Why continued access to affordable HIV drugs hangs on a bill in the Ugandan parliament

Today Wednesday 21st August 2013, a bill critical to the lives of half a million Ugandans enrolled on HIV treatment comes up for debate in the plenary of the Ugandan parliament. Not many Ugandans have heard about the Industrial properties bill (2009) but here is why we should pay attention. Uganda’s national HIV prevalence rates have shot up from 6.4% in 2005 to 7.3% in 2012 with a clearly worrying upward trajectory. Uganda continues to register steady increases in annual HIV infection rates since 2010. Annual infection rates have risen from 100,000 in 2010 to 150,000 in 2011 according to statistics from the AIDS Information centre (AIC). Now, here is why the industrial properties bill (2009) can make or break not just the lives of Ugandans currently enrolled on HIV treatment but the Ugandan economy as a whole given that a 2008 UNDP study showed that continued access to HIV treatment offsets the negative economic growth rate of HIV by 5.3%. According to the 2013 Ministerial policy statement signed by Dr Ruhakana Rugunda, the Health Minister, there are 520,000 Ugandans currently enrolled on HIV treatment- and counting. Over 90% of these half a million Ugandans depend on Indian generic antiretroviral drugs (ARVs) for treatment- according to Denis Kibira, a Pharmacist and Medicines Advisor at HEPS-Uganda. The trouble is that the Indian generic ARVs, and yes, even those manufactured by Quality Chemicals at Luzira, are not brand drugs. Put another way, the generics consumed by Ugandan ARV users were not developed by Indian pharmaceutical companies. Indian companies copied the formulas for manufacturing these drugs by companies mostly from Western Europe and North America (without their authority). Almost all these Indian ARVs were originally developed after painstaking research and development by a pharmaceutical giant after investing literally millions of dollars of their own R&D funds to develop these drugs and have taken though rigorous animal and human trials and getting them approved from agencies such as the Food and Drug Administration (FDA) in the US. These pharmaceutical giants are then granted patents or exclusive right of use and distribution of say 30 years under international trade law relating to intellectual property rights. These patents imply that the ARVs are NOT to be copied by another manufacturer, in Uganda’s case, an Indian one. Of course this would not be a problem if Ugandans could afford to buy these drugs from Pfizer or Norvatis. The trouble is that these drugs are often priced at prices tailored to western markets yet a quarter of Ugandans live below the poverty line and Indian generics, which go about a tenth of the price of brand drugs is all they can afford. Even the US’s PEPFAR program in Uganda depends on generic ARVs for 96% of those treated under its numerous implementing partners-according to PEPFAR’s 2012 country operational plan. Because of these patent and international trade law barriers to access to essential medicines, poor countries met in Doha, Qatar in 2001 and made the Doha declaration which provided for poor countries to overcome these patent barriers by domesticating its provisions in their laws allowing poor countries to disregard these pharmaceutical patents on account of public health emergencies such as HIV/AIDS. The grace period for manufacturing generic pharmaceuticals expires on 1st January 2016 unless the Ugandan parliament sits today and calls for amendments to the Industrial properties bill (2009) to include ‘flexibilities’ that allow Uganda to lawfully extend this deadline or suspend international pharmaceutical patents with regard to some specific public health emergencies or import these drugs from India. These ‘flexibilities’ were agreed upon by the World Trade Organization (WTO) in 2005 and all the Ugandan parliament needs to do is include them in the industrial properties bill (2009). Short of this, come 2016, generic HIV drugs will become illegal under Uganda law and western pharmaceutical giants would successfully enforce patents for HIV drugs in Ugandan courts. According to CSOs involved in access to medicines issues in a joint statement issued on Monday 19th August 2013, the current bill does not include these ‘flexibilities’. ’’ Every Ugandan who has ever taken a tablet or a syrup to treat an ailment should pay attention to the Industrial properties bill’’says Primah Kwagala of Center for Health, Human Rights and Development’’

