in the first place. Thus, the increasing trend that we see in the graph posted in this blog could be due to other factors, such as increased globalizations (travelers), sex work, urbanization, and poverty in the country.

    As the authors stated in the post, education on safe sex is important in reducing HIV risk among youths as they start exploring sexuality during teenage years. However, we also need to consider how these education programs could be implemented in the community to maximize the impact. As suggested by the authors of the blog, if the education services are implemented only in the hospitals and clinics, then it is very likely that the program will not reach those who do not have access to healthcare services. Furthermore, if the education services targeting youths are implemented in schools, then they are also going to miss those who either dropped out of school or simply lack access to education.

    Addressing HIV burden is very complex as the vulnerability to HIV is attributable to not only individual factors, such as sexual behaviors, but also cultural and structural factors, including food insecurity, poverty-driven transactional sex, and lack of employment access. I think the government must consider all aspects that contribute to one’s risk of HIV in order to better target appropriate intervention programs to those who need them.

  5. nidhi0912 Says:

    Thank you for sharing this interesting post! The trends of HIV incidence, prevalence and AIDS deaths are certainly worrisome. Despite the fact that more people have access to antiretroviral therapy, it is shocking to see the rising incidence of HIV in Uganda. I agree with the author’s comment on the importance of a comprehensive policy for educating females to help lower the incidence of HIV in Uganda. The key affected populations include men having sex with men, sex workers, adolescent girls, young women and intravenous drug users. There is pervading social stigma associated with these populations in Uganda which makes these populations less inclined towards obtaining HIV care and services. Additionally, as pointed out by the authors, there is a disproportionate effect of the HIV epidemic on young women in Uganda compared to young men. According to 2014 data, HIV prevalence among young women aged 15-24 in Uganda was estimated at 3.72% compared to 2.32% for men in the same age group (http://www.unaids.org/sites/default/files/country/documents/UGA_narrative_report_2015.pdf). The lack of education is certainly a leading cause of this disproportionate HIV prevalence in young women. These young women are subject to gender related violence including sexual abuse and lack access to education, health care services and social protection to help them cope with these inequities in the society. Additionally, this rising HIV incidence despite availability of ART is being attributed to some extent to the complacency of the people (in the fact that now a treatment is available for this disease) in some articles. Therefore, it is of utmost importance to identify these vulnerable groups and provide them with comprehensive education about HIV infection, testing and counseling, anti-retroviral therapy (ART) in order to lower the incidence of HIV in Uganda.

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