New research shows there has been a significant drop in HIV/Aids rate in Uganda since the early 1990s.
The study by the Uganda Virus Research Institute in collaboration with the London School of Hygiene and Tropical Medicine Uganda Research Unit, has found that new infections in men declined by 88 per cent, from 0.96 percent in 1990-1992 to 0.12 percent in 2018-2021. In women, the corresponding HIV/Aids incidence decline was 60 per cent – from 0.68 percent to 0.26 percent.
The study, titled “Thirty Years of Change in HIV Incidence among Adults in the Kyamulibwa General Population Cohort in Rural Southwest Uganda, 1989-2021”, was recently published in the International Journal of Infectious Diseases and attributes the sharp decline in HIV/Aids incidence to changes in sexual behaviour.
The first cases of HIV/Aids in Uganda were identified in 1982 in Rakai district, about 200km southwest of Kampala.
By 1986, up to 900 cases had been reported, rising to 6,000 cases by 1988, according to the Uganda Aids Control Programme (UACP).
In 1990, the prevalence rate stood at between 18 percent to 30 percent, with mother-child HIV transmission rate reaching 26 percent.
Prevention measures promoted
But by 1995, Uganda had become a global model for HIV/Aids prevention as efforts to change sexual behaviour effectively brought down new infections.
“Between 1989 and 1995, the percentage of people who reported at least one casual partner dropped from 35 per cent to 15 per cent in men and from 16 per cent to six per cent in women,” the authors write.
“In this study area, condom use has been promoted, and free condoms were distributed in the health surveys, and at the study clinic. Our proportion of reported condom use at last sex with a casual partner in 1997 is consistent with figures from the Uganda demographic and health survey.”
In addition, the researchers say the decline can also be attributed to increased delays in initiating first sex, especially among young women.
The researchers note that attitudes towards risk behaviour changed with the introduction of antiretroviral therapy (ART) in the early 2000s.
Even though ART was meant to enable people with HIV/Aids to live longer, it also significantly reduced the risk of HIV transmission. The government’s emphasis shifted to the promotion of ART as prevention, unwittingly leading to a steady increase in HIV/Aids incidence for a decade.
The Ugandan Government then turned to new prevention measures, such as circumcision. By 2020, 78 percent of the 1.3 million adults living with HIV/Aids were estimated to be on ART while 57.5 per cent of men aged 15-49 years had been circumcised.
HIV infections rate
Uganda Aids Commission says the country has registered a 37 percent decline in annual HIV/Aids related deaths – from 27,000 in 2016 to 17,000 in 2021. In the same year, new HIV infections stood at 54,000, which translate to about 0.12 percent.
The researchers say that even though overall HIV incidence has declined worldwide, there are remarkable variations between and within countries. For example, Africa’s estimated number of new HIV infections in 2021 was three times more than the global target, and 59 percent of the new infections were recorded in sub-Saharan Africa.
“The findings in this study reinforce the need for enabling HCT (haematocrit test that measures the percentage of red blood cells), particularly among young men and women, rapid ART initiation to maintain a high ART coverage, and support for ART adherence for viral suppression, alongside sustainable HIV prevention measures,” the researchers recommended.
The study, which has been running since 1989, was conducted among 20,959 residents in Kanungu District in Southwestern Uganda.