STI And HIV In Developing Nations - Essay Example

STI AND HIV PREVALENCE IN UGANDA Name Course Name and Code Institutions Name Instructor’s Name Date Introduction Over the past three decades, Sexually Transmitted Infections (STIs) and HIV/AIDS have been a global epidemic with developing countries being hardly hit by this epidemic. The first AIDS case was reported in 1981 whereas its virus, HIV, was first identified in 1983. According to the Global HIV Prevention Working Group (2008), the 2007 WHO estimated HIV statistics indicated that global HIV infections in 2007 were 2.5 million with 33.2 living with HIV and 2.1 million HIV deaths were reported. HIV/AIDS has left millions of children orphaned in developing countries and this has greatly affected the economic growth of these countries since poverty levels have been on the increase. In addition, women have been widowed and have been left by their partners weak and wasted by HIV/AIDS and hence cannot fend for their families, further worsening the economic condition of these developing countries. Children have also been infected with this incurable disease during birth through what is commonly known as mother- to- child transmission. In general, those adversely affected by this epidemic are women and children been who have been left to languish in poverty with some of them living positively with the disease. The relationship between STIs and HIV/AIDS is that STIs increase the risk of contracting HIV and especially if the STIs go on untreated (Bertozzi et al n.d). Genital ulcers and lesions caused by sexually transmitted infections such as herpes, syphilis and gonorrhoea increase the risk of contracting HIV. Additionally, vaginal infections such as bacterial vaginosis and trichomonas also increase the risk of contracting HIV (Bertozzi et al n.d). This paper focuses on the STI and HIV and AIDS situation in Uganda, a developing country in Sub-Saharan Africa that has over the years reported high levels of HIV/AIDS infections but has in the recent past had a miraculous reversal of the infection rates of this disease. It also focuses on the intervention strategies that have been implemented in the country to curb the spread of the disease as well as programs implemented to cater for the care of the infected populations. Discussed in the paper are also programs that can be implemented by the civil society and other non-governmental organizations in an effort to help the affected populations and to reduce the spread of the disease. STIs and HIV in Uganda It is almost three decades since the first AIDS case was reported in Uganda in 1982 and continued intensifying but with time, statistics were indicating that there has been a decrease in the spread of the disease (Tumushabe 2006, aidsuganda.org). In the year 1991, the World Health Organization estimated the adult HIV prevalence to be 15 percent and has over the years been on the decrease (World Bank 2011). According to estimates by UNAIDS, around half a million Ugandans had died of AIDS related complications by the end of 1997 and this was a great hit to the country since its total population was 20 million (Sengendo &Sekatawa 1999). In adults aged 25-44 years, AIDS was the leading cause of death after malaria by the year 2000 with an estimated 1.8 million Ugandans being infected with HIV (Sengendo &Sekatawa 1999). Initially, the AIDS epidemic in Uganda was concentrated near Lake Victoria and along the transnational highway from Kenya through Uganda to Rwanda and the Democratic Republic of Congo but was with time spread to other parts of the country with the northern region being the hardly hit part of the country (Sengendo &Sekatawa 1999). Furthermore, Sengendo &Sekatawa (1999) indicate that the most at risk populations in the early days of the epidemic in the country were the commercial sex workers, long distance truck drivers, urban residents, the youth and single women. Areas in the northern region have had the highest HIV prevalence with time and statistics show that half of the twelve districts highly affected by HIV come from the northern region (Sengendo &Sekatawa 1999). A 2004 UNAIDS/WHO Epidemiological Fact Sheet provided the statistics that the HIV prevalence among pregnant women in Kampala declined from 28 percent in 1991 to 6 percent in 2001 whereas the prevalence among pregnant women outside Kampala was 13 percent in 1992 and declined to 4.7 percent in 2002. In addition, 66 percent of 85 sex workers studied in 1997 were found to be HIV positive. From 1989-1999, HIV prevalence decreased among STI patients in Kampala from 52 percent to 23 percent. However, there was a recorded increase in HIV prevalence among military recruits in Kampala from 16 percent in 1992 to 27 percent in 1996 (UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance 2004). A 2010 health profile report about Uganda’s HIV situation by USAID shows that prevalence varies from one region to the other due to religious and cultural differences as well as urbanization. For instance, the Northwest region has a lower HIV prevalence due to strict Islamic values whereas the North Eastern region is very rural and does not have much external interaction with other regions. On the other hand, the Central, Kampala and North Central regions have higher HIV percentage of above 8 percent due to the high levels