“Slim”: HIV/AIDS in Uganda

Author: Sam Kamanzi

Originally Published at Peace and Conflict Monitor on: 08/18/2005

Category: Special Report

Uganda is a small East African country bordering Kenya to the East, Tanzania and Rwanda to the South, the Democratic Republic of Congo to the West, and Sudan to the North. It is inhabited by 24.7 million people 87% of whom live in rural areas in poor living conditions, according to the 2002 UNDP Human Development Report that put the national poverty levels at 37.5 percent, average literacy rates at 69 percent and access to health facilities at 51 percent of the population[1].

In the last two decades, Uganda, like most other Sub-Saharan African countries, has been hard hit by the HIV/AIDS epidemic which has already claimed an estimated one million lives, leaving behind about two million orphans whose numbers are expected to increase in the next decades[2] thus increasing the risks of having hundreds of thousands of youth on the streets as thieves, beggars, and drug addicts, and creating conditions for increased urban violence in the country.

This paper discusses the devastating effects the HIV/AIDS epidemic has had on the economic, personal, nutritional, environmental, and political security of Uganda. It is based on sound studies on the prevalence of the disease in the country, and on the personal experiences of the author, who, as a Ugandan, has witnessed his countrymen, including his own three sisters and numerous relatives, fall victim by hundreds of thousands to the disease.

HIV/AIDS prevalence

HIV/AIDS was first identified in Uganda in a fishing village along the shores of Lake Victoria in the Rakai district in1982. At this time only two cases were reported. The disease confused the villagers, and because the patients developed continuous diarrhea and lost so much weight the villagers simply called it “Slim”. In 1983, 17 cases were reported and in 1984 medical authorities confirmed that the disease was AIDS.

By 1999, there were 55,861 reported clinical AIDS cases and 1,438,000 HIV/AIDS infected people, and the country had already buried 838,000 people whose deaths were attributed to AIDS[3]. By this time all parts of Uganda were reporting thousands of cases.

The disease started by devastating urban areas and later it spread to rural areas where most people were illiterate and had no access to radio and newspapers and were therefore difficult to reach with standard anti-HIV/AIDS campaigns. By 2001 the average infection rate in the Ugandan capital of Kampala was 9.5 percent, compared to 1.7% in Moroto district, which is located in North Eastern Uganda and is one of the most rural parts of Uganda.

Today the cumulative infection of HIV/AIDS in Uganda stands at 1.9 million since 1982, of whom 1.4 million are living with HIV, 500,000 have died, and 120,000 are living with AIDS. According to the recently concluded national HIV/AIDS survey, 7 percent of the overall Ugandan population is infected.[4]

Effects of HIV/AIDS on human security.

Human security has been defined as freedom from fear, freedom from want, and equal opportunities for all[5].The 1994 Human Development Report lists the seven most important values of human security as “economic security, food security, health security, environmental security, community security, and political security.[6]” In short, human security means freedom from diseases, hunger, unemployment, crime, social conflict, political repression, and environmental hazards.

Clearly the idea is to protect the individual from both natural and man-made threats. I would like to argue that man must have a healthy body before anything else, and the rest will follow.

How has HIV/AIDS affected the values of human security?

As already observed, it is a healthy body that engages in gainful economic activities. If one is sick, there is no way he/she can make a living. Also, he will spend the few resources he has on treatment. In the case of HIV/AIDS in Uganda, the patients would take longer to die, leaving the poor villagers in debts for the costs incurred by treatment. At the national level the disease has had a heavily negative impact on the most productive labor force. It has robbed the country of thousands of professionals that are hard to replace. This has led to decreased productivity, poor output, poor income, and therefore a lower GDP[7]. This means that the prevalence of HIV/AIDS in Uganda is partly responsible for increased local and national poverty.

Another strain exerted on the economy by the devastating effects of HIV/AIDS is the time lost by workers due to funerals and the expenses involved in buying and transporting coffins. At the beginning, no one realized that these expenses would amount to a lot of money. But as the disease took its toll, the funerals became very frequent and workers started spending fewer hours in the office. The trend continued to increase and the government found itself without a solution. With such a poor economy, if the government left the workers on their own they could not afford their expenses. Besides the bosses themselves were as affected as the workers.

On food security, as already mentioned, 87 percent of the people of Uganda live in rural areas where they practice subsistence agriculture. Studies suggest that agriculture contributes 47 percent of Uganda’s GDP and 80 percent of agricultural work is done by women[8].HIV/AIDS has heavily impacted agricultural production by keeping women at home to look after the sick. This means that in rural areas, as a result of the disease, less time is being spent in the fields therefore there is less agricultural production. This is a direct threat to food security and national income, and is also directly responsible for increased poverty at home.

HIV/AIDS also poses a serious threat to health security in many ways. Normally it is not something to celebrate when a country realizes an increase in population growth rate, mainly because there are strains on national economies that cannot provide social services such as education and employment that a large population demands. But when a country realizes a reduction in its population growth rate as a result of a disease, this is a sure indicator of how dangerous that disease is. This is the case with HIV/AIDS in Uganda. Recent figures show that the current population growth rate with AIDS stands at 2.8% while the population growth rate without AIDS stands at 3.5%.This marks a significant reduction and indicates the rate at which the disease is killing people.

Other figures also illustrate the serious affect the disease is having on the population. For example, life expectancy with AIDS stands at 42.6 years, while life expectance without AIDS is 54.1 years. Other figures show that gross death rates with AIDS stand at 19 percent while gross death rates without AIDS stand at 12.5 percent. For children, infant mortality rates with AIDS stands at 92.9 percent, while infant mortality rate without AIDS stands at 81.3 percent. Clearly the above figures suggest that HIV/AIDS is not only a threat to the health security of every Ugandan but is an actual killer that must be given the attention it deserves.

