The Status of the HIV/AIDS Epidemic in

The HIV/AIDS

Epidemiological

Surveillance

Report 2010

STD/AIDS Control Programme , Ministry of Health, Uganda

Kampala June, 2010

TABLE OF CONTENTS

Forward ...... iii Acknowledgements ...... iv Abbreviations ...... v Executive Summary ...... vi Introduction ...... 1 Materials and Methods ...... 3 2.1 National Antenatal HIV Surveillance survey ...... 3 2.2 Antenatal HIV Surveillance survey in Lacor ...... 3 2.3 STD Sentinel Surveillance Survey...... 3 Figure 2.1 Map showing location of ANC sentinel surveillance sites in Uganda ...... 4 2.4 Data from HIV Counseling and Testing Programs ...... 4 2.5 Population-based HIV Surveillance Surveys ...... 4 2.6 Longitudinal Surveys ...... 5 2.7 Estimates and Projections from Mathematical Modeling ...... 5 2.8 AIDS Related Morbidity and Mortality Data ...... 5 Magnitude of HIV Infection - Current Situation and Trends...... 6 3.1. National HIV prevalence Estimates from modeling ...... 6 3.2. national HIV prevalence Estimates from sentinel surveillance ...... 6 3.2.1. Antenatal HIV prevalence Estimates ...... 6 3.2.2 Age group specific antenatal HIV Sero-Prevalence ...... 7 3.2.3 Prevalence of HIV infection among Young Women aged 15-24 years...... 8 3.2.4 Regional variation in HIV Prevalence ...... 8 3.2.5 Trends in Antenatal HIV prevalence ...... 10 Figure 3.1 Trends in Antenatal HIV prevalence in urban antenatal sentinel sites ...... 12 Figure 3.2 Trends in Antenatal HIV prevalence in sites outside urban antenatal sentinel sites ...... 12 Figure 3.4 Trends in Antenatal HIV prevalence at St Mary’s Hospital, Lacor...... 14 3.2.6. Trends in Age specific HIV Prevalence ...... 17 3.3 HIV Prevalence data from PMTCT Programs ...... 21 3.4 Prevalence of HIV from Testing at the AIDS Information Center...... 21 3.5 Estimates of HIV Prevalence and incidence from Cohort Studies ...... 23 3.5.1 MRC Kyamulibwa General Population Cohort ...... 23 3.5.1.1 Annual HIV Prevalence data ...... 23 3.5.1.2 Annual HIV Incidence data ...... 24 3.5.2 Health Sciences Program COHORT ...... 24 3.5.2.1 Annual HIV Prevalence data ...... 24 3.5.2.1 Annual HIV Incidence data ...... 26 4.1 HIV Prevalence by Socio-demographic Characteristic ...... 28 4.2 HIV Prevalence by Sexual Behavior ...... 29 4.3 HIV Prevalence by Other risk Characteristics ...... 30 4.4 HIV prevalence among Young People ...... 31 4.5 HIV Prevalence among Children Under Five ...... 33 AIDS Related Morbidity and Mortality ...... 34 Estimates and Projections from Modeling ...... 45 6.1 Estimates of the Magnitude of HIV/AIDS In Uganda ...... 45 6.2 Estimates of ART need In Uganda ...... 46 6.3 Global Estimates of the Magnitude of HIV/AIDS...... 46 Discussion and Conclusion ...... 47

ii Epidemiological Surveillance Report 2010 FORWARD

The HIV/AIDS epidemic continues to pose significant development and public health challenges in Uganda. The epidemic has resulted in substantial morbidity and mortality with significant socio-economic ramifications. It has impacted on household, community and national socioeconomic indices, affected survival indices and impacted on the delivery of health services.

The government of Uganda has responded with a multi-sectoral national response to control the spread of the epidemic. The public health response has been implemented in the areas of prevention, care and capacity development. In order to provide strategic information for the implementation of these interventions, routine surveillance is conducted. Evidence from surveillance data indicate that the epidemic has transitioned through three phases that include periods of rapid expansion in the late eighties, contraction in the mid nineties and stabilization in the last decade.

To maintain an effective national response, the Ministry of health and partners have expanded the package of surveillance activities. These activities include routine antenatal and STD surveillance in sentinel sites, conducting estimates and projections through modelling, collecting ART, VCT and PMTC program data, collating data from partners (MRC and Rakai Health Sciences) cohorts, conducting special studies and population based HIV surveys. Data from these activities have provided invaluable information for HIV/AIDS programs.

Data from surveillance indicate a significant burden of the epidemic. Median antenatal HIV prevalence in 2009 was estimated at 7.0 percent (8.4 percent, urban and 5.6 percent, rural). Based on these data, HIV prevalence was projected at 6.3 percent in the general population. Data from the ongoing Uganda AIDS Indicator Survey 2011 (UAIS 2011), will be used to calibrate these estimates and to improve the estimation of HIV prevalence in the general population. There is concern however that in-spite of the efforts of the last decade, the HIV/AIDS epidemic has remained stagnated at 6.0–7.0 percent.

Data indicate that there is a disproportionate burden of the HIV/AIDS epidemic in some geographical areas and demographic groups. This includes the high burden of HIV infection in Central, and North Central regions. Of concern is also the high burden of the epidemic in urban areas and among women. The Ministry of Health is also concerned about the observation of deteriorating indicators of sexual behaviour such as multiple concurrent sexual partnerships and non- use of condoms. The national HIV/AIDS response will target these challenges as we move forward.

I thank the staff of the AIDS control program for publishing this report. I commend the report to all stakeholders and hope that it will be a vital source of strategic information for planning HIV/AIDS prevention and control programs in the Country.

Dr. Nathan Kenya-Mugisha Ag. Director General of Health Services Ministry of Health

iii Epidemiological Surveillance Report 2010 ACKNOWLEDGEMENTS

The authors of this report were Dr. Joshua Musinguzi, Dr. Wilford Kirungi, Dr. Zainab Akol, Dr. Alex Opio, Dr. Benon Biryahwaho and Mr. Noordin Mulumba of the Ministry of Health. The report received contributions from Dr. Pontiano Kaleebu and Anatoli Kamali of the Medical Research Council (UK) and from Professor David Serwadda and Dr. Tom Lutalo of the Rakai Health Sciences Program. The authors also received reviews and comments from Dr. Wolfgang Hladik and Dr. Frank Kaharuza of CDC Uganda, and from Dr. Innocent Nuwagira of the World Health Organization for which they are extremely grateful. Secretarial support was provided by Ms. Ruth Nambwere and Ms. Annet Katamba.

The authors acknowledge the contribution of health workers from the 30 sentinel surveillance sites that participated in the 2009 ANC Sentinel Surveillance Survey. These sites include , Lacor, Arua, Jinja, , , Rubaga, , Hoima, Lira, , Nyakibale, Tororo, Kilembe, Kiwoko, , Nebbi, Pallisa, Lwala, Moyo, Atutur, Bwera, Aber, Kaabong, Kagadi, Amolatar, Kitgum, Kyangwali, Rwenkubo and Old . The authors would like to thank all survey respondents who agreed to participate in interviews and blood draw in the 2009 sentinel surveillance survey. The authors are grateful to program Managers and health workers who collated monitoring and evaluation data from Prevention of Mother To Child Programs (PMTCT), HIV Counseling and Testing (HCT), and Anti-Retroviral therapy programs (ART) that are presented in this report.

The authors also acknowledge the contribution of partner institutions that provided data that are presented in the report. These Institutions include the Medical Research Council (MRC) and Rakai Health Sciences Program who provided data from their long standing cohort programs. Authors are grateful to the Italian Instituto Superiori di Sanita (ISS) who provided funding and technical support for antenatal sentinel surveillance activities in Lacor hospital. Authors also acknowledge the management and staff of the AIDS Information Center who provided HIV counselling and testing data. The authors also acknowledge the staff at the Uganda Virus Research Institute HIV Reference Laboratory who conducted testing of blood specimens.

The authors acknowledge the US Centres for Disease Control and Prevention (CDC-Uganda), World Health Organization (WHO) and United Nations Program on AIDS (UNAIDS) for providing technical support in the design and implementation of surveillance activities. The authors are especially grateful to the US Centres for Disease Control and Prevention (CDC- Uganda) who provided funding for the antenatal surveillance activities and for the production of this report. The authors are also grateful to the members of the Surveillance Technical Working Group who include staff of Ministry of Health, Uganda AIDS Commission, CDC Uganda, USAID, WHO, and UNAIDS for their technical support and guidance. We are grateful to all partners for their contribution to the report.

The authors thank the policy makers, development partners, the press and the general public for the feedback and for support for the HIV/AIDS prevention and Control activities in Uganda. Finally, the authors acknowledge the support of the top management of the Ministry of Health for the advocacy and resource mobilisation for HIV/AIDS activities in Uganda.

iv Epidemiological Surveillance Report 2010 ABBREVIATIONS

ABC Abstinence, Be faithful and Condom use AIDS Acquired immuno-deficiency syndrome AIS AIDS Indicator Survey ANC Antenatal Clinic AOR Adjusted Odds Ratio ART Anti retro-viral therapy EPP Estimates Projection Package BCC Behaviour Change Communication CBO Community Based Organisation CDC Centres for Disease Control and Prevention (US) CI Confidence Interval DHS Demographic and Health Survey EPP Estimation Projection Package HBV Hepatitis B virus HCT HIV Counselling and Testing HIV Human immuno-deficiency virus HSV-2 Herpes simplex virus type 2 IEC Information, Education and Communication IGA Income generating activities M&E Monitoring and Evaluation MOH Ministry of Health MRC Medical Research Council (UK) NGO Non-governmental organisation OR Odds Ratio OVC Orphans and Vulnerable Children PLWHA People Living with HIV/AIDS PMTCT Prevention of Mother to Child HIV Transmission RCT Routine HIV Counselling and Testing STD Sexually transmitted disease STI Sexually Transmitted Infections TB Tuberculosis UAC Uganda AIDS Commission UBOS Uganda Bureaux of Statistics UAIS Uganda AIDS Indicator Survey UDHS Uganda Demographic and Health Survey UHSBS Uganda HIV/AIDS Sero-behavioural Survey UNAIDS United Nations Joint Programme on AIDS USAID United States Agency for International Development VCT Voluntary HIV Counselling and Testing WHO World Health Organisation ZTLS Zonal TB and Leprosy Supervisor

v Epidemiological Surveillance Report 2010 EXECUTIVE SUMMARY

The report presents HIVAIDS surveillance data collected from multiple sources. Antenatal surveillance data were obtained from consecutive sampling of pre-natal clients on their first antenatal visit over a 10-week period between June and August 2009 in 30 antenatal sentinel sites. The antenatal HIV prevalence estimates obtained were used in EPP and Spectrum software to model non-HIV prevalence estimates. The data from monitoring and evaluation of Prevention of Mother to Child (PMTCT), HIV Counseling and Testing (HCT) and Anti- retroviral treatment (ART) programs were obtained from analysis of facility data that were reported to the AIDS Control Program. Data from prospective cohort studies at the Medical Research Council (MRC) and Rakai Health Sciences were collected through annual surveys and shared with the AIDS Control program.

Data from modelling indicated national HIV prevalence estimates of 6.3 percent in 2009. This was comparable with the HIV prevalence estimate of 6.4 percent obtained from the Uganda HIV/AIDS sero-behavioural survey 2004-2005, (UHSBS 2004-05). The data also indicated that by end of 2009, 1,192,372 people were infected with HIV [1,042,711 (87 percent) adults and 149,661 (13 percent) children]. There were 124,261 new infections in 2009. Of the new infections, 56,079 (45 percent) were males and 68,182 (55 percent) were females. The models also indicated that there were 64,016 AIDS related death in 2009. Of these, 28,812 (45 percent) were males while 35,205 (55 percent) were females.

Data from antenatal surveillance indicate median HIV prevalence estimates of 7.0 percent in 2009. Antenatal HIV prevalence was higher in urban than in rural areas. In antenatal sites located in major urban areas, HIV prevalence ranged from 4.4 percent to 13.5 percent with a median of 8.4 percent. In the sites located outside major urban areas, HIV prevalence ranged from 1.4 percent to 18.9 percent with a median prevalence of 5.7 percent. Analysis for trends showed that the epidemic in Uganda has transitioned through three phases-a period of rapid expansion in the eighties, followed by a period of epidemic contraction between the mid nineties and 2000 and thereafter a period of a level epidemic.

Data from UHSBS 2004-05 indicated that the HIV epidemic had regional variations. Central, Kampala, and North Central regions had HIV infection prevalence above 8 percent. Regions with low HIV prevalence were West (2 percent) and Northeast (4 percent). Similar regional variations were observed in the antenatal surveillance data. In all regions, women had a higher prevalence of HIV infection than men.

Findings presented in the report indicate that the HIV/AIDS epidemic has had significant impacts on treatment needs for the Country. Data from modelling indicate that based on the new Ministry of Health treatment guidelines cut off of less than 350 CD-4 T-cells/ul, 540,094 adults and children needed ART by the end of 2009. Data on national ART enrolment indicated that by June 2010, 237,070 patients were on ART representing 47 percent of those in need. These findings should be taken in consideration in the design and implementation of HIV/AIDS programs in the Country.

vi Epidemiological Surveillance Report 2010 INTRODUCTION 1

To implement an effective national HIV/AIDS response, there is a need for comprehensive data to guide program interventions. The AIDS control program of the Ministry of health provides updates of these data in the HIV/AIDS Surveillance report. The 2009 Epidemiological Surveillance report presents data obtained from the 2009 Sentinel surveillance survey and from the 2003 and 2004 antenatal sentinel surveillance surveys for which specimens were previously not tested. Data from Ministry of Health (MoH) partners- the Medical Research Council, Rakai Health Sciences Program, AIDS information Center and the Italian Instituto Superiori di Sanita (ISS) are also presented in the report. Furthermore, the report also presents data from studies and HIV surveys by the MoH and partners.

The national HIV sentinel surveillance system generates most of the data that are utilized in the monitoring of HIV/AIDS programs in Uganda. The system comprises of 30 sentinel sites that are geographically spread across the country. In these sites, sentinel surveillance surveys are conducted annually to collect blood specimens and demographic data from pregnant women and clients with STDs. The data collected from these sites over time, have provided invaluable data on magnitude and trends of the epidemic. Through the over-sampling of young women 15-24 years, these data have also provided some insights into trends of new HIV infections.

There are some concerns on the effect of expanding ART coverage on the utility of HIV prevalence data in monitoring HIV prevention programs. The improved survival outcomes from expanded ART coverage complicate the interpretation of HIV prevalence data. The MoH has therefore strengthened collaboration with Institutions such as the Medical Research Council and the Rakai Health Sciences program that conduct prospective cohort studies that generate data on new infections. The MoH is also working with partners such as the Centers for Disease Prevention and Control (CDC-Uganda) to explore the utility of experimental Laboratory assays that could be used to estimate recent HIV infections from specimens collected in cross-sectional studies. Data from BED assays performed on specimens from the 2004-05 HIV/AIDS Sero-Behavioural survey provided useful information on HIV incidence and the risk factors for recent HIV infections in Uganda.

Whilst Surveillance and prospective cohort studies generate most of the routine data for monitoring HIV/AIDS programs in Uganda, there are other important non-routine sources of data. These include periodic HIV surveys such as the AIDS Indicator surveys and Demographic and Health Surveys (DHS). Two national level AIDS indicator surveys were conducted in Uganda in 1988 and 2004. These surveys provided invaluable data on population level indicators that were used in re-programming the AIDS response in the Country. A repeat AIDS Indicator Survey is currently being conducted to update data on these indicators and to establish trends. Similarly a series of Demographic and Health Surveys with an AIDS module were conducted in the Country in 1989, 1995, 2000 and 2006. The 2011DHS is currently in advanced stages of design and data collection will soon be conducted. Findings from these surveys have improved the understanding of the trends of AIDS indicators in the population which in turn provided vital information for programming.

In order to further improve the understanding of the dynamics of the HIV/AIDS epidemic in Uganda, the MoH and partners also conduct special studies. These studies target population groups that may have been excluded from surveillance surveys and population based studies.

1 Epidemiological Surveillance Report 2010 The program has participated in conducting HIV serological surveys in fishing communities, University populations and Plantation workers. Reports of the findings from these studies will be presented in individual reports in the near future.

