New Vision (Kampala) - December 3, 2001

It will take the next 50 to 100 years for scientists to find a solution to the HIV/AIDS epidemic and 20 years for a vaccine to be available.

This was revealed recently by Dr Samuel Okware, the first programme manager of the AIDS Control Programme (ACP), and currently commissioner of Health Services (Community Health), Ministry of Health. He said small pox was discovered in 1833 but it took almost 100 years to be eliminated. "We should be guarded. We should not be too optimistic," the renowned doctor pointed out.

From 1980, several scientists and health officials have predicted that it will take five to 10 years for an AIDS vaccine and are since still saying five to 10 years.

"It is not the only epidemic. There are new epidemics emerging and even other old diseases may remerge," he said. He listed some of them as plague, cholera, influenza and smallpox. More than 30 people had died of bubonic plague in Nebbi and Arua district by the end of this year. 100 cases had been recorded.

It is now two decades since the beginning of the epidemic. In 1982, Okware was one of the first doctors dispatched to Rakai by government to study cases of a disease called slim by the local populace. Patients were developing diarrhoea, wasting and then dying.

"We have braved it and are now living positively. Something that started as a rumour became a disease, then we had to admit it was an epidemic, then a tragedy and finally that the problem must live with us, said Okware referring to the early years of the epidemic.

Uganda was the first country in the world to document declining HIV prevalence rates. Sentinel surveillance prevalence rates have continued to decline in the in both rural and urban surveillance sites in the country.

The overall prevalence rate was 6.1% in 2000 down from 6.8% in 1999. In the urban sites prevalence dropped from 10.9% in 1999 to 8.7% in 2000 while in rural sites from 4.3% in 1999 to 4.2% in 2000.

Data on HIV infection trends is obtained from pregnant mothers attending sentinel surveillance sites in various parts of the country. This is because they represent a sexually active group. In addition, infection trends are monitored among STD patients attending one major hospital in Kampala.

Okware revealed that the community has been the greatest resource in face of the deadly disease. Many community based initiatives have come up in a bid to improve the community's own health.

"Through the epidemic we have generated community participation and the disease is being used as an entry point for primary health care. We have trained many health workers in offering of this kind of care," he said.

With the level we are at now, we can send the disease to a stage where it is no longer of public health importance," Okware said. But other health researchers noted that AIDS will remain of public health importance for a long time. "With 2 million infected since the start of the epidemic, and at any one time we have 1.2 million people with AIDS, 800,000 dead since the beginning of the epidemic, and 100,000 new cases per year, that is a big disease burden," they said.

Ministry of Health's Health Education Department was also a result of the AIDS epidemic and the Blood Bank has also improved from 25% capacity to over 90% capacity in offering blood transfusion services to people, Okware said.

He said government strategy to fight HIV/AIDS had helped them develop capacity to work on new emerging epidemics. "It is the same technique we used to stop ebola, and in all this the community has been the greatest resource," he said. He commended the NGOS for their work on AIDS.

The many strategies set up to fight the epidemic have also built up capacity for research on HIV and other diseases.

Dr Elizabeth Madraa, the AIDS Control Programme manager agreed with Dr Okware on the achievements made by different parties regarding HIV/AIDS. She however asked for more care and treatment of those with HIV.

She said the multi-sectoral approach that encouraged everybody to play a role in the war against AIDS had generally been successful.

Madraa however said that though each ministry was supposed to have an HIV component, the system had not been fully utilised to build up capacity. "All these programmes without support do not help," she said and suggested the hiring of consultants in respective ministries to handle HIV issues.

She said community based organisations need to be supervised so that their cash flow is not hampered.

Madraa however warned that the infection rate being less than 8% at national level does not mean that the campaign should stop there. "Senegal has sustained infection rate at 1% but it still remains a problem.

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