‘Why are you having sex?’: women bear brunt of Uganda’s high HIV rate

The Guardian

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A box for free condoms outside the Bwindi community hospital, western Uganda. Photograph: Andrew Aitchison/Corbis via Getty Images

KAMPALA  – The prevalence of HIV in Uganda is more than 3% higher among women than men, according to research revealed by the government.

While the overall rate of those aged between 15 and 49 living with the infection has declined in the past five years to 6% – from 7.3% – women remain disproportionately affected by the epidemic.

Health experts have attributed the disparity to the fact men tend to have more sexual partners, so a man with HIV would spread the infection to more people. Teenage girls and young women are also more likely to face discrimination when seeking preventative measures, such as asking for condoms.

A national survey found that while the proportion of men living with HIV has declined by 1.8% to 4.3% since 2011, the rate among women has decreased by just 0.8% – from 8.3% to 7.5% over the same period. The survey was conducted between August 2016 to March 2017, and the results represent the initial findings.

Analysis by the Uganda Aids Commission found that 570 Ugandan girls and young women aged 15 to 24 get infected with HIV every week.

The US ambassador to Uganda, Deborah Malac, said: “The burden of HIV infection in the country is still unacceptably high. Women remain disproportionately affected by the epidemic compared to their male counterparts. Ugandan youth, especially girls, carry the burden of new infections.”

Preliminary results reveal there are 1.3 million Ugandan adults and children living with HIV. Announcing the figures, Uganda’s health minister Jane Ruth Aceng said the country had made significant progress, a testament to its intensified HIV prevention programme.

“HIV prevalence has declined across socio-demographic sub groups and across the country. This decline may be a result of falling new HIV infections,” she said.

However, HIV advocacy groups have warned the information should be treated with caution until the full dataset is provided. Interviews and blood tests were conducted among 12,483 participating households. So far only the prevalence rate – a measure of the number of people with HIV in the population – has been released, rather than the incidence of HIV, which is an estimate of the rate of new infections.

Asia Russell, the Kampala-based executive director of global Aids advocacy organisation Health GAP, said it was unwise to over-interpret the reduction from 7.3% to 6%.

“The government is framing this as a good news story but how appropriate is that when the lion’s share of the data is missing? Nobody can say conclusively the decline is because there is a lower rate of HIV infections,” she said.

“Prevalence on its own is not helpful – what is important is incidence data, which is not expected until November. Research findings on the knowledge, attitudes and sexual practices of Ugandans is also vital.

“There is reams of important data still to come in establishing whether or not Uganda is on track to achieve epidemic control of HIV by 2030, which is a promise President Museveni made just a few weeks ago.”

While there have been positive developments over the past five years to address the HIV crisis, there remain “extremely concerning” political barriers to an effective Aids response, said Russell.

“Certain populations face stigma and discrimination, particularly gay Ugandan men and sex workers but also adolescent girls and young women.

“Teenage girls trying to access HIV prevention services from the health sector report discrimination at the first point of contact – nurses and other hospital staff are saying: ‘Why are you having sex? You should be married’.”

The first figures from the national survey have sparked concern that not enough is being done to tackle the high incidence of HIV among women and young people.

They show while 3.3% of 20- to 24-year-olds live with HIV the infection affects 5.1% of women compared with 1.3% of young men in the age group. The prevalence among 25- to 29-year-old is 6.3% but 8.5% of women are affected compared with 3.5% of men.

The government has said more prevention, awareness-raising and treatment is needed for those in the 15 to 29 age bracket.

Following the preliminary results of the survey, the health ministry called for “concerted efforts from all stakeholders for scale-up of evidence-based interventions for sustainable HIV epidemic control”.

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