Children below the age of 15 account for 11 per cent of the 1.6 million Ugandans living with HIV (2013 estimates). With the roll-out of Option B+, there has been a significant drop in new mother-to-child HIV infections, from 8.7 per cent in September 2012 to 7.9 per cent in 2017 (UNAIDS Estimates). Furthermore, preliminary data from the 2016 Uganda Population-based HIV Impact Assessment shows an 18 percent decline in HIV prevalence in the general population (15-49 years) from 7.3 percent in 2011 to 6.0 percent in 2016.
Turning the tide against AIDS wil require more concentrated focus on adolescents and young people
However, Uganda still lags behind in attaining validation for elimination of mother to child transmission (eMTCT) of HIV; Uganda’s MTCT case rate is 466 per 100,000 against the validation target of 50 per 100,000. To achieve eMTCT validation, it is required that the HIV prevalence among women aged 15-49 years from 5.9 to 2.5 per cent or the MTCT rate from 7.9 to 0.22 percent by reduced new infections among women and reduced transmission rate by increasing coverage of PMTCT services or improving effectiveness of regimens especially among adolescents and young women (AGYW).
High disparities remain between regions, and HIV continues to affect adolescents, especially girls, disproportionately; HIV Prevalence among AGYW is 4 times higher than boys of the same age group. Two thirds of all new HIV infections are found in adolescent girls (AG) in Uganda and yet only 30 per cent of Adolescent Girls receive HIV testing Services (HTS) at outpatient departments (UNAIDS). While the absolute number of AIDS-related deaths in children below 5 years dropped by more than 50 per cent between 2000 and 2017, the number of adolescents who lost their lives to AIDS doubled during the same period.
Adolescent girls are more vulnerable to HIV infection because their reproductive systems are not fully developed. Gender inequality and patriarchal norms also make it difficult for girls and young women to negotiate safe sex; Transactional sex reported by AGYW is 24 per cent and. cross generational sex among sexually active AG 10-14 is at 60 per cent (Risk Behaviour study 2017). Female SGBV prevalence is 22 per cent predisposing them to early pregnancies and HIV (UDHS, 2016).
With the success of the national HIV treatment programme, many children born with HIV are entering their adolescent years. Uganda now faces an unprecedented HIV and AIDS burden among adolescents, which also comes with opportunistic infections such as tuberculosis (TB) – a major threat to the survival of people living with HIV and AIDS.
Adolescents not only need improved access to screening and continuing treatment but also support to live positively with the disease and not pass it on to others. While adolescents grapple with the reality of living with HIV and AIDS, very young children are also being left behind. Paediatric HIV services lag considerably behind those for adults and pregnant women. While 92 per cent of infected women receive antiretroviral treatment (ART,) only 49 per cent of babies born to HIV-positive mothers are getting HIV medicine for six weeks after birth (2019 MoH PMTCT report). This gap between adult and child access to HIV treatment needs to be closed urgently.