As the world prepares to mark World Aids Day ,AIDS-related deaths have fallen by almost 70 per cent since their peak in 2004, and new HIV infections are at the lowest point since the 1980s.
But AIDS still takes a life every minute. From connecting people to the treatment, services and support they need — to the grassroots activism are pushing for action so all people can realize their right to health. President Yoweri Museveni has repeatedly stated that Uganda is determined to eliminate HIV/AIDS infections by 2030 .
AIDS response in low and middle-income countries needs over 8 billion dollars more per year to be fully funded. This must include scaled-up funding for local programmes led by people living with HIV, and prevention initiatives led by communities.
HIV activists in Uganda have made an outcry about shortages of an expensive HIV drug, raltegravir, which is recommended for decreasing the amount of HIV in the blood.
Raltegravir is used by people living with HIV that are on third-line treatment. It is administered as a tablet, chewable tablet, and as granules for oral suspension, prescribed for decreasing chances of developing Acquired Immunodeficiency Syndrome (AIDS) and HIV-related illnesses such as serious infections or cancer.
However, the drug has not been available in the selected centres according to the HIV activists. For those who are on third-line treatment they say for fear of interrupting their treatment outcomes, some of them have had to part with as much as 700,000 Shillings to buy the medicine from private pharmacies.
They say because of being consistently on treatment, they have been able to become undetectable and have not transmitted infection to their partners . This phenomenon is now being promoted as U=U, where activists are pushing it to mean Undetectable = Untransmittable.
About a thousand people are on third-line treatment which they start using after developing resistance to the common first-line drugs and the second-line medicines. Raltegravir is taken in combination with other antiretroviral drugs.
While the rest can be accessed for free in hospitals and clinics around the country, third-line treatments are offered at selected centres including at TASO and Makerere University John-Hopkins University (MUJHU) Research collaboration in Mulago Hospital complex in addition to the Joint Clinical Research Center (JCRC) along Entebbe road.
In first line, the available drugs are TDF/3TC/DTG (preferred) for adults, adolescents including breastfeeding and pregnant mothers. But there’s also ABC/3TC/DTG or TDF/3TC/EFV400 or TDF/3TC/ATV/r if DTG ATV/r is contraindicated
ARVs cost about 100,000-150,000 (first line), then 200,000-300,000 (2nd line) then 500,000 & above for 3rd line regimens. Then for children, there are given ABC/3TC/DTG as the preferred regimen (20-30kgs). If DTG is contraindicated, ABC/3TC/LPV/r (tablets) or AZT/3TC/DTG can work.
Those on the 2nd line regimens, are treated on AZT/3TC/DTG or AZT/3TC/DRV/r or ABC/3TC/DTG or TAF/TDF/3TC/DTG , depending on contraindications or exposure in first line.
A doctor who has cared for people living with HIV at Mildmay Uganda, says because about 0.1 percent of the 1.4 million Ugandans living with HIV are on the third line, their treatments are not prioritized and are often expensive for the government to procure. He says the shortage could be a result of the fact that there’s little demand and production is made in smaller quantities.
He urges people on treatment to swallow their medicines as recommended in order not to progress to the often unaffordable third-line treatment.
Stigma/discrimination plays a role in preventing HIV successes
Ms. Ruth Suubi Bulya an HIV?AIDS health worker said that remarkable strategies’ in medicine and science have transformed the HIV response in Uganda since the impact of AIDS related illness in the 1980’s which claimed lives. “I must add that research on HIV has improved the lives of people living with the virus today.”
Suubi , however, noted that stigma and discrimination is still a challenge fueled by the urge of medial personals, family and friends to disclose the HIV statues of another without their consent, even with the abundancy of information about available resources such as PrEP, PEP and ABC strategies .
“ People are afraid of testing for HIV, others are in denial, families are separating and those on treatment have refused to adhere, all in fear of what the society will think and hindering the goal to end HIV by 2030,” she stated .
Suubi added , “the Ministry of Health must know that people are no longer dying because of the virus but of the circumstances surrounding HIV such as stigma leading to mental heath instability and suicidal thoughts.
“On this world AIDS day, I would recommend the need for all those living and affected by the virus to equip yourselves with information by knowing your rights and how to fight back using the HIV/AIDS prevention and control ACT 2014 which provides for the “ the confidentiality of HIV test results and HIV status and penalizes, breaches of medical confidentiality and the unlawful disclosure of a person’s HIV status.”
