Morbidity of AIDS in Uganda

They formed alliances with healthcare providers, NGO's and other health groups in developed countries and argued that the cost of ARV was too high. Activists around the world demonstrated for lowering the price and increasing access to it by poor countries. This led to a revolutionary court case in 2002 against a consortium of 39 drug companies in South Africa, when the government won the right to source more affordable ARV drugs. Brazil and Thailand also played an important role in price reduction because both became manufacturers and started public production of generic versions of ARV drugs at a fraction of the cost of the patented ones (Ford, Calmy & Mills). A generic drug company in India called Cipla offered to manufacture triple therapy for less than a dollar a day.

This began a global competition that has brought worldwide prices down in the past 10 years to $50 USD/day per patient. These lower ARV prices are what made PEPFAR and ART scale up possible.

These prices enabled Uganda to treat millions more suffering from HIV and helped lower the rates of morbidity (Silnicki). Uganda did much better than its peers in providing antiretroviral treatment. Antiretroviral treatment studies show that Uganda achieved a higher coverage level of HAART than expected given its level of development, external resources, societal characteristics and disease burden. This can be attributed to the government for providing strong leadership and ensuring AIDS featured prominently in nationwide scale, and by building partnerships with societies on prevention and care. Ugandan government was also known to have been involved in coordinating a broadly diverse group of actors through the national AIDS Control Programme (Grebe). In the beginning, these programs mostly focused on getting people access to HAART. HAART therapy requires strict adherence to the prescribed drug schedule to prevent drug resistant strains of HIV from emerging. Patients had to be monitored closely, which was a very difficult task to accomplish in Uganda; especially in rural areas. However, the Rural Home-Based HIV counseling and testing (HBHCT) along with intensive community education and mobilization efforts have shown an increase in access to care and treatment for the HIV infected in rural areas (Shumba). Integrated Community Based Initiatives, a Uganda based NGO, designed a new community-based HIV counseling and testing program and linked it to care using community health extension workers (CHEWs) in rural areas.

They were trained in a 5-day session to conduct confidential testing, give HIV prevention education and referral information. Studies have shown that this approach is effective and inexpensive. It can also be scaled up in order to be able to increase high quality HIV/AIDS care to large numbers of people in remote areas (Asiimwe). "The government is committing itself to its promise of purchasing the ARVs for AIDS patients from the factory for the hospital patients" said Ugandan President Yoweri Museveni at the inauguration ceremony (NAM AIDSmap, 2009). Uganda also had a new pharmaceutical factory that began producing antiretroviral medication drugs locally. The facility is the first one in Africa to produce full triple-therapy ARVs (NAM AIDSmap). The plant was set up by a local company, Quality Chemicals Limited in partnership with Indian drug maker Cipla Limited, one of the world's largest producers of generic drugs. "The project has offered Ugandans a regular and cheap supply of ARVs. Our goal is for everybody who requires ARVs to get them" said the manager of Quality Chemicals, Emmanuel Katongole. The new manufacturing plant is seen as a continuing step in Uganda's fight to lower the rates of morbidity and mortality of HIV/AIDS ?” an effort that has shown Uganda as a model for some of the most effective HIV/AIDS care developed and delivered under incredibly difficult conditions. Over than 2 million people were reached in 2015/2016 with how to prevent the disease through religious meeting and programs offered by cultural institutions. Messages of HIV-1 prevention were send to millions more through channels of mass media that included radio, television, billboards, and posters (AVERT, 2018).

A great focus on sexuality education was done in life courses, which were developed for lower secondary school classes as part of their curriculum. In addition, more than 800 primary and secondary schools were outreached and provided with HIV-1 prevention information, while concentrating on the risks of having more than one partner, cross-generational, transactional and early sex. One-hour health education sessions in about HIV-1 reached a total of 360,000 children in 2015/16 (AVERT, 2018). The use of condoms and their availability is also a good way of preventing transmission of the disease, as according to UNAIDS data shows that in 2017 suggests 55.5% of men and 41.2% of women were using a condom the last time they had sex (AVERT, 2018). The government rose the distribution of male condoms in 2015 to about 240 million from 87 million in 2012. Nevertheless, the number of condoms required, taking into consideration the population size is way more than that. Reinforcing the supply chain for both male and female condoms, along with consistent condom promotion is an essential element in the prevention of HIV-1 transmission in Uganda (AVERT, 2018). Reducing the mother to child transmission of the disease plays an important role in prevalence, which is why more than 115,000 HIV-positive pregnant women received antiretroviral therapies to minimize the risk of mother-to-child transmission (MTCT) (AVERT, 2018).

Reduction in new infections by 86% among children between 2010 and 2016, shows how effective Uganda's MTCT strategy. On the other hand, 38% of HIV-exposed infants tested for HIV is still a low percentage (AVERT, 2018). Another proven bio-medical HIV-prevention intervention is voluntary medical male circumcision (VMMC), as it contributed to 60% reduction of female-to-male sexual transmission. Data from a research study in 2011 shows that HIV prevalence between circumcised men is 4.5% and 6.7% between uncircumcised men (AVERT, 2018). Though the percentage of men who are eligible to receive VMMC arose from 26.4% in 2011 to 40% in 2011, still the lack of coverage and funding are halting access to it (AVERT, 2018). Consequently, there was a decline in annual circumcisions during 2015 and 2016. Despite the continuity of traditional and religious derived circumcisions, they are far from effective due to coverage and safety problems that could hinder the success of this intervention (AVERT, 2018). Pre-exposure Prophylaxis does not contribute much to prevention as there are only about 400-500 users of PrEP in Uganda.

Nonetheless, this number could increase to 12,000-14,000 by combining clinical trials, demonstration projects, and implementation initiatives together (AVERT, 2018). CONCLUSION Uganda has successfully implemented a thorough long-term program for combating HIV-1/AIDS. Morbidity and mortality rates have decreased dramatically since the start of the crisis in the early 1980s. Several studies show a 70% decline in HIV prevalence. According to international standards these are considered extraordinary results. The crisis was a national health challenge facing a broken state which had just gotten out of a long bloody civil war that brought about destruction, poverty and societal breakdown. Since Uganda had no healthcare structure or funds to invest in anywhere, the government was forced to resort to radical and innovative ideas for the nation to survive, and halt the jaw dropping rates of mortality caused by AIDS. The government formed and managed a complex network of partnerships between CSOs, NGOs, patient groups and donors who provided funding and direct patient care, which allowed them to give people access to antiretroviral treatment, including those in remote areas of the country.

Next, they developed specific programs to dispense drugs and monitor patient adherence to their drug regimens. They solved the provider problem by training nurses and community health personnel to do the job themselves, which was shown to be as effective and cheaper than hiring physicians to do so. Uganda transitioned from monotherapy to the latest available therapies, such as triple therapy a combination of the three most effective drugs developed by leading drug designers. The three major drugs had to be taken separately because of patent protection (NAM Publishing), but now Uganda has full access to all three drugs in one pill, in a generic version developed by Cipla. Finally, Uganda then started manufacturing ARVs locally. The globalization of medicine as a trend has helped Uganda immensely (Crane, Ch. 7). The more HIV-1/AIDS becomes a chronic manageable disease in the west, the less medical opportunities for HIV-1 studies to be conducted, on the other hand in Uganda they still exist and draw all types of medical professionals there to work on HIV-1/AIDS studies, and universities in the U.S. and other countries are partnering directly with Ugandan universities. These partnerships and research provide direct benefit to Ugandan HIV sufferers. Eventually during the war on AIDS, the Ugandan people were found to be a smart, brave, entrepreneurial and a resilient society (Whyte).

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