NEWS: New study faults Uganda government on HIV resource allocation

New study faults Uganda government on HIV resource allocation

Saturday, June 6, 2009 from MONITOR ONLINE

After over 15 years and billions of shillings spent on promoting ABC, Uganda has been named as one of the countries which is committing little resources on national HIV prevention campaigns, writes Peter NyanziUganda is one of the countries where scarce resources are being spent on national HIV/Aids prevention campaigns that do not reach the people most at risk of infection, a new research has shown. The report, which was released at the end of May, decries a lack of an evidence-based approach to HIV/Aids, adding that there is a mismatch between resources and infection rates because prevention policies and programmes are not aligned and targeted to the populations in most need.The study, titled, “The Analysis of Prevention Response and Modes of Transmission," was carried out between 2007 and 2008 by Unaids and the World Bank in partnership with the Uganda Aids Commission; to find out how and where most HIV/Aids infections were occurring and whether existing prevention efforts and expenditure matched these findings. “The synthesis shows a mismatch between the epidemiology, policies and programmes and the resource allocation,” the report reads in part. “Despite the evidence of the risk factors and drivers of the epidemic, there are no policies targeting most at risk populations (MARPs), circumcision and the contextual factors.” Over the past 15 years, HIV/Aids prevention campaigns have been based on the assumption that young, single people who engaged in casual sex were most at risk of infection. Over the years, Uganda has spent billions promoting the ABC model (Abstain, Be faithful to one sexual partner and Condom use) but the study found that 43 per cent of infections still occurred among those who had multiple sex partners besides their regular partners. The report recommends “a re-alignment of prevention efforts to where the new infections are occurring and to the populations most in need,” adding that the focus of HIV/Aids spending should be on prevention campaigns aimed at married people or those in long-term relationships. It says only 31 per cent of the $249 million resource envelope used to fight HIV/Aids went to prevention strategies while the bulk of the funding (53 per cent) went towards care and treatment. About 1.5 million Ugandans are said to be HIV/Aids positive. Programme management and mitigation each took 8 per cent.Ms Debrework Zewdie, the director of the World Bank's Global HIV/Aids Unit, noted that the current global economic downturn made it more important than ever to get the most impact out of investments in HIV/Aids prevention. According to the report, the previously heralded decline in prevalence from a peak of 18 per cent in 1992 to 6.1 in 2002 ended and that there is a stabilisation of prevalence between 6.1 and 6.5 per cent in some antenatal testing sites and even a rise in others.This is accompanied by “a deterioration in behavioral indicators” especially an increase in multiple concurrent partnerships. There has also been a shift in the epidemic from single casual relationships to long term stable relationships. It says 43 per cent of new HIV/Aids infections were among monogamous relationships while 46 per cent are among persons reporting multiple partnerships. Commercial sex workers, their clients and partners of clients contribute 10 per cent of new infections. The report also confirms that there has been a shift in concentration of the epidemic from younger to older individuals with the highest prevalence for men (9.9 per cent) being among 35-39 year olds, while for women (12 per cent) it is among 30-34 year olds. Furthermore, the high burden of herpes simplex virus (HSV-2) of 44 per cent has fueled the epidemic.The report recommends the establishment of clearer policies, standards and guidelines to improve HIV counseling and testing services, information, education and communication (IEC), male circumcision and behaviour change interventions for married and long-term sexual partners, people living with HIV and at-risk groups. The research was also carried out in Kenya, Lesotho, Mozambique and Lesotho where it was also revealed that most new infections were occurring because people were continuing to have more than one partner at a time, both before and during marriage.