Some AIDS program indicators are not routinely available through surveillance and their collection through special studies is complicated by difficult study designs and high costs. Mathematical models have been designed and utilised to obtain some of these indicators. Working with UNAIDS and WHO, the MoH conducts annual HIV/AIDS modelling to provide these indicators. These include indicators of ART need, new HIV infections, new AIDS cases, AIDS death, burden of orphans etc. Data from modelling have been vital in HIV programming and in monitoring HIV/AIDS programs such as ART coverage.

The Ministry of Health will continue to consolidate and expand data collection for HIV/AIDS surveillance systems, HIV/AIDS monitoring and evaluation, public health evaluation and population based surveys. Programs to promote dissemination and data use will be strengthened to ensure evidence based program implementation. At the policy levels, further efforts will be made to generate policy briefs to enable the translation of data into evidence for decision making.

The report is divided into seven chapters. Chapter one is the introduction, Chapter two presents the Materials and Methods for data collection. Chapter three presents findings from antenatal surveillance, while Chapter four presents data from UHSBS 2004-05, on HIV prevalence, HIV/AIDS knowledge and sexual behaviour. Chapter 5 presents data on AIDS related morbidity and mortality and chapter six presents findings from mathematical modelling. Finally, chapter seven presents the discussion and conclusions from the findings presented in the report.

2 Epidemiological Surveillance Report 2010 MATERIALS AND METHODS 2

The data in this report were collected from multiple sources. These included the national antenatal HIV sentinel surveillance system, periodic population based HIV/AIDS surveys, monitoring and evaluation of HCT, PMTCT and ART programs. Data were also collated from collaborative Institutions that conduct prospective cohort studies namely the Medical Research Council (MRC) and the Rakai Health Sciences Program. Estimates of ART needs, AIDS morbidity and mortality estimates were obtained from mathematical modelling. This chapter presents the data sources and methods of data collection.

2.1 NATIONAL ANTENATAL HIV SURVEILLANCE SURVEY

Sentinel surveillance data were collected from 30 ANC sentinel surveillance sites that were routinely used to collect these data in the last two decades. The selection of the sites was done incrementally over the years and took consideration of geographical as well as urban-rural representation. The protocol for the survey was based on guidelines from the World Health Organization. It was reviewed and approved by the office of the CDC Associate Director of Science. The location of the sentinel surveillance sites is shown in figure 2.1.

Survey participants were enrolled by consecutive sampling of ANC clients presenting for their first antenatal visit over a 10-week period between June and August 2009. At each site, a minimum of 300 blood samples were collected from blood leftover from routine syphilis screening. At the sites, women found to be infected with syphilis during routine screening were treated with Benzathine penicillin in line with national STI treatment guidelines. Blood specimens were tested for HIV antibody at Uganda Virus Research Institute (UVRI) after removing all personal identifiers. Anonymously transcribed data included information on age, sex, education, occupation, residence, marital status, and parity. All women were offered services for PMTCT in the participating sites.

2.2 ANTENATAL HIV SURVEILLANCE SURVEY IN LACOR HOSPITAL

The Ministry of Health collaborates with the Italian based Italian Instituto di Sanita based in Rome, Italy to conduct annual antenatal sentinel surveillance surveys in St. Mary’s Mission Hospital in Lacor in . These surveys are conducted based on protocols similar with those for the national ANC sentinel surveys. These activities have been conducted since 1993. Data obtained are analysed and shared with the Ministry of Health for inclusion in the surveillance report.

2.3 STD SENTINEL SURVEILLANCE SURVEY

The MoH has been conducting STD sentinel surveillance surveys at the STD clinic in Mulago hospital since 1989. These data are part of the national HIV sentinel surveillance data base. The data collection methods for these surveys are similar with those for ANC-based surveillance. In the 2009 STD sentinel surveillance survey, participants who reported for the first time for STD illness were sampled consecutively in the period between June and August 2009. Blood specimens were collected from left-over blood from routine serological testing for syphilis and other STIs at the clinic. The sample size for the survey was similar to that for ANC surveillance and was estimated at 300 blood specimens.

3 Epidemiological Surveillance Report 2010 Figure 2.1 Map showing location of ANC sentinel surveillance sites in Uganda

2.4 DATA FROM HIV COUNSELING AND TESTING PROGRAMS

The AIDS Control Program conducts activities to monitor HIV Counselling and Testing Programs in the Country. Through these activities, HIV sero prevalence data are collected from HIV counselling and testing (HCT) and Prevention of Mother to Child HIV Transmission (PMTCT) programmes. Similarly, the AIDS Information Center collects data to monitor their testing programs. This report presents findings from the database of the Prevention of Mother to Child HIV transmission unit of the Ministry of Health. The report also presents findings from the database from the AIDS Information Center. There are inherent selection biases in the sampling of participants for HCT which should be taken into consideration in the interpretation of these data.

2.5 POPULATION-BASED HIV SURVEILLANCE SURVEYS

The Ministry of Health and partners conduct periodic population based HIV surveys to collect data to supplement and calibrate estimates from routine surveillance. These surveys include the Demographic and Health Surveys and the AIDS indicator surveys. The DHS are based on nationally representative household samples, providing national and sub-national estimates of a range of demographic and health indicators. The Uganda AIDS indicator survey are also nationally representative and provide national and sub-national estimates of behavioural as well biological indicators of the HIV/AIDS epidemic. The behavioural data that are collected in these surveys include measures of higher risk sex, multiple sex partnerships, primary and secondary abstinence, condom use, STIs and health seeking behaviour. Data are also collected on programme coverage including IEC/BCC, PMTCT, HCT, ART, condoms, care for orphans and vulnerable children and home based care. The

4 Epidemiological Surveillance Report 2010 AIDS indicator surveys collect and test biological markers of HIV infection such as HIV, syphilis and HSV-2 in addition to the behavioural data.

2.6 LONGITUDINAL SURVEYS

In order to more accurately monitor the implementation of the HIV/AIDS national response, the Ministry of health collaborates with partners to collect data on new infections. These partners include the Medical Research Council (MRC) and the Rakai Health Sciences Program who have been conducting large scale community based cohort studies in Uganda for the last 20 years. Data obtained from these studies have provided invaluable information for planning and implementation of the national response.

The MRC cohort was established in district in south-western Uganda in 1989. The community based cohort comprises of 10,000 individuals aged 13 years and above in 15 neighbouring villages. Annual HIV sero-prevalence surveys are conducted. In this report, HIV prevalence and incidence data are presented for the period 1990-2008.

The Rakai Health Sciences cohort was established in rural in 1990. It comprises of 12,000 adults aged 15–49 years who are resident in 44 villages. Annual HIV sero- prevalence surveys have been conducted since 1990. Annual HIV sero-prevalence surveys are conducted. In this report, HIV prevalence and incidence data for the period 1990-2008 are presented.

2.7 ESTIMATES AND PROJECTIONS FROM MATHEMATICAL MODELING

The Ministry of Health collaborates with UNAIDS, WHO, CDC, UBOS and the Uganda AIDS Commission to conduct mathematical models to obtain estimates of AIDS indicators that may not be obtained directly from routine surveillance. These indicators include the number of people infected with HIV (incident and prevalent infections), AIDS deaths, number of people in need of ART, number of orphans and other impacts of the epidemic.

The estimates for 2009 were conducted in a two stage modelling technique using the Epidemic Projection Package (EPP) and Spectrum software. In the first stage, EPP was used to model the HIV prevalence and incidence curves for urban and rural areas for the period 1989-2009. The model utilized HIV prevalence data obtained from ANC surveillance. In EPP, the rural and urban EPP projection curves were adjusted with HIV prevalence in the rural and urban areas obtained from UHSBS 2004-2005. In the second stage, the rural and urban incidence curves from EPP were fed into Spectrum. In spectrum, the output from EPP were triangulated with population and demographic data from the UN Population division, and with program coverage data from HIV prevention, ART and PMTCT programs. Using spectrum, estimates and projections for 2009 were obtained.

2.8 AIDS RELATED MORBIDITY AND MORTALITY DATA

To monitor the implementation of the HIV/AIDS national response, the AIDS control program collects data on AIDS related morbidity and mortality. This is done through patient reports on enrolment in ART programs in public health facilities. The AIDS morbidity data are summarised to provide information on numbers of clients on treatment in the ART treatment centres. Quarterly reports of these data are routinely published by the AIDS Control Program.

5 Epidemiological Surveillance Report 2010 MAGNITUDE OF HIV INFECTION - CURRENT SITUATION AND TRENDS 3

3.1. NATIONAL HIV PREVALENCE ESTIMATES FROM MODELING

The national HIV prevalence among adults aged 15-49 years for 2009 were obtained by Mathematical modelling. Data from the model indicated a national HIV prevalence estimate of 6.3 percent. Table 3.1 presents a summary of the number of HIV infected individuals. The data indicate that 1,192, 372 people were infected with HIV. Of these, 1,042,711 (87 percent) were adults 15 years and above while 149,661 (13 percent) were children 0- 14 years.

Table 3.1 Estimates of number of people infected with HIV in Uganda - December, 2009 No. of HIV Infected Individuals

Total 1,192,372 100% Males 512,070 43% Females 680,301 57% Adults (15 years +) 1,042,711 87% Children 0-14 years) 149,661 13%

3.2. NATIONAL HIV PREVALENCE ESTIMATES FROM SENTINEL SURVEILLANCE

3.2.1. ANTENATAL HIV PREVALENCE ESTIMATES

Antenatal sentinel surveillance data were obtained from 29 antenatal sentinel sites. A total of 13,416 blood samples were collected in the 2009 antenatal sentinel surveillance survey. The data are presented in table 3.2. The median HIV prevalence in all the sites was 7.0 percent. Antenatal HIV prevalence was higher in urban than in rural sites. In sites located in the major urban areas (cities and municipalities), HIV prevalence ranged from 4.4 percent to 13.5 percent with a median prevalence of 8.4 percent. In the sites located outside the major urban areas (semi-urban and rural areas), HIV prevalence ranged from 1.4 percent to 18.9 percent with a median prevalence of 5.7 percent.

Table 3.2: Antenatal HIV prevalence, 2009

HIV Sample Size 95 percent Confidence Prevalence Intervals Sentinel Sites located in Major Urban areas 11.8 654 9.5 - 4.6 Arua hospital 4.4 1,171 3.3-5.7 8.4 1,008 6.8-10.4 7.2 926 5.7-9.1 6.9 597 5.0-9.3 Rubaga hospital 7.5 991 5.9-9.3 8.8 102 5.0-9.6 Hoima hospital 9.1 503 6.8-12.1 13.5 490 10.6-16.9 Median 8.4 Sentinel Sites Located Outside Major Urban Areas Masindi hospital 7.3 561 5.4-9.9 Nyakibale hospital 7.9 328 5.3-11.5 Tororo hospital 6.8 459 4.7-9.6

6 Epidemiological Surveillance Report 2010 Kilembe hospital 6.3 304 3.9-9.7 Kiwoko hospital 8.8 353 6.1-12.4 1.4 208 0.3-4.2 Nebbi hospital 5.8 428 3.9-8.6 Pallisa hospital 2.8 545 1.6-4.6 Lwala hospital 3.9 127 1.3-8.9 Moyo hospital 5.1 215 2.6-9.0 Atutur hospital 2.6 306 1.2-5.3 Bwera hospital 3.3 489 1.9-5.4 Aber hospital 6.0 703 4.4-8.1 Kaabong hospital 2.0 197 0.6-5.1 Kagadi hospital 7.9 303 5.2-11.7 Amolatar HC IV 6.6 301 4.2-10.2 Kitgum hospital 18.9 407 15.3-23.1 Kyangwali HC IV 2.9 341 1.5-5.5 Rwekubo HC IV 5.6 620 3.6-11.0 Median 5.7 Overall 7.0 13,416 6.6-7.4

3.2.2 AGE GROUP SPECIFIC ANTENATAL HIV SERO-PREVALENCE

Antenatal HIV sero-prevalence data were analysed to understand the distribution of the epidemic in the different age groups. Table 3.3 presents the findings for the age groups 15-19, 20-24, 25-29, 30-34 and 35+ yrs. The data indicate that HIV prevalence was lowest in the 15- 19 year age-group, was highest and peaked in the age-group 25-34 years and thereafter declined in older respondents.

Table 3.3 Antenatal HIV prevalence by age, 2009 Sentinel site Percentage HIV Prevalence 15-19 yrs 20-24 yrs 25-29 yrs 30-34 yrs 35+yrs Total Major urban sites Mbarara hospital 11.6 12.6 14.4 9.8 2.1 11.8

Arua hospital 3.5 5.1 4.0 4.3 5.6 4.4

Jinja hospital 5.4 11.0 8.5 7.1 6.9 8.4

Nsambya hospital 0 5.2 6.8 13.4 6.5 7.2

Mbale hospital 2.2 5.6 10.9 12.0 4.9 6.9

Rubaga hospital 3.7 6.5 10.2 7.3 6.7 7.5

Soroti hospital 9.5 0.0 15.6 9.1 20.0 8.8

Hoima hospital 4.4 7.7 12.7 16.7 10.3 9.1 Outside Major Urban sites Masindi hospital 5.6 4.7 10.4 10.6 8.8 7.3

Nyakibale hospital 12.1 8.0 7.9 3.5 12.1 7.9

Pallisa hospital 0.0 1.6 5.5 6.4 0.0 2.8

Tororo hospital NA NA NA NA NA NA

Mutolere hospital 0.0 1.1 2.2 0.0 3.7 1.4

Kiwoko hospital 4.6 8.4 12.2 7.1 12.5 8.8

Bwera hospital 3.7 3.8 1.9 4.5 1.9 3.3

Range 0-12.1 0-12.6 1.9-15.6 0-16.7 0-20.0 1.4-11.8

7 Epidemiological Surveillance Report 2010 3.2.3 PREVALENCE OF HIV INFECTION AMONG YOUNG WOMEN AGED 15-24 YEARS

Data on prevalence of HIV infection among women aged 15-24 years are vital for monitoring and evaluating HIV prevention programs. These data serve as a proxy for HIV incidence because this population have only recently become sexually active. In addition, the HIV epidemic in this age group is less likely to be influenced by AIDS mortality and HIV related sub-fertility.

Table 3.4 presents data on HIV prevalence among women 15-24 years for sites that had adequate sample size for the analysis. HIV prevalence was higher in urban than in rural sites. In Urban sites, HIV prevalence ranged from 3.7 percent to 10 percent except in Mbarara where the prevalence was 12.3 percent. In the rural sites, HIV prevalence was below 5% except in Nyakibale where the prevalence was 9 percent. Overall, HIV prevalence increased with age, with higher prevalence observed in the 20 – 24 year age group compared with the 15-19 year age group.

Table 3.4 HIV prevalence among young antenatal women aged 15 – 24 by age-group, 2009 Sentinel site Percentage HIV Prevalence 15-19 yrs 20-24 yrs 15 – 24 yrs Major urban sites % N % N % N Mbarara hospital 11.6 86 12.6 254 12.3 340

Arua hospital 3.5 283 5.1 352 4.4 635

Jinja hospital 5.4 203 11.0 347 8.9 550

Soroti hospital 9.5 21 0 33 3.7 54

Mbale hospital 2.2 136 5.6 196 4.2 332

Rubaga hospital 3.7 109 6.5 385 5.9 494

Hoima hospital 4.4 136 7.7 182 6.3 318

Nsambya hospital 0 44 5.2 267 4.5 311

Outside Major Urban sites Nyakibale hospital 12.1 33 8.0 113 9.0 146

Masindi hospital 5.6 124 4.7 211 4.8 335

Mutolere hospital 0.0 29 1.1 87 0.9 116

Kilembe hospital 0.0 55 6.1 99 3.9 154

Pallisa hospital 0.0 96 1.6 188 1.1 284

Bwera hospital 3.7 109 3.8 156 3.8 265

Sites with zero prevalence in the 15-19 age group including Nsambya, Mutolere, Kilembe, and Pallisa were noted. Similarly, Soroti had zero prevalence estimates in the age group 20- 24 years. These sites will be observed closely in future surveys to determine if this is an accurate estimate and not a result of other limitations such as sample size.

