Uganda: Prevention And Health Systems Strengthening Still Key in Aids Fight

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The Monitor (Kampala)

OPINION
28 August 2008
Posted to the web 28 August 2008

Kakaire A. Kirunda

The 17th International Aids Conference (Aids 2008) was held in the first week of this month in Mexico City in the Latin American country of Mexico.

Bringing together about 22,000 people engaged in the response to the pandemic from across the world, the meeting was held under the theme Universal Action Now.

It was a solid five days of spirited discussions and presentations including one from former presidents Bill Clinton (US) and Festus Mogae (Botswana).

Leaders, policymakers, academics, scientists and activists called for a renewed commitment from the international community to strengthen the scale up of HIV prevention, treatment, care and support programmes worldwide, all aimed at providing universal access to these services by 2010.

Aids 2008 also reiterated the urgency of working towards achieving the Millennium Development Goals - which includes the target of halting the spread of HIV by 2015.

Just as the conference got underway the president of the International Aids Society Dr Pedro Cahn, whose two year term ended with Aids 2008, moved quickly to dismiss talk that Aids funding is weakening health systems in developing countries.

But as it emerged during the conference, this (health systems) and HIV prevention turned out to be the learning points for Uganda if the renewed onslaught on the Aids pandemic is to bear fruit.

Cahn argued that studies had made it clear that public health improves overall when there is an effective HIV/Aids programme in place. However, a study carried out in Uganda, Mozambique and Zambia on day three of the conference provided interesting findings on this subject that is of great significance to countries such as Uganda.

The study by the Centre for Global Development (CGD) concluded that billions of dollars in donor money being spent in developing countries to fight HIV/Aids can be much more effective if the big donor programmes pay more attention to their effects on the health systems of host countries.

According to the study, "Seizing the Opportunity on Aids and Health Systems", as donors expand their programmes in developing countries, they draw on the resources of domestic health systems, sometimes weakening them.

The director of CGD's HIV/Aids Monitor Programme Ms Nandini Oomman who was also the report's lead author said the big HIV donors "are creating Aids-specific systems that compete for health workers and administrative talent, share the same inadequate infrastructure, and further complicate already complex flows of information."

But as hinted earlier, it was not all about health systems. The meeting also re-emphasised the need for combination prevention and why it needed to go hand in hand with combination treatment as regards stopping the HIV epidemic. It was even more important coming hot on the heels of the latest UNAIDS report that showed that for every two people that began antiretroviral treatment last year, five became newly infected.

And there is no better example than the Uganda experience to put into picture the significance of the above. The situation in Uganda can better be described as a classic two steps forward and three steps backwards story. While the number of people receiving treatment is coming to 130,000, a similar number of people are infected with HIV every year.

"That is why we need to scale up our prevention efforts in that as we scale up treatment we at the same time stop as many new infections as we can. Otherwise, we will be fighting a losing battle," Dr Alex Coutinho, executive director of the Infectious Diseases Institute, said on the sidelines of the conference.

But unless action is taken now as the conference theme suggested, and countries such as Uganda expedite turning proven research (like the one on male circumcision) into policy and practice, achieving the 2010 and 2015 targets regarding the fight against HIV will not be met.

When the next world Aids meet comes up in two years in Vienna, it will be another week of lamenting.

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