The Commissioner National Disease Control in the Ministry of Health, Dr. Patrick Tusiime has expressed concern that in the management of HIV, Uganda has paid more attention to treatment with little resources allocated for prevention services and programs. He said this state of affairs leaves a lot to be desired. “This is a real problem and we need to pick the key findings from these studies and use them for planning in the Ministry of Health. It is true that we have made progress in HIV prevention in Uganda, but we need to address the need of the key populations”, he said. Dr. Tusiime was speaking at the dissemination ceremony for Crane Survey 2; a survey conducted in Kampala among female sex workers, men having sex with men, transgender women, Congolese refugees, persons with multiple sex partners, and drug users. The Crane Survey is a collaborative activity between Makerere University School of Public Health, the US Centres for Disease Control and Prevention, and the Ministry of Health (STD Clinic, AIDS Control Programme), Kampala, Uganda. The collaboration is funded by President’s Emergency Fund for AIDS Relief-Uganda.   

At the dissemination, Dr. Patrick Tusiime gave the research team an open invitation to present the findings to the Ministry of Health top management. “The Crane Survey is addressing the data gaps that the Ministry of Health has in programming. We need to serve all Ugandans without discrimination and as we talk of the 90-90-90, nobody should be left behind”. 

 

Dr. Tusiime speaking at the event

According to the survey, these key populations have higher than national average HIV prevalence; 16.6% among drug users, 31.3% among female sex workers, 13% among Men having sex with Men, 25% among persons with multiple sex partners, 6.1% among Congolese refugees and 20% among the transgender women. 

The dissemination meeting held at Golf Course Hotel, in Kamala was attended by participants of the different studies, implementing partners, UN agencies and civil society organisations.  They all appreciated the findings as very useful for planning and decision making at various levels. “The female sex workers size estimation will help with the planning for the female sex worker-led organisation that I represent. Bu we need the study expended because female sex workers are everywhere”, said Ms. Diana Natukunda a female sex worker.

Ms. Natukunda contributes to the discussion 

Mr. Samuel Ganaafa, a representative from Spectrum – an organisation for men having sex with men- wondered how the Crane Survey team can use the survey findings to influence policy making to address the needs of men having sex with men given that this is a legally and socially excluded group in Uganda.  

Closing the dissemination meeting, the Dean Makerere University School of Public Health, Associate Professor Rhoda Wanyenze pointed out the need to rethink coverage and packaging of interventions to reach out to key populations. “We want to see decline in some indicators in the next round of Crane Survey. Beyond HIV, we need to think about other issues that contribute to HIV, e.g. gender violence, Hepatitis, among other issues. There is need to design broader, comprehensive interventions and scale up, as well as being able to sustain such studies to keep informing policy and programming. In order to have national level size estimates we have to expand coverage of the studies, she empasised”.

She also pointed out the need to engage students at the Makerere University School of Public Health in conducting the studies to build capacity.

Associate Professor Rhoda Wanyenze, Dean MakSPH

Uganda faces a generalized HIV epidemic, with a national adult HIV prevalence estimated at 7.3%.  With national HIV prevention activities focused on the general population, relatively little attention is given to key populations, their contribution to the HIV epidemic, and their needs for HIV prevention and care.

Men who have sex with men (MSM), transgendered women (TG), female sex workers (FSW), and drug users (PWID) are known to be high risk groups for HIV infection in all settings, including generalized HIV epidemics. Key populations and their linked bridging populations are also important contributors to the HIV epidemic in the general population. Bridging populations may be seen as sex partners of key populations who then may interact with people at lower HIV acquisition risk in the general population, increasing the likelihood for the HIV epidemic to spread from high-risk populations to the general population. Key populations (KP) are likely to have specific needs for HIV prevention, care, and treatment.  In Uganda there remains a dearth of HIV prevention activities tailored to KP-specific needs and risk factors.  As in many other countries, in Uganda, many key populations and associated behaviours are highly stigmatized.  Homosexuality, sex work, as well as illegal drug use are also punishable by Ugandan law.

Left; some members of the study team (Dr. Herbert Kiyingi of CDC Uganda, Dr. Wolfgang Hladik of CDC Atlanta and Professor David Serwada of Makerere University School of Public Health) responding to questions and comments during the dissemination of the survey. Right; some of the study participants that attended the dissemination

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