of urbanization (USAID 2010). Demographically, women are hardest hit by the epidemic in all regions where the prevalence peaks between ages 30 to 34 years, which represents 12 percent prevalence (USAID 2010). These high infections can be attributed to high rates of sexual violence especially among teenage women who have reported numerous cases of rape. Married women are also more at risk of contracting HIV than women who have never been married (USAID 2010). In terms of wealth, statistics indicate that HIV prevalence is higher among the rich population as well as those that are in stable employment but decreases among the poor and unemployed (USAID 2010). Age wise, it is evident that HIV prevalence is higher among the youth because they are more sexually active as compared to other age groups. However, the most at risk populations in Uganda include commercial sex workers, fishing communities, internally displaced people and refugees, long-distance truck drivers, persons in uniformed services such as the army and people with disabilities (USAID 2010). Response to STIs and HIV/AIDS in Uganda In the mid 90s when the AIDS epidemic prevalence rates increased in other parts of the world, Uganda surprised the world by reporting a decline in the infection rates of the disease in the country as from 1993. This success story can be attributed to several AIDS intervention and prevention strategies that have been put in place by the government of Uganda as well as by the civil society. Firstly, there is the active involvement of the government in the nationwide AIDS campaign. In 1986 the national AIDS Control Programme (ACP) was set up and mandated with the duty of studying the extent to which the disease had spread and the modes of transmission. It was also endowed with the responsibility of ensuring that the national blood bank was safe to reduce transmission of the disease through blood transfusion (Tumushabe 2006). Through this programme, a mass education campaign about HIV/AIDS was held across the country with the aim of educating Ugandans on HIV/AIDS prevention and how to take care of the patients in the community (Tumushabe 2006, USAID 2010). The Uganda AIDS Commission (UAC) was set up in 1992 and mandated to “coordinate the development of policies and implementation of HIV/AIDS guidelines; forge the integration and harmonization of efforts to combat HIV/AIDS; and monitor HIV/AIDS activities in the country” (Tumushabe 2006). The president was also not left behind and between1988-1989 he was actively involved in the nationwide AIDS education programme (Tumushabe 2006). In addition, the government had in May 1986 openly announced that it was facing the great challenge of AIDS in the country (Tumushabe 2006, USAID 2010) and did not hesitate to talk about HIV/AIDS in public unlike other African governments. Moreover, the government of Uganda took the initiative of drafting a national HIV/AIDS policy. The government’s HIV/AIDS policy bore the National Operational Plan (NOP) that focused on three key areas namely prevention of HIV transmission through sexual intercourse; prevention of mother to child transmission; and prevention of infection through blood transfusion (Sengendo &Sekatawa 1999). Secondly, the ABC (Abstain, be faithful, use condom) strategy was widely used in the country especially by NGOs and other civil society organizations (Tumushabe 2006). This strategy advocated for pre-marital abstinence for teenagers and young people who are not married. The B (be faithful) part of the strategy focused on married couples and encouraged them to stay faithful to their marriage partners but this faced a significant challenge in the polygamous communities. Condom use was advocated for especially among people with more than one sexual partner but faced great opposition from the president and the Christian population especially the Pentecostal church movement (Tumushabe 2006). Thirdly, there has been strong donor support for HIV/AIDS programs in the country. International donor agencies such as USAID, UNAIDS and WHO have been actively involved in funding HIV/AIDS programs in Uganda. For instance, in the fiscal year 2009, USAID donated $132.8 million for HIV/AIDS programs and services that are implemented through the U.S President’s Emergency Plan for AIDS Relief (USAID 2010). HIV/AIDS programs and services in Uganda include sharing of information on HIV/AIDS, love and care for infected people, care and support for orphans, supply of condoms as well as education on correct and consistent use of condoms among sexually active groups, HIV testing and counselling services, behaviour change approaches and health services such as provision of antiretroviral drugs to reduce mother to child infections as well as prolong life of infected people. Another successful intervention is behaviour change communication (BCC) that entails talking to people about sexual abstinence, faithfulness in marriage was well as correct and consistent use of condoms (Sengendo &Sekatawa 1999). It also involves encouraging people to visit HIV testing centres to know their status. The aim of this strategy is to advocate for change in human behaviour for the better since it is through changing risky human behaviours such as engaging in unprotected sex that will help reduce the spread of the disease. Behaviour change