The Status of the HIV/AIDS Epidemic in Uganda 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 Hospital ........................................................ 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 Rakai 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, Kampala 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