Uganda was one of the first African countries where HIV/AIDS cases were identified in the early 1980s. Today it is one of the few sub-Saharan countries where significant success has been achieved in efforts to mitigate the spread and impact of the HIV epidemic. Current estimates from the Uganda AIDS Commission indicate that national HIV prevalence in the adult population (15-49) has fallen from about 18.5 percent in 1995 to about 8.3 percent in 2000 and recently to about 5 percent in 2002. In the capital city of Kampala, one of the hardest hit areas, HIV prevalence has dropped from 31 percent among antenatal clinic attendees in 1990/1 to 8 percent in 1998. In a higher risk group of STI clinic patients tested in Kampala, an overwhelming 42 percent of males and 62 percent of females tested HIV positive in 1989. By 1997, HIV prevalence in this group had declined to 37 percent. Much of this success has been attributed to the strong government leadership and a supportive political environment in fighting the epidemic.

While Uganda has had success in its fight against AIDS, it has had more difficulties in fighting malaria. Reported malaria cases increased from 2.3 million in 1997 to 12.3 million in 2003. One factor in the increase in malaria cases is the declining utility of chloroquine-fansidar as a treatment. The government is taking dramatic steps to counter the growing threat of malaria, including reintroducing DDT to combat mosquitoes, and switched its anti-malarial drug-treatment preference from chloroquine-fansidar to artemisinin.

Sources: BBC country profile; Synergy Project; AllAfrica.com, New Vision (Kampala), June 24, 2004

Strategies for combatting HIV/AIDS in Uganda include:

• decentralizing HIV/AIDS work to the district level
• conducting a national Information, Education and Communication (IEC) program
• procuring drugs for managing opportunistic infections such as TB
• improving home-based care
• improving voluntary counseling and testing (VCT) services
• increasing HIV surveillance
• distributing condoms

Uganda is also one of 13 nations taking part in the UNAIDS Accelerating Access Initiative (AAI), allowing it to purchase HIV/AIDS drugs from pharmaceutical companies at reduced prices. Uganda began a program of free distribution of anti-retroviral (ARV) drugs in January 2004. Initially orphans, pregnant women and researchers will have priority access to the drugs. Funds for the ARV treatments are coming from the World Bank, the Global Fund to fight AIDS, TB and Malaria (GFATM), and the United States. There have been some problems with counterfeit ARV drugs appearing on the market; physicians have been urged to be careful in verifying the source of drugs they prescribe, and steps were taken to end the sale of drugs on the open market. Uganda's ARV distribution program is attempting to close the gender gap in ARV distribution caused by male control over financial resources in most traditional households.

In order to combat TB, the Ministry of Health has developed a highly effective Community Based DOTS program that it has already implemented in 23 of 56 districts, and plans to expand nationwide by the end of 2004. Uganda's treatment success rate for the 2001 cohort of TB patients was 56 percent. The DOTS detection rate in 2001 was 52 percent. The Global Drug Facility and a World Bank loan have covered the costs of all essential TB drugs for Uganda, and the country has no funding gap for implementing its TB containment strategy.

Uganda's malaria program is being conducted in cooperation with the global Roll Back Malaria initiative. Specific initiatives of Uganda's anti-malaria campaign include:

• According tax-free status to anti-mosquito materials and insecticides.
• Discontinuing the use of chloroquine in response to the high levels of resistance Plasmodium falciparum is showing to that front-line drug.
• Beginning the use of DDT to combat mosquitoes, under conditions approved by the WHO and CDC.

Sources: Ministry of Health; WHO Report 2003: Global Tuberculosis Control; AllAfrica.com, The Monitor (Kampala), June 13, 2004; AllAfrica.com, New Vision (Kampala), June 17, 2004; AllAfrica.com, New Vision (Kampala), August 10, 2004; WHO 2004 Global Tuberculosis Report

Demographic data contained in this section was obtained from the following sources: The Population Reference Bureau’s 2009 World Population Data Sheet was used for total population, life expectancy at birth, infant mortality, fertility, birth rate, death rate, % of married women 15-49 using modern methods of contraception, % of population 15-49 with HIV/AIDS in 2007/2008, and the GNI PPP per capita (2008). Literacy rates were found in the Population Reference Bureau’s publication 2005 Women of Our World. HIV prevalence data for 2001 and 2003 was obtained from the UNAIDS Barcelona 2002 report; HIV prevalence and orphan data for 2005 was obtained from the UNAIDS Report on the Global AIDS Epidemic 2006. Data on the % women who have discussed AIDS prevention with their husband or partner can be found in ORC Macro and USAID’s Women’s Lives and Experiences: Changes in the Past Ten Years (Research Findings from the Demographic and Health Surveys). Childhood malaria mortality data was accessed in 2003 from the United Nations Statistics Divisions’ Millennium Indicators. Tuberculosis data was obtained from the United Nations Statistics Division’s Millennium Indicators: MDGInfo 2006. In some cases information was unavailable.

There are two national referral hospitals, Mulago Hospital and Butabika Hospital, both in Kampala. Below them are ten regional referral hospitals, located at Arua, Gulu, Hoima, Jinja, Kabale, Kabarole, Masaka, Mbale, Mbarara and Soroti. All of these referral hospitals, both national and regional, are teaching hospitals.