Ugandan housemaids a most at risk population for HIV infection-Daily Monitor

Ugandan housemaids are said to be an at most risk population for HIV infection according to the Daily Monitor newspaper of 5th August 2013.House maid are typically teenage girls who are ferried from a life of poverty and destitution in rural Uganda to urban middle class homes in Kampala to work as domestic servants engaged to do domestic chores like cooking, cleaning, looking after babies etc. Here is the article in its entirety: ''...The Ministry of Health has included house maids on the list of most at risk population in the spread of HIV/Aids. With a seven per cent prevalence rate, housemaids are feared to get infected and spread the virus at almost the same rate with prostitutes and fish mongers. According to junior Health minister (General Duties) Elioda Tumwesigye, the sexual network arising from housemaids is among the largest while their vulnerability puts the whole network at risk. “A housemaid may have sexual intercourse with the owner of the house, the male child, the home guard, the Shamba boy, the delivery boy and even neighbouring men, sometimes they have no power to dictate the use of condoms especially with their bosses,” Dr Tumwesigye told journalists at the Uganda Media Centre. Due to the nature of their jobs and lack of sensitisation, housemaids are also believed to be reluctant in seeking for medical help as well as finding out their status. The most recent UN Aids report indicates that Uganda is losing the fight against Aids given the increased prevalence rate, a fact the government blames on the reluctance of the population due to the presence of ARVs and low sensitisation on behavioural change as a tool against the virus. “The population has changed its mentality against the fight since they now know they can live with HIV/Aids,” said Dr Jane Aceng, the Director General Health Services.''

Ugandan activists decry patent barriers to accessing affordable generic HIV drugs

The World Trade Organization (WTO) last month extended the deadline for enforcement of patents and copyrights, mainly held by multinational companies, in the world’s least developed countries (LDCs) by a further eight years which elapse in 2021. The extension did not however include cheaper generic HIV drugs or pharmaceutical products in general whose deadline expires in 2016. Human rights organizations warn that the lives of half a million Ugandans enrolled on HIV treatment will hang in the balance if generic drugs are outlawed based on international trade law or the Trade Related Aspects of Intellectual Property Rights (TRIPS). According to Denis Kibira, medicines advisor for the non-governmental organisation HEPS-Uganda, over 90% of all HIV drugs in Uganda are generics manufactured in India. Generic drugs are identical copies of brand drugs manufactured by originator pharmaceutical companies, most of which are based in Western Europe and the US. HIV treatment was previously a preserve for patients in the west on account of the high prices of antiretroviral drugs (ARVs) and international patents which did not permit manufacture of ARVs at cheaper prices. HIV treatment became a possibility for millions in Sub Saharan Africa principally because of the introduction of generic ARVs in 2001. HIV drugs must be affordable Joshua Wamboga from The AIDS Support Organization, where over 100,000 people are enrolled on HIV treatment, said: "The ability to access cheap medicines on the market will be curtailed and the fight against HIV in Uganda may be lost if expansive trade laws are adopted without improving the incomes of Ugandans." According to the Ugandan Ministry of Health, there are over 500,000 antiretroviral users in the country. PEPFAR, the leading funder of HIV treatment in Uganda, indicated in its 2012 country operational plan that it depends on Indian generic drugs for 96% of those treated under its implementing partners. Generics drugs were a major factor in scaling up access to the over seven million who are currently on treatment in Africa according to a UNAIDS report of May 2013. Medicins San Frontiers reported this month the price of first line and second line antiretrovirals has fallen due to competition among generic drug manufacturers, further making antiretrovirals affordable by poor countries. The much more expensive second-line and third-line drugs, which are prescribed when a patient develops drug resistance to the first-line drugs are however, still patent protected. Putting lives at risk Outlawing generic antiretrovirals would jeopardize the lives of those already on treatment and be a crippling impediment to further scaling up access for those who become eligible for treatment. The demand for antiretrovirals in Uganda is set to increase given the increase in national prevalence of HIV from 6.4% in 2005 to 7.3% in 2012, according the Ugandan health ministry. The new World Health Organization HIV treatment guidelines issued on 30 June, recommend antiretroviral therapy now be initiated earlier before people’s CD4 counts get too low. So the demand for generic HIV pharmaceuticals is set to increase even further based on these recommendations. Professor Brook Baker of the US-based organisation Health GAP, in a joint statement with Uganda’s Centre for Health, Human Rights and Development (CEHURD), calls for least developed countries to start early in their quest for an unconditional extension to the grace period given by the World Trade Organization for manufacture and sale of generic antiretrovirals, which elapses in 2016. Uganda’s pharmaceutical industry Moses Mulumba, director at CEHURD, said: “Uganda has major technological and infrastructural deficiencies for its indigenous pharmaceutical industry to be able to develop its own original antiretrovirals. This would require millions of dollars in investment and highly qualified researchers.” He advised that Uganda could overcome these challenges through technology transfer arrangements with countries such as Brazil, China and India. Quality Chemicals is currently the only Ugandan pharmaceutical company manufacturing generic HIV drugs in a joint venture with Cipla of India.

