Friday, 5 March, 2024
McCreadie Andias
Uganda’s approach to managing HIV prevalence has been widely recognized for its effectiveness in reducing infection rates and mitigating the impact of the epidemic.
Since the early 1990s, Under the leadership of President Museveni, the country adopted sustained strategies and has implemented a comprehensive HIV/AIDS prevention and control program that has yielded significant results.
From sustained strategies that involved formation of HIV control programmes to Cooperation with Humanitarian organizations and non – governmental organizations, changing of its citizens sexual and cultural norms and massive countrywide media campaigns and awareness that helped to spread more information on preventive measures of HIV and abstinence from Unsafe practices. The epidemic has almost been brought to its knees.
A look at how it came from. The country had been grappling with HIV cases decades before. Uganda experienced its first HIV cases in 1987 which brought the country to one of its worst pandemics in decades.
The country had to take a shift that would see it reverse its status from one of the most affected countries HIV to one of the most successful countries in managing the pandemic.
However looking at what they did differently is exemplary to managing global prevelances.
First, Uganda’s government demonstrated strong leadership and political commitment to addressing the HIV/AIDS epidemic from the outset. President Yoweri Museveni declared HIV/AIDS a national priority and spearheaded efforts to raise awareness, mobilize resources, and coordinate a multisectoral response to the epidemic.
President Museveni’s public acknowledgment of the HIV/AIDS epidemic in the late 1980s and his subsequent advocacy for prevention efforts helped raise awareness and reduce stigma surrounding HIV/AIDS in Uganda.
Uganda prioritized prevention efforts as the cornerstone of its HIV/AIDS response. The country adopted a multi-pronged prevention strategy that included promoting abstinence, faithfulness, and condom use (the ABC approach), as well as targeted interventions to reach key populations such as sex workers, truck drivers, and young people. For instance, The “Zero Grazing” campaign, launched in the early 1990s, promoted fidelity and discouraged extramarital and casual sexual encounters. This campaign emphasized the importance of faithfulness in reducing the spread of HIV/AIDS and encouraged couples to remain faithful to each other.
Community Engagement and Participation was a key strategy to manage the epidemic. Uganda actively engaged communities, civil society organizations, religious leaders, and other stakeholders in the HIV/AIDS response. Grassroots mobilization and community-based initiatives played a crucial role in raising awareness, promoting behavior change, and delivering HIV prevention and care services at the local level.
The Uganda Network of AIDS Service Organizations (UNASO), a coalition of civil society organizations, played a vital role in advocacy, service delivery, and community empowerment. UNASO mobilized resources, built capacity, and facilitated collaboration among stakeholders to support HIV/AIDS programs nationwide.
Furthermore, Uganda integrated HIV prevention, treatment, care, and support services into existing healthcare systems, including maternal and child health clinics, antenatal care, and family planning services. This approach ensured that HIV/AIDS services were accessible, affordable, and integrated with other essential health services.For instance, The Prevention of Mother-to-Child Transmission (PMTCT) program integrated HIV testing, counseling, and treatment services into antenatal care clinics, enabling pregnant women living with HIV to access antiretroviral therapy (ART) to prevent transmission of the virus to their infants.
Access to Antiretroviral Therapy (ART) has proved significant results for HIV patients. Uganda expanded access to ART for people living with HIV/AIDS, significantly reducing morbidity, mortality, and transmission rates. The government partnered with international donors, NGOs, and pharmaceutical companies to increase the availability of affordable and quality-assured antiretroviral drugs.
The Uganda Ministry of Health’s “Test and Treat” policy, implemented in 2016, aimed to ensure that all individuals diagnosed with HIV/AIDS immediately initiate ART regardless of their CD4 cell count. This policy contributed to increased ART coverage and improved health outcomes for people living with HIV/AIDS.
In addition, Uganda recognized the disproportionate impact of HIV/AIDS on women and girls and implemented gender-responsive interventions to address their specific needs and vulnerabilities.
Efforts focused on promoting gender equality, empowering women and girls, and addressing structural drivers of the epidemic such as gender-based violence and economic inequality.
Initiatives like The “Sisters Keepers” program, launched by the Uganda Women’s Effort to Save Orphans (UWESO), provided socioeconomic support, education, and vocational training to vulnerable women and girls affected by HIV/AIDS. This program empowered women and girls to become economically independent and reduce their risk of HIV infection.
Ugandan Medium term plan 1989-1994
Uganda crafted the 1989–1994 Five Year plan, and 1989–1990 First Year Project Plan and Budget which directed immediate implementation of the budgetary allocations.
The project plan was funded by WHO Trust Fund $10.6 million, Bilateral funds (e.g. from USAID, ODA, etc) $7.1 million, and Ugandan $0.5 million budget making it $18 million in three years.
Many organizations and bodies were involved in management and planning of the program but uganda was to remain centered in tje program and its staffing was enhanced to 45 Ministry of Health staff, supplemented by 6 WHO staff making it one of the largest staffed programs
the 1989 Ugandan health education budget was greatly prioritized among all strategies implemented.
As was the case at the time for all programs in central and east Africa, it was essentially demanded of WHO by the country’s government that enough funds be made available to ensure a safe blood supply, and have the laboratory supplies and facilities to perform this function.
The Ugandan program also became the first country to both field test HIV sentinel surveillance at antenatal clinics and other settings (Nsambya, Uganda being the first sentinel surveillance site in Africa and is still operational), and then the first country to expand this system initially to six sites, and then country wide.
However with this infrastructure in place, including management, lab support, blood screening, and HIV monitoring, it was then completely unique on the continent to have funds remaining for a national AIDS health education budget to be supported at the level noted. Full country AIDS program budgets for the six neighboring countries were all in the range of $1–4 million total (cf. $18 million for Uganda).
The Uganda program was then free to prioritize and implement throughout the country the most widespread, extensive and well thought out information, education, and communication program for AIDS prevention (and care) of any country in Africa.
The Uganda Health Education budget itself was to specifically prioritize local and decentralized programming, local local rather than international expenses, and to ensure local staff salaries and per diems.
It is clear that Uganda had to take an unprecedented turn to fight the pandemic. Formation of the Nation AIDs control program was very significant since the programme helped formulate and review policies that helped fight the pandemic including screening of blood during transfusion.
The NACP also helped to lobby humanitarian assistance from World Health Organisation, UNAIDs and other non-governmental and humanitarian stakeholders that granted funds and offered assistance in the process.
The dissemination of information about AIDS into grassroot systems and a strong media campaign that would catch countrywide alert on the pandemic was well worth. The massive awareness programmes and education on preventive ways and abstinence from sexual and cultural norms that increased vulnerabilities to the disease was also well invested in.
We can conclude that Uganda did a good homework in its fight and it paid off from the results. Third world countries still struggling with the pandemic should adopt the strategies that uganda Upheld to increase their chances of Victory against the pandemic.
