The Impacts and Management of HIV in Uganda

Impacts of the Disease

HIV puts economic stress onto the young and the old, as they have to provide for the family if their relative who is of a working age is infected with HIV. This is made worse by the fact that 58% of all jobs are in the primary sector- using resources directly from the land- meaning that the young and the old are physically strained by work which they are forced to do in order to survive, which is not suitable for their body or their age. This also means that instead of farming and then selling their produce for money, they are forced into subsidence farming (providing for themselves alone), as they need to survive. This decrease in agriculture is also producing a huge loss or workforce across Uganda, which is directly impacting its GDP as a country. This, therefore is undoing decades of economic progress made by Uganda, and is hindering its economic development massively.

The financial costs of caring for patients with HIV/AIDS can also be huge, relative to total household income. In the Rakai district, households reported spending up to a third of their total annual income on medical care for one month, or for a funeral. This then puts more strain on the carers to make more income, putting huge amounts of economic and emotional stress on the already-vulnerable age groups. This could lead to mental problems such as depression and high levels of anxiety, which sometimes causes suicide, especially prevalent amongst young people.

HIV affects Uganda’s healthcare in 2 ways: it increases the number of people in need of services, and healthcare specifically for HIV is a lot more expensive than for other infectious diseases. By 1993, 54% of the admissions in Rubaga hospital (on the outskirts of Kampala), were HIV-positive and mortality rate of these patients was 17.4%, as oppose to the mortality rate for those not infected, which was 5.8%. Hospital occupancy rates has increased due to the huge amount of people seeking help with their HIV, and so this is putting a huge strain on the health sector in Uganda, which is already under massive amounts of pressure, given the high number of people with other infectious diseases such as malaria, TB and cholera, which require lots of medical attention.

The transmission rate in Uganda is also extremely high from lack of education about the disease, resulting in more cases, more poverty and more strain on both private and public resources. This could also be due to the fact that there is still a huge social stigma around HIV, and so high risk groups aren’t aware that the person they are getting it from even has HIV.

Education in Uganda is also extremely low, with the only 53.3% of children finishing primary school in 2011. This is somewhat due to children having to act as carers for sick relatives, or having to work to gain income for the family. This results in families being trapped in the poverty cycle because if people aren’t educated they can’t receive a high-paying specialised job, resulting in a very low income and poverty.

Management Strategies

The main approach to preventing HIV in Uganda is known as the ABC system:

·         Sexual abstinence

·         Be faithful to a single partner or reduce the number of partners

·         Always use a condom

This means that high risk groups are less likely to get/pass on HIV, as the number of unsafe sex encounters are drastically reduced. This initiative started when the government realised that the number of Ugandans who reported using condoms at their last sexual experience was at 13.7 percent in 2011. People, however, tend to not follow this advice, or are forced into having unsafe sex due to either domestic violence, rape culture or prostitution. This campaign is a change from abstinence-based approaches to prevention, which became dominant in previous years due to PEPFAR's significant investment of money for these types of programme. Delaying sex until marriage is hoped to reduce HIV infection rates among young people, and billboards across various cities in Uganda widely advertise this. However, ignoring the importance of condom use is contributing to rising HIV rates, showing how important all three areas of the ABC approach are.

A community-based organisation called The AIDS Support Organisation was set up in 1987 to help people come to terms with their disease and try and reduce the taboo of HIV, and was one of the first action groups in Uganda to help those with HIV.

Prevention of mother-to-child transmission (PMTCT): expectant mothers are encouraged to know their HIV status in Uganda, as this seriously affects the health of their baby. Around 94 percent of pregnant women who attended antenatal clinics in Kampala received counselling and testing for HIV in 2011, which suggests that knowledge about PMTCT is relatively high in the capital, however, this is only true for the women who went to antenatal clinics, which is around 68% of the city.

The World Bank has also significantly contributed to the HIV healthcare of Uganda, as it has donated a total of over $100 million dollars on HIV prevention and treatment over the last 50 years- drastically improving the prevalence of the disease in the last decade.

Uganda’s government has also ‘mainstreamed’ HIV issues in its Poverty Eradication Plan- raising awareness of the disease, various prevention methods and the socio-economic stress put on a large segment of the population.