Beware Ugandan cultural expressions are being ‘stolen’, repackaged and sold to you

It was October 2010. President Yoweri Museveni was locked in a bitter presidential election contest with Dr Kizza Besigye. A decisive blow, an event, an endorsement was needed by either camps to turn the tide. Then came the idea of turning a ,then recent, video skit in which President Museveni ‘rapping’ a traditional Ankole song ‘mpa enkoni’ into a modern hip hop rap track complete with electronic beats and baptized ‘another rap’. It was an instant success. ‘ Do you want another rap’ became viral on you tube. Hundreds wanted to watch a head of state who could rap like Eminem. More importantly for the producers of ‘another rap’, who included respected Producer Richard Kaweesa, ‘You want another rap?’ got traction among the critical Ugandan youth voters who formed the demographic bulk of registered voters. Beyond the electoral contest, ‘another rap’ became a pop culture hit in Uganda, and beyond.The President was advised to copy right the song. Not so fast, said Mwambustya Ndebesa and Dr Deo Katono. The historians maintained that ‘another rap’ could not be copy righted arguing that it was a traditional cultural expression of the banyankole people and could not therefore be claimed as private property by an individual. ‘’ I sang Mpa enkoni before I went to school. It was sang by my father, and grand father before him. It has been here for many generations. President Museveni must have first sang this song before he was probably four. He did not make any intellectual in put into it’ Mwambustya Ndebesa, a political historian at Makerere University, told a meeting of intellectual property rights experts at Africana Hotel on 28th June 2013. The dispute regarding whether ‘Another rap’’ merited copy right protection went as far as the Ugandan courts which held that ‘Another rap’ was a ‘derivative’ work’ –an adaptation taken from existing work. And that is the crux of the debate. What constitutes Ugandan folklore and who owns it? And when does an adaptation from it qualify as copy right?. The Africana hotel workshop which attracted Ugandan intellectual property rights legal experts and performing artists interest groups was organized by Anthony Matovu, a PhD student, with funding from the University of Illinois in the US. Mwambutsya blamed the current debate on turning collectively-held cultural rights into privately-held commodities on ‘marketization’ where ‘’ the rich appropriate the cultural resource of the poor’’. He argued that privatization and individual economic rights are western concepts which is why in Africa, cultural expressions were communally held but the advent of western neo-liberal ideology is endangering African cultural expressions. One of the participants observed that African people are an oral people and as such did not document their cultural expressions as well as western societies, which is why they remained largely in orature form. From 1980’s with Philly Lutaaya’s ‘Tulo tulo kwata omwana’ to the contemporary Nawulira by Navio, Ugandan artists have taken Ugandan cultural expressions and converted them into popular culture saleable commodities. But just how much is their individual in-put and what remains cultural property? According to Jeroline Akubu, Principal Legal Officer at Uganda Law reform Commission, Ugandan folkore or ‘cultural expressions’ are not currently protected by existing intellectual property laws which opens them up to several private copy right claims by individuals claiming that they have added value to the folklore existent in Uganda’s over 60 ethnic groups. Ghana has done better than Uganda on cultural assets by imposing a domestic tax on folklore by visiting foreigners. ‘’ We can make our cultural expressions a brand because we live in a world of markets and brands. There has been a favourable shift in attitude by Ugandans towards folklore which, in the past was seen as inferior’’ said Roger Mugisha, the renown radio personality, who attended the workshop. He reported that some enterprising Chinese are studying the traditional ‘endingidi’ with a view of teasing out a commercial prototype that they can re-package and sell- no doubt to a super market near you. Ndere Troupe’s Steven Rwangyezi said he was uneasy about reported efforts to seek a private patent for Ugandan bark cloth. A representative of the Ministry of Trade, at the workshop, reported that studies are yet to be done to quantify the contribution of Uganda’s cultural assets and industry to GDP. ‘’ We often complain that we have high youth unemployment rates but converting our cultural assets and industry into the market economy can help reduce unemployment. One Ugawood film script can create 100 jobs through actors, script writers, directors etc and a Ugandan CD can create 50 jobs through studio staff, graphic designers and vendors’ said Dick Matovu, General Secretary of Uganda Musician Union. ‘’ Nigeria is the second highest oil producer in Africa but nollywood is the second national revenue source. Cultural industries are overtaking traditional industries in some countries’’ he added. Charles Batambuze, an intellectual property rights expert, reported that government has set up a national creative economy committee under the Office of the Prime Minister and efforts are being made to document and quantify the importance of this industry to Uganda. Expressions of folklore are collective cultural assets and ordinary Ugandans should not be deprived of them. Globalization poses a clear and present danger of commoditization of African cultural expressions in a manner of exclusion. Ugandans as a people should document all the cultural expressions in their diversity and recognize them and protect them by law as Ghana has done. From that baseline, determining works that merit copy right protection, and those that Uganda can package and sell to the world, will be made a lot easier.

