InterPress News Service (IPS); Sunday, 9 March 1997.
Vukoni Lupa-Lasaga and Nana Rosine Ngangoue

A report by the Ugandan Health Ministry's STD/AIDS Control Programme (STD/ACP) shows that HIV infection is declining in parts of the country. The October 1996 report, released to the media in February, also indicates that Ugandans have significantly changed their sexual behaviour to avoid infection.

STD/ACP researchers monitored infection among pregnant women at six hospitals between 1991 and 1995. In two of these institutions, the average rates dropped from 27.8 and 22 percent in 1991-1992 to 16.8 and 13 percent in 1993-1995 respectively.

In three others, HIV infection went down from 27.4, 24.4, and 12.1 percent of all expectant mothers to 20.2, 16.6 and 7.7 percent respectively. Only at one hospital was the decrease insignificant: from 12.8 to 12.4.

However, Uganda's overall statistics -- and Africa's -- remain grim. The Ugandan health ministry estimates that there are 1.5 million infected Ugandans. The WHO, for its part, says there are about 14 million people living with HIV in Africa -- about 63 percent of all cases worldwide.

Over 48,000 cumulative cases of the aquired immune deficiency syndrome (AIDS) have been reported in Uganda since the mid-1980s, but when unreported cases are included, the real figure could be five to 10 times higher. Cases reported throughout Africa up to November 1996 total 553,291, but the WHO estimates that there are about five million people living with AIDS on the continent.

Up to November, 783.700 AIDS deaths had been reported on the continent, according to Dr. Guerma Tegust, head of the AIDS/STDs Programme at the WHO Regional Office for Africa in Brazzaville.

The HIV-infection rate among expectant mothers is one of the variables used to estimate overall HIV-prevalence in countries. In addition to Uganda, African nations with infection rates of more than 10 percent among pregnant women include Kenya, Malawi, Rwanda, Tanzania, Zambia and Cote d'Ivoire, said Tegust.

At least two other nations are expected to join this category: "Botswana and South Africa have experienced a very high increase in HIV-prevalence in their populations," Tegust said. "The rates there will soon be higher than 10 percent."

Although the overall rate in Uganda is still high, the decrease in HIV-prevalence among pregnant women is significant. "This drop has been possible due to the multi-sectoral approach we adopted," retired Anglican bishop Misaeri Kauma, head of the Uganda Aids Commission (UAC), told IPS.

The multi-sectoral approach is a web of coordinated efforts starting from the UAC's national secretariat through ministries and districts down to village councils.

Technical committees that coordinate efforts in research and development, prevention and control, care and support, traditional practices, policy and ethics are helped by various task forces and steering committees.

NGOs, religious groups, academics and researchers, the media, the private sector, unions, workers, employers, herbalists, people living with HIV/AIDS, artists and other groups are all considered partners by the UAC.

Benjamin Sensasi, information officer at the WHO's country office in Kampala told IPS Uganda's multi-sectoral approach to AIDS prevention, which the WHO has helped to fund, offers useful lessons to other countries.

"The Ugandan experience has obviously enriched WHO's global approach to AIDS and the multi-sectoral approach to AIDS prevention is one of them," he said.

The UAC was set up by an act of parliament in 1992 and placed directly under the Office of the President, not only to contain the spread of HIV but also to find a cure for AIDS.

But not everybody is happy with the commission. Prof. Charles Ssali, an AIDS researcher who claims that his Mariandina A and B pills actually cure AIDS, criticises its approach. "They have been wasting money on counting dead bodies rather than funding research into a cure for AIDS," he told IPS.

Ssali, an Ear, Nose and Throat specialist whose research and views on AIDS have stirred up much controversy in Uganda, charged that western pharmaceutical firms, in connivance with UAC and health ministry officials were more interested in sidelining genuine local researchers than collaborating with them.

But Kauma said it was essential for the UAC, the medical council and the national institute of science and technology to streamline and regulate research into an AIDS cure.

"We make sure that everybody who does research does not do it his own way but in a way which is scientifically and internationally accepted," he said. "The problem we have with Prof. Ssali is that he doesn't show where he started, what he has achieved and how."

He added that it was not true that HIV-related research was not being supported in Uganda. The UAC has overseen research on possible cures, especially by a Joint Clinical Research Centre set up by the national army, one of the institutions hardest hit by the spread of AIDS.

And traditional health practitioners, through the Traditional Health and Modern Doctors Against Aids (THETA), have developed herbs that can effectively treat AIDS symptoms such as diarrhoea, vomiting and shingles, Kauma told IPS.

He admitted that there were shortcomings and constraints in the multi-sectoral approach, such as friction with the Catholic church over the use of condoms, but stressed that there was now a consensus that AIDS is more than just a medical problem.

"Our approach is definitely worth emulating, and, internationally, many parts of the world heard of the multi- sectoral approach through us," he said. But inadequate funding remains a big problem, the UAC chairman added. In the 1995/1996 financial year for example the commission's budget was slashed from the equivalent of about 486,000 U.S. dollars to around 198,000 dollars.

This is a difficulty facing the anti-AIDS fight in much of Africa, according to WHO's Tegust, who explained that hospitals in Africa often lack the resources to conduct HIV tests. There are also socio-cultural factors which hamper the fight against HIV prevention, including poverty, migration and armed conflicts.

"During migrations from one country to another, men often do not have their wives with them and they take other women," said Tegust. "When they return home, they can infect their wives if they have the virus.

"When there is war, there are refugees, there is rape and sexual abuse ... There are also psychological factors such as after genocide when people think they have to multiply so they do not protect themselves."

The link between war and AIDS is evident in Uganda.

Infection rates have been dropping in urban areas -- partly because much of the anti-HIV/AIDS effort has been in towns -- but increasing in villages, and according to Fred Odongkara, a UAC documentation officer, this is especially true in areas in the north and northeast that have been plagued by civil war.

"These areas offer a good environment because, rape, defilement and abduction of women took place," he said. (END/IPS/VLL/NRN/KB/97)

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