How Uganda got results in its fight against Aids
Antiretroviral drugs have brought down the infection rate, but complacency can still kill
Harriet: ‘I’m doing well. I thank God for that because there are so many people who died before and I hope to live.’ Photograph: Jane Fallon Griffin
Uganda’s response to HIV/Aids is immediately apparent in the capital, Kampala.
Billboards dominating the roadsides advocate testing for children and protected sex and highlight the importance of taking ARVs – drugs that prevent the progression of the virus.
A marketplace sign indicates its support for communities living with HIV. Brightly wrapped condoms can be seen at intervals between vendors’ stalls of fresh fruit and vegetables.
Though Ugandans still ask whether HIV will ever be totally eradicated, the situation has vastly improved over the past 25 years.
In the early 1990s, HIV/Aids reached a peak in Uganda – 14 per cent of the population was infected with the virus.
However, rapid action by Ugandan-founded NGOs such as the Aids Support Organisation (Taso), as well as the Ugandan government’s public campaigns promoting abstinence, monogamy and condom usage, brought the rate to 8 per cent by 2000.
Figures for 2015 show a slight further reduction to 7.1 per cent.
Harriet (43) became a widow at 24 when her husband died after contracting HIV.
It was 1997 and the antiretroviral drugs (ARVs) were not yet widely available in Uganda.
Her husband had been in jail in Mombasa for a year. When he came back he was sick.
She says he never told her exactly what happened in jail.
Harriet later tested positive for HIV and herpes and was left alone with three children to care for.
“A few years before the advent of ARVs, having HIV was actually a death sentence. People had given up,” says Taso’s executive director, Dr Michael Etukoit.
“There were many people at that time who had even distributed their own property, their own wealth, land and even houses knowing they were going to die,” he recalls.
“People left their workplaces, which sometimes were far away, and moved to the villages to wait to die near home and family to minimise the expense of moving a dead body from somewhere far.”
Taso was formed in 1987, before there was any official response in Uganda, by those affected and infected with the virus.
At the time, the stigma of HIV was so bad that many doctors refused to treat HIV-positive patients. Many of the founding members of Taso died due to a lack of treatment options.
“I vividly remember what the picture was at the clinic,” Etukoit says of the year 2001.
“Somebody who did not see that picture cannot understand the significant transformation that the ARVs have brought.”
The widespread arrival of antiretroviral drugs signified the dawning of a new era. People accessed the treatment and were no longer dying in staggering numbers.
Harriet credits ARVs with her own survival. She began taking them three years ago and they have been so effective that the virus is no longer detectable in her system.
This does not mean that she is HIV-negative, simply that the viral load has decreased significantly.
“I’m doing well,” she says. “I thank God for that because there are so many people who died before and I hope to live.”
Still, increased survival rates have brought their own challenges. Being HIV-positive is no longer viewed as a death sentence, but concern is growing that it is also not now recognised as a life-altering virus.
Many no longer go for testing. Kampalans say if it isn’t fatal, they don’t want to know their status – knowing they are HIV-positive would make them sick from stress anyway.
“With ARVs, the survival rate increases, so the message gets distorted either out of ignorance or deliberately,” Etukoit says. “There are ARVs available, so it is a ‘cure’.”
Modern treatments continue to clash with older versions; messages are spread that certain procedures are a substitute for medication – which Etukoit stresses they are definitely not.
One common belief is that circumcision stops the spread of the virus, whereas in reality the procedure can actually spread of the virus when carried out by untrained individuals using unsterilised instruments.
In rural areas, traditional healers often encourage people to end their treatment. Certain religious groups advocate prayer as a cure.
For those taking antiretroviral drugs, the biggest challenge is often hunger. Taking ARVs on an empty stomach is difficult.
Some children say the effects are so severe that they are tempted not to take the drugs because they interfere with their schooling.
They find going to the hospital to collect their drugs frightening in case any of the locals see them and realise they are HIV-positive.
Robinnah, a Kampalan who has been positive for 27 years, is a keen advocate of antiretroviral drugs in her community.
“When you take it as the doctor prescribed, you don’t get problems,” she says. “If you don’t take them, well, you can’t cope.”
It is actually hard to find someone who will admit to not taking their drugs. Most speak to me with a medical healthcare professional present, and will not admit it.
Overall, the situation has vastly improved. Uganda has been praised for the manner in which it has sought to control the HIV/Aids epidemic of the 1980s and 1990s.
Increased complacency is simply another challenge in Uganda’s journey towards achieving its aim of a HIV-free generation.
Series concluded. This article was supported by a grant from the Simon Cumbers Media Fund Student Scheme.