Relief in Uganda as LDCs granted TRIPS deadline extension

After intensely heated and acrimonious negotiations, The World Trade Organization (WTO) on 11th June 2013, agreed an eight-year deadline extension on enforcement of trade marks, patents and copy rights which are largely held by western companies and individuals, collectively known as intellectual property rights (IPRs) in the world’s poorest countries. Under a 1995 WTO treaty known as the Trade Related aspects of Intellectual Property Rights (TRIPS), a 2013 ‘transition’ deadline was set for enforcement of intellectual property rights ranging from educational books, pharmaceutical products to high-yield agricultural seeds. Intellectual property law protects the rights of innovators and inventors from copyright infringement. Most patents and copyrights are held by western companies and individuals, including in poor countries where the overwhelming majority of patents and applications are held and filed by foreign entities. The 2013 deadline meant that trademarks, patents and copy rights were to be enforced in poor countries and any breach would be punishable by law especially in countries like Uganda which have recently reformed their laws to recognize intellectual property rights. The latest WTO deadline extension goes as far as July 2021 and provides for a further deadline extension application. In November 2012, Haiti, on behalf of poor countries designated as ‘Least Developed Countries’ (LDCs), formally sought an unlimited extension whereby intellectual property rights enforcement would be suspended for as long as a country was designated as an LDC. The negotiations were long drawn-out and took several months. The Ugandan NGO, Centre for Health, Human Rights and Development (CEHURD), in a joint-statement with Health GAP , applauded the extension as ‘a partial victory’. They argued that the WTO decision will enable ‘’access to more affordable medicines and medical technologies, educational resources, agricultural inputs, and green and climate control technologies.’’ adding that ‘’ The US and Europe had pushed these countries to implement the standards of patent protection, copyrights, trademarks, and other forms of intellectual property in the next few years that today’s rich countries refused to implement while they were focused on development’’. The WTO in informal negotiations was willing to grant a TRIPS deadline extension of 5-7.5 years which LDCs opposed as too short a period with in which to build a viable technological base. "This is unacceptable as the TRIPS Agreement states that upon a duly motivated request, the TRIPS council shall grant an extension. LDCs, to which Uganda is categorized, are justified in seeking an unlimited extension for so long as they are so classified because the suggested 5-7years will not give us adequate time to overcome capacity constraints to develop a viable and competitive technological base," says Moses Mulumba, a director at the Center for Health, Human Rights and Development (CEHURD). The deadline for enforcement of the even more critical pharmaceutical patents is not until 2016 . It is understood that LDCs are planning a similar negotiations, in this regard, starting next year. ‘’In addition, LDCs and their allies will have to begin early to win an even better extension of the pharmaceutical product transition period which will expire in 2016. Here, too, the LDCs should insist on an unconditional extension (like the one they won in 2002) and it should last as long as a WTO member is an LDC. The fight against HIV, tuberculosis and malaria, and the simultaneous fights against neglected tropical diseases and non-communicable diseases, depend on affordable access to generic medicines of assured quality’’ said Prof Brook Baker of Health GAP. “As a region with overwhelming capacity constraints in local pharmaceutical production and 80% of the population depending on generic drugs, this offer to extend the transition time illuminates how much more effort civil society needs to put in asking for an indefinite extension of pharmaceutical product patents come 2016. It is very evident that civil society in the third world has a voice in the global agenda on trade in intellectual property rights,” said Moses Mulumba, Executive Director of CEHURD. “We are glad to see that our governments stood up to pressure, and fought for the right to pro-development policies,” added Kwagala, Policy Advocacy manager for CEHURD. “An extension of 8 years with a possibility of a further extension come 2021 is important. This will position our region to benefit from flexible intellectual property policies to be able to build a viable technology base. It is also opportune timing to focus on building the capacity of our local industries.” She said.

