Needs of gay men and sex workers ignored in new Ugandan HIV plan
World’s first presidential Fast-Track initiative puts Uganda back in driving seat of HIV response, but a lack of recognition of rights of at-risk groups will continue to hamper their efforts.
At the release of Uganda’s new HIV strategy, The Presidential Fast-Track Initiative, Ugandan President Yoweri Museveni called on all men to test for HIV and learn their status – but failed to acknowledge gay men, sex workers and people who use drugs who are the populations most at risk.
Launched in Kampala last week, the new initiative is based on a ‘Five-Point Plan’, devised to reinvigorate and accelerate the Ugandan response to HIV in order to achieve UNAIDS 90-90-90 Fast-Track Targets (90% people living with HIV tested; 90% on treatment; 90% virally suppressed).
The plan focuses on women and girls, and reaching men with testing services, and includes:
- Engaging men in HIV prevention and halting new infections among adolescent girls and young women.
- Driving forward the ‘test and treat’ strategy, particularly targeting men and young people.
- Continuing the positive results achieved from prevention of mother-to-child transmission (PMTCT) programmes.
- Ensuring financial stability for the HIV response.
- Ensuring institutional effectiveness for a well-coordinated multisectoral response
The omission of key marginalised groups from the plan – all of whom regularly experience harassment and violations of their human rights, increasing their vulnerability to HIV – was highlighted by Ugandan civil society.
Sylvia Nakasi, Policy and Advocacy Officer at the Uganda Network of AIDS Service Organisations (UNASO) told the Guardian, “Uganda will not end AIDS if these populations are left out and [continue] to be marginalised, stigmatised and discriminated against in our planning. They have high HIV prevalence and incidence.”
Around 1.5 million people are living with HIV in Uganda – 7.1% of the population. According to Uganda’s last narrative report to UNAIDS on the HIV epidemic, HIV prevalence among men who have sex with men (sometimes referred to as MSM) was 13.7%, and up to 34.2% for sex workers. There exists no official data on people who inject drugs.
These estimates may well only represent a small fraction of the HIV burden on these populations. Stigma, punitive laws and violence affect the ability of members of these groups to come forward for health services, this also affects effective data collection and monitoring. Same-sex relations, drug use and sex work are all criminalised offences in Uganda.
Outside of these key groups, great strides have been made in the prevention of mother-to-child transmission, with new HIV infections in babies falling ten-fold, from 25,000 to 3,500 among children overall between 2010 to 2015. People dying from AIDS-related illnesses has nearly halved, from 50,000 to 28,000. New HIV infections fell from 130,000 to 83,000 over the same period.
Museveni called on all men to test for HIV, acknowledging the gap in health services uptake between the genders. Only 60% of Ugandan men have tested for HIV, compared to 92% of Ugandan women. This reflects the success of PMTCT and health service integration. Men are also far less likely to be enrolled in treatment - just 52% are accessing treatment, compared to 81% of all women living with HIV.
“I call upon men to go for voluntary HIV counselling and testing. If you find you are HIV-positive, take HIV treatment. It will not cure you, but when the virus is suppressed, you prolong your life. And you will not infect other people. This is something that must be done.”