The first case of AIDS in Uganda was reported in 1982 on the shores of Lake Victoria in Rakai district. Since then HIV spread rapidly and the number of people living with HIV peaked in the early 1990s when the average national antenatal HIV prevalence was 18 % in rural areas and between 25%-30% in major urban areas. This marked the first phase of the epidemic.

The second phase (1992-2000) saw declining HIV prevalence and incidence, particularly in urban areas. In the 1990s HIV prevalence declined among antenatal clinic attendees and voluntary counselling and testing clients. Similarly, a decrease in HIV incidence and prevalence were observed in population-based surveys in the rural areas of the Masaka and Rakai districts. The decline in HIV incidence and prevalence was attributed to delayed sexual debut among young people, reduction in sexual partners outside of marriage and an increased use of condoms.

The third phase of the Uganda HIV epidemic (since 2000) has been characterised by the stabilisation of HIV prevalence between 6% and 7%.1 According to UNAIDS/WHO estimates for 2007 the HIV prevalence in Uganda is 5.4%. 810,000 adults and 130,000 children (0-14 years old) were living with HIV at the end of 2007. At the end of 2007, there were 115,000 people on antiretroviral treatment.

Prevalence was estimated at 7.5% among women and 5% among men. This gap is higher among 15-24 years old: 3.9% among women and 1.3% among men. HIV prevalence in urban areas is almost double that in the rural areas (10.1% and 5.7% respectively).

Uganda developed the Multi-sectoral Approach to the Control of AIDS (MACA) was developed and adopted in 1992 to ensure a concerted response. This policy and strategy calls for the involvement of all stakeholders in the response to HIV.

The Uganda AIDS Commission (UAC) was established in 1992 under the Office of the President to ensure a focused and harmonized response. Uganda’s response to the epidemic has been characterized by strong political commitment and support, open dialogue, multisectoral interventions and coordination, the involvement of religious leaders, decentralised planning, programmatic targeting for discrimination issues, supportive policy and social environment, the availability of local and external resources, the involvement of local communities and investment in research.

The National HIV & AIDS Strategic Plan (NSP) 2007- 2011 was developed through a broad consultative process aligned to the Country’s Poverty Eradication Action Plan (PEAP). It focuses on Human Development and emphasizes preventive health care and commodities for basic curative care. The NSP’s main objectives are:

• Reduce the incidence of HIV by 40% by 2012
• Improve the quality of life of people living with HIV by mitigating the health effects of HIV by 2012
• Mitigate the social, cultural and economic effects of HIV at individual, household and community levels
• Build an effective support system that ensures high-quality, equitable and timely service delivery

Since 2002 Uganda’s response to HIV has been mainly coordinated through the National HIV & AIDS Partnership arrangement. At district level, the response is coordinated through a technical District AIDS Committee and a political District AIDS Taskforce. This arrangement is translated at all Local Government levels down to the grassroots community.

• Launch of the AIDS Control Programme in 1986
• Creation of the AIDS Support Organisation (TASO) in 1987 to support ogranisations of people living with HIV
• Creation of the Joint Clinical Research Centre (JCRC) in 1992 to conduct clinical research on HIV/AIDS and care and treatment
• Launch of the AIDS Information Centre (AIC) in 1992 to provide voluntary counselling and testing services
• Launch of the Uganda AIDS Commission (UAC) in 1992 to coordinate the multisectoral response to HIV
• Launch of the multisectoral National Operational Plan and HIV/AIDS Policy Guidelines in 1992
• Launch of the multisectoral National Operational Plan (NOP) and HIV/AIDS Policy Guidelines in 1993
• Launch of the Five-year National Strategic Framework (NSF) for HIV/AIDS in 1997 New NSF launched in 2000 covering the period 2000 – 2005

• Shortage of skilled human resources
• Heavy reliance on external donors for funding and concern over sustainability of funding;
• poor physical infrastructure
• Inequitable access to services across the country (easier access in urban areas than in rural areas, difficulty reaching the northern part of the country
• Linkages to and integration of services: many vertical projects - resulting in loss of harmonisation and synergies
• Inefficient supply chain management
• Under-resourcing and under-performing of monitoring and evaluation
• Weak mainstreaming of HIV in the public and private sectors
• Gender mainstreaming inadequate
• Limited access and uptake of services, for example voluntary counseling and testing and antiretroviral therapy services

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