We have seen that another important value of human security is political security. This means that a human being should have freedom from political persecution, abuse of human rights by political establishments, politically instigated displacement, etc. This value can be affected by HIV/AIDS if the disease kills and threatens to wipe out good political leaders that have created conditions for democratic governance, transparency, and accountability. In the early 1990s Uganda lost very important political leaders that had contributed to the establishment of a new government that was promising, and indeed eventually instituted positive changes in the country that have led to successful reconstruction and establishment of democratic institutions accountable to the people of Uganda.

Throughout the 1970s and the 1980s Uganda was under the control of bad undemocratic regimes that almost led to the total collapse of the country. This necessitated resistance against these governments. Thus in 1981 a group of 27 young men under the umbrella of the National Resistance Army (NRA) led by Mr. Yoweri Museveni went to the bush where they started a war of resistance against the dictatorships. After 5 years of a successful guerrilla war, they captured state power and indeed established positive changes that saw Uganda reconstructed and even with a place in the international community as a world leader in combating HIV/AIDS.

No sooner had the leaders of the NRA arrived in Kampala than they started engaging in unprotected sex for the purpose of celebrating their victory. Within two years of capturing power they started dying in large numbers, which worried the new government to the extent that it immediately formulated policies to counter the spread of HIV/AIDS.

One particular incident is instructive because it shows that HIV/AIDS can be a worse enemy than an armed combatant. In February 1991 three members of the NRA high command by the names of Col. Patrick Lumumba, Col. Stanley Muhangi, and Col.Fred Mugisha died of AIDS with in one month of each other. This single incident more than any other worried President Museveni so much that he thought all his comrades were at risk of being wiped out with in a short time. He decided to act by himself, mobilizing resources and promoting awareness about the threats paused by HIV/AIDS to his country both locally and internationally. Most importantly the quick demise of these commanders who had withstood the firepower of heavy artillery warned Ugandans that if nothing was done, they would fall in large numbers within a very short time.

What is significant here is that HIV/AIDS had killed good political leaders soon after a successful revolution, thus denying them the chance to participate in the creation of new institutions to ensure democratic governance and the protection of human rights for which they had fought. Thereafter very many of their comrades followed them to the extent that out of the 27 men that started the liberation war only 2 are still surviving today. Almost all of the rest fell to AIDS. Today Ugandans are regretting their death because their replacements did not measure up. Probably if these leaders had lived they would have resisted President Yoweri Museveni’s attempts to change the constitution to allow himself to stay in power.

What has been done?

Uganda has done a lot in the struggle against HIV/AIDS and a lot has been achieved. It is now an acclaimed leader in the world because of its success against AIDS. At a political level, the President got personally involved in almost all the HIV/AIDS programs in the country. At an institutional level, the government has established many important institutions that have successfully spearheaded the campaign against AIDS. These include: National AIDS Control Program established in 1986, the Uganda AIDS commission established in 1992, the Uganda Virus Research Institute, the Mildmay HIV/AIDS Centre, and many others. All these institutions are engaged in “coordinating a multisectoral approach to HIV/AIDS prevention and control through joint planning, joint monitoring, and evaluation, and information sharing[9]

Specific programs involving mass campaigns at the grassroots and the establishment of health education net works throughout the country have been established. Other programs involving the promotion and use of condoms and the promotion and popularization of the use of what has come to be known as the ABC Ugandan model (meaning Abstinance, Be faithful, and use a Condom) are taking place as well, not to mention the development of modules on behavior change, and the conducting of peer education in post-primary and tertiary institutions.

Uganda has also carried out successful fundraising campaigns for its HIV/AIDS programs abroad. These efforts have paid off, as many governments – notably the US government – and private foundations – notably the Gates Foundation – are involved in supporting these programs. Uganda is also a beneficiary of the Global Fund for HIV/AIDS which has helped the Ministry of Health to buy drugs which are being distributed free of charge to those living with AIDS at designated centers throughout the country.

However a lot more still needs to be done. For example, there are remote areas that cannot easily be accesses by radio. Therefore, alternative means such as home delivery of weekly publications such as Straight Talk, published by the New Vision news paper and dedicated to the protection of the Youth against HIV/AIDS, should be devised to help raise the consciousness of the residents of such areas about HIV/AIDS.

Results

As a result of the numerous programs taking place under the multisectoral approach against HIV/AIDS, HIV/AIDS awareness in Uganda is confirmed to be universal. There are also notable positive trends such as the reduction in sex with no regular sexual partners from 52.7 percent to 14.1 percent, and the increase in the mean age of first sexual contact from 14 years to 16 years. There has also been a marked increase in condom use from 7% in 1989 to 42% in 1995.Voluntary Counseling and Testing (VCT) services are being provided in almost all the districts[10].

Conclusion

I cannot find better words to conclude this paper than what was expressed in the 2003 Uganda Poverty Report which observed that “HIV/AIDS is one of the major challenges to Human development at individual, community, and national levels. The disease poses a grave burden to the health of the people, reduces their incomes, threatens their livehoods, and poses a threat to the economy and security of the nation. Of all societal groupings, the poor have born and continue to bear the brunt of the problem”[11].With these words it is important for the world community to devote more energy and resources to the war against HIV/AIDS if man kind is to be freed from fear and want, and to create opportunities to enhance human development.

Footnote:

Bio: Sam Kamanzi is from Uganda. He holds a Master’s degree in International Peace Studies from the University for Peace.