Monday, November 26, 2012

The coming armageddon:HIV funding cuts amidst Uganda's escalating infection rates

On 1st December 2012,  the world will commemorate the annual World AIDS day.

For Ugandans, December 1st should offer a sobering reminder of what has gone wrong with Uganda's once touted HIV success story.

For the past  twenty years, Uganda has had reason to look forward to every first of December with glee. You see, Uganda for many years was a global leader in taming run way HIV infection rates from an all-time high prevalence rate of 30% in the  80s to single digits in a matter of years.
HIV epidemiologists and country HIV control teams  from all over the world shuttled in and out of Kampala for many years. Uganda was an HIV prevention mecca of sorts. But that was then.

Earlier this year, Health Minister, Christine Ondoa announced results from a large national survey that show that Uganda's HIV prevalence rate has risen to 7.3% in 2012 from 6.4% in 2005.

''We feel embarrassed when we attend international HIV meetings and are terrified to announce we are from Uganda. Everyone wants to know what happened to Uganda's HIV success story?'' a Health Ministry official who didn't want to be identified intimated to me.

Unless one hasn't been keenly paying attention, it is not hard to seen where the train run off the rails.
Dr  Charles Watiti, a renown HIV treatment columnist(who is himself is living with HIV) acknowledged in his Monday, 26th November 2012 New Vision column that antiretroviral treatment (ART) ironically, has bred a tragic complacency.Uganda's mixed HIV prevention messages and strategies have also been cited as have an increase in concurrent multiple sexual partnerships especially among supposedly monogamous couples.

A few days ago, UNAids announced an astonishing decrease in HIV infections in Sub Saharan Africa. Malawi registered a 73% decrease,Botswana 71%,Namibia 68 and Zambia 58.
 As for Uganda, it was among the 69 countries which have not registered a decline in HIV infections between 2005 and 2011.

Last year, AIDS Information Centre's Dr Byarugaba announced that Uganda's annual HIV infection rate have reason to 150,000 cases continuing a trend for the past four years.

Uganda is headed for an Armageddon unless current HIV infection rates are reversed. Over 85% of HIV treatment costs are met the American tax payer through PEPFAR with the Global Fund running a close second.

In a joint report, WHO,UNAids and Unicef in 2011 revealed that international funding for HIV programmes fell from $8.7bn to $7.6bn in 2010. Contrast this with a recent World Bank study which projects that Uganda's annual HIV treatment costs will rise from a current $ 250 million to$ 1.5 billion in 2025.

Uganda's dependence on the US and the Global fund for HIV treatment remains threatened by the enduring global financial crisis and changing political climates in the Western Europe and US( the Obama administration was initially keen on switching from PEPFAR to child and maternal health causes).

The Global fund last year deferred  the next round of funding for HIV/AIDS,TB and Malaria till 2014 due to declining contributions from the mainly western donor countries.

As I write, several of those who are becoming clinically eligible for enrollment on antiretroviral therapy (ART) are being turned away at ART treatment centres who citing funding caps dont allow for enrollment of new patients. TASO earlier this year closed several of its outreach centres.

Can we treat our way out of the HIV epidemic? A study published in the Lancet last year suggested that, yes we can with $ 63 bn, the world could eradicate HIV in a couple of years by testing and treating all with HIV.

Global HIV funding trends however suggest that this may fiscally be a tall order for as long as the funders of HIV treatment remain the rich western world and the epicenter of the epidemic remains a needy SubSaharan Africa.


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