The economic cost of HIV/AIDS in Uganda

There is hardly a Ugandan who has not been touched by AIDS. It may have been a parent, a brother, a cousin, a friend, an old boy, a neighbour or the main bread winner in a family. We have all had our share of the grief and pain that AIDS visits upon us. The emotional strain and social face of HIV and AIDS is visible and tangible. Seeing your loved one painfully and helplessly waste away before your very eyes, feeling the pain and anguish of looking after the ill and subsequently attending that funeral with the mixed emotions of loss and a guilty relief-it is all over. For the patient and for you; the long suffering caregiver. AIDS is no longer only a human loss but a substantially economic one, which poses a serious threat to economic growth, development prospects and poverty alleviation in Uganda. In Uganda,the HIV prevalence rate has risen from 6.4% in 2005 to 7.3% in 2012, with even higher rates shown in some longitudinal studies in Masaka and Rakai, the direct and indirect economic costs of the epidemic are set to become greatly compounded. According to UNDP, Uganda has 130,000 new HIV infections every year. This equates to around 10,000 people being newly infected with HIV every month, which is a worrying trend. Surprisingly, there have not been many recent empirical studies on the economic impact of the epidemic in Uganda as compared to say, South Africa, where several studies and models have been developed. The reasons for this differ not least of which is that macro-economic models for estimating the economic toll of the epidemic vary, and there has been debate on their accuracy of findings (how do you isolate HIV from other factors?) but the economic impact of HIV is undeniable. A Ministry of Finance and Uganda AIDS Commission study (Assessing the Macro Economic impact of HIV/AIDS in Uganda) funded by UNDP shows that Uganda’s economic growth rate will slow by 1.2% due to the impact of HIV on Uganda’s labour force and the costs households incur in treating their infected members. The report, released in November 2008, estimates that by 2025 Uganda’s economy will be reduced by up to 39% on account of the epidemic. The same study shows that HIV and AIDS raise the overall poverty rate in Uganda by 1.4% every year. Times this by ten years and the cumulative effect becomes mind boggling. ‘’When a poor family is affected by HIV/AIDS, it increases poverty by 2% on individual homes across the country,” says Dr Keith Jeffries who led the study. Other studies now show that the HIV pandemic has resulted in socio economic reversals that cut off 4% on national economic growth rates in Sub Saharan African countries. The World Bank shows that in Uganda the economic impact of HIV-related deaths is stronger than other types of deaths such as malaria since households spend their savings on prolonged treatment and funerals. From an individual perspective, the economic toll is evident. The costs of prolonged hospitalizations, buying drugs, depleting personal savings for treatment costs, loss of productive hours while caring for the sick and those notoriously expensive Ugandan funerals push individuals and households down the poverty ladder. In Botswana, according to a 2006 UNAIDS study it was estimated that, on average, every income earner was likely to acquire one additional dependent over the next five years due to the AIDS epidemic. “We will see a ripple effect from the individual to firstly, households; secondly, businesses and communities, and lastly the welfare system,” said George Gavin, research fellow at the Health Economics and AIDS Research Division of the University of KwaZulu-Natal in South Africa. A 2002 study estimates that households suffer a decline in income of between 48 percent and 78 percent when a member of their household is lost to HIV, excluding the costs of funerals. Household expenditure on funerals can be as much as seven times their total monthly household incomes as reported by some families in some studies in South Africa. The loss of young adults due to prolonged illness and of course death in the most productive age group of 25-54 reduces the country’s labour supply and productivity. In the Uganda Railways Corporation, the loss in productivity per employee on account of AIDS is $300 according to a recent study. Ugandan businesses’ competitiveness and profitability has been impacted by HIV due to employee absenteeism on account of illness, expenditures on employee medical care, staff funeral expenses and attendance and training costs to replace departed workers. In Ethiopia, a World Bank Study on 25 rural households found the average cost of treatment, funeral and mourning expenses totaled several times the average household incomes. In a Henry Kaiser Foundation study conducted in South Africa in 2002, poor households with members living with HIV and AIDS were reducing spending on necessities. Households were likely to cut spending on clothing by 21% and on electricity by 16%. Even expenditure on food was reduced among 6% of the households affected by HIV with nearly a half of all households reporting not having enough to eat at some point. Neither is agriculture spared by HIV. A study by the Zimbabwe Farmers’ Union revealed that the AIDS-related death of a breadwinner led to a reduction in Maize production in the small holder farming sector by as much as 61%. HIV and AIDS has diminished the available agricultural production workforce in Southern African by between 14-20%, compromising food security at household and national levels. Ironically, those on antiretroviral therapy need lots of food due to the toxic nature of antiretroviral drugs. The education sector does not remain unscathed. A reduction in enrolment is one of the effects of the epidemic as pupils stay at home to look after sick parents and pupils drop out due to sick parents’ inability to raise fees. There has also been a reported direct loss of teachers to the epidemic. In Swaziland, a 2002 UNAIDS report shows that school enrolment dropped by 25-30% on account of AIDS 2000. Although antiretroviral therapy (ART) has been shown to reduce the economic impact of HIV, prevention remains the greatest hope of responding to the pandemic as treatment efforts are hopelessly outpaced by the increasing prevalence rates. A 2011 UNAIDS report estimates that for every patient put on antiretroviral therapy, two are newly infected in their place. Source: Key Correspondents » Login to post comments Pri

