Why is HIV incidence rising in Uganda?

On January 14, 2009, in HIV/AIDS, PEPFAR, prevention, Uganda, by Karen Grepin

Two recent news articles from Africa made me aware that it seems as though HIV incidence rates may be on the rise again in Uganda. After many years of being the poster child for HIV prevention, there is news that the incidence rates may once again be on the increase in this East African country.

Apparently – I have not read the study – a new report produced by Makerere University experts on behalf of the Uganda AIDS Committee and the UNAIDS (“The Modes of Transmission study”) showed that incidence rates are on the rise, and that the rates are rising fastest among married people aged 30-40. They argue that prevention programs tend to focus on younger populations, potentially neglecting those who are also in need of prevention messages. The article suggests that prevention programs should be expanded to include more interventions directed to older and married populations, not just younger populations.

Another news story instead blames the failure not just on a lack of targeting to a particular population, but rather on the influence of PEPFAR which has supposedly changed the emphasis of prevention activities in Uganda away from broader prevention messages to abstinence only programs.

It is not at all clear which theory is right, or even what other factors may be to blame, but it does demonstrate the fragility of prevention programs. In theory, the populations that are seeing the increased incidence rates today were the populations that were targeted by the prevention programs initiated in Uganda 10-15 years ago. Either the effect of these efforts declines over time, or maybe new messages are needed over time. Whatever is going on, it certainly means that we are far from knowing what works for prevention.

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