Country situational analysis [1]

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 6.1 and 6.5% in some antenatal care (ANC) sites and even a rise in others. According to the 2010 UNAIDS Report on the global AIDS epidemic, the HIV prevalence in Uganda was estimated at 6.5% at the end of 2009.

The rise in HIV prevalence is accompanied by worsening of behavioural indicators especially an increase in multiple concurrent partnerships. There has also been a shift in the epidemic from people in single casual relationships to those in long-term stable relationships. Incidence modeling reveals that 43% of new HIV infections are among monogamous relationships while 46% are among persons reporting multiple partnerships and their partners.

According to UNAIDS, there were 1.2 million people living with HIV at the end of 2009. The report estimates that 200,413 people were on antiretroviral treatment - 39% of all those in need - and that the perecentage of HIV pregnant women receiving antiretroviral treatment to prevent mother-to-child transmission was 53%.

Key elements of the national response

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.

Key achievements

• 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
• Launch of the national HIV prevention strategy, embedded in the NSP (2007/8-2011/12) and Road Map to Accelerating HIV Prevention, 2008

Key challenges

Policy implementation and M&E environment

• Delayed enactment of the National HIV&AIDS Policy
• uncoordinated data bases at national level, unclear system for information sharing, improper data validation system and scattered data collection tools

HIV prevention

• the pace of behavioral change has either been slow or stagnant
• high unmet need for HIV counselling and testing
• low coverage for PMTCT
• challenges in addressing infection control and infection safety especially in the context of TB-HIV

Treatment, care and support

• Uganda is yet to develop an adequate human, logistical, supply and other systems resource base to cope with the demands of the HIV&AIDS epidemic to effectively manage the national AIDS response. As a result, provision of treatment is largely donor-driven and evidently this makes it unsustainable.

Social support

• Limited funding to cope with the magnitude of needs of orphans and vulnerable children, people living with HIV, affected families communities
• inadequacy of human resource capacity to provide services

Useful links

• National Strategic Plan
• Uganda AIDS Commission (UAC)
• PMTCT and Paediatric Care and Treatment - factsheet
• Modes of transmission (MOT) study
• 2010 UNGASS Report

Contacts

UNAIDS Country Office
P.O.Box 24578
Kamapal
Uganda
Tel: 256 712 806463
Fax: +256 414 340113

Uganda AIDS Commission (UAC)
Bishop Barnabas Halem'Imana
Chairman
P.O. Box 10779
Kamapal
Uganda
Tel: +256-414288065
Email: nadic@uac.go.ug
Email: uac@uac.go.ug

Networks of organisations working on HIV and AIDS

UNASO (Uganda Network of AIDS Service Organisations)
Block 773
Kabakanjagala Road, Mengo
P.O. Box 27346 Kampala - Uganda
Tel: 256-041-274730
Email: unaso@unaso.or.ug Website: www.unaso.or.ug

Networks of people living with HIV and AIDS

NAFOPHANU (National Forum of People Living with HIV/AIDS in Uganda)
11 Portal Avenue, Adam House Block B, No. 2
P.O. Box 7033
Kampala, Uganda
Tel. +256 41 250525
Email: nafophanu@infocom.co.ug

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1. All epidemiological data comes from the country's 2010 UNGASS Report, unless otherwise stated.