Ending AIDS in Uganda: What will it take?

Taking stock of an off-track AIDS response: During 2011-2012, Uganda attracted concern—and criticism—as a result of its troubling epidemiological trends, indicating an off-track response to HIV. The Uganda AIDS Indicator Survey showed that prevalence had risen from 6.4 to 7.3% between 2006 and 2012 and incidence also rose during the same period. Condom use by men and women declined starkly over the same period—reported condom use during sex with a non-cohabitating partner declined significantly between 2005 and 2011 from 47% to 29% and from 53% to 38% among women and men, respectively. Importantly, Uganda was the only PEPFAR “Focus Country” reporting rising HIV incidence—all other PEPFAR focus countries have consistently reported declines in incidence as well as prevalence in recent years.

At the same time, recent game-changing scientific advances in HIV prevention and clinical care are making it possible for all high-burden countries to begin to achieve an “AIDS Free Generation,” defined as a halt to sexual transmission, an end to disease progression for those who are HIV positive, and an end to perinatal transmission. In particular, recent data show that HIV treatment is not only life saving but is also one of the most powerful prevention tools available—groundbreaking new research shows that earlier treatment of HIV positive people—at CD4>350—results in 96% reduction in the risk of HIV transmission through sex with an uninfected partner,4 is highly cost effective, and provides significant clinical benefit.6 Uganda’s faltering response means an attaining an AIDS Free Generation will take stronger, more urgent action—with bolder leadership.

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