In 1982, the world’s first AIDS victim succumbed to the disease in the Rakai District of Uganda, marking it as the birthplace of this epidemic. By the late 1990s, 15 percent of all adults in the country and almost 30 percent of all those living in urban areas were reported as infected with the virus (Avert, 2011). Currently, about 6.5 percent of Ugandans are living with HIV, and the country is lauded as a success story in the effort to lower transmission rates and prevent AIDS-related deaths. It has become a case study for the political, social and economic issues raised by the public health catastrophe, and what may be successful responses to them. Unfortunately, what the recent numbers and statistics do not reveal are several underlying barriers to treatment and prevention. After years of declining infection rates, prevalence of HIV is again beginning to rise in Uganda.
Below are three ironies (from my experience living in Uganda) that illustrate why the UN’s vague declarations aren’t enough to cure our global communities of the devastation wrought by HIV/AIDS.
1. Antiretroviral (ARV) drugs are made free to any Ugandan with HIV. There are several clinics (funded largely by international organizations like the UN) that are designated to dispense these drugs.
Unfortunately, ARVs are less effective if you have any pre-existing health conditions (like chronic malaria—almost universal in the region) or if you don’t have access to clean water and a healthy diet. Furthermore, the multiple medications in an ARV cocktail must be taken at specific times during the day. If you are unable to stick to the strict regimen, you can develop a resistance to the medicine. A majority of Ugandans walk long distances to acquire medication, so bad weather conditions and impassible roads can make it difficult to take the medication when needed.
Increased funding won’t make it easier for individuals to consistently access clinics and care or improve their responses to the drugs. Instead, holistic campaigns to build more efficient infrastructures, clean water sources, education systems and community development plans are necessary to address the root problems that are fueling the HIV epidemic.
2. Thanks to a thorough publicity push in Uganda over the past 15 years, almost everyone is aware of the disease and its dangers. Public service announcements, posters and songs about HIV awareness permeate throughout everyday culture, and children are taught at an early age that they should be tested for the disease whenever possible. (I visited an elementary school, and when we announced that children would be given an opportunity to get tested for HIV, they broke into spontaneous applause!)
Unfortunately, despite the once effective campaigns that promoted using condoms, being faithful to a partner and taking sexual health precautions, along with the influx of ARVs (from international organizations), people—especially young adults—no longer feel that contracting HIV is a dangerous death sentence. While a fellow researcher and I were chatting casually with a 16-year-old male, he made it clear that he didn’t think it was necessary to use condoms during his sexual relations. When we asked him why not, he said, “If I get sick, I will just take drugs and get better. The drugs are everywhere in Uganda—it is no problem here.” The recent upward spike in Uganda’s HIV transmission rates reflects this attitude in larger the society as well.
Increased funding for drugs will not help to revamp education programs to show the real dangers of the disease and the crucial distinction between preventing and treating the epidemic. If another generation of Ugandans is wiped out by the AIDS virus (like what occurred in the 1990s), the country will suffer terrible economic and social relapses into poverty, dependency and instability.
3. The international community’s focus on preventing, treating and raising awareness of HIV/AIDS has been a tremendously important aspect of Ugandan life. The cooperation between countries and the global effort to inspire scientific advances has provided countless Ugandans with care, treatment, drugs and information that have inspired progress and development in many aspects of society.
Unfortunately, the complete focus on HIV/AIDS-related issues in Uganda means that many other crucial developmental concerns have been ignored or deemed unimportant, ultimately demonstrating the unsustainable nature of one-sided international involvement. Budgets for government-run clinics usually only designate funding for HIV/AIDS treatment, leaving little leftover for other crucial medical needs, such as malaria and diarrhea treatment, family planning options, sanitation devices (gloves, needles, etc) and salaries for care providers.
Access to free ARVs does not help the women and girls who are forced into prostitution in order to eat or pay school fees, and it does not eradicate the common diarrheal diseases that cause a majority of child mortalities. It also does not empower women to have control over their sexual and reproductive health, and it does not provide job training or education that represents a pathway out of poverty for communities.
Until the UN is willing to listen to and work with experts in the field, take wider perspectives of what prevention entails and commit to action with real results, not just suggestions, I am positive that UN Secretary General Ban Ki-moon’s statement that we will eradicate HIV by 2020 is simply empty diatribe. What do you think?
Personal field experience in Uganda during 2009 – please send me a message if you are interested in learning more!
Edited by Kate Kunkel