(Kampala) Activists and People Living with HIV in Uganda have responded to President Museveni’s World AIDS Day message saying, it attempts to pour cold water on the new approaches to HIV prevention and treatment that scientists and policymakers are describing as key to bringing about an end to the AIDS pandemic.
In his1December 2011 speech, delivered by Vice President Hon. Edward Ssekandi, the President argued that the country should be “careful” of implementing“new medical tools”against HIV, because such innovations “can lead to laxity in behavior.” The President argued that “eliminating negative sexual behaviours” should be the fundamental priority in the country. Activists say this message is not only inaccurate but also harmful, and shows the continued lack of political will to revamp the national response to the HIV/AIDS crisis that has gone completely off track.
“Of course reaching communities, particularly most at risk populations, with accurate and high impact behaviour-change interventions is important—but it is just not enough,” said Leonard Okello of the International HIV/AIDS Alliance in Uganda. “We are calling for a prevention and treatment revolution—and that means accelerating access to treatment for people living with HIV and initiating such treatment early to harness its prevention benefits; strategic implementation of pre-exposure prophylaxis (PrEP) for people in discordant relationships and other vulnerable groups; and more ambitious scale up of safe medical male circumcision, alongside other proven, effective biomedical prevention tools.”
Unprecedented new research findings have shown that antiretroviral (ARV) treatment for HIV not only saves lives, but it also reduces the risk of sexual transmission by 96% (see http://bit.ly/uXYm00), making HIV treatment an incredibly powerful HIV prevention tool. The “Partners PrEP” study, conducted in Uganda and Kenya, also found that antiretroviral drugs reduced the risk of infection byas much as 73% when taken by HIV-negative people in serodiscordant relationships (see http://bit.ly/u59g3x). Safe medical male circumcision and access to ARV treatment for HIV positive pregnant women are other crucial biomedical prevention interventions that urgently need to be taken to national scale in Uganda. Expanding investments in these interventions will not only save lives—they will also substantially reduce the costs of the AIDS response over time, according to experts.
“These data have provided hope that through accelerated scale up of treatment, as well as other proven prevention and treatment strategies, the end of AIDS could be possible,” says Richard Hasunira, Coordinator of Uganda Civil Society HIV Prevention Working Group.
According to the activists, technical experts in the Ministry of Health are supportive of these new approaches—but the backward-looking message from the President appeared designed by advisors who are not keen on expanding government investments in the fight against the HIV epidemic.
Uganda’s response to HIV is faltering badly, according to experts. Ugandais one of the few countries in the world with rising HIV infection rates, with an estimated 132,500 infections annually. More than 50% of Ugandans in urgent need of HIV treatment currently do not have access to treatment to save their lives and prevent new infections. One in five new HIV infections in Uganda is from mother to child.
“We have no time for equivocation as a country,” said Dr. Stephen Watiti, Board Chair of NAFOPHANU. “Our people are dying; incidence rates are rising. Shaming people with talk of negative sexual behaviours is not helpful at all, since as we all know many people are getting infected without practicing what the President calls ‘negative sexual behavior.’ At this critical time, no one should be talking as if they have the moral high ground; it is not helpful. Moreover, all Ugandans need access to effective prevention and treatment services—not stigma and exclusion.”
By contrast, U.S. President Barack Obama on World AIDS Day announced that the U.S. willscale up treatment access to reach a total of 6 million people on antiretroviral treatment by 2013 through the President’s Emergency Plan for AIDS Relief (PEPFAR)—doubling the pace of scale up for the programme. Obama committed the U.S. to using emerging science to “begin to end” the global AIDS crisis—a concept unimaginable just a few years ago.
“President Obama just put forward a powerful down payment toward the end of the AIDS crisis,” said Lillian Mworeko, the Executive Director of the International Community of Women Living with HIV East Africa. “But we are deeply concerned that Uganda will not seize this incredible opportunity—we are calling on the Government to also double its investments in life saving treatment to turn the tide of HIV in Uganda.” With AIDS treatment proven both to save lives and halt new infections, new science shows that expanding access is essential to getting ahead of the epidemic. The activists called on Uganda AIDS Commission’s Director General to advise the president correctly, accurately and based on scientific evidence. “A game of ‘hide and seek’ will not help the citizens of this country,” continued Mworeko.
Activists also expressed concern that Uganda was not making use of public health flexibilities that would make it easier for Uganda to gain access to low-cost, generic medicines, particularly in the future. “Uganda needs to be forward looking—instead of making excuses, the government should take advantage of flexibilities other countries are already using to reduce the price of essential medicines,” said Moses Mulumba, Executive Director of Centre for Health, Human Rights and Development (CEHURD).
Civil society called on the Uganda AIDS Commission and Ministry of Health to jointly launch a costednational strategy for rolling out a comprehensive HIV prevention and treatment response, including:
—80% male circumcision coverage among adult men by 2015
—Rapid and strategic scale up of ARVtreatment to all people with HIV with CD4 cells <350, and earlier ARV initiation to leverage the prevention benefit of treatment for people in serodiscordant couples, pregnant women, and other key populations
—Strong transparency and accountability of funds, to ensure that funding is not wasted, diverted, abused or stolen
—Strategic implementation of pre-exposure prophylaxis project in vulnerable populations
—Doubling the pace of ARV treatment initiation, with requisite increases in domestic financing