By Dr. Freddie Ssengooba
Kampala, Uganda
As we exhaust the simple solutions to control the spread of HIV/AIDS, we are left with the task of tackling the complex ones.
Despite Ugandas leading role in reducing the spread of the HIV infection from about 25 to 6 per cent of the population, the recent estimates show that there are over 110.000 new infections each year.
Already, over 150.000 persons are on HIV treatment and about 600.000 are yet to start the treatment.
There is, therefore, a big buildup of HIV infected persons that will need life-long treatment and palliative care services.
Currently, most of these services are provided by donors such as US government Ireland, the UK, the World Bank and countries contributing to the Global Fund. Without this support, Uganda cannot shoulder the burden.
As the simple solutions to prevent new HIV infections are exhausted, Uganda is faced with more complex causes of HIV transmission.
A major source of new infections is unsafe sex among the discordant (uoverensstemmelse) couples and the youth. Discordant couples refer to marital relationships where one partner has HIV and the other does not. This contributes to about 60 per cent of the new infections among adults.
About a-quarter of the new infections are emerging from persons aged 25 years and below. The increasing number in the population implies that more individuals have HIV at the current population of 35 million people.
The new infections in 2002 were estimated at 70.000 compared to about 110.000 in 2006. The increase in population is mostly responsible for more cases of HIV among the Ugandans.
Although male circumcision is not 100 per cent effective, it is the most feasible solution to reduce HIV infection among young couples. The youth face several huddles as they transit into marriage and becoming parents.
Simple solutions of abstinence from sex and using condoms soon become erratic, irrelevant or sustainable over a long time.
A young couple will need to have children and will at some stage abandon the condom. In the short-term, the couple can test for HIV before getting marriage but many married couples acquire the infection during their marriage.
According to a 2005 survey by the Ministry of Health and the Uganda Bureau of Statistics, one couple in every five has an extra-marital sex problem. The survey shows that extra-marital sex is a window for HIV to invade erstwhile clean couples.
To prevent HIV infection arising from extra-marital sex, the current solution is that the practice must be stopped or condoms must be used.
The use of condoms in extra-marital sex was found to be only 34 per cent during the Demographic and Health Survey of 2006. The implication is that 64 per cent of all the extra-marital sex every day is prone to HIV infection.
As we advocate for abstinence (seksuel afholdenhed), faithfulness and the use of condoms, we need to provide contingency plans for those that fail on all these solutions.
With circumcision of boys and men, we will be providing a contingency method to the persons that are reckless in their sexual behaviour. Male circumcision can provide a safety-net that is 50 per cent effective in preventing new infections.
There is no doubt that male circumcision is more complex than radio and drama massages to promote abstinence or the use of condoms.
We have reached a time in the evolution of the HIV/AIDS epidemic where the simple ABCD (Abstinence, Being-faithful, Condoms and Drugs) approach is not sufficient to plug all the holes in HIV transmission.
The public and our leaders need to seize the challenge and prepare for the tough solutions such as male-circumcision.
The writer is a lecturer at the Makerere Institute of Public Health
Kilder: New Vision (Uganda) – AAGM og The Push Journal
