This year’s commemoration of World AIDS Day occurs in a complicated terrain where essential services have been disrupted by the COVID-19 pandemic. Under the theme “End Inequality, End AIDS. End pandemic” this day is more than a call for a balance in health interventions to give all patients the chance to have equitable access to health services.
HIV AIDS has been prevalent in Uganda for more than thirty years, with the prevalence among adults 15-49 years standing at 6.0% (UPHIA). In the early 2000s, there were about 80,000 annual deaths due to HIV. With the interventions of the Uganda HIV Commission set up in 1992 and its technical and financial partners, including the United Nations in Uganda, which accompanied the implementation of national action plans to fight against HIV, the country in 2020 recorded 22,000 annual deaths according to the report of the commission.
In the same year, Uganda recorded 38,000 new HIV infections including 12,000 adult men, 21,000 adult women, and 5,300 children, which is a very large reduction from the alarming number of new annual cases observed in the 1980s and 1990s.
COVID-19 could reverse the hard-won gains in the fight against HIV in Uganda.
The reorganization of the health system that the country has undergone during the COVID-19 pandemic, the increasing need for partner funding to help Uganda respond effectively to the pandemic, the implementation of lock-down and social distancing measures have had an impact on HIV and AIDS prevention and control services in Uganda.
COVID-19 has led to the reduction of 30% in the use of HIV testing services in communities and health facilities; the initiation of antiretroviral therapy has decreased by 31% between April and June 2020 alone; between December 2019 and June 2020, viral load coverage has decreased from 96% to 85%, and CD4 access decreased from 31% to 22%.
These observations challenge us all in our efforts to achieve the SDG3 in the country which is access to good health and well-being for all.
I commend the Ugandan government for adopting the “Test and Treat” policy – the global standard for HIV treatment that states that anyone who tests positive for HIV should promptly start on antiretroviral treatment. We welcome this important step forward in ensuring that free treatment for all is the practice throughout Uganda.
In August 2020, the Uganda AIDS Commission (UAC) launched a five-year national strategic plan on HIV/AIDS. The Health sector has also updated the Health sector HIV/AIDS strategic plan that aims at reducing HIV incidence and HIV related mortality by 50% by 2023.
Today, the response to HIV is guided by the UNAIDS “95-95-95” metric, which aims for 95% of HIV-infected people to know their status, 95% of those diagnosed to receive antiretroviral therapy (ART), and 95% of those on treatment to achieve viral suppression.
In Uganda, according to the Uganda AIDS Commission’s 2020 report, 91% of people living with HIV know their status. Of these, 90% are on antiretroviral treatment. And, of those, 82% are virally suppressed. This is a plausible advance in the fight against the disease in the country, but we must remain vigilant about the resurgence of cases.
With COVID-19, people living with HIV appear to be at elevated risk for virus-related illness and death. There is a need to evaluate our public health interventions in the country in order to provide balanced support in the testing and management of HIV patients.
We must ensure that everyone, everywhere, has equal access to HIV prevention, testing, treatment and care, including COVID-19 vaccinations and services.
HIV services must remain crucial during the COVID-19 pandemic. We need to make our efforts more visible in the fight against HIV in Uganda. The strategic plan 2020 -2025, is a tool that we must make good use of.
On this World AIDS Day, the WHO Regional Director for Africa Dr. Matshidiso Moeti urges governments to prioritize investment in health funding for community-led, human rights-based, gender transformative responses. We must boost our essential health workforce, and secure equitable access to life-saving medicines and health technologies.
The distribution and allocation of medical personnel and funding to the response to COVID-19 should take into account the management of other diseases in the country, including HIV. We must all be involved in this fight if we want HIV to be among the low-level endemic diseases by 2030.
We must work for equitable access to health services to end HIV and prevent future epidemics in the country.
The writer is the WHO Representative in Uganda
Dr Yonas Tegegn Woldemariam