Table of Contents
AIDS has been one the biggest epidemics that have affected many parts of the world; however, countries in Africa seem to have had the most adverse impact. For many reasons, Uganda has been the one country in African that has been able to control and reduce their HIV/AIDS transmission.
Background
As of 2017, Uganda roughly has a population of 40 million (World Health Organization, n.d.). There are 1.2 million individuals between the ages of 15 and 64 living with HIV in Uganda (Ministry Health 2017). Of those 1.2 million people, 62.9% are females and 53.9% are males. There are also approximately 468,000 children between the ages of 0 and 14 living with HIV. This number is relatively low compared to other countries in Africa.
Uganda is one of the youngest and rapidly growing countries in Africa (The World Factbook: UGANDA, 2018). Uganda gained its independence in 1962 after a battle over power with Britain (The World Factbook: UGANDA, 2018). During this time Uganda was divided into three separate political parties, and this caused the country to struggle with cohesiveness after gaining independence. Furthermore, Uganda is not an independent functioning country, nor is it in good economic standing.
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Uganda’s agriculture is an important part of their economic wealth due to the coffee, gold, cooper and other minerals that they can generate wealth from exporting. However, Uganda’s lack of modern technology, financial planning and poor infrastructure has had an unfortunate impact on their productivity (The World Factbook: UGANDA, 2018). Uganda relies greatly on outside sources and donations to help with funding the development of their healthcare system, education and well-being.
HIV/AIDS Outbreak
Uganda first cases of AIDS were recognized in 1983, and the number of cases quickly increased (Slutkin et al., 2006). Three years later there, in 1986, there were approximately 900 cases reported, and by 1988 that case number rose to 6,000. Sex workers counted for a large percentage of the cases at 86%, 33% of truck drivers tested positive for HIV, 14% of blood donors and 15% of pregnant women (Slutkin et al., 2006).
In 1986, the government began initiating programs in efforts to take control of this epidemic, and this is when the National Committee for the Prevention of AIDS (NPCA) was developed. Along with the NPCA, the World Health Organization (WHO) helped Uganda develop the first emergency national plan that was set to be implemented immediately (Slutkin et al., 2006). NPCA and WHO alongside Uganda’s government also developed a short-term plan, which would come about over the span of the next two years and medium-term plan, which would come into effect over the span of the next 3-5 years.
Implementation of Plans
Early in the plans, Uganda highly prioritized educational campaigning. In these campaigns, officials focused on informing the public on how the disease is transmitted and best way to avoid transmission. Slutkin et al. (2006) noted Uganda as being the first country to follow through all plans, funding and implementation for HIV/AIDS. Between the years of 1987 and 1989, Uganda had received a total of $18 million dollars to implement their plans. With this $18 million dollar, $7.2 million was spent on health education, $5.0 million was spent on lab support, $4.3 million was spent on surveillance and care, $1.6 million was designated for management of the plans (Slutkin et al., 2006).
The Health Education Campaign was developed to promote educational training for HIV/AIDS. Their main goal was to provide correct information about the transmission of HIV/AIDS, destigmatize the diagnosis of HIV/AIDS, inform the population about care services that will be provided and the use of condoms to aid in prevention (Slutkin et al., 2006). The campaign also provided two and three-day seminars held for health care professional and other influential sectors such as police, school official, and religious organizations to educate and provide other individuals with correct information pertaining to HIV/AIDS (Slutkin et al., 2006).
The National Committee for the Prevention of AIDS (NPCA) targeted media as an educator source for individuals. There were an endless number of commercials that provided correct information about HIV/AIDS (Slutkin et al., 2006). They were also pamphlets and flyers distributed to diffuse common misconceptions about HIV/AIDS. Most importantly, NPCA provided information about services offered for testing and treatment. This method was very effective as it was reported that 96% participants in a study recalled viewing these media outlets (Slutkin et al., 2006).
After these campaigns were initiated, there was a change in sexual behaviors. Officials believe that this campaign is what contributed to Uganda being ahead of other countries in Africa controlling the epidemic (Slutkin et al., 2006). Slutkin et al. (2006) studies show that the youth delayed sexual intercourse for later ages, individuals reported having fewer sexual partners, there was higher condom use, and overall sexual activity was reduced.
Uganda was also the first country to implement surveillance at clinics throughout the country to monitor the epidemic (Slutkin, et al., 2006). Within these six designated sites located across Uganda, they tracked current HIV/AIDS patients and recorded new cases to evaluate how successful their implementation had been. However, these surveillance sites only measured changes amongst individuals between ages 15 and 64 years of age (Slutkin et al., 2006).
Uganda seen the healthcare setting is an importance in the plan. All blood donated was screened before transfusions could be done (Slutkin et al., 2006). There were also extensive trainings on things such as workplace safety through the sterilization of instruments used in the facilities to reduce chances of cross contamination resulting in transmission. Health care professionals at most clinics and hospitals were also instructed to consistently offer HIV/AIDS testing to all patrons regardless of the nature of their doctor visit.
Barriers
While it seems that Uganda had their AIDS epidemic under control, they were also subject to various barriers due to their country’s economic and societal norms. Females have higher HIV/AIDS prevalence’s compared to men (Ministry of Health, 2017). In Ministry of Health’s assessment report of 2017, females have double the amount of prevalence until the age of 45. It was also found that females between the ages of 15-19 and 20-24 had 4x’s as much prevalence as men.