3.2.4 REGIONAL VARIATION IN HIV PREVALENCE

Data were analyzed to assess regional variations of the epidemic. Not all districts have sentinel sites, and therefore the analysis was made at regional level. The regions were

8 Epidemiological Surveillance Report 2010 determined by grouping sentinel sites from district groupings similar to those of UHSBS 2004-2005. Table 3.5 presents the regional variation in antenatal HIV sero-prevalence.

Data indicate that the HIV/AIDS epidemic exhibited a heterogeneous distribution similar to that observed in UHSBS 2004-05. HIV prevalence was highest in the Northern (range, [6- 18.9] percent) and Central regions (range, [7.2-8.8] percent). HIV prevalence was medium in the Eastern region (range, [2.6-8.8] percent) and Western region (range, [1.4-11.8] percent)and was lowest in Karamoja region (range, [2.0-3.8) percent and West Nile region (range, [4.1-5.8] percent).

There were also intra-regional heterogeneities. In the Northern region for example, although the median HIV prevalence was 10.1 percent, HIV prevalence ranged from 6.0 percent in Aber hospital to 18.9 percent in Kitgum hospital. Furthermore, in the Western region where median HIV prevalence was 3.6 percent, HIV prevalence ranged from 1.4 percent in Mutolere to 11.8 percent in Mbarara hospital. Intra-regional variations were less prominent in West Nile, Karamoja, Central and Eastern regions.

Table3.5. Regional Antenatal HIV prevalence, 2009 Sentinel site Percentage HIV Sample Size Prevalence Northern region Aber hospital 6.0 703 Kitgum hospital 18.9 407 Lira hospital 13.5 490 Amolatar HC IV 6.6 301 Median 10.1 Range 6.0 - 18.9

West Nile Arua hospital 4.4 1,171 Nebbi hospital 5.8 428 Moyo hospital 5.1 215 Median 5.1 Range 4.4 - 5.8

Karamoja Region Kaabong 2.0 197 hospital Matany hospital 3.8 238 Median 2.9 Range 2.0 – 3.8

Central Region Nsambya 7.2 926 hospital Rubaga hospital 7.5 991 Kiwoko hospital 8.8 353 Median 7.5 Range 7.2 - 8.8

Eastern Region Mbale hospital 6.9 597 Soroti hospital 8.8 102 Tororo hospital 6.8 459 Jinja hospital 8.4 1,008

9 Epidemiological Surveillance Report 2010 Pallisa hospital 2.8 545 Lwala hospital 3.9 127 Atutur hospital 2.6 306 Median 6.8 Range 2.6 - 8.8

Western Region Mbarara hospital 11.8 654 Masindi hospital 8.4 1,008 Nyakibale 2.8 545 hospital Hoima hospital 3.9 127 Kilembe hospital 2.6 306 Mutolere 1.4 208 hospital Bwera hospital 3.3 489 Kagadi hospital 7.9 303 Kyangwali HC IV 2.9 341 Rwekubo HC IV 5.6 620 Median 3.6 Range 1.4 - 11.8

3.2.5 TRENDS IN ANTENATAL HIV PREVALENCE

The national HIV surveillance system has a data base for antenatal surveys for the period 1989 to 2009. Table 3.6 and figures 3.1 and 3.2 present trends of these data for sentinel sites that have participated in the surveys over the time. In this report, data are presented for previously published surveys, for the 2003 and 2004 sentinel surveillance surveys (which were previously not published) and for the 2009 sentinel surveillance survey.

Like in previous analyses, the data indicate three phases of the epidemic in Uganda. These are the period of rapid epidemic expansion in the eighties that peaked in the mid nineties, followed by a period of epidemic contraction between the mid nineties and 2000 and thereafter a period of a level epidemic.

Table 3.7 and figure 3.3 present trend data for median HIV prevalence. Trends for median HIV prevalence followed the same pattern as that for HIV prevalence. Overall median HIV prevalence was 22 percent in 1991, declined to 5.2 percent in 2000 and was 6.5 percent in 2009. Again, HIV prevalence was higher in urban sites compared to sites outside major urban areas.

10 Epidemiological Surveillance Report 2010 Table 3.6 Annual Trends in Antenatal HIV prevalence from Sentinel Sites, 1989 - 2009 Sentinel site 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2009 Major urban areas Nsambya 24.5 25.0 27.8 29.5 26.6 21.8 16.8 15.4 14.6 13.4 12.3 11.8 9.5 8.5 4.0 5.7 7.5 13.6 8.4 7.2 Rubaga -- -- 27.4 29.4 24.4 16.5 20.2 15.1 14.8 14.2 10.5 10.7 10.4 8.1 9.1 4.8 7.1 11.0 7.8 7.5 Mbarara 21.8 23.8 24.3 30.2 18.1 17.3 16.6 15.0 14.5 10.9 11.3 10.0 10.6 10.8 2.3 0.0 11.1 17.5 13.7 11.8 Jinja 24.9 15.8 22.0 19.8 16.7 16.3 13.2 14.8 11.0 10.5 10.8 8.3 7.4 5.0 7.8 -- 8.4 6.4 7.4 8.4 Mbale 3.8 11.0 12.1 14.8 8.7 10.2 7.8 8.4 6.9 6.3 5.7 5.5 5.6 5.9 22.2 3.1 7.3 11.6 8.0 6.9 Soroti ------9.1 -- 8.7 7.7 5.3 7.7 5.0 5.0 5.0 4.6 5.7 3.6 7.1 7.8 7.1 8.8 Hoima ------12.7 9.0 5.4 3.5 -- 5.3 4.6 6.7 -- 5.4 15.2 9.2 9.1 Arua ------4.4 ------5.2 5.2 4.8 5.2 6.7 -- 9.0 7.0 3.8 4.4 Lacor ------27.1 21.9 14.7 14.3 16.3 12.8 12.3 13.1 11.3 11.9 -- -- 11.0 12.4 9.0 -- Lira ------11.2 13.5 Median 23 20 24 29 17 17 15 15 13 11 11 9.2 7.4 5.9 6.7 3.6 7.5 12 8.2 8.4 Outside Major Urban Areas Tororo -- 4.1 12.8 13.2 11.3 10.2 12.5 8.2 9.5 10.5 4.5 4.7 7.0 6.3 8.4 7.4 5.8 14.8 5.9 6.8 Kilembe ------7.0 16.7 11.1 10.4 8.5 -- 7.5 4.2 2.1 4.2 12.1 5.5 4.9 5.1 6.2 6.3 Pallisa ------7.6 5.0 1.2 -- -- 3.2 2.6 3.2 3.8 3.7 -- 0.7 1.8 2.1 7.9 4.3 2.8 Matany ------2.8 7.6 -- 2.0 1.6 1.3 0.9 1.9 1.7 0.7 0.0 0.0 0.0 5.9 - 3.8 Kagadi ------10.3 11.5 11 10.5 7.4 6.4 5.1 -- 1.3 8.9 6.9 7.9 Mutolere -- 4.1 5.8 -- 4.2 -- 3.6 2.6 -- 2.5 2.3 2.1 4.1 1.5 0.4 1.7 4.7 4.2 2.4 1.4 Moyo ------5 ------3.2 5.2 2.7 2.7 4.3 8.4 2.3 2.0 3.9 3.6 5.1 Aber ------5.3 7.6 7.0 0.0 -- 8.8 6.4 6.0 Lwala ------7.9 4.4 1.3 0.8 2.0 6.4 4.8 3.9 Masindi ------4.7 5.9 5.6 7.8 10.0 8.0 7.3 Nebbi ------1.3 1.6 3.1 3.3 6.2 10.6 5.8 Kiwoko ------5.8 5.1 4.9 9.7 6.3 8.8 Atutur ------2.6 1.2 1.9 11.3 9.5 2.6 Bwera ------0.4 -- 1.3 4.0 3.5 3.3 Nyakibale ------0.0 5.7 7.9 14.2 7.1 7.9 Kaabong ------2.7 -- 0.0 12.0 -- 2.0 Amolatar ------8.5 6.6 Kitgum ------7.2 18.9 Kyangwali ------4.8 2.9 Rwekubo ------5.6 5.6 Median -- 4.1 9.3 10.4 5.0 8.9 11.1 5.4 8.5 2.9 4.5 3.8 4.1 4.4 2.7 2.3 2.1 8.4 6.3 5.6 Overall ------18.0 ------10.0 9.8 6.8 6.1 6.5 6.2 6.6 3.8 6.0 9.7 7.4 7.0

11 Epidemiological Surveillance Report 2010

Figure 3.1 Trends in Antenatal HIV prevalence in urban antenatal sentinel sites

Nsambya Rubaga Mbarara Jinja Tororo Mbale Lacor

35.0

30.0

25.0

20.0

15.0

10.0 Prevalence (%) Prevalence 5.0

0.0

Year

FIGURE 3.2 TRENDS IN ANTENATAL HIV PREVALENCE IN SITES OUTSIDE URBAN ANTENATAL SENTINEL SITES

Tororo Kilembe Pallisa Matany Kagadi Mutolere Moyo Aber Lwala Masindi Nebbi

18 16 14 12 10 8 6 4 2 0

12 Epidemiological Surveillance Report 2010

Table 3.7 Median Antenatal HIV Prevalence by location of sentinel site Location of 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 09 sentinel Site Major urban 24.3 29.4 17.4 16.9 14.7 14.6 12.8 10.7 10.5 9.2 7.4 5.9 6.7 4.2 7.5 11.6 8.2 8.4 areas Outside Major Urban 9.3 10.4 5.0 8.9 11.1 5.4 8.5 2.9 4.5 3.8 4.1 4.4 2.7 2.3 2.1 8.4 6.3 5.6 Areas

Overall 22.0 19.8 8.9 16.4 12.9 11.6 9.5 9.1 5.5 5.2 5.5 5.0 5.7 3.1 5.2 8.9 7.1 6.5

FIGURE 3.3 TRENDS IN MEDIAN ANTENATAL HIV PREVALENCE AMONG MAJOR URBAN AND OUTSIDE MAJOR URBAN SENTINEL SITES

Major urban Outside Major Urban

35

30

25

20

15 Prevalence ( % ) % ( Prevalence 10

5

0 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2009 Year

Data were analyzed to examine trends in selected sentinel sites in the different regions of the country. The analysis indicated that national trends were also observed in the rest of the country. In central-north, HIV prevalence declined in Lacor hospital from 27.1 percent in 1993 and has remained between 11-12 percent from 2001 to-date as indicated in figure 3.4.

13 Epidemiological Surveillance Report 2010 Figure 3.4 Trends in Antenatal HIV prevalence at St Mary’s Hospital, Lacor.

30

25

20

15 Prevalence (%)Prevalence 10

5

0 Year

In the East-Central region, antenatal HIV prevalence in Jinja hospital was highest in the eighties, and declined to a low of 5 percent in 2002. This was followed by a phase of a stable prevalence ranging from 5- to – 8 percent between 2002 and 2009. There were similar patterns in other sites in the region.

Figure 3.5 Trends in Antenatal HIV prevalence in Jinja, Hospital, Eastern Uganda.

25

20

15

10 Prevalence (%)Prevalence

5

0 Year

In the central region, antenatal HIV prevalence was highest in Nsambya and Rubaga in 1992, declined to 4 percent in 2003 in Nsambya and to and 4.8 percent in 2004 in Rubaga. This was followed by a slow decline till 2005 and slight increases thereafter.

14 Epidemiological Surveillance Report 2010 Figure 3.6 Trends in Antenatal HIV prevalence in Nsambya Hospital, Kampala Uganda.

30

25

20

15

Prevalence (%) 10

5

0 Year

In South Western Uganda, trends were similar with those in other regions. In Mbarara hospital, HIV sero prevalence peaked at 30 percent in 1992, declined to 10 percent in 2000 and thereafter levelled at 10-to -11 percent during 2000 – 2005. During 2005 – 2009 there were variable trends in which HIV prevalence increased to 17.5 percent in 2006 and thereafter declined to 11.8 percent in 2009. In Nyakibale hospital, HIV prevalence was measured for the duration 2003-2009 and was lower than in Mbarara

Figure 3.7 Trends in Antenatal HIV prevalence in Mbarara Hospital.

35

30

25

20

15 Prevalence (%) 10

5

0 Year

In Mid-Western Uganda, data were collected from Kagadi, Hoima and Masindi hospitals. Trend analysis in these sites indicated a pattern similar to other regions. In Hoima hospital, HIV prevalence was highest at 12.7 percent in 1996 and declined to 3.5 percent in 1999. HIV prevalence was 4-to- 5 percent during 2000 – 2005 and thereafter increased to 9.1 percent in 2009

15 Epidemiological Surveillance Report 2010 Figure 3.8 Trends in Antenatal HIV prevalence in Hoima Hospital.

16

14

12

10

8

Prevalence (%) 6

4

2

0 Year

Data were analysed to assess trends for sites that had data for the period 2002 - 2009. Eight sites namely Tororo, Rubaga, Nsambya, Mbale, Masindi, Jinja, Kagadi and Pallisa had prevalence estimates that were relatively stable. In six sites, namely, Kilembe, Moyo, Mbarara, Hoima, Soroti and Nebbi. HIV prevalence generally increased. In five sites, namely, Lwala, Mutolere, Aber, Lacor and Arua, HIV prevalence generally decreased. Figures 3.9, 3.10, and 3.11 present the findings of this analysis.

Figure 3.9 Sentinel sites where Antenatal HIV prevalence was stable between 2002 and 2009

25

20

15

10 Prevalence (%) Prevalence

5

0 Tororo Rubaga Nsambya Mbale Masindi Jinja Kagadi Pallisa Year

2002 2003 2004 2005 2006 2007 2009

16 Epidemiological Surveillance Report 2010 Figure 3.10 Sentinel sites where Antenatal HIV prevalence increased between 2002 and 2009

18 16 14 12 10 8

Prevalence (%) 6 4 2 0 Kilembe Moyo Mbarara Hoima Soroti Nebbi Year

2002 2003 2004 2005 2006 2007 2009

Figure 3.11 Sentinel sites where Antenatal HIV prevalence decreased between 2002 and 2009

14

12

10

8

6

Prevalence (%) 4

2

0 Lwala Mutolere Aber Lacor Arua Year

2002 2003 2004 2005 2006 2007 2009

3.2.6. TRENDS IN AGE SPECIFIC HIV PREVALENCE

Data were analyzed to assess age specific HIV prevalence. Trends in young age groups 15-24 years have provided some understanding on trends of new HIV infections in the Country. These trends also provide invaluable information for Program Managers in assessing the impact of programmatic interventions.

Table 3.8 and figure 3.12present trends in age specific HIV prevalence among antenatal women in Lacor hospital in Gulu, Northern Uganda for the period 1993-2007.

17 Epidemiological Surveillance Report 2010 Table 3.8: Trends in Age group specific HIV prevalence at St Mary’s Hospital, Lacor Year 15-19 yrs 20-24 yrs 25-29 yrs 30-34 yrs 35 + yrs *Total % N % N % N % N % N % N 1993 21.5 284 31.8 333 28.9 204 25.7 109 15.2 46 27.1 998 1994 17.2 587 24.5 710 25.5 501 20.9 258 15.7 89 21.9 2160 1995 8.7 483 17.8 646 20.4 422 10.2 197 10.0 80 14.7 1842 1996 9.6 281 15.9 396 14.4 250 20.4 137 11.9 59 14.3 1131 1997 11.5 828 17.6 1000 20.2 682 19.2 308 11.1 144 16.3 3004 1998 10.2 1039 13.0 1414 16.8 955 12.5 432 6.3 191 12.8 4085 1999 7.4 1321 13.1 1704 15.9 1164 15.2 566 9.6 261 12.3 5042 2000 7.1 198 14.5 249 14.0 171 23.9 88 7.5 40 13.1 746 2001 6.3 302 11.1 305 17.7 147 11.0 154 8.2 98 11.3 1006 2002 5.9 270 10.0 339 15.4 201 21.1 152 9.8 112 11.9 1074 2003 7.1 452 9.7 496 15.2 244 14.3 238 13.7 153 11.5 1583 2004 6.5 353 10.7 354 19.1 178 14.6 178 11.9 118 12.5 1181 2005 5.8 347 13.3 346 12.0 249 12.1 149 9.1 99 11.0 1190 2006 4.2 259 10.5 352 12.6 182 19.9 181 23.3 120 12.4 1194 2007 4.2 1315 8.1 2195 10.5 1700 14.0 1138 9.5 601 9.0 6974

In Lacor Hospital, HIV prevalence in 15-19 year olds declined from a peak of 21.5% in 1993 to 4.2% in 2007. Antenatal HIV prevalence among women 20-24 years in this site declined until 2003 and has since stabilized. There were no clear trends among older women.

