The preliminary results of 2016 Uganda Population HIV Impact Assessment (UPHIA) demonstrate that Uganda has made significant progress in the national HIV response. HIV prevalence has declined across socio-demographic sub groups and across the country. This decline may be a result of falling new HIV infections.
Furthermore, almost 60% of people living with HIV (PLHIV) have suppressed viral load which means that treatment programs are successfully reaching the majority of the population with HIV.
Results of the 2016 Uganda Population HIV Impact Assessment (UPHIA) indicate that the current prevalence of HIV among adults aged 15 – 49 years in Uganda is 6% (this means that 6% of adults aged 15-49 years in Uganda are living with HIV).
Among children under age five years, HIV prevalence is 0.5%, while among those aged 5 – 14 years, it is also 0.5%. Based on the survey results, the total number of adults and children of all ages living with HIV in Uganda is estimated to be approximately 1.3 million
These results are based on the 2016 UPHIA, a nationwide survey that was conducted to provide estimates of HIV incidence, HIV prevalence, viral load suppression, syphilis, hepatitis B infection, and other important HIV/AIDS programme indicators.
Data were collected in all districts of the country from a sample of households that are representative of the Ugandan population. The survey was conducted from August 2016 to March 2017 from 12,483 households and achieved very high participation rates of over 95% for both interviews and blood draws.
A total of 16,670 women and 12,354 men aged 15-64 years were interviewed and tested for HIV, syphilis and hepatitis B. In addition, 10,345 children aged 0-14 years were tested, including 6,527 aged 0-4 years and 3,818 aged 5-14 years
Adult HIV prevalence was higher among women at 7.5% compared to 4.3% among men. It was also higher among residents of urban areas (7.1%) compared to 5.5% in rural areas.
The magnitude of HIV varied considerably among the ten geographic regions in the survey, from a low of 2.8% in West-Nile; 3.4% in North East region; 4.4% in East Central (or Busoga region); 4.8% in Mid-East region; 5.5% in Mid-West region; 6.6%
In Kampala; 7.4% in Central 2 (Greater Mubende, Luwero and Mukono); 7.6% in Central 1 region (greater Masaka); to 7.7% in South Western region.
This is similar to the findings of the 2011 Uganda AIDS Indicator Survey (UAIS) when Mid-Eastern showed the lowest, and Central 1 the highest estimated HIV prevalence.
The HIV prevalence among young people 15 – 24 years was 2.1% (0.8% in men and 3.3% among women). Among adults, HIV prevalence is lowest in those 15-19 years. It is highest among men aged 45 to 49, at 14.0%. Among women, HIV prevalence is highest in the age groups of 35 to 39 years and 45 to 49 years, at 12.9% and 12.8%, respectively.
The 2011 Uganda AIDS Indicator Survey estimated national HIV prevalence among adults at 7.3% compared to 6.0% in 2016 UPHIA. Among women and men, HIV prevalence declined from 8.3% and 6.1% in 2011 to 7.5% and 4.3% in 2016 respectively. In urban areas, it declined from 8.7% to 7.1% while in rural areas it fell from 7.0% to 5.5%. These declines in HIV prevalence may be due to a decreasing number of new infections in recent years due to the impact of the intensified HIV prevention and treatment services in the country.
The 2016 UPHIA also established the rates of suppressed HIV viral load (VLS) which is a marker of effective treatment. People living with HIV (PLHIV) with suppressed viral load live longer, have fewer complications due to HIV, and are less likely to transmit the virus to others.
UPHIA showed that adults age 15-49 years had a VLS of 57.4%; this finding shows that with support from development partners such as PEPRAR, the Global Fund and other programs, the Government of Uganda’s HIV programme is having an impact and making great progress toward the UNAIDS and national goal of having population level VLS of at least 73% by 2020.
Interventions are needed to ensure young people know their status and if HIV positive are linked to care.
Male circumcision is one of the strategies for HIV prevention in Uganda. The proportion of men aged 15-49 years that are circumcised has increased from 26% in 2011 to 43% in this survey. The proportion of men circumcised ranges from 14% in Mid Northern region to 69% in Mid-Eastern region. The prevalence of male circumcision was highest among young people 15 – 29 years at over 45%.
UPHIA also established the magnitude of syphilis and hepatitis B infection in the general population. The prevalence of active syphilis among adults aged 15 – 49 years was 1.9% (2% among women, and 1.8% among men).
This was similar to the findings in 2011 in which the prevalence of syphilis was 1.8%. The prevalence of active hepatitis B infection among adults was 4.3% (5.6% among men and 3.1% among women).
Hepatitis B prevalence was highest in the Northern Region: Mid North (4.6%), followed by North East (4.4%), and West Nile (3.8%). Hepatitis B infection was lower in the rest of the country with a range of 0.8% in the South West region to 2.7% in East Central Region.
In spite of the progress that has been made, the burden of HIV infection in the country is still unacceptably high. More prevention, awareness creation, and treatment is needed for those 15-29 years. These results call for concerted efforts from all stakeholders for scale up of evidence-based interventions for sustainable HIV epidemic control.