The most important of the NGO hospitals are Nsambya, Rubaga, Mengo, Lacor and Matany.

There are also two palliative care centers in Uganda, one run by the government and another by an NGO.

Source: Ministry of Health

AIDS Information Center ( website )

AMREF Uganda

Source: GlaxoSmithKline press release

Joint Clinical Research Center (JCRC) ( website )

Makerere Institute of Social Research ( website )

Makerere University, Medical School, Mulago ( website )

Johns Hopkins University has entered this collaboration in 1996; Dr. Brooks Jackson of JHU oversees the assays done for the CWRU-MU HIVNET work, and in partnership with Professor Francis Mmiro of Makerere University conducts studies of perinatal transmission.

Mulago Hospital (affiliated with Kampala's Makerere University) and Nsambya Hospital (also in Kampala) were two of the five African sites involved in the UNAIDS Perinatal Transmission (PETRA)) study on mother-to-child transmission of AIDS. Early results found that anti-retroviral treatment begun at the time of delivery and continued for one week can reduce the chance of HIV transmission by 37 percent. UNAIDS organized the PETRA trials with significant contributions from the CDC, NIH, and the French Agence Nationale de Recherche sur le Sida (ANRS). The PETRA study received financial support from:

• Australian AID
• Istituto Superiore di Sanita (Italy)
• Het AIDS Fonds (Netherlands)
• The Swedish Agency for Research Cooperation with Developing Countries

Makerere University, Institute of Public Health ( website )

Mbarara University of Science and Technology

Med Biotech Laboratory ( website )

Current research projects of Med Biotech Laboratories include:

• Natural Human IGG Subclass Responses to Plasmodium Falciparum Serine Repeat Antigen
• The LYS-76-THRr mutation in pfcRT and chloroquine resistance
• Baseline dyhydrofolate reductase (DHFR) mutations in Plasmodium falciparum isolates
• Preliminary studies of malaria during pregnancy
• Development of Plasmodium falciparum choline kinase inhibitors as anitmalarial drugs
• Protein prenylation in Onchocerca volvulus as a possible biochemical drug target
• Molecular cloning and preliminary characterisation of PfNSF

Med Biotech Laboratory receives financial support from the following organizations:

• WHO/TDR
• International Atomic Energy Agency
• Third World Academy of Sciences
• Howard Hughes Medical Institute
• American Society of Microbiology

Mildmay Palliative Care Center ( website )

National Chemotherapeutics Laboratory (NCTL)

Source: AllAfrica.com, New Vision, 9-12-2003.

The AIDS Support Organisation (TASO)

Uganda AIDS Commission ( website )

Uganda Virus Research Institute

In addition to the above listed institutions, there are some research projects that carry out activities in Uganda. The two most prominent are the Rakai Project and the Kyamulibwa Project which are affiliated to the Uganda Virus Research Institute, Makerere University and several other universities in the US and UK and have been conducting various HIV/AIDS and other health related activities in Rakai and Masaka districts over the last fifteen years. The Rakai Project, which has ... additional information

1. The Uganda Virus Research Institute (UVRI) will work with the International AIDS Vaccine Initiative (IAVI) to accelerate the development and testing of three new potential AIDS vaccines. The partners will also work to strengthen the capacity of Ugandan scientists to play an active role in vaccine research and development and to support efforts to strengthen clinical trial infrastructure as preparation for taking the most promising candidate vaccine into efficacy trials as soon as ... additional information

2. The USAID-Uganda mission has developed a new 2002-2007 Integrated Strategic Plan that addresses health and education issues through an integrated social sector objective focused on human capacity development. While shown as requests in support of this SO, FY 2002 resources ($21,482,000 CSD and $5,700,000 DA) will be obligated under the new strategy. Health and education synergies achieved through the new strategy will increase impact in building human capital. During 2001, new ... additional information

3. Makerere University School of Medicine with funding from Pfizer will soon set up an Infectious Diseases Institute. The institute will provide training on infectious diseases - specifically in HIV/AIDS care and prevention to in-service health providers. It is anticipated that the training will take about 8 weeks and will be a representative “cluster” (physician, nurse, midwife, labtech, pharmacist, counsellor, for a particular site) training to health providers. The rationale is that since all ... additional information

4. Uganda is one of the countries approved to receive support from the Global TB Drug Facility, (GDF) mechanism designed to expand access to, and availability of, high-quality TB drugs by enabling governments and non-governmental organizations (NGOs) to implement effective TB control programmes based on the DOTS strategy. According to the Uganda Health Sector Strategic Plan, 2000-2005, one of the activities through which the government plans to ... additional information

5. The Uganda AIDS Commission will soon conduct a study funded by the Pfizer Foundation to determine which preventive measures have been most effective in curbing HIV infection. The study will be conducted over 18 months and be done in collaboration with UNAIDS and UNICEF.

6. The Global Fund to Fight AIDS, Tuberculosis and Malaria has approved a grant for $70.1 million to fight AIDS in Uganda. A grant agreement have not yet been signed.

   Source: GFATM