Figure 3.12 Trends in age group specific antenatal HIV prevalence at St Mary’s Hospital, Lacor

35 30 25 20 15

Prevalence (%) Prevalence 10 5 0 15-19 20-24 25-29 30-34 35 + Age (Years)

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Data were analyzed to assess age specific trends for sentinel sites in urban areas. Figure 3.13 presents trends in HIV prevalence among young women aged 15-19 years. The trends in the sites indicate declines in the nineties. There was a reversal of the trends after 2002 with modest increases that peaked in 2006. This was followed by slow declines during 2006- 2009.

18 Epidemiological Surveillance Report 2010 Figure 3.13Trends in antenatal HIV prevalence among women aged 15-19 years in five sites

30

25

20

15

Prevalence (%) Prevalence 10

5

0 Nsambya Mbale Jinja Mbarara Rubaga Selected Sites

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2009

Trends of HIV infection for antenatal women 20-24 years are presented in figure 3.14. Like for women 15-19 years, HIV prevalence in this group declined in the nineties, increased between early 2000’s and 2006 and thereafter declined modestly.

Figure 3.14: Trends in antenatal HIV prevalence among women aged 20-24 years in five sites

40 35 30 25 20

15 Prevalence (%) Prevalence 10 5 0 Nsambya Mbale Jinja Mbarara Rubaga Selected Sites

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2009

19 Epidemiological Surveillance Report 2010 The trends for older women 25-29 years are presented in figure 3.15. In all sites, there was no definite pattern in trends in this age-group. This was the same for women 30-34 years as indicated in figure 3.16.

Figure 3.15: Trends in antenatal HIV prevalence among young women aged 25-29 years in five sites

40 35 30 25 20

15 Prevalence (%) Prevalence 10 5 0 Nsambya Mbale Jinja Mbarara Rubaga Selected Sites

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2009

Figure 3.16Trends in antenatal HIV prevalence among young women aged 30-34 years in five sites

50 45 40 35 30 25 20

Prevalence (%) Prevalence 15 10 5 0 Nsambya Mbale Jinja Mbarara Rubaga Selected Sites 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2009

20 Epidemiological Surveillance Report 2010

3.3 HIV PREVALENCE DATA FROM PMTCT PROGRAMS

Data from monitoring of PMTCT programs are vital for the design and implementation of HIV/AIDS programs. The AIDS Control Program have recently conducted activities that have resulted in increased coverage of PMTCT programs in the Country. Analysis of data from these programs have improved the understanding of the dynamics of the HIV/AIDS epidemic in the population. Figure 3.17 presents data from PMTCT program monitoring for the period July 2009 - June 2010.

Figure 3.17 Number of women in the National PMTCT Programme, July 2009- June 2010

During this period, 1,001,014 pregnant women attended antenatal care in health facilities providing PMTCT services. Of those who tested, 919,097 (92 percent) were counselled, tested and received their results. Of these, 60,413 (6.5 percent) tested HIV positive. Of the women who tested positive, 44,167 (73 percent) and 20,625 (34 percent) of their babies received antiretroviral drugs for PMTCT.

3.4 PREVALENCE OF HIV FROM TESTING AT THE AIDS INFORMATION CENTER.

Table 3.18 and figure 3.19 present data from a historic database obtained from HIV testing at the AIDS Information Center. The database was compiled over two decades of HIV testing during 1990 - 2009. In this analysis, data are presented for young individuals 15-24 years who presented for first time testing at the Kampala branch of the AIDS Information Center between 2000 and 2009.

The data indicate that HIV prevalence was higher among females compared to males. HIV prevalence was 1.8 percent among males and 5.0 percent among females in 2009. In females, HIV prevalence declined from a peak of 10.1 percent in 2000 to 5.0 percent in 2008. Among males however, HIV prevalence stabilised between 3-4 percent during 2000-2007 and thereafter declined to 1.8 percent in 2009.

21 Epidemiological Surveillance Report 2010 Table 3.18: HIV prevalence among first time testers, 15-24 years at AIC Kampala, 2000-2008 Year Male Female

HIV+ HIV- Total Prevalence HIV+ HIV- Total Prevalence

2000 205 5666 5871 3.5 883 7871 8754 10.1

2001 221 5795 6016 3.7 961 8542 9503 10.1

2002 337 11864 12201 2.8 1,619 14100 15719 10.3

2003 74 2279 2353 3.1 395 4000 4395 9.0

2004 84 2399 2483 3.4 439 4342 4781 9.2

2005 87 2070 2157 4.0 342 3979 4321 7.9

2006 10 242 252 4.0 49 506 555 8.8

2007 60 1338 1398 4.3 255 3032 3287 7.8

2008 41 1541 1582 2.6 248 2936 3184 7.8

2009 233 12465 12698 1.8 901 17258 18159 5.0 Source: AIDS Information Centre (AIC), Kampala, Uganda

Figure 3.19: Trends of HIV prevalence among 15-24 year old first time testers at AIC, Kampala branch

Source: AIDS Information Centre, Kampala, 2008

22 Epidemiological Surveillance Report 2010 3.5 ESTIMATES OF HIV PREVALENCE AND INCIDENCE FROM COHORT STUDIES

To effectively plan, implement and evaluate HIV/AIDS programs, HIV/AIDS surveillance programs should provide data on new infections. However due to methodological and logistical limitations, there are difficulties in measuring direct estimates of new HIV infections at national level. In this report therefore, we present sub-national data from large scale cohorts collected and provided by colleagues from the Medical Research Council (MRC) and the Rakai Health Sciences program.

3.5.1 MRC KYAMULIBWA GENERAL POPULATION COHORT

3.5.1.1 ANNUAL HIV PREVALENCE DATA

Figures 3.20 and 3.21 present HIV prevalence data obtained from annual surveys conducted by MRC. The data indicate that HIV prevalence declined from 7.9 percent to 6.8 percent between 1990 and 2000. This was followed by HIV prevalence increases from 6.8 percent to 10.4 percent between 2000 and 2009. Overall, HIV prevalence was higher in women than in men.

Figure 3.20 HIV prevalence among men, 1990-2009

HIV Prevalence by Age

Males

25

20

15

10

Prevalence(%)

5 0

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 Survey Year

13-19 20-24 25-34 35+

Figure 3.21 HIV prevalence among women, 1990 - 2009.

HIV Prevalence by Age

Females

25

20

15

10

Prevalence(%)

5 0

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 Survey Year

13-19 20-24 25-34 35+

23 Epidemiological Surveillance Report 2010 3.5.1.2 ANNUAL HIV INCIDENCE DATA

The incidence of HIV in the MRC cohort in 2009 was 3.16 per 1,000 person years of observation (pyo), [males 1.86 per 1,000 pyo, females 4.22 per 1,000 pyo]. Between 1990 and 2000, the MRC cohort demonstrated declining trends in incidence. HIV-1 incidence declined from 8.0 to 5.2 per 1,000 pyo during 1990-2000, with significant sex-specific and age-specific trends. By sex, HIV incidence decreased among women from 6.4 to 4.4 per 1,000 pyo, while among men it decreased from 9.7 to 6.0 per 1,000. Between 2000 and 2009, HIV incidence in this cohort showed varying trends.

Figure 3.22 HIV incidence per 1000py, 1990-2009

HIV Incidence by Gender

12

10

8

6

4

HIV Incidence (per1,000)

2 0

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 Survey Year

Males Females

3.5.2 RAKAI HEALTH SCIENCES PROGRAM COHORT

3.5.2.1 ANNUAL HIV PREVALENCE DATA

Figures 3.23, 3.24 and 3.25 present HIV prevalence data from the Rakai Health Sciences program obtained from annual surveys conducted in the period 2003 - 2011. The data indicate that HIV prevalence was higher in males compared to females. There were significant declines in HIV prevalence in females aged 15-19 years from 4.3 percent to 1.7 percent and among males 20-29 years from 8.6 percent to 5.9 percent. There was a significant increase in HIV prevalence from 12.9 percent to 20.0 percent among females aged 40-49 years.

24 Epidemiological Surveillance Report 2010

Figure 3.23 Overall HIV Prevalence in the Rakai Cohort, 2003-2011

Figure 3.24 Female HIV Prevalence by age in the Rakai cohort, 2003-2011

25 Epidemiological Surveillance Report 2010 Figure 3.25 Male HIV Prevalence by age in the Rakai cohort, 2003-2011

The increase in HIV prevalence may be explained by two reasons. Firstly, the increased coverage of ART programs may have resulted in improved survival among HIV positive patients. Secondly, the ageing of the HIV positive population especially in women 40-49 years may account for increasing HIV prevalence in older populations.

3.5.2.1 ANNUAL HIV INCIDENCE DATA

Figures 3.26, 3.27 and 3.28 present data on HIV incidence collected from annual surveys conducted by the Rakai Health Sciences program in the period 2003-2011. The data indicate that like HIV prevalence, HIV incidence was higher among females comapred to males. Significant declines in HIV incidence were observed among females age 15-19 years, from 2.1 to 0.2/100 person years of observation in the 5 years. Non-significant declines in HIV incidence were also observed among males aged 20-29 years.

Figure 3.26 Overall HIV Incidence in the Rakai cohort,2003-2011

26 Epidemiological Surveillance Report 2010

Figure 3.27 Female HIV Incidence by age in the Rakai cohort, 2003-2011

Figure 3.28 Male HIV Incidence by age in the Rakai cohort, 2003-2011

27 Epidemiological Surveillance Report 2010 POPULATION-BASED HIV PREVALENCE AND SEXUAL BEHAVIOUR 4

4.1 HIV PREVALENCE BY SOCIO-DEMOGRAPHIC CHARACTERISTIC

There have been previous presentations of reports for data from UHSBS2004-05. These data indicated a significant burden of HIV infection in the Country estimated at 6.4 percent of the adult population. For children 0-5 years, UHSBS data indicated that only 0.7 percent of children were HIV infected. The HIV epidemic showed regional variations. Central, Kampala, and North Central regions all had HIV infection prevalence above 8 percent. Regions with low HIV prevalence were West Nile (2 percent) and Northeast (4 percent). In all regions, women had a higher prevalence of HIV infection than men. In this report, those data are presented disaggregated by some important sexual behaviour and socio-demographic covariates.

Table 4.1HIV prevalence by socio-demographic characteristics, UHSBS 2004-05

Women 15-49 Men 15-49 Total 15-49 Socio-demographic Percentage Number Percentage Number Percentage Characteristic HIV positive tested HIV positive tested HIV positive Number tested Marital status Currently in union 5.9 5,977 6.8 3,973 6.3 9,950 Widowed1 31.2 557 32.2 94 31.4 651 Divorced/separated 16.0 742 10.8 500 13.9 1,241 Never in union 2.7 2,075 0.8 2,910 1.6 4,985 Ever had sex 5.6 816 1.2 1,584 2.7 2,400 Never had sex 0.8 1,259 0.2 1,327 0.5 2,585 Type of union In polygynous union 5.7 1,959 7.5 858 6.2 2,818 Not in polygynous union 6.0 4,018 6.6 3,115 6.3 7,133 Not currently in union 10.3 3,373 3.0 3,504 6.6 6,877 Pregnant at time of Survey Pregnant 6.5 1,068 na na Na na Not pregnant/not sure 7.7 8,250 na na Na na Birth in previous 3 years None 8.5 4,854 na na Na na Birth and ANC 6.0 3,866 na na Na na Birth and no ANC 8.4 630 na na Na na

Total 15-49 7.5 9,391 5.0 7,515 6.4 16,906 Total 15-59 7.3 10,227 5.2 8,298 6.3 18,525

Note: Totals include a small number of cases with missing information. ANC = antenatal care na = Not applicable The category ‘widowed’ consists of those who are not currently married and who had a previous spouse who died. It may be slightly overestimated to the extent that respondents who are currently divorced but previously widowed are considered widowed instead of divorced. HIV prevalence was related to marital status. Table 4.1 shows that respondents who were widowed were most likely to be HIV infected. Almost one-third of women and men who were widowed were HIV positive, compared with 6 percent of those who were married at the time of the survey. Those who were divorced or separated had intermediate levels of HIV infection (14 percent), while those who had never been in a marital union had a relatively low prevalence (2 percent).

A comparison was also made for women who gave birth in the three years preceding the survey and who had received antenatal care as opposed to those who did not or those who did not give birth during the time period. The data showed that those who had ANC for a recent birth were slightly less likely to be HIV positive (6 percent) than those who either had a birth but did not receive ANC (8 percent) or did not have a birth (9 percent).

28 Epidemiological Surveillance Report 2010 4.2 HIV PREVALENCE BY SEXUAL BEHAVIOR

Data were analyzed to examine the prevalence of HIV infection by various sexual behaviours among respondents who had ever had sexual intercourse. Table 4.2 presents the findings and the data indicated a tendency for lower HIV risk for those who initiated sex at a later age especially among women. For example, HIV prevalence was higher among women who first had sex before age 15 (11 percent) and steadily declined to only 6 percent among women who delayed first sex until age 20 or older. Among men, the opposite pattern prevailed.

Table 4.2HIV prevalence by sexual behaviour characteristics, Uganda 2004-05 Women 15-49 who ever Men 15-49 who ever Total 15-49 who ever had sex had sex had sex Percentage Percentage Percentage Sexual behaviour HIV HIV HIV Characteristic positive Number positive Number positive Number Age at first sex <15 11.4 1,417 4.3 905 8.6 2,322 15-17 9.1 3,652 6.4 2,193 8.1 5,845 18-19 7.5 1,473 6.2 1,442 6.9 2,915 20+ 5.6 1,549 6.6 1,611 6.1 3,160 Higher-risk sex in past 12 months Had higher-risk sex 15.4 1,068 6.3 1,947 9.6 3,015 Had sex, not higher risk 6.1 5,871 6.2 3,331 6.2 9,202 No sex in past 12 months 14.4 1,152 4.9 873 10.3 2,025 Number of partners in past 12 months 0 14.5 1,149 4.7 867 10.3 2,015 1 7.3 6,673 5.5 3,709 6.7 10,382 2 14.0 249 7.8 1,198 8.9 1,447 3+ * 21 9.2 377 9.1 398 Number of higher-risk partners in past 12 months 0 7.5 7,024 6.0 4,187 6.9 11,211 1 15.1 966 6.3 1,478 9.7 2,443 2 20.8 87 5.5 326 8.7 413 3+ * 14 8.8 160 8.5 174 Any condom use ever Used condom 12.2 2,454 6.9 3,081 9.3 5,535 Never used condom 6.9 5,638 5.3 3,070 6.4 8,707 Condom use at last sex in past 12 months1 Used condom 14.7 631 5.9 841 9.7 1,472 Did not use condom 6.8 6,306 6.4 4,429 6.6 10,734 Condom use at last higher-risk sex in past 12 months1 Used condom 15.0 494 5.0 1,034 8.3 1,527 Did not use condom 15.8 572 7.9 905 11.0 1,477 No higher-risk sex 6.1 5,871 6.2 3,331 6.2 9,202 Total 15-49 8.5 8,091 6.1 6,151 7.5 14,242 Total 15-59 8.2 8,924 6.1 6,928 7.3 15,851 Note: Higher-risk sex refers to sex with a non-nmarital, non-cohabiting partner. An asterisk refers to a figure based on fewer than 25 un-weighted cases that has been suppressed. 1 Refers to those who had sex in the past 12 months.

Women who had higher-risk sex (sex with a non-marital, non-cohabiting partner) in the year preceding the survey had a higher prevalence (15 percent) compared to those who had sex but not higher-risk sex (6 percent). Interestingly, women who had ever had sex but had not had sex during the 12 months preceding the survey had almost as high prevalence of HIV infection (14 percent) as those who had higher-risk sex. This might be a result of the fact that those who had ever had sex but not during the past 12 months were less likely to be in a marital union. For men, there was almost no difference in HIV prevalence by higher-risk sex categories. Prevalence of HIV infection was 6 percent among men who reported having higher-risk sex in the past 12 months, as well as for those who had sex but not higher-risk

29 Epidemiological Surveillance Report 2010 sex, and it was 5 percent for those did not have sex in the previous year. The number of sexual partners in the 12 months preceding the survey showed the expected positive relationship with HIV prevalence for men, but not for women. Among men, HIV prevalence increased as the number of partners increased, from 5 percent among those who did not have sex in the previous 12 months to 9 percent among men who had three or more partners in the previous year. For women, those who did not have sex in the previous year were as likely to be HIV-positive as those who had two sexual partners in the previous 12 months.