Social
Abimanyi-Ochom (2011) conducted a study in 2011 to evaluate risk factors for women with HIV/AIDS in Uganda. There were 10,826 Kenyan and Ugandan HIV positive women used in this study. There were 64% of Ugandan women who were married, 8% were widowed and 8% were divorced. It is apparent that married, widowed or divorced women are more susceptible to HIV/AIDS than women who were never married.
In Uganda, the social role of a woman is to honor her husband. In this type of family dynamic, the man has dictatorship over his wives’ sex life and sometimes the sex life of women outside of his partner (Abimanyi-Ochom, 2011). This make women who are partnered more exposed to contracting and further transmitting HIV/AIDS.
In addition to women being more vulnerable to HIV/AIDS, wealthy and professional women are susceptible to HIV/AIDS (Abimanyi-Ochom, 2011). These women are more likely to engage in sexual intercourse with wealthy men, who can have the financial ability to afford several sexual partners or even multiple wives. While condom use is often associated with wealthier women due to the cost and availability, the use of condoms isn’t typically supported nor at they often used during these sexual encounters (Abimanyi-Ochom, 2011).
Economic
While women who are partnered are more susceptible to HIV/AIDS due to the social norms of Uganda, women who are single also have a possibility of contracting HIV/AIDS due to Uganda’s economic status. Single women cannot depend on men, who are the primary breadwinners, to provide for them. Therefore, they often face restrictions to economic resources, so they may engage in sexual transactions to obtain necessities such as food or shelter (Abimanyi-Ochom, 2011). This greatly increases their risk for HIV/AIDS transmission.
Uganda’s campaign has provided mobile and home-based healthcare professionals to provide care for HIV/AIDS patients, there aren’t nearly enough healthcare professionals to provide care for all the individuals who are HIV/AIDS positive. Rural populations do not have access to medical facilities near for the testing and treatment (Abimanyi-Ochom, 2011). And others simply cannot afford to pay a taxi for transportation (Bajunirwe et al., 2016).
While some Ugandans experience economic struggles when trying to access treatment, other individuals who have access to treatment experience their own set of struggles. Sheri et al. (2010) found that food insecurity, or lack of adequate food, has impacted treatment for individuals. When ART and other drugs are prescribed, it is instructed that one takes it with food to reduce side effects. In Sheri et al. (2010) study, 14 out of 36 patients reported missing their doses due to food insecurity. Unfortunately, Uganda has limited means for providing food, education and proper health care (The World Factbook: UGANDA, 2018).
HIV/AIDS Psychological/Stigma
There is a lot of negative stigma associated with a positive HIV/AIDS diagnosis. While the World Health Organization (WHO) and National Committee for the Prevention of AIDS (NPCA) heavily promoted safe sex practices, some of their advertisements and campaigning, which heavily utilized scare tactics, helped develop negative connotations (Slutkin, et al., 2006).
Nyanzi-Wakholi et al. (2009) conducted a qualitative study that analyzed the different coping mechanisms for individuals living with HIV/AIDS in Uganda; in this study, Nyanzi- Wakholi categorized the three most common types of stigma that participants suffered from: self-inflicted, family-inflicted and community-inflicted.
Individuals typically become depressed and wonder if people can tell if they are HIV positive. Overall, they are fearful of how people will perceive them with their new diagnosis (Nyanzi-Wakholi et al., 2009). Participants reported their family abandoning them after they disclose their positive testing (Nyanzi-Wakholi et al., 2009). Some individual’s experienced discrimination and phobic interactions from people within their community after disclosing their status. To prevent people from figuring out their status, many people instruct health care professionals not to visit their home and they never seek treatment (Nyanzi-Wakholi et al., 2009).
Inconsistency in Service
In 2015, Bajunirwe et al. (2016) study of the gaps for implementation in HIV prevention, care and treatment, found that the planning and resources had not been consistently implemented or used. Also, many of the HIV/AIDS service providers were not working together to provide people living with HIV adequate care. There are some facilities that only provide certain services and are supposed to refer patients to other facilities to get their needs met. However, most healthcare professionals simply do not follow through with referrals, are unware of the other services that other facilities offer, and when patients are referred, the service providers are not available or altogether absent at the referral centers (Bajunirwe et al., 2016). In some cases, there is limited access to antiretroviral drugs, which was probably the biggest problem.
Some healthcare providers reported having no knowledge of when to start the treatment for ART in pregnant women (Bajunirwe et al., 2016). In addition, there was not any sustainable way to supply milk for HIV infected mothers to avoid transmission through breastmilk. Children affected with HIV are not offered the same amount of care as adults living with HIV (Bajunirwe et al., 2016). Many health professionals are not trained to adequately administer and implement treatment for children living with HIV.
Not Targeting High Risk Population
Providing care to people living with HIV/AIDS is the main goal of transmission prevention. However, there are populations with a higher risk for HIV/AIDS that should be targeted to prevent further transmission such as sex workers, truck and bus drivers, uniformed professionals and drug users (Bajunirwe et al., 2016). Unfortunately, Bajunirwe et al. (2016) study reported that these populations are not targeted. In fact, sex workers are often neglected when it comes to providing services and treatments due to the nature of their work.
