Kyetume, Uganda - One of the African countries worst hit by Aids, Uganda has drastically cut infection rates by distributing free drugs and condoms, and holding campaigns to dispel HIV's stigma.
But the effectiveness of medication could cause a lapse in caution.
Nurse Margret Nanyonga frantically leafs through a heap of medical files while attending to people queueing for free antiretroviral drugs at a health centre in central Uganda.
About 900 out of a total 2 000 regular patients at the centre in Kyetume east of Kampala are HIV positive, the nurse says.
“Two years ago, they were 600. And the number of people enrolled here for Aids drugs is increasing. People are rushing to get the drugs,” she adds.
But more HIV patients does not mean one of the African countries most affected by the epidemic - where entire villages were nearly wiped out by Aids in the early 1990s - is losing the battle. On the contrary.
“It is not that the number of infected people is increasing. It is (that) people are seeing the importance of treatment,” Nanyonga says.
Uganda's HIV prevalence rate has gone down to 7.3 percent of the population in 2011 from 18.5 percent in 1992, according to the latest figures.
The number of new infections declined to an estimated 137 000 this year from about 162 000 in 2011, according to the United Nations agencies UNAIDS and Unicef.
About 680 000 Ugandans are taking antiretroviral drugs, up from 324 000 in 2011. Medication has helped reduce the number of Aids-related deaths to about 61 300 in 2013 from nearly 73 000 in 2011, according to the UN agencies.
“About 90 percent of Ugandan pregnant women who are HIV positive are on treatment and this has led to the number of babies born with the virus getting lower,” said Musa Bungudu, the Uganda director of UNAIDS.
People like Richard Aliwaali, who has been living with the virus since 1998, have teamed up with health workers to encourage social acceptance of HIV.
“We are telling people not to fear. We are telling people we have HIV and that they should not point fingers at those who are infected,” says the 49-year-old, who lost his wife to Aids in 2003.
Shortly after he took office in 1986, President Yoweri Museveni also launched a campaign promoting abstinence before marriage, monogamy in marriage and condoms as a last resort.
The number of condoms distributed by the government free of cost has risen to 100 million this year from 85 million in 2012, Deputy Primary Care Health Minister Sarah Opendi said.
“The demand is high but due to financial constraints, we are only able to procure a quarter of what is needed. That shows that people actually use the condoms,” she added.
Angello Nsereko, chairman of Kawuga village 18 kilometres east of Kampala, confirms that young Ugandans are keen to get condoms.
“I have been giving them out, especially in beer bars and disco halls,” he says.
But Museveni's information campaign has been less successful in persuading Ugandans to be monogamous.
“I know so many of my friends 1/8who are 3/8 with many women,” says Richard Kulanga, a 40-year-old shopkeeper at Bugujju trading centre 22 kilometres east of Kampala.
Antiretroviral drugs that make HIV positive people look healthy could paradoxically be favouring the spread of the disease, he says.
“Medicine makes it difficult to know that someone is sick. People are going out with sick people who look healthy. Women at home may be taking precautions, but the men bring the virus home to them,” Kulanga adds.
An extensive US-funded survey conducted in 2011 found that only 38 percent of men and 29 percent of women who were sexually active used condoms regularly. It also found that significant numbers of people, especially men, had relationships outside of marriage.
Uganda's anti-HIV programme - supported heavily by donors, who contribute about 20 percent of the country's health budget - does not yet reach all those in need of drugs.
While 822 000 of the estimated 1.6 million infected with HIV are drug candidates based on the amount of virus in their blood, only 680 000 receive drugs regularly.
And more than half of new infections occur in people aged between 14 and 24 years.
“Young people . (are) one of the most sexually active segments of the population,” Bungudu says. “People in these age brackets are daring, adventurous and very likely to engage in reckless sex.”
A new campaign to launch awareness about HIV among young people was launched recently by Museveni, who kicked the first ball of a match between his cabinet and lawmakers under the motto “This is your game - do not let Aids score.” - Sapa-dpa