Table 4.2 also shows data on HIV infection by the number of higher-risk partners in the previous 12 months. For women, HIV prevalence increased as the number of recent higher- risk sexual partners increased, while for men, there was only a weak positive association. Sexually experienced women who reported having no higher-risk sex partners in the previous 12 months had a prevalence of 8 percent, while prevalence was 15 and 21 percent, respectively, for those who had one or two or more higher-risk sex partners in the previous 12 months. For men, prevalence of HIV infection was 6 percent among those with 0, 1, or 2 sexual partners in the previous 12 months, and increased to 9 percent among those who reported having three or more higher-risk sexual partners.

When used consistently and correctly, condoms are a very effective way of preventing HIV infection, sexually transmitted infections, and unwanted pregnancy. Results from the UHSBS did not show any consistent pattern of HIV infection levels by condom use. Among women, HIV prevalence was higher among those who had ever used a condom (12 percent) than among those who had not (7 percent), and was also higher among those who used a condom at last sex (15 percent) than among those who did not (7 percent). It was about equally as high among those who used a condom at last higher-risk sex as among those who did not (15 and 16 percent, respectively). Among men, differences were much smaller, though HIV prevalence was lower among men who used a condom at the last higher-risk sex (5 percent) than among those who did not (8 percent).

4.3 HIV PREVALENCE BY OTHER RISK CHARACTERISTICS

Data were analysed to examine the relationship between HIV infection and other risk characteristics including history of STI symptoms and weather respondents had ever tested for HIV infection. Table 4.3 presents the findings of the variation in HIV prevalence among men and women who had ever had sex. Women and men who had a recent history of a sexually transmitted infection (STI) or STI symptoms in the 12 months preceding the survey had higher rates of HIV infection than those with none (13 percent compared with 5 percent). This pattern was the same for both women and men.

Respondents who had tested for HIV were more likely to be HIV positive than those who had not. Among those who had ever had sex, the prevalence of HIV infection among women and men who had tested for HIV was 11 percent compared with 7 percent for those who had never been tested for HIV. Among women who had ever had sex, HIV prevalence was 14 percent among those who had ever compared with 8 percent among those who had never been tested. Among men, 8 percent of those previously tested were HIV positive, compared with 6 percent of those who had not tested.

30 Epidemiological Surveillance Report 2010 Table 4.3 HIV prevalence by other characteristics related to risk, UHSBS 2004-05 Women 15-49 who Men 15-49 who Total 15-49 who ever had sex ever had sex ever had sex Percentage Number Percentage Percentage HIV of HIV Number HIV Characteristic positive women positive of men positive Number Had STI in past 12 months Had STI or STI symptoms 13.4 2,716 12.9 1,310 13.3 4,026 No STI, no symptoms 6.1 5,375 4.2 4,841 5.2 10,216 Prior HIV testing status Ever tested 13.8 1,300 7.5 857 11.3 2,157 Never tested 7.5 6,792 5.9 5,293 6.8 12,085 Total 8.5 8,091 6.1 6,151 7.5 14,242 STI = Sexually transmitted infection

Table 4.4 presents data about the relationship between prior HIV testing and the actual HIV status of respondents. The results show that many respondents who were HIV positive had not tested and did not know their status. Eighty percent of infected respondents (77 percent of infected women and 85 percent of infected men) did not know their HIV status, either because they had not tested or because they were tested and did not receive their HIV test results.

Table 4.4 HIV prevalence by prior HIV testing status, Uganda 2004-05

Prior HIV testing status Women 15-49 Men 15-49 Total Percentage Percentage Percentage Percentage Percentage Percentage HIV HIV HIV HIV HIV HIV positive negative positive negative positive negative Ever tested, knows results of last test 23.5 11.8 15.0 10.3 20.5 11.1 Ever tested, does not know results 2.2 2.0 2.0 1.6 2.1 1.8 Never tested 74.4 86.2 83.0 88.1 77.4 87.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 701 8,634 377 7,084 1,079 15,718

4.4 HIV PREVALENCE AMONG YOUNG PEOPLE

Prevalence of HIV among young people aged 15-24 represent more recent infections and serve as an important indicator for detecting trends in both prevalence and incidence. Table 4.5 presents data on HIV prevalence among young people by a variety of indicators of sexual behaviour in UHSBS 2004-2005. The prevalence of HIV infection for the 15-24 age-group was 3 percent. However, there was a sizeable gender gap. HIV prevalence among women age 15-24 years was 4 percent, while among men, it was only 1 percent. HIV prevalence rose rapidly with age, especially among women.

Urban youth were more likely to be infected with HIV than those in rural areas (5 percent versus 3 percent). Young people in Kampala, Western, East Central and North Central regions were more likely to be HIV positive than those living elsewhere, especially those in West Nile and Northeast regions.

31 Epidemiological Surveillance Report 2010 4.5 HIV prevalence among young people aged 15-24, Uganda 2004-05 Women 15-24 Men 15-24 Total 15-24 Background Percent HIV Number of Percent HIV Number of Percent HIV characteristic positive women positive men positive Number Age 15-17 1.9 1,293 0.3 1,214 1.1 2,508 18-19 3.9 757 0.2 707 2.1 1,465 20-22 5.5 1,174 2.3 762 4.3 1,935 23-24 7.7 623 2.5 414 5.7 1,036 Residence Urban 6.9 694 1.8 506 4.8 1,200 Rural 3.8 3,153 0.9 2,591 2.5 5,744 Region Central 4.8 681 1.7 602 3.4 1,284 Kampala 6.3 324 0.6 248 3.8 572 East Central 5.0 620 0.8 445 3.3 1,064 Eastern 2.9 314 1.3 304 2.1 618 Northeast 2.8 286 0.4 198 1.8 484 North Central 5.1 323 1.9 244 3.7 566 West Nile 1.3 369 0.4 306 0.9 676 Western 5.5 442 1.5 333 3.8 774 Southwest 4.2 488 0.6 417 2.5 906 Marital status Currently in union 5.7 1,673 3.9 415 5.3 2,088 Widowed (38.2) 25 * 1 (39.7) 26 Divorced/separated 10.7 227 7.5 99 9.7 327 Never in union 2.0 1,922 0.4 2,582 1.1 4,504 Ever had sex 4.1 687 0.5 1,302 1.7 1,989 Never had sex 0.9 1,235 0.2 1,281 0.5 2,515 Higher-risk sex in past 12 months Had higher-risk sex!Unexpected End of Formula 6.8 598 1.4 951 3.5 1,549 Had sex, not higher risk 5.7 1,690 4.2 328 5.5 2,018 No sex in past 12 months 5.7 325 0.6 538 2.5 862 Number of partners in past 12 months 1 0 5.8 324 0.6 537 2.6 860 1 5.9 4,337 1.6 1,827 4.6 6,165 2+ 8.7 237 3.5 726 4.8 963 Number of higher-risk partners in past 12 months 1 0 5.7 3,705 2.6 1,191 5.0 4,895 1 6.5 1,088 0.9 1,395 3.3 2,483 2+ 10.9 105 2.7 504 4.1 609 Any condom use ever Used condom 6.9 1,243 1.9 1,105 4.5 2,348 Never used condom 5.2 1,369 1.3 711 3.9 2,081 Condom use at last sex in past 12 months2 Used condom 6.4 350 0.6 491 3.0 841 Did not use condom 6.0 1,936 3.1 782 5.2 2,717 Condom use at first sex 1 Used condom 5.9 761 1.7 586 4.1 1,348 Did not use condom 6.0 1,851 1.7 1,230 4.3 3,082 Total 4.3 3,847 1.1 3,097 2.9 6,944 Note: Higher-risk sex refers to sex with a non-marital, non-cohabiting partner. Numbers in parentheses are based on 25-49 un-weighted cases; an asterisk refers to a figure based on fewer than 25 un-weighted cases that has been suppressed. 1 Refers to those who have ever had sex. 2 Refers to those who had sex in the past 12 months.

32 Epidemiological Surveillance Report 2010 HIV infection was highest among the small number of youth who were widowed, divorced, or separated, followed by those who were married at the time of the survey. The lowest levels of infection were among young people who had never married. Among young women, those who had higher-risk sex were more likely to be HIV positive than those who had non-higher- risk sex. The opposite was true for young men.

4.5 HIV PREVALENCE AMONG CHILDREN UNDER FIVE

In UHSBS 2004-05, data were collected on HIV prevalence among children under five. This involved more detailed testing, because children under 18 months whose mothers were HIV positive were likely to test positive on standard ELISA HIV tests even if they were not themselves carrying the virus. To get accurate data for these young children, it was necessary to do a confirmatory test on all positive cases using a polymerase chain reaction test. The data on HIV prevalence among children under five are presented in table 4.6. The data indicated that only a tiny fraction of children were HIV positive—less than 1 percent. Prevalence was slightly higher among children in urban areas, and specifically Kampala, than in other areas. HIV prevalence was also higher among children whose mothers were widowed, divorced, or separated, because as shown in previous tables, HIV infection was also higher among these mothers. The most striking figure was that HIV prevalence was very high (10 percent) among children whose mothers were also HIV positive. Because mother-to- child transmission is by far the most likely means of transmission of HIV infection among children, this is hardly surprising. Only a tiny fraction (one-tenth of 1 percent) of children whose mothers were HIV negative were themselves HIV positive. HIV prevalence was also relatively high (4 percent) among children whose mothers had died.

Table 4.6 HIV prevalence among children under age five, Uganda 2004-05 Background Characteristic Percentage HIV positive Number of children Age <18 months 1.0 2,666 18-59 months 0.5 5,689 Sex Male 0.7 4,148 Female 0.7 4,226 Residence Urban 1.5 814 Rural 0.6 7,560 Mother's marital status Never married 0.6 185 Married 0.5 6,284 Widowed 2.5 255 Divorced/separated 2.1 407 Missing/not interviewed 0.6 1,244 Mother's HIV status Positive 10.2 364 Negative 0.1 6,671 Missing/not interviewed 0.8 1,339 Mother's survival Alive, not sick 0.7 6,979 Alive, sick 0.7 179 Alive, illness status missing/ not in household 0.4 1,069 Dead 4.4 80 Don’t know/missing 0.0 67 Total 0.7 8,374

33 Epidemiological Surveillance Report 2010 AIDS RELATED MORBIDITY AND MORTALITY 5

Data on AIDS related morbidity and mortality were obtained from the AIDS Control program, ART Monitoring section. They were compiled from routine reports of health units providing care and treatment. The data are summarized to present the status of ART service delivery in Uganda as of December, 2010. As of December 2010, the number of accredited and active ART service outlets in the country were 423. All referral and general hospitals in the country were providing adult ART services. About 86 percent of HC IVs and 6 percent of HC IIIs were providing adult ART services. Overall, 91.8 percent of outlets from HCIV onwards were providing adult ART services. There were 36 adult ART clinics operated by research programmes.

By the end of December 2010, the number of accredited and active ART service outlets providing paediatric ART services in the country were 322. All referral hospitals, 90 percent of general hospitals and three quarters of HC IVs were providing paediatric ART services. Overall, 80 percent of facilities from HC IV and above were providing paediatric ART services. Furthermore, there were 31 clinics operated by research programmes/specialised clinics and 23 private-for-profit clinics also providing paediatric ART services.

By the end of December 2010, the number of active clients enrolled into antiretroviral therapy countrywide were 260,865. Of these, 239,102 (91 percent) were adults aged 15 years and above, and 21,763 (9 percent) were children 0-14 years. Table 5.1 presents the number of clients enrolled on ART in Uganda as of December 2010.

Table 5.1 Number of clients enrolled on ART, December 2010. District ART Service Level Implementing Cumula No. No. Total New No New Total Source of outlet: Partner(s) tive No Adults Childre No. on Adults Childre New on data on ART on n on ART on n on ART ART ART ART ART West Nile Region Adjumani Adjumani Hosp Hosp PIDC, MoH 672 402 38 440 14 4 18 Facility Report Arua Arua RRH RRH MSF, MoH 9282 5049 519 5568 236 15 251 Facility Report Kuluva Hosp Hos PIDC, MoH 375 330 16 346 18 2 20 Facility Report Koboko Koboko HC IV HCIV PIDC, MoH 1016 993 48 1041 54 3 57 Facility Report Moyo Moyo Hosp Hosp SUSTAIN, MoH 492 276 10 286 24 5 29 Facility Report Nebbi Nebbi Hosp Hosp SUSTAIN, MoH 1700 1245 107 1352 38 4 42 Facility Report Angal Hosp Hosp PIDC, MoH 175 163 3 166 15 2 17 Facility Report Pakwach HC IV PIDC, MoH 155 146 9 155 11 0 11 Facility Report Zombo Nyapea Hosp Hosp IRCU,MoH 470 368 21 389 88 3 91 Facility Report Nyadri Maracha Hos Hosp PIDC, MoH 153 10 2 12 10 2 12 Facility Report Yumbe Yumbe Hosp Hosp PIDC, MoH 284 267 17 284 ND ND ND Facility Report Midigo HC IV HC IV PIDC, MoH 46 44 1 45 8 0 8 Facility Report Kampala Region Kampala TASO Mulago AIDS TASO 4056 3313 73 3386 80 3 83 Facility Report Clinic Mulago CDC AIDS MJAP, MoH 885 438 0 438 71 0 71 Facility Report Clinic MUJU AIDS SUSTAIN, MoH 1938 1189 0 1189 85 0 85 Facility Report Research Clinic Mulago ISS NRH MJAP, MoH 7344 5511 0 5511 149 0 149 Facility Report Mulago TB- AIDS MJAP, MoH Facility Report HIV Clinic 1827 187 0 187 45 0 45

34 Epidemiological Surveillance Report 2010 District ART Service Level Implementing Cumula No. No. Total New No New Total Source of outlet: Partner(s) tive No Adults Childre No. on Adults Childre New on data on ART on n on ART on n on ART ART ART ART ART Post Natal AIDS PIDC, MoH CDC Clinic Clinic 302 0 202 202 0 34 34 Infect Dis Instit AIDS MJAP, MoH CDC Clinic 6757 6969 0 6969 387 0 387 Kampala HC II MoH 100 50 0 50 ND ND ND Facility Report Dispensary PIDC Ward 15 AIDS PIDC, MoH CDC Clinic 4528 1172 2390 3562 66 153 219 NRH NRH MJAP, MoH 1017 390 5 395 21 0 21 Facility Report Univ Hospital PART/HIPS, 282 144 0 144 6 0 6 Facility Report MoH IRCU, MoH 3007 2025 129 2154 160 9 169 Facility Report Hospital Hospital IRCU,MoH 1064 1059 5 1064 66 10 76 MEEPP/ MOH Rubaga Hospital MOH 1912 1215 5 1220 123 1 124 Facility Report Hospital Internat Hosp Hospital PART/HIPS, 363 195 4 199 14 0 14 Facility Report MoH Hospital Hospital MoH 345 204 2 206 26 0 26 Facility Report Nsambya HC AIDS AIDS Relief 4704 173 13 186 Facility Report Clinic 3475 322 3797 Nsambya AIDS MoH 782 606 97 703 ND ND ND March Report MTCT Clinic Nsambya Hospital MoH 248 223 0 223 12 0 12 Facility Report Police Nsambya Priv Hospital SUSTAIN, MoH 1085 679 18 697 50 0 50 Facility Report Nsambya Clinic PART/HIPS, ND ND ND ND ND ND ND General MoH Military Hospital DOD, MoH 1127 322 0 322 8 0 8 Facility Report Murchsion Bay Hospital MoH 1048 719 0 719 65 0 65 Facility Report Kisenyi HC IV HC IV IDI, MoH 1013 754 0 754 92 0 92 Facility Report HC AIDS SUSTAIN 274 258 0 258 17 0 17 Facility Report Clinic Kawempe HC HC IV IDI, MoH 1891 1484 250 1734 11 3 14 Facility Report Kyadondo Med Clinic PART/HIPS, 33 13 0 13 6 0 6 Facility Report Ce MoH Uni HC IV MoH 62 32 0 32 1 0 1 Facility Report Naguru HC IV HC IV IDI, MoH 1221 1124 0 1124 67 0 67 CDC Kitebi HC III HC III IDI, MoH 779 654 160 814 86 6 92 Facility Report Komamboga HC III IDI, MoH 267 223 0 223 41 0 41 Facility Report HC III HC III IDI, MoH 832 711 0 711 72 0 72 Facility Report Kirudu HC III HC III IDI, MoH 994 652 138 790 55 1 56 Facility Report Kiswa HC III HC III IDI, MoH 3060 1997 431 2428 122 6 128 Facility Report JCRC AIDS JCRC 24765 6076 1601 7677 314 41 355 JCRC Clinic St Catherines Clinic PART/HIPS, 83 ND ND ND MEEPP MoH 16 10 26 Africa Air Clinic PART/HIPS, 112 169 1 170 5 1 6 Facility Report Rescue MoH St Joseph Clinic PART/HIPS, 2 2 0 2 ND ND ND MEEPP MoH Clinic PART/HIPS, ND ND ND MEEPP MoH 24 20 4 24 Bank of Clinic PART/HIPS, 98 96 0 96 ND ND ND Facility Report Uganda MoH Crane Health Clinic PART/HIPS, 2 2 0 2 ND ND ND MEEPP Service MoH Case Medical Clinic PART/HIPS, 439 366 0 366 44 0 44 Facility Report Center MoH White Horse Clinic PART/HIPS, 1 1 0 1 ND ND ND MEEPP Nursing MoH Jumbo Corner Clinic PART/HIPS, ND ND ND ND ND ND ND Clinic MoH Kadic Med Clinic PART/HIPS, 213 134 0 134 3 0 3 Facility Report Center MoH Kamwokya AIDS AIDS Relief 2554 117 1 118 Facility Report CCC Clinic 1892 28 1920 KIMS Med Clinic PART/HIPS, 96 67 0 67 3 0 3 Facility Report Cent MoH SAS Clinic PART/HIPS, 695 271 0 271 ND ND ND MEEPP Foundation MoH The Surgery Clinic PART/HIPS, 180 178 2 180 6 0 6 Facility Report

