Uganda Remains Model Country in War Against AIDS

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KAMPALA, UGANDA – Alice Nakato, 52, sells vegetables in the Nakawa Market in Uganda’s capital city of Kampala. Nakato says she has known she was HIV positive since 1995, when her husband committed suicide and left a letter accusing her of infecting him.

At the time of his death, Nakato had never been tested and says she didn’t fully understand the implications of the disease. “I knew I didn’t want to die and leave my four children orphans,” she says. Her children were 12, 10, 8 and 4 years old at the time.

Out of fear, Nakato says she waited for more than two years before working up the nerve to visit a local clinic and get tested. Every time she heard people talking about “slim,” as AIDS is commonly referred to in Uganda, she says she thought they were talking about her. “The whole village in Naguru knew why my husband had committed suicide, so they were pointing fingers behind my back,” she says.

Eventually, a friend told her about TASO, The AIDS Support Organization, a local HIV/AIDS service group founded in 1987 by Noerine Kaleeba and 15 other colleagues, many of whom have now passed away from AIDS. Her friend told her that at TASO she could get tested for HIV and, if she was positive, they would give her the medication she would need to stay alive.

She says she approached TASO several times, but was frightened when she saw people who were thin and had rashes and lesions on their skin. Nakato worried that soon she too would also lose weight have rashes covering her body.

“I couldn’t sit still when I was being counseled,” she recalls about her eventual visit to TASO. Once her blood was taken back to the laboratory for testing she says she walked away and was certain she would not return for the results.

But a month later, Nakato found a rash on her body and made the difficult walk back to TASO. She says she burst into tears when the counselor told her she was HIV positive. “I couldn’t listen to what the counselor was saying. All I thought about were my children,” she says.

More than 10 years later, Nakato has come to terms with her diagnosis. While a visit to TASO was once difficult, it is now routine. She collects her antiretroviral medicine, ARVs, every week. She says she takes her pills every night at 8 p.m. “I am happy that my trip to TASO has kept me going for this long. I can watch my children grow and I am happy to provide for them,” she says.

There are an estimated 1.1 million people living with HIV in Uganda. In recent years, Uganda has become the model for strong governance, leadership, free distribution of ARVs and effective public education. It is one of the few countries in Africa that has seen a significant decline in the number of people living with AIDS. In the 1990s the prevalence rate was more than 15 percent. It is now less than five percent.

In 2007 Uganda became the only country in Sub-Saharan Africa to produce full triple therapy generic ARVs — most ARVs are imported from India and the Middle East.  Uganda now plans to export their ARVs to neighboring East African countries including Kenya, Burundi, Rwanda, Tanzania, the Democratic Republic of Congo and Sudan, many of which are currently facing a shortage of the drug.

“South Africa has a plant for producing ARVs, but they do not do triple therapy combinations,” says Emmanuel Katongole, managing director of Quality Chemical Industries, QCI, a joint venture between the government of Uganda and the Indian pharmaceutical company, Cipla. QCI is located in a suburb of Kampala and boasts job creation for more than 500 Ugandans while producing enough ARVs to allow more than 200,000 people here to receive free access to the drugs. In addition to ARVs, QCI also produces the anti-malaria medication Lumartem, which has become a significantly cheaper option than the World Health Organization’s, WHO, recommended name brand with the same ingredients, Coartem.

The plant is one of many highly regarded government endeavors that seeks to increase the number of people who have access to free or low cost ARVs in East Africa. While neighboring countries like Kenya are struggling to stave off a shortage of ARV drugs and funding, Uganda  received a new wave of support from the United States last month in the form of a $5.5 million supply of emergency ARV drugs intended to provide more than 70,000 Ugandans with medication over the next two years.

“There are people who are ashamed of AIDS so they die,” says Judith Akello, who works in a military hospital. One of Akello’s recent patients refused to take his medication because of the shame associated with picking up ARVs and taking them regularly, a routine that is essential for the drugs to fight the HIV virus.  “His wife found bottles of ARVs hidden in his briefcase after his death,” she added.

“This donation will help bridge the gap in the availability of ARV drugs in Uganda and prevent stock-outs of the life-saving HIV/AIDS medications,” the U.S. ambassador to Uganda, Jerry Lanier told the Associated Press last month.

The increase in funding comes at a time when the Uganda Virus Research Institute, UVRI, revealed that Uganda’s fishing community — one of the hardest hit populations — may be experiencing a recombinant form of HIV or a re-infection.

The HIV rate is nearly 28 percent among fishing communities, truck drivers and sex workers, while it has declined to less than five percent among the general population.

According to the UVRI, a new sub-type of HIV has been reported within the fishing communities in the Wakiso and Masaka districts on the shores of Lake Victoria. Globally, there are a handful of HIV strains circulating. Strains A and D are the most common in Uganda and were found in most of the 117 men and women surveyed from five fishing communities. But the UVRI study also found that 29 percent had recombinant forms of HIV called A/D and D/A. While HIV re-infection has long been a concern for researchers, the biggest issue is that recombinant strains are often drug resistant.

“We are starting to see transmission of viruses that are resistant to some drugs,” says Pontiano Kaleebu, director and head of the Basic Sciences Program at the Medical Research Council and UVRI, which is conducting a three-year study among the fishing communities that ends in 2012.

While HIV re-infection is an issue that perplexes international scientists and researchers, Uganda is leading the way in the fight against AIDS in Africa.

According to a government source, Uganda continues to actively seek new funders for this work, as 95 percent of the ARV program is currently donor funded, mainly by the United States’ PEPFAR, the President’s Emergency Plan for AIDS Relief. According to the United Nations report, additional PEPFAR funding has been “flat lined” and the U.S. plans to cap funding to Uganda in 2011.