A recent report released by the Uganda Aids Commission indicates that an average of 70 individuals below 25 years are diagnosed with HIV/AIDS every day, a trend which dates back to the last two years.
What is even more distressing about the statistics is the fact that young people account for a staggering three-quarters of all new infections, with 39,000 out of 50,900 cases reported in 2021 and 2022.
Similarly, children aged 0-14, who acquired infections through mother-to-child transmission (MTCT), were 11,900. The 50,900 infections in the age group were part of a total of 106,000 new HIV infections for the general population in the two years.
The statistics further indicate that of the 19,000 young people aged 15-24 who contracted HIV last year, young women contributed 15,000 infections.
Dr Cordelia Katureebe, the national coordinator of HIV Care and Treatment at the Health Ministry says the current trend at which HIV spreads casts a shadow on the country’s ambition to end the virus by 2030.
“We are off target to ending Aids by 2030,” Dr Katureebe says. “Currently as we speak, we still have new infections among children and we still have a burden of children and adolescents living with HIV,” she adds.
According to Dr Katureebe, although the country has seen a 52 per cent reduction in new HIV infections over the years, the new infections registered annually are still unacceptably high.
“The decline we expected to see for new infections is also off-track. We still see that the maternal anti-retroviral therapy (ART) coverage is still low (at 72 per cent) and that explains the cracks we continue to see. There still remains treatment inequity among children and adolescents,” she says.
UAC figures indicate that a total of 47,000 new infections were registered among children and young people below 25 years in 2010, a figure which is about two times higher than the 24,900 new infections registered in the same age group in 2022.
The Health ministry, in a move to curb new HIV infections, last week launched the Global Alliance to End Aids in Children by 2030, an initiative hinged on four pillars; early testing and comprehensive treatment and care, as well as closing the treatment gap and optimising the continuity of treatment for pregnant and breastfeeding women living with HIV.
The initiative also seeks to prevent new HIV infections among pregnant and breastfeeding women and address rights, gender equality, and the social and structural barriers that hinder access to services.
Dr Nelson Musoba, the UAC director general, says ending Aids by 2030 is feasible. He notes that this would involve embracing the strategies the government has come up with and taking personal responsibility in the fight would see the country achieve the target of ending Aids.
“Our goal of ending Aids by 2030 means zero new infections, zero AIDS-related deaths and zero stigma and discrimination. It is seven years to go and we believe we can hit that target if we get everyone involved,” he says.
“We want to acknowledge the progress the country has made, moving this epidemic from a double-digit HIV prevalence of 18 per cent in the 1980s to 5.2 per cent as we speak now in terms of HIV prevalence. We have also had a reduction in new infections over the last decade from 120,000 annually to about 52,000 annually and Aids-related deaths from about 94,000 to 17,000,” he notes.
Dr Musoba, however, acknowledges that interventions are there to stop infections but the numbers are still high. This, he said, is a threat to the fight. “We need to take responsibility to reduce new infections. The science is there, we know how to protect ourselves but we still have 1,000 new infections every week and it is infecting predominantly young people between the age of 15-24,” he says.
“If you look at the girl child specifically, the infections are about four times higher than their male counterparts because of the societal dynamics – intergenerational sex and transactional sex.”
This comes amid the commemoration of 2023 World Aids Day today (December 1st) under the theme: ‘Let Communities Lead.’
Ms Jacqueline Makokha, the country director of the Joint United Nations Programme on HIV/Aids (UNAIDS) says the theme tackles issues of accountability and equity issues in accessing services which affect the fight.
“Communities connect people with person-centred public health services, they build trust, they innovate, they monitor implementation of policies and services and they hold service providers accountable,” she says.
“Globally, communities are being held back and are struggling. They are facing funding shortages, policy and regulatory hurdles, capacity constraints and crackdown on some community groups,” she adds.
Ms Ruth Akulu, a young person who was born with HIV by a teenage mother, reinforces Ms Makokha’s views. Ms Akulu currently works with the International Community of Women living with HIV in Eastern Africa.
“We are still being held back in leadership. That is because some people think we have capacity issues. Here I am, I am an economist and a very good analyst and that means I can contribute meaningfully to the HIV response,” she says.
“We need to be at the core of HIV programming. Adolescents and young women still face heightened vulnerability to HIV and this is no secret. We see increasing rates of new HIV infections among adolescents and young women, according to statistics from the UAC,” she adds.