communication can be done through focus group discussions (FGDs), television drama, skits and theatre and arts. STI and HIV priorities by an NGO in Uganda Though there have been success stories of the HIV/AIDS epidemic in Uganda, there are areas that need more emphasis so as to push the infection rates to zero levels. Below are programs and services that an NGO in Uganda focusing on HIV reduction should adopt to achieve most desirable outcome: Behaviour change communication (BCC) strategies/programs: it can be argued that since there is no known cure for AIDS, the best strategy for now should be advocating for human behaviour change. Through drama, theatre and arts people can be advised on how to change their behaviours especially those that put them at risk of contracting AIDS. These risky behaviours include engaging in unprotected sex, having more than one sexual partner, drug use, and infidelity in marriage, sharing of cutting tools such as circumcision knives and early sexual activity. Through behaviour change communication, people are enlightened on matters pertaining to HIV transmission and prevention. Preventive strategies that are discussed through behaviour change communication include proper and consistent use of condoms, being faithful to ones partner as well as avoiding sharing of cutting and injecting tools such as syringes. This behaviour change communication should target the youth since statistics show that HIV prevalence among the youth in Uganda in high. Improvement of reproductive health services especially in the rural areas: reproductive health is a basic human right and is part of primary health care but in most developing countries, it is not viewed as being an important part of health care. From the discussion above, it can be seen that infection with sexually transmitted diseases increases the risk of contracting HIV. Women are the hardest hit part of the population as shown by the above statistics that indicate that in all regions of Uganda women have the highest rates of HIV infections. Therefore, it is important that any NGO dealing with HIV services should invest more in reproductive health and education. Provision of free antiretroviral drugs especially in rural areas: in most cases, the rural areas tend to be overlooked by the government and other development agencies. It is therefore important that any NGO dealing with HIV services in Uganda deals with the provision of antiretroviral drugs in the rural areas to ensure that those infected can live longer. HIV prevention programs for children: in the race to curb HIV infection, children below the age of 10 years have been ignored and there has not been any program to deal with HIV awareness among this young population. This age group should not be ignored since some of them have been infected through mother to child transmission and it is therefore important to educate them on HIV to encourage them to live positively. They can also be taught on ways of preventing future transmissions when they are sexually active. Conclusion STIs and HIV infections around the globe have been on the increase but Uganda has been reporting the opposite due to the implementation of successful HIV programs. Since the first HIV case in the 1980s, Uganda was hardly hit by the epidemic but as years went by the active involvement of the government in prevention strategies led to a decrease in the spread of the disease in the country. Prevention programs such as behaviour change communication, implementation of the Uganda AIDS Commission, establishment of a national HIV/AIDS policy and the use of the mass media in disbursing information on HIV/AIDS contributed much to the reduction of the spread of the disease in the country. However, the government, non-governmental organizations as well as the civil society should put more emphasis on behaviour change and invest more in reproductive health. References Bertozzi, S et al n.d, HIV/AIDS Prevention and Treatment. Available at www.files.dcp2.org/pdf/DCP/DCP18.pdf Global HIV Prevention Working Group. 2008. Behaviour Change and HIV Prevention: (Re) Considerations for the 21st Century. Available at www.GlobalHIVPrevention.org Hogle, J.A. 2002. What Happened in Uganda? Declining HIV Prevalence, Behaviour Change, and the National Response. USAID, Washington. Sengendo, J & Sekatawa, E.K. 1999. A cultural approach to HIV/AIDS prevention and care: UNESCO/UNAIDS research project: Uganda’s experience- country report. UNESCO, Kampala. Status of HIV& AIDS Prevention. Care and Treatment in Uganda. Available at www.aidsuganda.org/.../... Tumushabe, J. 2006. The Politics of HIV/AIDS in Uganda. United Nations Research Institute for Social Development (UNRISD), Geneva. UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance 2004, Epidemiological fact sheets on HIV/AIDS and Sexually Transmitted Infections. Available at http://www.unaids.org UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance. 2009. Epidemiological fact sheet on HIV and AIDS: Core data on epidemiology and response; Uganda 2008 update. Available at http://www.unaids.org USAID. 2010. Uganda: HIV/AIDS health profile. Available at http://www.usaid.gov/our_work/global_health/aids/Countries/africa/uganda.html World Bank. 2011. Reproductive health at a glance: Uganda. Available at www.worldbank.org/population Read More

