Uganda’s dramatic progress in combating HIV/Aids has been undermined by a new survey that challenges the country’s reputation as a beacon for a continent that is being ravaged by the disease.
The non-governmental National Guidance and Empowerment Network, which surveyed 53 of the country’s 56 districts, claimed on Wednesday that 17% of the adult population was infected — more than four times the official rate.
The network said a 14-month survey by members who were themselves HIV positive contradicted estimates from the government and the United Nations, which said just 4.1% of adults had the virus.
If validated, the statistics would be a devastating setback not just to Uganda but to other African countries which looked to it as a model for reining in a pandemic which infects about 25-million Africans.
Experts were sceptical about the NGO’s unorthodox methodology and said 17% was too high. But several agreed the official rate was too low and that Uganda’s success story had been oversold.
The network is a respected organisation of people living with the virus, which is partly funded by an initial £50 000 grant from Britain’s Department for International Development (Dfid).
Doubtful of the government’s estimate of 1,2-million HIV positive Ugandans, it sent researchers to towns and villages to count the number of sick people suspected of having the virus.
”We used people who are educated and respected in their own communities to do the counting,” said Rubaramira Ruranga (56) a serving army major who founded the network and who said he has lived with HIV for 21 years, the last eight with the help of anti-retroviral drugs.
”I was not surprised by the findings because if you look at our rates of teenage pregnancy and fertility it is clear we have not changed our behaviour.”
He accused President Yoweri Museveni’s government and its western donors of underplaying the pandemic to promote Uganda as a showcase for aid. Its advocacy of abstinence, fidelity and condoms was credited with rolling back a pandemic.
Privately some aid workers echoed the major’s allegation but it was rebutted by David Serwadda, director of the institute of public health at Kampala’s Makerere University, who defended the government’s figures.
Speaking at the press conference in which Major Ruranga unveiled his findings, a doctor from the health ministry’s Aids control programme, Elizabeth Nagamala, welcomed the research but said it was less scientific than the government’s. ”We do not only count patients, we test patients. Not everyone who is sick actually has HIV, and not everyone who has HIV is sick.”
Official statistics are based on so-called sentinel sites at maternity clinics which test pregnant women, of which 6,2% tested positive for HIV. UNAids extrapolated that to estimate that 4,1% of the adult population was infected.
For years UNAids has been accused of exaggerating HIV prevalence in sub-Saharan Africa and its latest Ugandan estimate reflects a newfound caution.
In a tacit admission of the confusion, the government launched a nationwide survey of HIV prevalence two months ago which is expected to be published next year.
”I prefer to wait until then before commenting, but I would say that 17% sounds a little high,” said Ros Cooper, a health adviser at Dfid’s office in Kampala.
Beatrice Were, head of HIV/Aids in Uganda for Action Aid, agreed the major’s figure was too high, but she said the official measurement overlooked women unable to reach maternity clinics because of poverty, remoteness or the war in the north. ”I would say the infection rate is between 10 and 12%.”
Some anecdotal evidence bolstered that view. – Guardian Unlimited Â