allAfrica.com: Uganda: Can this Country Provide Arvs to All Patients By 2010? (Page 1 of 1)

In this second instalment of a three-part series about Uganda's efforts to control the spread of HIV/Aids ,we examine the country's ability to provide antiretroviral drugs to all HIV patients by 2010.

At the recently concluded 17th International Aids Conference in Mexico City (AIDS 2008) Saturday Monitor managed to talk to the Executive Director of the Mulago based Infectious Diseases Institute Dr Alex Coutinho who expressed doubt that the country would meet its obligations to provide universal care to HIV patients by 2010.

Dr Coutinho said: "Possibly we might meet the treatment target; but it depends on the scale up of antiretroviral therapy." Dr. Coutinho, had earlier in his presentation at the conference stated that Uganda and other developing countries would not be in position to meet the 2010 target of providing universal access to HIV prevention, care and treatment and other related social support services.

According to Ministry of Health estimates, currently there are 130,000 (42 percent) on antiretroviral therapy out of the 312,000 in urgent need.

While Dr Coutinho has hope of Uganda meeting the commitment on treatment, the medic said the high annual incidence of 132,000 infections over the last two years was matter of concern. The high number of infections, he argued, was a threat to the treatment programme.

The Director of the Joint Clinical Research Centre Prof. Peter Mugyenyi expressed a similar view when he stated that in order to have effective control of spread of HIV/Aids, the prevention and treatment interventions should be carried out concurrently .

"If you have got more people still getting infected, it is like mopping the floor while the tap is running. You will never dry the floor. So you need to be stronger on prevention before you can succeed on treatment," he noted.

The reputed Aids clinician and researcher however said he also thinks Uganda has the ability to meet the 2010 treatment target but due to laziness, "I share your concern that we may not be able to achieve these targets." Despite being somewhat optimistic, the two medics' fears on the possibility of Uganda failing to meet the treatment target are not unfounded. The civil society raises similar concerns as well.

At the start of this financial year, Government budgeted Shs 60 billion for procuring antiretroviral drugs, a move that would bring over 100,000 persons on treatment. But the deal has already been criticised by the civil society.

They argue that without investing in supporting infrastructure, these funds may not necessarily increase accessibility to treatment.

They also expressed fear that the decision may have been made with the vested interest of supporting the newly- established ARV factory. "The health civil society would like to make it clear that it welcomes the manufacture of ARVs in Uganda, but in the same breathe appeal to Government to ensure that procurement of ARVs produced locally is transparently done at competitive prices," a group of 22 health civil society organisations wrote in a statement to the speaker of parliament in the aftermath of the budget reading.

But even in a situation where there were drugs for all, Uganda's problems are further compounded by management problems in the supply chain. There have been reports of the drugs running out and others expiring in government medical stores. The lack of sufficient drugs is compounded by the population's

reluctance to carry HIV tests. Only an estimated 12 percent of the population know their HIV status and yet testing is key for the infected people to get care and treatment.

According to a report released by WHO, Unaids and Unicef "Towards universal access: Scaling up priority HIV/Aids interventions in the health sector", several countries including Uganda are still far from meeting the universal access HIV/Aids care and treatment..

The report which was released in June, noted that although the number of people receiving antiretroviral therapy (ART) has increased in 2007, the estimated need for treatment has gone up as well. It reads: "The parameters for estimating needs have changed based on updated evidence.

The estimated time between treatment eligibility and death without treatment has increased from 2 to 3 years. This has resulted in a significant increase in the number of people considered to be in immediate need of treatment. Estimates of need will likely continue to change as more people become eligible each year and as treatment guidelines evolve," reads the report from the three UN agencies.

And because of leaving out sexual minorities such as the gay in the national strategic plan for HIV/Aids, Uganda has been criticized from with in and outside of the country, especially at the recently concluded Aids 2008.

"We should separate morality from public health judgment. If you do a public health programme, make it available to everyone," said Dr Coutinho. Next Saturday read about universal access to social support.

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