2008 Country Profile: Uganda

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U.S. President's Emergency Plan for AIDS Relief

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2008 Country Profile: Uganda

National HIV prevalence rate among adults (ages 15-49): 6.7 percent1
Adults and children (ages 0-49) living with HIV at the end of 2005: 1 million1
AIDS deaths (adults and children) in 2005: 91,0001
AIDS orphans at the end of 2005: 1 million1

Uganda is one of the Emergency Plan’s 15 focus countries, which collectively represent approximately 50 percent of HIV infections worldwide. Under the Emergency Plan, Uganda received nearly $90.8 million in Fiscal Year (FY) 2004, more than $148.4 million in FY 2005, and approximately $169.9 million in FY 2006 to support a comprehensive HIV/AIDS prevention, care and treatment program. The Emergency Plan supports more than 70 active international and local partners, implementing a range of prevention, treatment, care and system-strengthening interventions in all program areas. PEPFAR is providing $236.6 million in FY 2007.


Recognizing the global HIV/AIDS pandemic as one of the greatest health challenges of our time, President George W. Bush announced the President’s Emergency Plan for AIDS Relief (Emergency Plan/PEPFAR) in 2003 — the largest international health initiative in history by one nation to address a single disease. The United States is changing the paradigm for development, rejecting the flawed “donor-recipient” mentality and replacing it with an ethic of true partnership. These partnerships are having a global impact and transforming the face of our world today.

Partnership to Fight HIV/AIDS

The U.S. Government (USG) response was strongly influenced by the Ugandan response to HIV/AIDS, which is viewed as a model for the rest of sub-Saharan Africa. Uganda’s strategy involves strong public commitment; mass mobilization and education efforts; political openness; an extraordinary range of community- and faith-based partners; and the political vision that recognizes HIV/AIDS as a threat to development, as well as a health problem. The national coordinating body is the Uganda AIDS Commission, which oversaw the creation of the National Strategic Framework (2000 - 2006) and is currently developing the new five-year National Strategic Plan (2007 - 2012).

Uganda was a pioneer among African governments in responding to the HIV/AIDS epidemic. In 1986, the Ministry of Health created the STD/AIDS Control Program – the first HIV/AIDS control program in sub-Saharan Africa. There are now 13 active HIV/AIDS control programs in government ministries. In addition, almost 2,000 indigenous Ugandan non-governmental and faith-based organizations contribute to the national response – a best practice of the Ugandan response.

The USG response builds on several key principles. Those include:

  • Supporting a strong family and community response;
  • Improving service delivery systems and institutions;
  • Implementing a broad portfolio of proven interventions and innovative new activities; and
  • Supporting the establishment of the network model that links services, communities and families.
Emergency Plan Results in Uganda
# of individuals receiving antiretroviral treatment as of September 30, 20071   106,000
# of HIV-positive individuals who received care and support in FY2007 (including TB/HIV)1   414,500
# of orphans and vulnerable children (OVCs) who were served by an OVC program in FY20071   307,800
# of pregnant women receiving HIV counseling and testing services for PMTCT since the beginning of the Emergency Plan1,2   1,246,300
# of HIV-positive pregnant women receiving antiretroviral prophylaxis for PMTCT since the beginning of the Emergency Plan1,3   62,400
# of counseling and testing encounters (in settings other than PMTCT) in FY20071   1,490,900
# of individuals reached with community outreach HIV/AIDS prevention programs that promote Abstinence and/or Being Faithful in FY2007   7,165,400
# of individuals reached with community outreach HIV/AIDS prevention activities that promote Condoms and related prevention services in FY2007   1,001,100
# of USG condoms shipped from Calendar Year 2004 to 2007   115,416,000

Note: Numbers may be adjusted as attribution criteria and reporting systems are refined.
Numbers above 100 are rounded to nearest 100.
1 Total results combine individuals reached through downstream and upstream support.
2 It is possible that some individuals were counseled and tested more than once.
3 It is possible that some pregnant women received antiretroviral prophylaxis more than once over the four-year period, e.g. HIV positive women who were pregnant more than once.

Uganda Logo Emergency Plan Achievements in Uganda to Date

HIV/AIDS in Uganda

Uganda faces a generalized HIV epidemic. There were sharp declines in HIV prevalence in the mid- and late-1990s, but in recent years, prevalence trends have stabilized. In 2005, the national HIV prevalence rate among adults ages 15 to 29 was estimated at 6.7 percent. Nationwide, HIV prevalence is higher in urban areas than in rural areas. Major vulnerable population groups include young women, people in prostitution and military personnel.2 Transmission occurs mainly through heterosexual contact (75 to 80 percent), while mother-to-child HIV transmission accounts for 15-25 percent of new infections. Adherence to behavior changing practices is weak; a 2004 to 2005 national household survey found condom use was erratic (only about half the men and women surveyed reported using a condom the last time they had sex with a casual partner), and almost one in three men said they had had more than one sexual partner in the previous year.

Challenges to Emergency Plan Implementation

Certain traditional practices in Uganda hasten the spread of HIV infections, including widow inheritance, polygamy, wife sharing, blood brotherhood and infertility-related practices. Moreover, traditional marriage values prevent a woman from acting against a

  Uganda Map
husband who places her at risk. This cultural aspect along with the value placed on large families and social pressure on women to frequently reproduce increases the number of HIV-infected women and children. Discrimination and stigma remain significant and the practice of self stigmatization is one of the greatest threats, as people resist seeking treatment and care for fear of being identified and maligned by co-workers and peers. The cost of drugs and laboratory services also remains high.2 There are gaps at all levels in capacity, infrastructure and resources. Poverty and the devastating effects of the conflict in the north exacerbate these gaps.

Critical PEPFAR Interventions for HIV/AIDS Prevention:

  • Supported an increase in the number of PEPFAR-supported service outlets providing a minimum package of prevention of mother-to-child HIV transmission (PMTCT) services from 100 outlets in FY2004 to 524 outlets by the end of FY2007. Additional service outlets have reached more pregnant women at community levels, including hard-to-reach areas, such as camps for internally displaced persons and conflict regions.
  • Supported the Ugandan President’s Initiative for AIDS Strategy Communication for Youth (PIASCY), an initiative that reaches students with HIV prevention messages focused on abstinence and faithfulness.
  • Piloted “Prevention for Positives” interventions, including partner testing, sexually transmitted infection diagnosis, antiretroviral treatment, referrals for family planning and PMTCT, targeting people living with HIV/AIDS. One of the most critical steps in prevention is the adoption of behaviors that prevent the spread of infection by people who are living with HIV/AIDS.

Critical PEPFAR Interventions for HIV/AIDS Treatment:

  • Supported 154 sites in FY2007 providing antiretroviral treatment, and trained or re-trained, according to national and/or international standards, 4,600 health workers in the provision of treatment.
  • Supported 168 laboratories in FY2007 that now have the capacity to perform HIV tests, CD4 tests and/or lymphocyte tests.

Critical PEPFAR Interventions for HIV/AIDS Care:

  • Supported a diverse range of organizations in Uganda involved in delivery of HIV/AIDS care services, including organizations delivering clinical and facility-based care, home-based care, and community outreach programs. Networks have been established among organizations providing care services and the communities they serve as a mechanism to expand access to a comprehensive package of care for people living with HIV/AIDS. Through these interventions, access to palliative care significantly increased.
  • Trained or retrained 4,900 health workers in counseling and testing in FY2007.

1 UNAIDS, Report on the Global AIDS Epidemic, 2006.
2 WHO, Summary Country Profile on HIV/AIDS Treatment Scale-up – Uganda, 2005.

   
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