Mr Trevor Emojel, a young person who was also born with HIV, says there is still a lot of stigma against persons living with HIV (PLHIV) and also self-stigma among those living with the virus. Mr Emoojel, now a graduate, is the reigning Mr Y+ 2022 and country youth coordinator of AHF Uganda Cares.
He explains that 2015 while in a boarding school, he got a lot of stigma after seeking to become the health prefect. He says one of his competitors who knew about his HIV status, stole his medication and spilled it all over.
“And he went ahead to write on the blackboard that ‘Trevor has Aids, how can you want such a person to be your leader? This is a disabled person who cannot lead.’ I was devastated. I was left with shame, sadness and bitterness and I sunk deep into self-stigma,” Mr Emojel says.
Consequently, he says, he stopped taking my medication and developed suicidal thoughts and tendencies and had to get out of school for a particular period.
“Fortunately, that was also my turning point where I was introduced to very good health workers who were very loving as opposed to others who were a bit tough and stigmatised me,” Mr Emojel says. He adds that he has been virally suppressed for eight years now because of medication adherence.
“I finished school, I have a job. I have been able to disapprove that a young PLHIV couldn’t handle leadership,” he says. Dr Joshua Musinguzi, the head of the Aids Control Programme at the Health Ministry, says they have put strategies to address stigma in school and also empower through government skilling and livelihood programmes for young people to avoid intergenerational and transactional sex.
“We want to work with school administrations, especially school health services such as the nurses and other people that provide health services in school to make sure we bring them up to speed and on board so that when these children go there, they can support them psycho-socially, talking to them so that they can feel loved and don’t feel abandoned so that they continue taking their drugs even when they are in school,” he says.
“Sometimes we give them a big stock of drugs especially for those who are stable with their treatment so that they don’t have to keep coming out of school to look for treatment. If you have drugs for three months, you can finish a term and also we want school health services to support those with issues arising. We are also educating people about the disease to reduce stigma,” he adds.
Dr Musinguzi says they have been promoting many approaches to HIV prevention. “We also have behavioural interventions, things like abstinence, being faithful and condom use. We also have biomedical interventions, making sure that people access HIV testing, those who are negative should be strengthened to remain negative but also refer them to other interventions like circumcision for boys and make sure they remain negative,” he says.
Dr Jane Ruth Aceng, the Health Minister on her part, says the country will achieve the target of ending Aids by 2030. “The need for testing kits will increase as we run the race towards ending Aids by 2030 because we want everyone to carry out a test to know whether they have HIV or they don’t have it using the self-test kits because we can’t move everywhere, it is too expensive but if you are uncertain, take a test, and report to the nearest health facility,” she says.
On high infections in urban areas, Dr Aceng says: “There are too many activities in the urban areas including the minority populations but we are not worried about them because most of the people in urban areas quickly test and get on treatment and they have information.”
How to protect your child from HIV infection
According to health experts, protecting a child from HIV infection starts from pregnancy with every pregnant mother undergoing an HIV test to know her HIV status. If HIV-positive, the mother should take anti-retroviral drugs (ARVs) consistently to prevent mother-to-child transmission of the virus.
Prof Philippa Musoke, the executive director of Makerere University –Johns Hopkins University, a research collaboration that has been central in preventing HIV infections in children, said teenagers should always be kept busy to minimise infection risks.
“Parents should make every effort to keep their teenagers busy, including home chores, homework, and some fun activities. It is important that the parents know where the children are spending their free time, who is at home with them and what they are watching,” she said.
“The holidays provide time to hold open discussions about sexuality, friendships, and intimacy. The parents should talk about HIV prevention including A- Abstinence, B-Being faithful and C-condoms with open non-judgmental discussion because some teenagers are sexually active and pre-exposure prophylaxis (PREP) is available,” he said.
“If the parents are uncomfortable discussing these topics, they should identify another relative or counsellor to provide opportunities for open discussion and support,” she added.
Dr Daniel Byamukama, the head of HIV prevention at Uganda AIDS Commission said many children have been infected at the hands of relatives visitors and “houseboys”.
“Parents must child-proof their home. You shouldn’t leave your daughter in the hands of a houseboy at home or a distant relative who may turn against her. A significant number of girls are contracting HIV because of sexual violence at the hands of trusted friends and relatives. The recklessness of leaving your child to stay with the headmaster must stop,” he said.
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