Uganda tobacco industry shifts to indirect advertising-study

Every year on May 31st, the world stops to reflect on the millions of lives lost to tobacco use around the world and the one billion set to lose their lives to tobacco use this century unless current trends are reversed. Uganda already has AIDS and malaria to worry about and yet a perfectly preventable epidemic of tobacco-use associated diseases is brewing. Tobacco use is the most preventable cause of death globally and is currently responsible for killing one in 10 adults worldwide. Globally, tobacco use kills more people every year than AIDS, malaria and Tuberculosis combined. This year, the World Health Organization (WHO) has selected theme of the ban on tobacco advertising, promotion and sponsorship. Scientific studies unequivocally show that a comprehensive ban on tobacco advertising has been followed by a reduction in cigarette consumption and that children and young people are more vulnerable to deceptive tobacco advertising. On 24th June 2007, Uganda became a signatory to the first global public health treaty in history known as the Framework Convention on Tobacco Control (FCTC) part of which commits countries to institute a comprehensive ban on tobacco advertising, promotion and sponsorship (TAPS) under article 13. Last year between June and August, I was principal investigator in a survey to investigate Uganda’s compliance with the ban on tobacco advertising, sponsorship and promotions made possible by a grant from the Geneva-based Framework Convention Alliance (FCA). Our research team scoured four key streets in each of the survey towns of Kampala, Gulu and Mbarara ,to reflect three strategic parts of Uganda, to collect data on Uganda’s compliance on the ban on tobacco advertising, promotion and sponsorship. As we commemorate World No Tobacco Day, it is an opportune moment to disseminate the findings of this study. First the good news: Our research team did not come across any billboard advertising tobacco in the streets of Kampala, Gulu and Mbarara we visited which suggests that direct tobacco advertising has reduced considerably. And now, the not so good news: The tobacco industry in Uganda has changed strategy from direct to indirect advertising in response to advertising restrictions. It circumvents the ban on advertising through innovative indirect forms of advertising such as ‘corporate social responsibility schemes’, product launches and promotions, branding and more recently, cigarette price increases in the print media. Violations at retail outlets are widespread in Uganda and considerable pictorial evidence was compiled for this report in the three towns visited. Point of Sale violations were abundant at super markets, kiosks and stalls, bars, gas stations .The violations are in form of posters, umbrella shades, branded display cases and branded tobacco company vehicles. Ugandan youth have been especially targeted by the industry as the tobacco posters we came across were placed in places favored by youth such as night clubs. Tobacco promotional events happen in youth hang outs. A 2002 Global Youth Survey revealed that almost 60% of Ugandan youth had seen pro-cigarette ads in newspapers and magazines in the past 30 days.. The industry especially targets youth because they are impressionable and therefore more susceptible to acting on tobacco messages, an irresistible lure of recruiting life-long clients to replace half of their clientele who eventually die from tobacco use. Additionally, countries like Uganda have very young populations compared to say Europe with the majority under the age of 30 and therefore a potentially lucrative market. In low and middle income countries, a third of young people own an object with a cigarette logo-according to the International Union against Tuberculosis and Lung disease. Unsurprisingly, the Tobacco Atlas (2012) lists Uganda among countries with a ‘complete absence of the ban on tobacco advertising’. The WHO 2009 report card on Uganda indicates that is no national ban on tobacco advertising, With the tobacco control bill (2012) coming before parliament soon, Uganda needs to follow in the footsteps of Kenya which instituted a ban in 2007, South Africa in 1999 and Ghana in 2012, to legislate for a comprehensive ban on tobacco advertising, promotion and sponsorship in all its forms, both direct and indirect.