More than 40 civil society organizations led by ICWEA, HEPS – Uganda, Sexual Minorities Uganda have launched the 2021 edition of “The People’s Voice,” a set of ambitious recommendations describing shifts the U.S. Government should make regarding how it funds HIV treatment and prevention in Uganda. The launch took place at Protea Hotel in Kampala on Wednesday, April 21, 2021.
The American people, through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), support the fight against global AIDS through bilateral and regional programs in 65 countries. PEPFAR is the largest commitment by any nation to address a single disease in history.
Since 2004, PEPFAR has collaborated with the Government of Uganda, national, international, and civil society organizations on building Uganda’s capacity to lead the HIV/AIDS response.
The U.S. government has committed USD398.5 million or UGX1.442 trillion to the HIV response for a period of one year between October 1, 2021 – September 30, 2022.
Despite an overall decline in the incidence of new infections and AIDS-related deaths, an estimated 156,247 people still do not know they are living with HIV, and poor retention in care is a serious obstacle resulting in treatment failure, disease progression, the onward transmission of HIV, and death.
Uganda has 73,000 new HIV infections annually, mostly among adolescent girls and young women (AGYW) – according to Uganda AIDS Commission. Despite the high number of new infections, highly effective prevention tools such as Pre-Exposure Prophylaxis (PrEP) are only available in a limited subset of clinics.
Globally, the number of new pediatric HIV infections reduced by 35 percent between 2010 and 2017 – according to UNAIDS statistics. However, in Uganda, an estimated 4,800 children below 15 years died of AIDS-related causes and about 100,000 were living with HIV – according to Uganda AIDS Commission. A 2019 UNAIDS report indicates that Uganda has 880,000 orphans due to AIDS.
In 2019, only 65% of HIV-exposed children were tested for HIV; only 65% of those tested were initiated on ART; and only 48% of children on ART were virally suppressed, indicating major underperformance of Uganda’s pediatric HIV program. New pediatric infections are estimated at 466 per 100,000 live births, far above the elimination target of fewer than 50 new infections per 100,000 live births.
A call to action from the People to PEPFAR
In order to generate the recommendations, the civil society collected evidence from users of HIV services during community-led monitoring (CLM) of PEPFAR-supported clinic sites in Uganda. They also carried out an analysis of HIV prevention and treatment data available from PEPFAR and the Ministry of Health.
The release of the 2021 People’s Voice comes at a critical policy setting and program planning moment when PEPFAR is deciding how it will spend its bilateral funding for HIV in Uganda.
In the 2021 People’s Voice, advocates emphasized the need to ensure that people living with HIV can stay on lifelong HIV treatment once they start funding networks of people living with HIV to implement a national community-led treatment literacy program. “PEPFAR’s treatment programme not prioritizing what matters most can only worsen retention,” says Lillian Mworeko, Executive Director of the International Community of Women Living with HIV Eastern Africa. “That is community-based HIV treatment literacy programs to empower people living with HIV to demand their health rights; community health workers who are adequately paid and trained to carry out quality community outreach when people miss clinic appointments; and programs that combat the human rights violations experienced by so many, particularly women and girls in all their diversity, and key populations,” she elaborates.
Richard Lusimbo, Coordinator of the Uganda Key Populations Consortium observes that “PEPFAR must expand funding for programs designed and carried out by key populations themselves and support decriminalization in order to challenge stigma and discrimination we experience every day in clinics and hospitals.”
Commenting on the People’s Voice recommendations on pediatric HIV, Kenneth Mwehonge – the HEPS-Uganda Programs officer – Policy advocacy noted that, “The pediatrics program in Uganda must urgently improve the quality of services it provides to children and their caregivers.’ ‘Children are dying needlessly,’ he says adding that ‘we are calling upon PEPFAR and our government to fund standard testing for children exposed to HIV, and ensure their families have the supportive services they need to be healthy in care.”
While officiating at the People’s Voice launch, Elizabeth Mushabe, Chairperson of AIDS Development partners noted that the successes, targets, and efforts reflect movement-building in reality and rooted for building stronger institutions across the country.
Civil society organizations are confident that if the recommendations contained in the People’s Voice are implemented by PEPFAR, Uganda would secure much-needed improvements in the national AIDS response.
Please see the full People’s Voice Launch Statement with key issues and 2021 targets on https://www.heps.or.ug/file-download/download/public/428