Human immunodeficiency virus and AIDS in Uganda.

ABSTRACT

PIP: In 1982 the first cases of "slim disease" in Uganda were identified in Rakai District. This disease was not recognized as AIDS until 1985. AIDS is now a serious public health problem for Ugandans. Currently, about 1.5 million Ugandans have HIV infection, acquired mainly via heterosexual transmission; about 10% acquired HIV infection via the mother-child transmission route. In two studies, the mother-child HIV transmission rate reached 26%. 400,000-450,000 Ugandans have died from HIV/AIDS. HIV/AIDS is associated with the death of about 50% of adults in some areas of Uganda. Between 1993 and 1995, there has been a significant decrease in HIV seroprevalence among pregnant women in Kampala as well as in two rural communities. Cases and hospital admissions of tuberculosis (TB) have risen markedly in Uganda. Clinical manifestations of HIV infection include Kaposi's sarcoma, cryptococcal meningitis, toxoplasmosis, cardiomyopathy, and atypical or extrapulmonary TB. Uganda has well-developed HIV-focused epidemiologic and clinical research programs, particularly those addressing TB, maternal-child HIV transmission, and sexually transmitted diseases (STDs). The response to the HIV/AIDS epidemic in Uganda has been unique. The government has openly addressed it since the late 1980s, and this has opened the doors to the creation of innovative services for education, testing, and counseling and care for AIDS patients. Both the government and nongovernmental organizations have developed extensive HIV prevention programs. The AIDS Support Organization provides counseling and care for more than 35,000 persons with HIV/AIDS and has trained hundreds of counselors. Two possible reasons for the decline in the HIV seroprevalence that is now emerging in Uganda include: the AIDS epidemic either has reached a natural plateau or behavioral change has made a difference, improved treatment of STDs, and increasing availability and use of condoms has contributed to the reduction in HIV seroprevalence.