The HIV Shift

By Henry Zakumumpa

Unfaithful couples contributing to ominous rise in national infection rates

New studies in Uganda show that married or co-habiting couples today stand a higher risk of contracting HIV than single or young people. This marks an astonishing shift in the pandemics infection patterns in the country. Uganda’s HIV/AIDS prevention campaigns, since the onset of the pandemic in the early 1980s, have been premised on the perception that young people between 15-24 years were at a higher risk of infection than older age groups, particularly those in the 30-40 age bracket.

There has been a shift in the epidemic from people in single casual relationships to those in long-term relationships, says the March 2010 Uganda epidemic status report by the Uganda AIDS Commission funded by UNAids. 43 percent of new HIV infections are among monogamous relationships while 64 percent are among persons reporting multiple partnerships and their partners.

The Director General of the Uganda AIDS Commission Dr Kihumuro Apuuli said: In our studies four or five years ago, the main new infections were among [people aged] 20 to 25. But now there is a shift upwards and the most new infections are among people between 30 and 34 years, and 40 and 45 years.  The UNAIDS 2009 epidemic report concurs with these findings in Uganda.

Studies show that between 1995 and 2006, the proportion of men and women who reported having had sex with someone other than their spouse increased from 12 percent to 16 percent for women, and from 29 percent to 36 percent for men. The Uganda AIDS Commission unveiled study results that show that 42 percent of  the 130,000 new HIV infections between 1996 and 2005 were among married couples.
Already HIV prevention health communication programmes such as those run by the Uganda Health Marketing Group (UHMG), a USAID-funded entity, have shifted attention from messages targeted at young people to a special focus on married couples.

Get off the sexual network and live a good life, advertise  radio spots repeatedly on Uganda’s FM radio stations. Married couples in Uganda are urged to discard their side dishes, an euphemism for mistresses. Side dishes, moreover, are likened to be extremely promiscuous. A signpost near Protea Hotel in central Kampala shows a gloomy infant girl next to an ailing mother with the caption Mum is always sick because she ate a side dish.

But the national HIV/AIDS prevention effort, in general, has been slow to adapt to the shift in the infection patterns. Efforts such as those by the Uganda Health Marketing group are few and far in between. They are certainly a far cry from the aggressive behavioural change campaigns favoured in the early 1990s which were funded by the government before the advent of AIDS donor support money. However Dr Kihumuro says that Uganda’s prevention efforts will now be tempered by the pandemic’s demographic changes and the need to refocus prevention strategies. Uganda AIDS Commission has in the past few weeks been running regular adverts in the print media targeted at married couples along the ‘sexual network’ concept of UHMG.

Donors have been slow as well in adapting to the demographic changes of the pandemic and most HIV/AIDS  prevention funding in Uganda. Therefore programming is still skewed towards young people.

Uganda is famed for having tamed HIV/AIDS prevalence rates from 30% at the height of the scourge in the late 1980s and early 1990s to about six percent by the late 1990s. However, recent studies show that the prevalence rates are on the rise again  in Uganda. Michel Sidibe, Executive Director of UNAids, blames this on complacency  occasioned by  the widespread use of anti-retroviral treatment (ART) and scaling down on prevention efforts in Uganda.

“After the reduction and introduction of treatment, most of the people were not feeling any more of the same pressure for prevention programmes, Sidibe told the BBC  in a recent interview.

Several other reasons have been cited by studies which include the increase in concurrent sexual partnerships, reduction in use of condoms, ignorance of ones HIV status, among others.

Current epidemiological trends would suggest that to avoid HIV infection in Uganda you may need to avoid getting married. How times have changed. There was a time in Uganda when marriage was the recommended option to avoid catching HIV.

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The writer is a Partners Uganda key correspondent for the International HIV/AIDS Alliance zakumumpa@yahoo.com