35 Epidemiological Surveillance Report 2010 District ART Service Level Implementing Cumula No. No. Total New No New Total Source of outlet: Partner(s) tive No Adults Childre No. on Adults Childre New on data on ART on n on ART on n on ART ART ART ART ART MoH Victoria Med C Clinic PART/HIPS, ND ND ND ND ND ND ND MoH Kitante Med Clinic PART/HIPS, 585 347 3 350 12 0 12 Facility Report Center MoH Ikan Clinic Clinic PART/HIPS, 9 1 0 1 ND ND ND MEEPP MoH Phoenix Med Clinic PART/HIPS, 1 1 0 1 ND ND ND MEEPP Center MoH Life Link Med Clinic PART/HIPS, 4 4 0 4 ND ND ND MEEPP Center MoH St. AIDS Uganda Cares, MoH 2070 2071 40 2111 59 0 59 Facility Report Balikudembe Clinic Joy Medical Clinic PART/HIPS, 268 167 1 168 20 0 20 Facility Report Cent MoH SIMS Med Clinic PART/HIPS, 201 90 1 91 8 1 9 Facility Report Cent MoH Alive Med AIDS MoH 3024 2586 256 2842 269 24 293 Facility Report Cent Clinic Intern Med Clinic PART/HIPS, 265 5 0 5 Facility Report Cent MoH 258 7 265 Hosp Clinic PART/HIPS, ND ND ND ND ND ND ND MoH Hope Clinic Clinic PART/HIPS, 126 108 8 116 23 0 23 Facility Report SUSTAIN, MoH Kampala Clinic PART/HIPS, ND ND ND ND ND ND ND Family Clinic MoH Home Med Clinic PART/HIPS, ND ND ND ND ND ND ND Center MoH Makindye HC HC III DOD, MoH 89 72 0 72 ND ND ND MEEPP Busabala Nurs Clinic PART/HIPS, 15 15 0 15 1 0 1 Facility Report MoH Paragon Hosp Clinic PART/HIPS, 11 2 0 2 0 0 0 Facility Report MoH UGACOF Co Clinic PART/HIPS, 2 1 0 1 ND ND ND MEEPP MoH SDA Clinic PART/HIPS, 8 8 0 8 1 0 1 Facility Report MoH Nakigala Tea Clinic PART/HIPS, 4 2 0 2 ND ND ND MEEPP Estate MoH Melisa Fowers Clinic PART/HIPS, 4 2 0 2 ND ND ND MEEPP MoH Mirembe Med Clinic PART/HIPS, 84 49 0 49 7 0 7 Facility Report Center MoH Mukisa Clinic PART/HIPS, ND ND ND ND ND ND ND Nursing H MoH Banda AIDS REACHOUT, MoH Facility Report Clinic 282 247 17 264 12 1 13 Bugolobi Clinic PART/HIPS, ND ND ND ND ND ND ND Nursing MoH Family Hope AIDS AIDS RELIEF 3170 2072 90 2162 100 15 115 Facility Report Cent Clinic Kinawataka AIDS REACHOUT, MoH Facility Report Clinic 1041 905 60 965 34 5 39 Naguru Med Clinic MoH ND ND ND ND ND ND ND Laboratory Mbuya Reach AIDS REACHOUT, MoH Facility Report out Clinic 912 774 39 813 25 2 27 Kayunga Kayunga Hospital Walter Reed, MoH 1549 987 112 1099 58 10 68 Facility Report Hospital Busana HC III HC III Walter Reed, MoH 84 8 0 8 9 0 9 Facility Report Bbaale HCIV HCIV Walter Reed, MoH 474 343 21 364 24 6 30 Facility Report Garilaya HC IV HC IV Walter Reed, MoH 137 126 11 137 17 2 19 Facility Report Kangulumira HC IV Walter Reed, MoH 721 670 53 723 56 2 58 Facility Report Luwero Bombo Milit Hospital DOD, MoH 10388 1125 58 1183 144 3 147 Facility Report HC IV Mildmay, MoH ND ND ND ND ND ND ND Luwero HC IV HC IV Mildmay, MoH 492 333 1 334 6 3 9 Facility Report Holy Cross HC III Mildmay, MoH 254 149 21 170 31 0 31 Facility Report Kiky Ndejje Uni HC HC IV Mildmay, MoH 20 19 2 21 ND ND ND Facility Report

36 Epidemiological Surveillance Report 2010 District ART Service Level Implementing Cumula No. No. Total New No New Total Source of outlet: Partner(s) tive No Adults Childre No. on Adults Childre New on data on ART on n on ART on n on ART ART ART ART ART Kasaala HC HC III Reach out, MoH 290 230 32 262 20 2 22 Facility Report Nyimbwa HC IV Mildmay, MoH 76 59 3 62 10 0 10 Facility Report Bishop Asili HC IV Mildmay, MoH 432 254 26 280 29 0 29 Facility Report Kasana St Luke HC III IRCU,MoH 246 116 3 119 4 0 4 Facility Report Namaliha Mityana Mityana Hospital Mildmay, MoH 2025 1259 78 1337 51 6 57 Facility Report Hospital St Padre Pio HC IV MoH 364 264 76 340 0 0 0 Facility Report Kyantungo HC HC IV Mildmay, MoH 344 196 11 207 18 4 22 Facility Report Mwera HC IV HC IV Mildmay, MoH 175 175 0 175 24 3 27 Facility Report Tamteco- Clinic PART/HIPS, 128 101 0 101 ND ND ND MEEPP Mityana MoH Mpigi Nkozi Hospital Hospital Mildmay, MoH 940 600 70 670 46 9 55 Facility Report Fiduga Clinic Clinic PART/HIPS, 47 45 0 45 ND ND ND HIPS MoH Buwama HC HC III Mildmay, MoH 829 350 39 389 29 1 30 Facility Report Double Cure Med Clinic PART/HIPS, 45 45 0 45 ND ND ND MEEPP MoH Mpigi HC IV HC IV Mildmay, MoH 1310 962 78 1040 54 4 58 Facility Report Butambala Gombe Hospital Mildmay, MoH 1781 1168 143 1311 77 8 85 Facility Report Hospital Gomba Maddu HC IV HC IV Mildmay, MoH 338 332 7 339 19 0 19 Facility Report Mukono Nagalama Hospital Mildmay, MoH 1710 1122 79 1201 16 1 17s Facility Report Kojja HC IV HC IV Walter Reed, MoH 283 207 20 227 8 12 20 Facility Report Mukono COU HC IV Mildmay, MoH 686 174 23 197 40 4 44 Facility Report HC Mukono HC HC IV MoH 310 351 33 384 18 9 27 Facility Report Kyetume Static HC III IRCU 428 256 0 256 19 0 19 Facility Report center Royal VanZan Clinic PART/HIPS, 38 38 0 38 1 0 1 Facility Report Ten MoH Family Hope AIDS AIDS RELIEF 2663 1788 171 1959 85 7 92 Facility Report Center Clinic Buvuma Buvuma HC IV Mildmay, MoH 73 72 3 75 3 0 3 Facility Report Buikwe Nile Breweries Clinic PART/HIPS, 30 20 0 20 ND ND ND MEEPP MoH St Francis Clinic IRCU 1178 1048 29 1077 129 3 132 Facility Report Health Care Nkonkojeru Hospital Mildmay, MoH 300 239 0 239 29 0 29 Facility Report Nyenga Mobile Hospital AIDS Relief, MoH 714 535 74 609 56 7 63 Facility Report Kawolo Hospital SUSTAIN, MoH 1381 1076 78 1154 74 2 76 Facility Report Hospital SCOUL Hospital PART/HIPS, 31 31 0 31 8 0 8 Facility Report MEHTA MoH Buikwe Hosp Hosp Mildmay, MoH 302 241 36 277 34 6 40 Facility Report Nakaseke Kiwoko Hospital IRCU, MoH 1500 ND ND ND MEEPP Hospital 1017 1 1018 Nakaseke Hosp Hospital Mildmay, MoH 393 324 0 324 47 1 48 Facility Report Wakiso TASO AIDS TASO 4148 3484 108 3592 209 17 226 Facility Report Clinic MRC AIDS SUSTAIN 838 795 14 809 0 0 0 Facility Report Clinic Entebbe Grade Hospital Mildmay, MoH 867 531 2 533 23 0 23 Facility Report Hospital Hospital Mildmay, MoH ND ND ND ND ND ND ND Katabi Hospital Hospital DOD, MoH 494 486 8 494 40 0 40 Facility Report Saidina Hospital IRCU,MoH 1024 788 6 794 47 0 47 Facility Report Abubaker Buwambo HC HC IV Mildmay, MoH 225 79 5 84 7 0 7 Facility Report HC IV Mildmay, MoH ND ND ND Facility Report HC 182 164 15 179 Ndejje HC IV HC IV Mildmay, MoH 179 113 4 117 1 1 2 Facility Report

37 Epidemiological Surveillance Report 2010 District ART Service Level Implementing Cumula No. No. Total New No New Total Source of outlet: Partner(s) tive No Adults Childre No. on Adults Childre New on data on ART on n on ART on n on ART ART ART ART ART Wakiso HC IV HC IV Mildmay, MoH 317 312 3 315 24 1 25 Facility Report Mildmay AIDS Mildmay, MoH 9899 5731 1220 6951 259 13 272 Facility Report Hospital Clinic Wagagai Clinic Clinic PART/HIPS, 96 83 4 87 11 1 12 Facility Report MoH Kabubu HC II Mildmay, MoH 187 32 2 34 6 0 6 Facility Report Clinic SUSTAIN 127 106 21 127 0 1 1 Facility Report Child Touch Clinic PART/HIPS, 167 168 0 168 15 0 15 Facility Report Namuwon MoH 1st Div Hosp DOD, MoH 129 291 6 297 15 0 15 Facility Report Mil Masajja Clinic PART/HIPS, 4 4 0 4 March Report Nursing MoH Tropical Clinic Clinic PART/HIPS, 110 51 0 51 ND ND ND MEEPP MoH Fortportal Region Bundibugyo Bundibugyo Hospital PIDC, MoH 428 277 15 292 ND ND ND Facility Report Nyahuka HC HC IV PIDC, MoH 263 174 9 183 ND ND ND Facility Report Ntoroko

Kabarole Fortportal RRH RRH SUSTAIN, MoH 4583 1635 426 2061 0 0 0 JCRC Kabarole Hospital AIDS Relief, 1445 1027 193 1220 22 9 31 Facility Report Hospital MoH Hospital AIDS Relief, 2598 1928 250 2178 40 6 46 Facility Report MoH Bukuuku HC HC IV PIDC, MoH 236 168 7 175 15 0 15 Facility Report HC III HC IV PIDC, MoH 85 85 0 85 ND ND ND Facility Report Kibito HC IV HC IV PIDC, MoH 615 609 9 618 ND ND ND Facility Report Kiyombya HC HC III PIDC, MoH 120 72 0 72 26 0 26 Facility Report Yerya HC HC III PIDC, MoH 256 174 14 188 ND ND ND Facility Report Kaswa HC III HC III PIDC, MoH 108 88 0 88 ND ND ND Facility Report Rutete HC III HC III PIDC, MoH 73 73 0 73 6 0 6 MOH Reportig Mugusu HC III PIDC, MoH 101 59 0 59 ND ND ND Facility Report Kisomoro HC HC III PIDC, MoH 98 190 0 190 5 0 5 Facility Report HC III HC III PIDC, MoH 511 320 11 331 24 0 24 Facility Report Tam Toro Clinic PART/HIPS, Facility Report Kahuna MoH 154 124 0 124 12 0 12 Kamwenge Rukunyu HC HC IV PIDC, MoH 820 424 40 464 18 5 23 Facility Report Ntara HC IV HC IV PIDC, MoH 422 315 13 328 0 0 0 Facility Report Kasese Bwera Hospital Hospital PIDC, MoH 823 434 61 495 14 2 16 Facility Report Kilembe Hospital PIDC, IRCU, MoH 1878 1016 175 1191 82 10 92 Facility Report Hospital SUSTAIN, MoH 495 445 50 495 11 2 13 Facility Report Hospital Kasanga PHC HC III AIDS RELIEF 702 490 49 539 27 4 31 Facility Report St Paul' HC HC III SUSTAIN, MoH 615 466 19 485 43 1 44 Facility Report Kasese Cob Clinic PART/HIPS, 133 112 1 113 5 0 5 Facility Report Comp MoH Micro care Hima Clinic PART/HIPS, 203 Facility Report Cement Factory MoH 141 4 145 12 0 12 Kyenjojo Kyarusozi HC HC IV PIDC, MoH 399 328 34 362 29 3 32 Facility Report Kyenjojo HC HC IV PIDC, MoH 1880 ND ND 1245 106 22 128 Facility Report Mwenge Finlay Clinic PART/HIPS, 398 384 14 398 14 1 15 Facility Report MoH Kyegegwa Kyegegwa HC HC IV PIDC, MoH 672 441 54 495 37 3 40 Facility Report Gulu Region Amuru Atiak HC IV HC IV NUMAT, MoH 241 177 14 191 11 0 11 Facility Report Pabbo HC III NUMAT, MoH 84 39 9 48 ND ND ND MEEPP Nwoya Anaka Hospital Hospital NUMAT, MoH 567 454 46 500 27 5 32 Facility Report Koch Goma HC III NUMAT, MoH 136 113 7 120 3 1 4 Facility Report Gulu TASO Gulu AIDS TASO 4093 2666 222 2888 161 24 185 Facility Report

