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Abstract
HIV prevalence and incidence are no longer falling in Uganda – a case for renewed prevention efforts: evidence from a rural population cohort 1989-2005, and from ANC surveillance
L.A. Shafer1, S. Biraro1, A. Kamali1, H. Grosskurth1, W. Kirungi2, E. Madraa2, A. Opio3
1MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda, 2National AIDS Control Programme, Ministry of Health, Uganda, Kampala, Uganda, 3National AIDS Control Programme, Ministry of Health, Uganda, Entebbe, Uganda
Background: Throughout the 1990s, Uganda has successfully controlled its HIV epidemic, with falling prevalence and incidence rates. Recent evidence, however, indicates that this decline may not be continuing. Here we report recent epidemiologic trends.
Methods: Two sources of data were used. A rural cohort, established in 1989, provided HIV prevalence, incidence and sexual behaviour data. ANC surveillance provided prevalence among pregnant women.
Results: In the rural cohort, prevalence reached a low of 5.6 (95%C.I. 4.9-6.3) among males and 6.9 (95%C.I. 6.2-7.7) among females in 2000. Since then, prevalence has increased to 6.5% in men and 8.8% in women in 2004, and the trend appears to have continued in 2005. Incidence estimates follow similar trends (fig). Though the recent upward trend of HIV prevalence and incidence in this population is not yet statistically significant, similar results were found in some ANC surveillance sites: HIV prevalence declined from 1992-2000. Since 2002, the declining trend continued in 7 of 24 sites, but in 10 sites there appears to be a rise in HIV prevalence. Analysis of behavioural data from various sources in Uganda provides some evidence that during the period of the change in the course of the epidemic, there was a corresponding change in risky behaviour (see abstract Biraro et al).
Conclusions: Uganda has been highly successful in controlling its HIV epidemic. Factors influencing the recent trends of the epidemic are still unclear, but may include increased risk behaviour, the natural epidemiologic cycle and others. To solidify Uganda’s success, the ongoing efforts in HIV prevention need to be re-emphasized.
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