Flat funding, harsh laws could hurt Uganda's battle against HIV

Inadequate funding coupled with harsh laws targeting same sex unions could erode the gains so far made in the fight against HIV in Uganda, activists warn.

While the Anti-Homosexuality Act (AHA) is already in force, activists have expressed fears that the HIV/AIDS Prevention and Control Bill 2014 - passed by parliament on 13 May and stipulating fines and jail terms of up to 10 years for those found guilty of "willful and intentional" transmission but still awaiting presidential assent - could stigmatize those with the virus and restrict access to health.

On 12 June, Finance, Planning and Economic Development Minister Maria Kiwanuka announced in her 2014-2015 budget speech that the government had allocated US$38.5 million, the same as the previous financial year, to enroll a further 100,000 people living with HIV on life-prolonging anti-retroviral (ARV) drugs.

"This financial year [2014/2015] budget comes when the response to HIV is at a crossroads in Uganda," Asia Russell, Health GAP's director for international policy, told IRIN.

"Uganda must ensure at least 190,000 additional people are newly enrolled on HIV treatment this coming financial year - maintaining the current pace of treatment scale-up - in order to save lives and help halt sexual transmission. Now is not the time for government to flat-line national funding for life-saving medicines. The budget for ART [anti-retroviral therapy] should increase by 50 percent at minimum," she said.

Dennis Odwe, executive director of the Action Group for Health, Human Rights and HIV/AIDS (AGHA), said: "Investing US$38.4 million annually for treatment is a drop in the sea when 1.3 million people living with HIV/AIDS need treatment and the new infections are increasing every year."

Civil society groups have called on the Ugandan parliament to reject the budget proposals unless the government increases investments to help those with HIV, child and maternal health and the recruitment and motivation of health workers.

"Civil society demands the national budget for financial year 2014/2015 prioritize life-saving health service delivery for pregnant women and children, people living with HIV, TB and malaria," said a 19 June statement signed by 60 civil society organizations.

Health Gap's Russell said: "The harmful legal and policy environment - intensified by AHA and the HIV Prevention and Management Bill in particular - are taking the country's AIDS response backwards."

According to AGHA's Odwe, criminalizing HIV transmission could prevent people from voluntarily testing and "knowing their HIV status".

Over the past five years HIV prevalence in Uganda has risen from 6.4 to 7.3 percent.

According to the Uganda AIDS Commission, the country's HIV response is externally funded to the tune of 67 percent.

Some donors withhold funding

Already, several bilateral donors such as the USA, Sweden, the World Bank and Norway have suspended, slashed or withheld aid to Uganda worth about $140 million, to protest against AHA.

For instance, on 19 June, the US government announced it had imposed sanctions, including travel bans, cancellation of military cooperation and funding to the Ministry of Health over Uganda's poor human rights record including the enactment of AHA.

In response, the Ugandan government said it considered the announcement by the US "regrettable as some of the halted funding and programs in Uganda are those that will affect the most vulnerable people that the US government purports to support and aims to protect."

Government statistics show that Uganda enrolled some 194,000 new HIV patients on ARVs in 2013, bringing to 570,370 the number of those on ART. This, however, represents less than 70 percent of the 1.3 million people in need of treatment. The government has set a target to reach 80 percent of HIV-positive people with ARVs by 2015.

"The country is caught between a rock and a hard place. Unfortunately, as we shall see [even] more new infections…, the government has less and less resources to do the much-needed prevention work. The end to AIDS is so far away for us," Milly Katana, a long-term HIV activist, told IRIN.

Margaret Happy of the International Community of Women Living with HIV in Eastern Africa told IRIN the fight against HIV required both resources and a favourable legal environment. "Commitment to HIV response requires resources but also [a] conducive legal environment. If the legal environment is not friendly, resources may be there and the services in plenty, but who will access it?"

Meanwhile, government officials told IRIN ways are being explored to find resources to fill the gaps left by the funding cuts.

"The government will continue to mobilize and increase resources for prevention, care and treatment of HIV," Asuman Lukwago, the permanent secretary in the Ministry of Health, said.

The HIV and AIDS Prevention and Management Bill 2014, for instance, establishes the legal framework for an HIV Trust Fund to finance local-level programmes using money generated by levies on bank transactions and savings interest, air tickets, beer, soft drinks and cigarettes, as well as taxes on goods and services traded within Uganda.