38 Epidemiological Surveillance Report 2010 District ART Service Level Implementing Cumula No. No. Total New No New Total Source of outlet: Partner(s) tive No Adults Childre No. on Adults Childre New on data on ART on n on ART on n on ART ART ART ART ART Clinic Gulu RRH RRH SUSTAIN, MoH 2036 1521 310 1831 43 3 46 Facility Report Gulu Indep Hospital MoH ND ND ND ND ND ND ND Hosp Gulu Mil 4th Hospital JCRC, DOD, MoH 888 795 3 798 45 0 45 Facility Report divis Lacor Hospital Hospital AIDS RELIEF, MoH 4615 3274 338 3612 163 10 173 Facility Report Bobi HC III HC III NUMAT, MoH 144 135 9 144 18 0 18 Facility Report Awach Hc IV HC IV NUMAT, MoH 196 159 27 186 20 1 21 Facility Report Lalogi HC IV HC IV NUMAT, MoH 634 524 36 560 ND ND ND Facility Report Kitgum St Joseph Hospital AIDS RELIEF 1875 1417 163 1580 68 19 87 Facility Report Kitgum Madiopei HC IV MSF, MoH 402 359 43 402 ND ND ND Facility Report Namokora HC IV NUMAT, MoH 244 164 17 181 16 7 23 Facility Report Kitgum Hospital NUMAT, MoH Facility Report Hospital 2136 843 100 943 53 11 64 Lamwo Pala Ber Kal HC III NUMAT, MoH 129 21 0 21 ND ND ND Facility Report HC Padibe HC IV HC IV NUMAT, MoH 427 384 35 419 ND ND ND Facility Report Pader 5th Div Acholi Hospital DOD, MOH 562 562 0 562 ND ND ND MEEPP PII Pajule HC IV HC IV NUMAT, MoH 325 249 16 265 ND ND ND Facility Report Atanga HC III NUMAT, MoH 156 146 9 155 22 4 26 Facility Report Pader HC III HC III NUMAT, MoH 166 299 18 317 8 0 8 Facility Report Agago Kalongo Hospital AIDS Relief, MoH 1005 765 88 853 29 3 31 Facility Report Hospital Patongo HC IV HC IV NUMAT, MoH ND ND ND ND ND ND ND Hoima Region Hoima Kyangwali HC III MoH 75 166 25 191 7 1 8 Facility Report Kabalega Med Clinic PART/HIPS, 80 9 0 9 Facility Report Center MoH 12 0 12 Hoima RRH RRH SUSTAIN, MoH 2737 2035 191 2226 95 3 98 Facility Report Kikuube HC IV HC IV IDI, MoH 321 321 0 321 46 0 46 Facility Report Kyehoro HC Clinic HIPS 41 41 0 41 5 0 5 Facility Report Kibaale Kagadi Hospital IDI, MoH 1222 891 30 921 58 3 61 Facility Report Hospital Kakumiro HC HC IV IDI, MoH 322 220 20 240 38 0 38 Facility Report Kakindo HC IV HC IV IDI, MoH 307 142 10 152 22 2 24 Facility Report Kibaale HC IV HC IV IDI, MoH 304 195 20 215 10 1 11 Facility Report Kiboga Kiboga Hospital SUSTAIN, 831 671 51 722 80 6 86 Facility Report Hospital MoHIDI Bukomero HC IV IDI, MoH 147 139 6 145 6 0 6 Facility Report Ntwetwe HC HC IV IDI, MoH 172 142 3 145 11 1 12 Facility Report Buliisa Buliisa HC IV IDI, MoH 84 77 6 83 17 2 19 Facility Report Kyankwanzi

Masindi TASO Masindi AIDS TASO 2765 2085 115 2200 207 7 214 Facility Report Clinic Masindi Hospital SUSTAIN, MoH 635 518 23 541 79 5 84 Facility Report Hospital Bwijanga HC HC IV MoH 113 84 3 87 5 0 5 Facility Report Masindi Hospital DOD,MoH 17 17 0 17 17 0 17 Facility Report Military Kinyara Sugar Clinic PART/HIPS, 88 77 7 84 13 5 18 Facility Report Works MoH Kiryandongo Kiryandongo Hospital MoH 586 328 47 375 24 4 28 Facility Report Mubende Mubende HC III DOD, MoH 75 75 0 75 ND ND ND MEEPP Rehabilitation CentreMilitary

39 Epidemiological Surveillance Report 2010 District ART Service Level Implementing Cumula No. No. Total New No New Total Source of outlet: Partner(s) tive No Adults Childre No. on Adults Childre New on data on ART on n on ART on n on ART ART ART ART ART Mubende RRH RRH SUSTAIN, MoH 3451 3106 222 3328 133 4 137 Facility report People’ Clinic Clinic PART/HIPS, 25 9 0 9 ND ND ND MEEPP Kasanda MoH Nakasongola Nakasongola Hospital DOD, MoH 30 5 35 Facility Report Military 74 52 17 69 Luwero Indust Clinic PART/HIPS, 76 69 0 69 ND ND ND MEEPP MoH Nakasongola HC IV Mildmay, MoH 330 306 40 346 0 0 0 Facility Report HC Jinja Region Bugiri Bugiri Hospital Hospital STAR EC, MoH 830 391 23 414 154 20 174 Facility Report Nankoma HC HC IV STAR EC, MoH 137 112 7 119 22 4 26 Facility Report Banda HC III HC III STAR EC, MoH 21 20 1 21 ND ND ND Facility Report Namayingo Buyinja HC HC IV STAR EC, MoH 244 92 5 97 25 2 27 Facility Report Sigulu HC III STAR EC, MoH 27 14 0 14 14 1 15 Facility Report Iganga Iganga Hospital Hospital STAR EC, MoH 1094 558 47 605 103 10 113 Facility Report Busesa HC IV STAR EC, MoH 275 195 12 207 32 4 36 Facility Report Bugono HC IV HC IV STAR EC, MoH 91 82 9 91 5 2 7 Facility Report Namungalwe HC III STAR EC, MoH 125 14 2 16 Facility Report HC 117 6 123 Busembatia HC III STAR EC, MoH 38 60 5 65 20 0 20 Facility Report

Luuka Kiyunga HC IV HC IV STAR EC, MoH 257 193 7 200 31 6 37 Facility Report Jinja TASO Jinja AIDS TASO 5123 3657 161 3818 186 6 192 Facility Report Clinic Jinja Reg Hosp RRH SUSTAIN, MoH 1428 482 117 599 28 29 57 Facility Report JCRC AIDS THALUS, MoH 1777 587 127 714 0 0 0 JCRC RCO Clinic Kakira Hospital Hospital PART/HIPS, 313 278 6 284 ND ND ND Facility Report MoH HC HC IV PIDC, MoH 300 156 6 162 7 0 7 Facility Report IV Budondo HC HC IV PIDC, MoH 123 75 1 76 18 0 18 Facility Report HC HC IV PIDC, MoH 207 118 4 122 26 1 27 Facility Report Walukuba HC HC IV PIDC, MoH 203 91 0 91 ND ND ND Facility Report Mpumudde HC HC IV PIDC, MoH 130 92 0 92 14 0 14 Facility Report Intern Med Clinic PART/HIPS, 265 258 7 265 5 0 5 Facility Report Cent MoH Nytil Picfare Clinic PART/HIPS, 16 3 0 3 ND ND ND MEEPP MoH Kaliro Bumanya HC HC IV STAR EC, MoH 127 112 8 120 4 2 6 Facility Report Nawaikoke HC HC III STAR EC, MoH 29 32 3 35 18 3 21 Facility Report Namugongo HC III STAR EC, MoH 30 28 2 30 14 2 16 Facility Report HC Kamuli Kamuli Hospital STAR EC, MoH 996 466 32 498 122 14 136 Facility Report Hospital Nankandulo HC IV STAR EC, MoH 34 14 1 15 14 1 15 Facility Report HC Namwendwa HC IV STAR EC, MoH 74 23 2 25 23 2 23 Facility Report HC Kamuli Miss Hospital STAR EC, MoH 503 371 25 396 24 9 33 Facility Report Hosp Buyende Kidera HC IV HC IV STAR EC, MoH 96 51 5 56 51 2 53 Facility Report Bugaya HC III HC III STAR EC, MoH 15 63 1 64 6 0 6 Facility report Mayuge Buluba Hospital IRCU, MoH 682 486 19 505 ND ND ND Facility Report Hospital Kityerera HC HC IV STAR EC, MoH 104 76 5 81 13 0 13 Facility Report Kigandalo HC HC IV STAR EC, MoH 182 129 6 135 15 0 15 Facility Report Mayuge HC HC III STAR EC, MoH 81 48 6 54 13 1 14 Facility Report Wabulungu HC III STAR EC, MoH 42 42 5 47 15 4 19 Facility Report Namutumba

40 Epidemiological Surveillance Report 2010 District ART Service Level Implementing Cumula No. No. Total New No New Total Source of outlet: Partner(s) tive No Adults Childre No. on Adults Childre New on data on ART on n on ART on n on ART ART ART ART ART Nsinze HC IV HC IV STAR EC, MoH 216 169 8 177 4 1 5 Facility Report Namutumba HC III STAR EC, MoH 224 175 19 194 46 9 55 Facility Report Ivukula HC III STAR EC, MoH 84 84 10 94 25 0 25 Facility Report HC III STAR EC, MoH 30 30 0 30 5 0 5 Facility Report Region Kabale Kabale RRH RRH SUSTAIN, MoH 3102 2097 216 2313 75 11 86 Facility Report Kigezi Health Hospital MoH 652 622 4 626 ND ND ND Facility Report Care Foudation Hamurwa HC HC IV STAR-SW, MoH 220 178 23 201 29 2 31 Facility Report Mparo HC IV STAR-SW, MoH 222 161 12 173 7 1 8 Facility Report Muko HC IV STAR-SW, MoH 172 140 10 150 32 4 36 Facility Report Rubaya HC IV STAR-SW, MoH 79 43 4 47 3 0 3 Facility Report Maziba HC IV STAR-SW, MoH 75 55 0 55 6 0 6 Facility Report Rugarama HC HC IV STAR-SW, MoH 457 182 10 192 21 1 22 Facility Report Bukinda HC IV HC IV STAR-SW, MoH 311 147 21 168 5 4 9 Facility Report Kamwezi HC HC IV STAR-SW, MoH 235 402 36 438 4 5 9 Facility Report Kamukira HC HC IV STAR-SW, MoH 150 53 4 57 51 6 57 Facility Report Kanungu Kambuga Hosp Hospital STAR-SW, MoH 583 308 30 338 35 10 45 Facility Report Kinkinzi Hospital PART/HIPS, 504 270 18 288 ND ND ND Facility Report Hospital MoH Kihihi HC IV HC IV STAR-SW, MoH 437 271 30 301 37 4 41 Facility Report Bwindi Comm HC III STAR-SW, MoH 468 267 20 287 44 3 47 Facility Report

Kanungu HC HC IV STAR-SW, MoH 437 271 28 299 37 4 41 Facility Report Kisoro Hospital Hospital STAR-SW, MoH 706 482 34 516 28 3 31 Facility Report Mutolere Hosp Hospital STAR-SW, MoH 252 154 12 166 4 1 5 Facility Report Rukungiri TASO AIDS TASO Facility Report Rukungiri Clinic 3628 2722 182 2904 209 16 225 Kisiizi Hospital Hospital IRCU, MoH 1011 718 97 815 20 6 26 Facility Report Nyakibale Hospital STAR-SW, MoH 1009 593 57 650 10 2 12 Facility Report Hosp Kebisoni HC IV STAR-SW, MoH 3 3 0 3 3 0 3 Facility Report Bugangari HC IV STAR-SW, MoH 7 7 0 7 5 0 5 Facility Report Lira Region Amolatar Amai Hospital AIDS Relief, 713 542 37 579 28 6 34 Facility Report Community MOH Amolatar HC HC IV NUMAT, MoH 437 319 26 345 22 0 22 Facility Report Etam HC III HC III NUMAT, MoH 79 12 7 19 12 7 19 Facility Report Namasale HC III NUMAT, MoH 165 121 7 128 21 0 21 Facility Report Apac Apac Hospital Hospital NUMAT, MoH 1582 1427 118 1545 ND ND ND Facility Report Aduku HC IV HC IV NUMAT, MoH 586 370 100 470 53 5 58 Facility Report Akokoro HC III NUMAT, MoH 216 227 17 244 17 2 19 Facility Report Kole Aboke HC IV HC IV NUMAT, MoH 672 598 45 643 ND ND ND Facility Report Bala HC III NUMAT, MoH 226 191 10 201 20 1 21 Facility Report Dokolo Dokolo HC HC IV NUMAT, MoH 1375 1237 0 1237 69 6 75 Facility Report Kwera HC III NUMAT, MoH 161 152 20 172 5 0 5 Facility Report Batta HC II NUMAT, MoH 256 282 10 292 24 0 24 Facility Report Agwata HC III NUMAT, MoH 25 3 0 3 3 0 3 Facility Report Lira Lira RRH RRH SUSTAIN, MoH 5553 4286 442 4728 282 25 307 Facility Report Ogur HC IV HC IV NUMAT, MoH 598 510 20 530 52 0 52 Facility Report Pag Mission HC IV NUMAT, MoH 407 277 32 309 41 10 51 Facility Report Amach HC IV HC IV NUMAT, MoH 974 829 55 884 69 3 71 Facility Report Barr HC III HC III NUMAT, MoH 137 108 29 137 4 1 5 Facility Report Lira Medical Clinic MoH 586 52 5 57 23 3 26 Facility Report Center Ayira Med Clinic PART/HIPS, 17 6 0 6 ND ND ND Facility Report Center MoH Charis Clinic PART/HIPS, ND ND ND MEEPP MoH 52 46 6 52 Otuke Orum HC IV HC IV NUMAT, MoH 518 480 26 506 16 4 20 Facility Report

41 Epidemiological Surveillance Report 2010 District ART Service Level Implementing Cumula No. No. Total New No New Total Source of outlet: Partner(s) tive No Adults Childre No. on Adults Childre New on data on ART on n on ART on n on ART ART ART ART ART Alebtong Alebtong HC HC IV NUMAT, MoH 781 639 50 689 53 6 59 Facility Report Oyam Aber Hospital Hospital AIDS Relief, 869 700 81 781 63 12 75 Facility Report MoH Otwal HC HC III NUMAT, MoH 323 329 27 356 23 2 25 Facility Report Agulurude HC III NUMAT, MoH 48 48 1 49 11 1 12 Facility Report Anyeke HC IV HC IV NUMAT, MoH 1069 471 31 502 38 6 44 Facility Report Masaka Region Kalangala Kalangala HC HC IV SUSTAIN, MoH 687 510 36 546 38 4 42 Facility Report Bukasa HC IV MoH 6 18 1 19 3 0 3 Facility Report Lyantonde Lyantonde Hospital Mildmay, MoH, 1072 664 47 711 10 3 13 Facility Report Hosp IPH Lyantonde HC IV IRCU, MoH 473 39 0 39 Facility Report Islam 407 7 414 Masaka TASO Masaka AIDS TASO 4393 3644 235 3879 130 3 133 Facility Report Clinic Masaka RRH RRH Uganda Cares, MoH 6298 4190 378 4568 210 16 226 Facility Report Kyanamukaka HC IV Mildmay, MoH 64 114 12 126 8 0 8 Facility Report Kiyumba HC HC IV Mildmay, MoH 119 115 4 119 14 4 18 Facility Report Kinoni HC III HC III Mildmay, MoH 205 153 15 168 17 4 21 Facility Report AID Child Clinic Mildmay, MoH 56 18 36 54 0 0 0 Facility Report Kiwangala HC HC IV Mildmay, MoH 175 138 8 146 ND ND ND Facility Report Kyazanga HC HC IV Mildmay, MoH 68 49 0 49 ND ND ND Facility Report Kitovu Mobile AIDS MoH 1332 1105 51 1156 34 4 38 Facility Report Clinic Lambu Clinic PART/HIPS, 27 11 3 14 7 2 9 Facility Report MoH Bukomansimbi Butenga HC IV HC IV Mildmay, MoH 106 77 8 85 ND ND ND Facility Report Lwengo Lwengo HC IV HC IV Mildmay, MoH 112 105 6 111 19 3 21 Facility Report Kalungu Villa Maria Hospital AIDS Relief, 2469 1684 220 1904 65 16 81 Facility Report Hosp MoH Bukulula HC HC IV Mildmay, MoH 293 217 44 261 ND ND ND Facility Report Kalungu HC IV HC IV Mildmay, MoH 76 56 3 59 ND ND ND Facility Report Kyamulibwa HC IV Mildmay, MoH 136 56 3 59 ND ND ND Facility Report HC MRC AIDS Mildmay, MoH 411 303 43 346 7 11 18 Facility Report Kyamulibwa Clinic Rakai Hospital MoH 1503 1310 48 1358 57 2 59 Facility Report Hospital Rakai Hospital Hospital MoH 1539 982 33 1015 108 3 113 Facility Report Kakuuto HC IV HC IV MoH, IPH 973 809 41 850 ND ND ND Facility Report Med Clinic PART/HIPS, 70 13 0 13 12 1 13 Facility Report Center MoH Rakai Health AIDS IPH Facility Report Sciences Proj Clinic 2723 2188 125 2313 50 4 54 Ssembabule Ntuusi HC IV Mildmay, MoH 108 42 0 42 ND ND ND Facility Report Mataate HC IV HC IV Mildmay, MoH 490 297 22 319 19 5 24 Facility Report Sembabule HC HC IV Mildmay, MoH 412 264 6 270 20 4 24s Facility Report Mbale Region Bududa Bududa Hospital 461 242 54 296 11 7 18 Facility Report MoH Bukwa Bukwa HC IV HC IV STAR E, MoH 56 30 2 32 4 2 6 Facility Report Busia Busia HC HC IV STAR E, MoH 178 124 8 132 11 3 1s4 Facility Report Dabani Hospital STAR E, MoH 44 42 2 44 9 0 9 Facility Report Hospital Masafu HC IV HC IV STAR E, MoH 765 595 54 649 41 5 46 Facility Report Budaka

