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  • Title: Human immunodeficiency virus and AIDS in Uganda.
    Author: Mugerwa RD, Marum LH, Serwadda D.
    Journal: East Afr Med J; 1996 Jan; 73(1):20-6. PubMed ID: 8625856.
    Abstract:
    HIV-1 infection, initially described as "slim disease", was first recognized in Uganda in 1982, and is now a predominant health problem. Approximately 1.5 million Ugandans are now infected, largely through heterosexual transmission. In many areas half of adult deaths are now caused by HIV. Seroprevalence rates in urban antenatal clinics have been dropping in the last several years, as have rates in young adults in two rural community cohorts where the epidemic is long established. Tuberculosis cases and admissions have increased dramatically. Among the clinical manifestations of HIV in Uganda, epidemic Kaposi sarcoma, cryptococcal meningitis, suspected toxoplasmosis and cardiomyopathy, as well as atypical or extrapulmonary tuberculosis are seen with increasing frequency. Mother to child transmission of HIV accounts for about 10% of total cases, with a transmission rate of 26% in two studies. Epidemiological and clinical research programs are well developed in Uganda, especially in areas of tuberculosis, maternal and paediatric HIV infection and sexually transmitted infections. Societal openness, a multisectoral approach by the government and innovative programmes, including large-scale HIV testing and counselling and the pioneering work of The AIDS Support Organization (TASO), distinguish the Ugandan response to the epidemic. In 1982 the first cases of "slim disease" in Uganda were identified in Rakai District. This disease was not recognized as AIDS until 1985. AIDS is now a serious public health problem for Ugandans. Currently, about 1.5 million Ugandans have HIV infection, acquired mainly via heterosexual transmission; about 10% acquired HIV infection via the mother-child transmission route. In two studies, the mother-child HIV transmission rate reached 26%. 400,000-450,000 Ugandans have died from HIV/AIDS. HIV/AIDS is associated with the death of about 50% of adults in some areas of Uganda. Between 1993 and 1995, there has been a significant decrease in HIV seroprevalence among pregnant women in Kampala as well as in two rural communities. Cases and hospital admissions of tuberculosis (TB) have risen markedly in Uganda. Clinical manifestations of HIV infection include Kaposi's sarcoma, cryptococcal meningitis, toxoplasmosis, cardiomyopathy, and atypical or extrapulmonary TB. Uganda has well-developed HIV-focused epidemiologic and clinical research programs, particularly those addressing TB, maternal-child HIV transmission, and sexually transmitted diseases (STDs). The response to the HIV/AIDS epidemic in Uganda has been unique. The government has openly addressed it since the late 1980s, and this has opened the doors to the creation of innovative services for education, testing, and counseling and care for AIDS patients. Both the government and nongovernmental organizations have developed extensive HIV prevention programs. The AIDS Support Organization provides counseling and care for more than 35,000 persons with HIV/AIDS and has trained hundreds of counselors. Two possible reasons for the decline in the HIV seroprevalence that is now emerging in Uganda include: the AIDS epidemic either has reached a natural plateau or behavioral change has made a difference, improved treatment of STDs, and increasing availability and use of condoms has contributed to the reduction in HIV seroprevalence.
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