in 2015, key and priority populations contributed 45% of new HIV infections world wide although the the annual global number of new HIV infections among adults has remained at a static estimation of 1.9 million people.
Criminalization and stigmatization in the health sector and among policy makers of same-sex relationships, sex work and drug possession and use are preventing key populations from accessing HIV prevention services.
HIV prevention and treatment programmes for key and priority populations are currently too few and too small to result in a significant reduction in new infections.
Key populations are between 10 and 50 times in greater risk of HIV infection compared to other adults.
Studies conducted in southern Africa have found HIV prevalence 10–20 times higher among sex workers than among adults in the general population, with rates of HIV infection reaching 50% of all sex workers tested, and HIV prevalence reaching 86% in one study in Zimbabwe.
Analysis of the data available to UNAIDS suggests that more than 90% of new HIV infections in central Asia, Europe, North America, the Middle East and North Africa in 2014 were among people from key populations and their sexual partners, which accounted for 45% of new HIV infections in 2015.
HIV among the Key Populations in Uganda
HIV prevalence among sex workers was estimated at 37% in 2015/16
It is estimated that sex workers and their clients accounted for 18% of new HIV infections in Uganda in 2015/16 and their HIV prevalence was estimated at 37% within that period.
People who inject Drugs
HIV prevalence among people who inject drugs in Uganda was at 16.7% in Uganda in 2014. Prior, the government had in many cases marginalized this group leaving them with very little in the way of adequate HIV and health services. Currently the government has implemented some programs but they are still very inadequate as drug use continues to rise especially among the youths.
Men who have Sex with Men (MSM)
The latest data shows that HIV prevalence among MSM was estimated at 13.4% in 2013
A 2017 found that 40% of MSM had experienced homophobic abuse and 44.5% had experienced suicidal thoughts. The same study found that 36% of respondents reported regular unprotected anal sex, 38% selling sex, 54% having multiple steady partners, 64% having multiple casual partners, and 32% injecting drugs.
The Uganda Anti-Homosexuality Act was passed by parliament in December 2013 has resulted in increased harassment and prosecution based on sexual orientation and gender identities.
Although the law was annulled in August 2014 due to a technicality, it has triggered negative discussions advocating for violence and anti-homosexual discrimination from the general population on social media. This has resulted in men who have sex with men feeling less inclined to access HIV services.
HIV prevalence among Uganda’s fishing communities is estimated to be three times higher than the general population. A 2013 study of 46 fishing communities found HIV prevalence to be at 22%.
The reason for such high prevalence among this community is thought to be the a high degree of mobility, a high rate of fishermen who pay for sex, injecting drug use, and a lack of access to HIV prevention and testing services
Uganda’s 2015/2016-2019/2020 prevention strategy identifies three objectives:
- to increase adoption of safer sexual behaviours and reduction in risk behaviours
- to scale up coverage and use of biomedical HIV prevention interventions (such as voluntary medical male circumcision and PrEP), delivered as part of integrated health care services
- to mitigate underlying socio-cultural, gender and other factors that drive the HIV epidemic
MNL’s prevention strategy for key populations
Main barriers to the HIV response in Uganda
Social stigma and discrimination
Prejudices and social discrimination are some of the leading causes for certain groups of Uganda’s population, such as sex workers and men who have sex with men, to avoid seeking health care or HIV testing.
A 2015 survey conducted by HIV support organisations, in partnership with the National Forum of People Living with HIV/AIDS (NAFOPHANU), of people living with and affected by HIV in central and south-western Uganda found stigma, both internal and external, to be high. When the study began, more than half (54%) reported experiencing some form of discrimination or prejudice as a result of having HIV.
Violence and gender based violence
Violence is common, with more than 80% of sex workers experiencing recent client-perpetrated violence and 18% experiencing intimate partner violence.
The criminalization of sex work and social stigma means sex workers often avoid accessing health services and conceal their occupation from healthcare providers.
In particular, stigma towards male sex workers who have sex with men is exacerbated by homophobia. Indeed, many sex workers in Uganda consider social discrimination as a major barrier in their willingness or desire to test for HIV.
The Uganda Anti-Homosexuality Act was passed by parliament in December 2013 and officially signed into law in February 2014. Although the law was annulled in August 2014 due to a technicality based on the number of MPs present during the vote, it is thought to have resulted in increased harassment and prosecution based on sexual orientation and gender identities. It has also triggered negative discussions from the general population on social media, in which violence and anti-homosexual discrimination are advocated.
HIV outreach workers and services providers working in Uganda with men who have sex with men have also reported heightened challenges in reaching this population.
Structural and resource barriers
All Ugandan districts report frequent stock outs of HIV testing kits and inadequate human resource to offer comprehensive testing and treatment services.
Services are further constrained by lack of tools and health workers trained to meet the specific needs of key population groups, weak data management and tracking of clients who are on treatment, and limited coordination of efforts by the numerous implementing partners involved in Uganda’s HIV response.
HIV funding challenge in Uganda
Uganda’s experience has shown that donor funding is not guaranteed, is unpredictable and is becoming less available.
Funding for Uganda’s current National Strategic Plan (NSP) (2015/2016 to 2019/2020) is projected to require US $3,647 million. Care and treatment accounts for 55% of this, prevention interventions accounts for 23%, while social support and system strengthening account for 4% and 18% respectively. The cost of the NSP for the next five years is set against projected resources of US $2,868 million from domestic and international spending, which leaves a financing gap of US $918 million by the year 2019/2020.
The concentration of donor funding for HIV among a very small number of international donors in Uganda suggests potential vulnerability should the magnitude of their funding commitments change in the future.