In adults aged 25-44 years, AIDS was the leading cause of death after malaria by the year 2000 with an estimated 1.8 million Ugandans being infected with HIV (Sengendo &Sekatawa 1999). Initially, the AIDS epidemic in Uganda was concentrated near Lake Victoria and along the transnational highway from Kenya through Uganda to Rwanda and the Democratic Republic of Congo but was with time spread to other parts of the country with the northern region being the hardly hit part of the country (Sengendo &Sekatawa 1999).

Furthermore, Sengendo &Sekatawa (1999) indicate that the most at risk populations in the early days of the epidemic in the country were the commercial sex workers, long distance truck drivers, urban residents, the youth and single women. Areas in the northern region have had the highest HIV prevalence with time and statistics show that half of the twelve districts highly affected by HIV come from the northern region (Sengendo &Sekatawa 1999). A 2004 UNAIDS/WHO Epidemiological Fact Sheet provided the statistics that the HIV prevalence among pregnant women in Kampala declined from 28 percent in 1991 to 6 percent in 2001 whereas the prevalence among pregnant women outside Kampala was 13 percent in 1992 and declined to 4.

7 percent in 2002. In addition, 66 percent of 85 sex workers studied in 1997 were found to be HIV positive. From 1989-1999, HIV prevalence decreased among STI patients in Kampala from 52 percent to 23 percent. However, there was a recorded increase in HIV prevalence among military recruits in Kampala from 16 percent in 1992 to 27 percent in 1996 (UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance 2004). A 2010 health profile report about Uganda’s HIV situation by USAID shows that prevalence varies from one region to the other due to religious and cultural differences as well as urbanization.

For instance, the Northwest region has a lower HIV prevalence due to strict Islamic values whereas the North Eastern region is very rural and does not have much external interaction with other regions. On the other hand, the Central, Kampala and North Central regions have higher HIV percentage of above 8 percent due to the high levels of urbanization (USAID 2010). Demographically, women are hardest hit by the epidemic in all regions where the prevalence peaks between ages 30 to 34 years, which represents 12 percent prevalence (USAID 2010).

These high infections can be attributed to high rates of sexual violence especially among teenage women who have reported numerous cases of rape. Married women are also more at risk of contracting HIV than women who have never been married (USAID 2010). In terms of wealth, statistics indicate that HIV prevalence is higher among the rich population as well as those that are in stable employment but decreases among the poor and unemployed (USAID 2010). Age wise, it is evident that HIV prevalence is higher among the youth because they are more sexually active as compared to other age groups.

However, the most at risk populations in Uganda include commercial sex workers, fishing communities, internally displaced people and refugees, long-distance truck drivers, persons in uniformed services such as the army and people with disabilities (USAID 2010). Response to STIs and HIV/AIDS in Uganda In the mid 90s when the AIDS epidemic prevalence rates increased in other parts of the world, Uganda surprised the world by reporting a decline in the infection rates of the disease in the country as from 1993.

This success story can be attributed to several AIDS intervention and prevention strategies that have been put in place by the government of Uganda as well as by the civil society. Firstly, there is the active involvement of the government in the nationwide AIDS campaign. In 1986 the national AIDS Control Programme (ACP) was set up and mandated with the duty of studying the extent to which the disease had spread and the modes of transmission. It was also endowed with the responsibility of ensuring that the national blood bank was safe to reduce transmission of the disease through blood transfusion (Tumushabe 2006).

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