42 Epidemiological Surveillance Report 2010 District ART Service Level Implementing Cumula No. No. Total New No New Total Source of outlet: Partner(s) tive No Adults Childre No. on Adults Childre New on data on ART on n on ART on n on ART ART ART ART ART Budaka HC IV HC IV STAR E, MoH 181 160 3 163 4 1 5 Facility Report Butaleja Busolwe Hospital STAR E, MoH 586 26 2 28 Facility Report Hospital 224 13 237 Kapchworwa Kapchorwa Hospital STAR E, MoH 453 310 22 332 17 5 22 Facility Report Kween

Manafwa Magale HC IV HC IV MoH 356 192 28 220 ND ND ND Facility Report Mbale Mbale RRH RRH SUSTAIN, MoH 5810 2505 349 2854 73 23 96 Facility Report TASO Mbale AIDS TASO 4935 3490 332 3822 211 29 240 Facility Report Clinic Busiu HC IV HC IV STAR E, MoH 121 98 0 98 ND ND ND Facility Report Pallisa Butembo HC IV STAR E, MoH 91 86 9 95 7 3 10 Facility Report Pallisa Hospital Hospital STAR E, MoH 493 344 47 391 38 6 44 Facility Report Kibuku Kibuku HC IV HC IV STAR E, MoH 247 184 26 210 35 6 41 Facility Report Sironko Budadiri HC HC IV STAR E, MoH 387 290 34 324 35 5 40 Facility Report Bulambuli Muyembe HC HC IV STAR E, MoH 318 340 30 370 34 6 40 Facility Report Tororo TASO Tororo AIDS TASO 6038 4544 125 4669 181 12 193 Facility Report Clinic St. Anthony Hospital MoH 57 40 0 40 2 0 2 Facility Report Tororo Hospital MoH 788 464 11 475 34 1 35 Facility Report Hospital Rubongi Mili Hospital DOD, MoH 347 131 3 134 11 0 11 Facility Report Mukuju HC IV HC IV SUSTAIN, MoH 510 400 77 477 18 2 20 Facility Report Mulanda HC HC IV MoH 132 81 8 89 4 1 5 Facility Report Bushenyi Ishaka Hospital Hospital IRCU, MoH 1792 1397 53 1450 111 5 116 Facility Report Comboni Hospital AIDS Relief, 1706 1328 110 1438 72 11 107 Facility Report Hospital MOH Katungu Med HC III AIDS Relief 1912 1427 107 1534 65 4 69 Facility Report Center Mcleod Russel Clinic PART/HIPS, 18 14 0 14 1 0 1 Facility Report (Finlays MoH Ankole) Rubiziri Rugazi HC HC IV STAR-SW,MoH 130 108 4 112 25 0 25 Facility Report Buhweju Nsiika HC IV MoH 39 37 2 39 0 0 0 Facility Report Mitooma

Sheema Kitagata Hospital STAR-SW, MoH 1121 840 47 887 51 5 56 Facility Report Hospital Kabwohe Med HC IV AIDS Relief 2478 1784 146 1930 104 9 113 Facility Report Center Ibanda Ibanda Hospital Hospital STAR-SW, MoH 755 450 53 503 6 0 6 Facility Report Ishongororo HC IV STAR-SW, MoH 26 24 2 26 ND ND ND Facility Report Ruhoko HC HC IV STAR-SW, MoH 92 83 9 92 ND ND ND MEEPP Isingiro Kabuyanda HC HC IV MoH ND ND ND ND ND ND ND Kiruhura Rushere Hospital STAR-SW, MoH 755 633 38 671 45 3 48 Facility Report Hospital Family Health Clinic PART/HIPS, ND ND ND MEEPP Resource MoH Center 90 90 0 90 Mbarara TASO Mbarara AIDS TASO 4340 3033 156 3189 234 19 253 Facility Report Clinic Mbarara ISS RRH SUSTAIN, MJAP, 10186 5663 519 6182 315 24 339 Facility Report

43 Epidemiological Surveillance Report 2010 District ART Service Level Implementing Cumula No. No. Total New No New Total Source of outlet: Partner(s) tive No Adults Childre No. on Adults Childre New on data on ART on n on ART on n on ART ART ART ART ART MoH Mbarara AIDS MJAP, MoH 406 124 0 124 37 0 37 Facility Report TB/HIV Clinic Mbarara Com Hospital MoH 377 170 4 174 14 2 16 Facility Report Hospital UPDF, 2ND Hospital DOD, MoH 311 255 1 256 ND ND ND Facility Report DIVI Mbarara Mun HC IV MJAP, MoH 2945 2028 95 2123 152 12 164 Facility Report Coucil Bwizibwera HC IV MJAP, MoH 2067 1499 151 1650 100 18 118 Facility Report HC Kinoni HC HC III MJAP, MoH 52 51 2 53 2 0 2 Facility Report Mayanja Clinic PART/HIPS, 490 251 4 255 7 0 7 Facility Report Memorial MoH Hospital STAR-SW, MoH 1486 838 32 870 84 4 88 Facility Report Rwashamire HC IV STAR-SW, MoH Facility Report HC 161 114 23 137 4 2 6 Rubaare HC HC IV STAR-SW, MoH 276 221 47 268 23 1 24 Facility Report Kitwe HC IV HC IV STAR-SW, MoH 422 283 10 293 12 2 14 Facility Report Rushooka HC IV STAR-SW, MoH 89 86 3 89 24 1 25 Facility Report Moroto Regio Abim Abim Hospital Hospital MoH 227 230 21 251 11 0 11 Facility Report Kaabong Kaabong Hospital SUSTAIN, MoH 215 138 11 149 ND ND ND JCRC Hospital Moroto Moroto Mili HC III DOD, MoH 18 213 2 215 8 0 8 Facility Report HC III Moroto RRH RRH MoH 113 106 16 122 14 6 20 Facility Report Napak St. Kizito Hospital MoH 370 258 24 282 25 6 31 Facility Report Matany Nakapiripirit Tokora HC HC IV MoH 37 16 1 17 ND ND ND March data Nakapiripirit Hospital MoH 6 3 3 6 ND ND ND March data Nabiratuk HC IV MoH 26 24 0 24 ND ND ND Facility Report Kotido Kotido COU HC III IRCU 18 18 0 18 ND ND ND Facility Report HC III Amudat Amudat Hospital MoH 14 13 2 15 2 1 3 Facility Report Soroti Region Soroti TASO Soroti AIDS TASO 3880 3014 324 3338 138 20 158 Facility Report Clinic Soroti RRH AIDS Uganda Cares, MoH 3905 2562 25 2587 100 4 104 Facility Report Clinic Soroti RRH RRH SUSTAIN, MoH 532 116 183 299 13 14 27 Facility Report Princes Diana HC IV PIDC, MoH 3 3 0 3 ND ND ND Facility Report Amuria Amuria HC IV HC IV PIDC, MoH 214 212 20 232 ND ND ND Facility Report Kapelabyong HC IV PIDC, MoH 27 24 3 27 ND ND ND MEEPP Kaberamaido Lwala Hospital Hospital PIDC, MoH 481 251 32 283 8 2 10 Facility Report Kaberamaido HC IV PIDC, MoH 927 233 32 265 43 3 46 Facility Report HC Katakwi Katakwi HC IV HC IV SUSTAIN, MoH 697 442 25 467 ND ND ND JCRC Kumi Atutur Hospital Hospital PIDC, MoH 865 345 25 370 26 6 32 Facility Report Kumi Hospital Hospital PIDC, MoH 666 438 45 483 ND ND ND Facility Report Hospital SUSTAIN, MoH 819 629 25 654 ND ND ND JCRC Bukedea Bukedea HC IV PIDC, MoH 25 10 1 11 0 1 1 Facility Report Serere Serere HC IV HC IV PIDC, MoH 298 44 24 68 ND ND ND Facility Report TOTAL

44 Epidemiological Surveillance Report 2010 ESTIMATES AND PROJECTIONS FROM MODELING 6

The Chapter presents data on estimates and projections for the year 2009 obtained from mathematical modelling. Global estimates were conducted by UNAIDS. National estimates were conducted by the Ministry of Health in collaboration with partners who included UNAIDS, World Health Organization, CDC Uganda, UBOS and the Uganda AIDS Commission.

6.1 ESTIMATES OF THE MAGNITUDE OF HIV/AIDS IN UGANDA

National estimates were conducted using Epidemic Projection Package (EPP) and Spectrum software provided by UNAIDS and WHO. The parameters that were fitted into the model included the antenatal sentinel surveillance data, population demographic data for urban and rural Uganda, and programme coverage data for ART and PMTCT. The estimates were corrected against population based HIV prevalence estimates from UHSBS 2004-05.

Data from the model indicated a national HIV prevalence estimate of 6.3 percent. Table 6.1 presents the summary of HIV/AIDS related morbidity and mortality indicators. The data indicate that 1,192, 372 people were infected with HIV as of December 2009. Of these, 1,042,711 (87 percent) were adults 15 years and above while 149,661 (13 percent) were children 0- 14 years. When the data were further disaggregated by sex, 512,070 were males while 680,301 were females.

Table 6.1 Estimates of the Magnitude and Impact of HIV/AIDS in Uganda - 2009 Number of HIV Infected Individuals Total 1,192,372 100% Males 512,070 43% Females 680,301 57% Adults (15 years +) 1,042,711 87% Children 0-14 years) 149,661 13%

Number of new HIV infections Total 124,261 100% Males 56,079 45% Females 68,182 55%

Number of AIDS Related Deaths Total 64,016 100% Males 28,812 45% Females 35,205 55% Adults (15 years+) 48,000 80% Children (0-14 years) 16,016 20%

45 Epidemiological Surveillance Report 2010 Data from the models indicated substantial numbers of new infections. It was estimated that 124,261 new infections occurred in 2009. There were more new female infections than males. Of the new infections, 56,079 (45 percent) were males and 68,182 (55 percent) were females.

Data from the model also indicated a substantial number of AIDS related deaths. There were 64,016 AIDS related death. Majority, 48,000 (80 percent) were adults 15 years+, the rest were children 0-14 years. Of the 64,016 AIDS death, 28,812 (45 percent) were male while 35,205 (55 percent) were female.

6.2 ESTIMATES OF ART NEED IN UGANDA

Estimates of ART need in the country were obtained based on the new ART eligibility criteria at CD-4 <350 T-cells/ul. Table 6.2 presents data of national ART needs as of December 2009.

Table 6.2 Estimates of ART need in Uganda - 2009 Category of People Adults and Children 540,094 Adults 15 years + 463,334 Males 193,604 Females 269,740 Children 0-14 years) 76,750 The data indicate that out of the 1,192,372 people that had HIV infection, 540,094 individuals were in need of ART. Of these, 463,334 (86 percent) were adults 15 years and above while 76,750 (14 percent) were children 0-14 years. Of the adults who were in need of ART, majority, 269,740 (58 percent) were females while 193,604 (42 percent) were males.

The data for ART need based on the new criteria of <350 CD-4 T-cells/ul were compared with those on the previous criteria of <250CD-4 T-cells/ul. It was noted that there was a significant increase in number of patients in need of ART from 442,103individuals at < 250 CD-4 T-cells /ul compared to 540,094 individuals in need of ART at< 350 CD-4T-cells/ul.

6.3 GLOBAL ESTIMATES OF THE MAGNITUDE OF HIV/AIDS.

Table 6.3 Global estimates of the magnitude of HIV/AIDS Regional HIV and AIDS statistics People living with HIV New HIV infections AIDS deaths Sub-Sahara Africa 22.5million 1.8million 1.3million Middle East and North Africa 460,000 75,000 24,000 South and South-East Asia 4.1million 270,000 260,000 East Asia 770,000 82,000 36,000 Oceania 57,000 4,500 1,400 Central and South America 1.4 million 92,000 58,000 Caribbean 240,000 17,000 12,000 Eastern Europe and Central Asia 1.4 million 130,000 76,000 Western and Central Europe 820,000 31,000 8,500 North America 1.5 million 70,000 26,000 Total 33.3 million 2.6 million 1.8 million Source: UNAIDS Updates for 2010

46 Epidemiological Surveillance Report 2010 DISCUSSION AND CONCLUSION 7

The findings presented in the report indicate a significant burden of the HIV/AIDS epidemic in the Country. The epidemic disproportionately affects some geographic areas and socio- demographic groups. Populations in central and Northern regions were more affected than those in other areas. Women and urban residents were also more affected than men and rural residents. The data indicated that there was also a large number of new infections occurring in the Country. The new infections were predominant in urban areas, among women and unlike in the early years of the epidemic in stable marital relationships.

Data indicate that HIV prevalence remains low among children. UHSBS indicates that HIV prevalence is less than 1 percent among children under five years. Prevalence was slightly higher among children in urban areas. HIV prevalence was also higher among children whose mothers were widowed, divorced, or separated. The most striking figure was that HIV prevalence was very high (10 percent) among children whose mothers were also HIV positive. Although the HIV burden remains low among children, comprehensive programs for prevention of mother-to-child transmission should be designed to eliminate MTCT. The programs should be comprehensive to include primary prevention, family planning, use of ART, as well as early infant diagnosis, referral and treatment. These programs while focusing on population segments most affected should also be universally accessible to women and children at risk.

The report indicates that the burden of HIV remained stable between 2000 and 2009. This was unlike in the period 1990-2000 when there was a steady epidemic contraction. The data also indicated that risky sexual behaviours remain prevalent. These include multiple sex partnerships, higher risk (non-spousal) sex, extra-marital sex and non-use of condoms. In the 2005-7 Surveillance report, we presented the risk factors associated with recent infection. They included multiple sex partners, infection with herpes simplex virus type 2, history of a sexually transmitted disease and being an uncircumcised man. The national response should consider these findings in the design of HIV/AIDS programs.

The HIV/AIDS epidemic continues to have significant impacts. It was estimated that in 2009, there were approximately 1,192,372 people living with HIV/AIDS, 124,261 new infections and 64,016 AIDS-related death. The number of individuals that require life-long treatment with antiretroviral drugs continued to increase. This was compounded by the change of policy in the criteria for ART enrolment. With the new ART enrolment criteria at < 350 CD-4 T cells/µl, the number of people who required ART in 2009 were 540,094. This was significantly higher than the 442,103 people who required ART with the older enrolment criteria of < 250 CD-4 T cells/µl. This calls for increased funding and improved planning for ART programs in order to sustain individuals on treatment and to enrol those in need.

In conclusion, the burden and impacts of the HIV/AIDS remains enormous. The AIDS program should intensify and provide universal access to interventions for IEC/BCC, PMTCT, HCT, STD control, blood safety, infection control, care including ART and medical male circumcision. The program should continue to conduct surveillance and epidemiological studies to generate evidence for these interventions as well as to monitor their impact. AIDS programs in Uganda should be implemented considering the prevailing epidemiological situation. Resources should be targeted to implement interventions in population segments most at risk and in those impacted by the disease.

47 Epidemiological Surveillance Report 2010

This report was supported by Cooperative Agreement Number PS000936-02 from Centres for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.

For more information contact: STD/AIDS Control Programme, Ministry of Health, P.O .Box, 7272, Kampala, Uganda.