UN Integrated Regional Information Network - December 15, 2008

Prevalence of over 20 percent in the early 1990s declined to about six percent in 2000, and since then has gone down slightly to the current UNAIDS estimate of 5.4 percent.

An update on the global epidemic, published by UNAIDS in July 2008, pointed to signs in Uganda of "a possible resurgence in sexual risk-taking that could cause the epidemic to grow again."

First Lady Janet Museveni, who has been active in Uganda's AIDS efforts, commented that the country's previous success in reducing its HIV rate was achieved through "concerted and focused effort from all sections of society ... the 'do or die' push of a desperate people".

She blamed the current situation of "regression amidst plenty" partly on poorly conceived prevention campaigns. Billboards discouraging "cross-generational" sex, for example, could be read as telling young people that sex was safe as long as it was with someone their own age.

"The programme activities being funded may not be helping to prevent AIDS but may actually be fuelling the rate of infection," said Museveni.

According to the most recent data, HIV incidence [new infection] rates are highest among couples in long-term relationships when one or both partners also have other sexual relationships at the same time.

Some have blamed the recent resurgence in HIV infections on complacency, arguing that since life-prolonging antiretroviral (ARV) drugs became freely available, Ugandans think of HIV/AIDS as just another chronic but manageable disease.

Dr Chris Baryomunsi, vice-chairperson of the parliamentary committee on HIV/AIDS, said business was booming at lodges where couples conducted illicit affairs; such establishments used to stock their rooms with condoms, but no longer. "People are relaxed, [they're] not taking precautions," he said.

The considerable resources available for the fight against HIV/AIDS may have contributed to the complacency, said Thomas Munghono, an HIV consultant at the HIV/AIDS Alliance in Uganda, a global partnership of nationally based organisations working to support community action on AIDS in developing countries.

"The donors believe in us because we did right the first time. The question is - are we still doing it right?" he said.

Baryomunsi said too many HIV/AIDS programmes were continuing as usual, despite mounting evidence that they were ineffective, while others appeared to have run out of steam.

Uganda recently launched a five-year strategic plan with an estimated price tag of US$2 billion, which aims to decrease the rate of new infections by 40 percent, but Baryomunsi said prevention messages would have to take into account new research about what was driving the country's evolving epidemic.

"Previously, the messages were for young people, but the risk is much higher among married people now. It is important that we review our work," he told IRIN/PlusNews.

There is general consensus that reinvigorating HIV prevention in Uganda will mean tailoring programmes to address behaviour driving the epidemic, such as multiple partnerships, lack of HIV testing, and unprotected sex between discordant partners (where one is HIV-positive and the other negative).

Recent studies have also identified certain population groups with HIV prevalence rates way above that of the general population. In fishing communities around Lake Victoria, for example, up to six out of 10 people are HIV-positive, according to a report released earlier in 2008 by the Lake Victoria Fisheries Organisation.

The high local infection rate is fuelled by fishermen with disposable income to spend on alcohol and sex workers. Many of the sites where fishermen land their catches also lack access to HIV/AIDS information and services.

In its five-year national strategic plan, the Uganda AIDS Commission said it planned to reduce new infections by continuing to use the ABC (Abstain from Sex, Be faithful and use a Condom) approach but would also implement strategies to prevent infections in key high-risk groups.

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