Makerere University Takes the HIV Bull by the Horn

It became clear in 2009 when the HIV Modes of Transmission Report for Uganda was released. The number of new infections was increasing again and the population mostly contributing to this were the adults. Since the report came out, several other, though, smaller studies have confirmed everybodyÔÇÖs fear. Indeed, the prevalence rate stands at 7.2% up from 6.7%.

Makerere University, Uganda├ö├ç├ûs premier University has however, taken the issue to another level; a level that should have been reached as soon as the Modes of Transmission report was released.  A public discussion of whether Uganda is implementing the right strategies, targeting the right people and deploying resources in the right places. 

As one of the activities to mark Makerere├ö├ç├ûs grand old age of 90 years, the School of Public Health at the Makerere University College of Health Sciences, in partnership with the US Centres for Disease Control and Prevention (CDC), today held a public debate on ├ö├ç├┐HIV Prevention in Uganda: Are We Moving in the Right Direction?├ö├ç├û. The public debate held at the Imperials Royale Hotel attracted close to 1,000 people of different walks of life. 


 The panellists were nationally and internationally eminent researchers, implementers and activists in the field of HIV/AIDS in Uganda. On the proponents├ö├ç├û bench was Associate Professor Fred Wabwire- Mangen, Director for Regional Centre for Quality of Health Care at the College of Health Sciences and Dr. Stella Alamo-Talisuna, Executive Director, Reach-Out Mbuya.  The opponents├ö├ç├û bench was occupied by Dr. Alex Coutinho, Executive Director of the Infectious Diseases Institute at the College of Health Sciences and Ms. Milly Katana, a long-time HIV activist of national and international repute. 

In a win-win environment, both sides eloquently brought out the key issue in the HIV/AIDS arena in Uganda today. One of the key issues that came out from the proponents was the fact that clearly there has been some modest positive change in the behaviour of Ugandans.


Professor Wabwire noted that there are new infections occurring because of ARVs where infected people are living longer-which is a positive thing- and may be contributing to the prevalence.  He said over the years, human resources have been mobilised to scale up HIV services to have impact, after it was observed that the interventions being implemented were not on scale to have the desired impact. 


Professor Wabwire the country also has one of the best HIV Prevention Strategies in Africa, whose goal is to reduce HIV infection by 30% by 2015, which would result into averting 200,000 new infections in the next five years. Most importantly, the strategy calls for the scaling up of interventions. 

In her submission, Dr. Stella Alamo noted that Uganda has been judged harshly and gave a few pointers to the fact that the country is moving in the right direction. ├ö├ç┬úThe landmark for Prevention of Mother To Child Transmission of HIV was coined here in Uganda, the 66% prevention control in circumcised men was coined here├ö├ç├ÿ, she submitted. 

Dr. Alamo said that the prevention agenda has shifted to engagement in other crucial areas of prevention, like dialogue with sex workers and men who have sex with men. 


The debate opponents collectively put up an articulate submission pointing at areas where the current interventions have failed to make impact. Key areas of concern to Dr. Alex Coutinho were lack of leadership commitment, weak community engagement, promotion of single interventions like circumcision and abstinence creating a ├ö├ç├┐magic bullet├ö├ç├û illusion, writing wonderful-reading documents (policies and plans) without commitment to implementation. 

Dr. Coutinho elaborated that what brought down the infections in the early phase of the epidemic in Uganda was committed leadership right from the President to the village leaders, religious leaders as well as cultural leaders. This, he said, was complimented by focused, well-developed messages that had a tinge of fear. 

Dr. Coutihno also said that while all Uganda├ö├ç├ûs neighbours are doing well with the epidemic, with prevalence rates between 6% (Kenya) and 3% (Rwanda), Uganda stands out as a regional sore finger.  


In her submission, Ms. Milly Katana pointed out the need for openness that matches with realities that characterise the HIV epidemic today, specifically bringing out the issue of sex workers and men having sex with men. She also emphasised the need for integrated approaches that handle all the key issues like poverty that forces young women into commercial sex work.