ACKNOWLEDGEMENT
I
DECLARATION
APPROVAL
DEDICATION
ACRONYMS
TABLE OF CONTENTS
ACKNOWLEDGEMENT………………………………………………………………………………………………………………………. i
DECRALATION……………………………………………………………………………………………………………………………….…. ii
APPROVAL………………………………………………………………………………………………………………………………………. iii
DEDICATION……………………………………………………………………………………………………………………………………. iv
ACRONYMS………………………………………………………………………………………………………………………………… v
CHAPTER ONE
Introduction, Background and Rationale………………………………………………………………………………………. 1
Problem Statement………………………………………………………………………………………………………………………. 4
Main Objective…………………………………………………………………………………………………………………………… … 4
Specific Objective…………………………………………………………………………………………………………………………... 4
Other Objectives………………………………………………………………………………………………………………….…………. 5
Project Justification………………………………………………………………………………………………………………………… 6
Scope of the project…………………………………………………………………………………………………………………...…. 7
CHAPTER TWO
Literature Review……………………………………………………………………………………………………………………………. .9
CHAPTER THREE
Methodology or Methods Used……………………………………………………………………………………………………. 10
CHAPTER FOUR
Challenges………………………………………………………………………………………………………………………………… 12
Recommendations and conclusion……………………………………………………………………………………………… 13
CHAPTER FIVE
CHAPTER ONE
This chapter involves the background and rationale of controlling the high growth rate of HIV/AIDS in
Nyondo Sub-county Mbale district, Problem statement, Project justification and Scope of the project
in Mbale city Eastern Uganda.
Introduction, Background and Rationale
Controlling the high growth rates of HIV/AIDS in Nyondo sub-county, Mbale district Eastern Uganda.
Human Immunodeficiency Virus is a zoonosis, “an infection or disease that originated in animals and
passed into human hosts”. Human Immunodeficiency Virus (HIV) is closely related to the Simian
Immunodeficiency Virus (SIV) found in chimpanzees in central Africa. This virus is called SIVcpz to
distinguish it from forms of SIV less closely related to HIV, found in other primates. SIVcpz causes an
AIDS-like illness in chimpanzees. SIVcpz is found in wild chimpanzees of two species (Pan troglodytes
and Pan troglodytes Schweinfurt ii) in southern Cameroon and north-eastern Gabo, as well as in
small groups in western Tanzania and the Democratic Republic of Congo (DRC).
SIV probably entered the human populations as a result of hunting and butchering chimpanzees. Its
plausible that transmission could have occurred through a hunter being wounded and blood from a
chimpanzee entering his bloodstream. These usually avoids human beings, so it’s likely that
chimpanzees crossed into humans as a result of human encroachment into forest areas. European
colonialist of equatorial Africa in the late 19th century led the exploitation of previously untouched
rainforests for farming of rubber and other commodities.
There are two major types of the human immunodeficiency virus: HIV-1 and HIV-2.
The most widespread type is HIV-1, which can further be divided into four groups. Each group
represents one virus transfer from a primate to a human all viruses in the group are descended from
that transfer;
GROUP M is the predominant form and accounts for almost all HIV-1 infections that have occurred.
GROUP N has been found in a small number of people in Cameroon.
GROUP O has been found in small number of people in Cameroon, Gabon, and Congo.
GROUP P has been found in Cameroonian woman in France. Its closely to SIVgor, a form of SIV found
in gorillas in a small area of southwestern Cameroon.
HIV-2 is similar to HIV-1 but causes severe immune deficiency less often. HIV-2 originated in sooty
mangabey monkeys in west Africa. it is descended from SIVsmm, a form of SIV that is similar to
SIVcpz. Using the technique as of HIV-1, researchers estimate that the two major groups of HIV-2
entered human population in 1940. At least eight separate groups of HIV-2 have been identified,
suggesting that numerous transfers have taken place. This was less easily transmitted during sexual
intercourse, HIV-2 infection seems to have spread in west Africa mainly through the use of non-
sterile needles and syringes to administer injectable treatment for sleeping sickness and tuberculosis
(Pepin, pp 247-50).
The first cases of AIDS were identified among gay men in the United States in 1981. (Center for
disease control and prevention) subsequent investigations have found probable cases in adults and
dating children back to 1978, supporting the view that HIV began to circulate in the United States in
the 1970s.
A family in Norway died of AIDS in 1976 and stored blood samples show that the father had acquired
HIV-1 type O while in Africa in 1961.
In Haiti, probable cases of AIDS were identified 1978 and 1979. The number of cases began to grow
from 1980 onwards, and cases of AIDS were also diagnosed in Haitians who had emigrated to the
United States and Canada.
Globally as of 2020, of all people living with HIV, 84% knew their status, 73% were accessing
treatment and 66% were virally suppressed.
Global estimates of the HIV epidemic-1997
Region Adults and children living with HIV/AIDS
Eastern Europe and central Asia 190,000
North Africa and middle east 210,000
Caribbean 310,000
East Asia, pacific and south pacific 432,000
Western Europe 480,000
North America 860,000
Latin America 1,300,000
South and south east Asia 5,800,000
Sub-Sahara Africa 21,000,000
In Africa, a disease known locally as “SLIM” began to appear in Rakai district of Uganda neighboring
districts of Kagera in Tanzania in 1980. In Zaire now “DRC”, illness subsequently recognized as AIDS-
related were recorded by hospitals in Kinshasa from 1975 onwards. A retrospective study of mothers
who gave birth in Kinshasa in 1980 found that 3% were HIV positive.
As one of the first countries in Africa where HIV was recognized, the effect of AIDS epidemic in
Uganda has been severe. Rakai district is 180 km outside the capital city of Kampala. HIV increased
rates rapidly throughout the country and by 1980s it appeared that Uganda had the highest rates of
HIV infection in Africa, and indeed in the world.
In 1982, the first case of “slim disease” in Uganda was identified in Rakai district. this disease was no
recognized as AIDS until 1985. AIDS is 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 mother-child transmission route. In two studies, the mother-child HIV
transmission rate reached 26%. 400,000-450000 Ugandans have died from HIV/AIDS. 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.
Many Ugandan celebrities have died due to the syndrome, before death, some accepted their fate,
they came out publicly and declared their statuses whereas for others we just had rumors since they
never came out to announce that they HIV positive till their death. Here is a list of some of the
Ugandan celebrities who have succumbed to the virus;
Philly Bongole Lutaaya was the first on the list because he’s the first Ugandan celebrity who came
out to say that is infected with the disease. He was a music maestro whose songs still hit the waves
up to now especially during Christmas festivals, he died on 15 December, 1989 when the virus is still
fresh in the eyes of the world.
Livingstone Kasozi was a kandongokamu singer whose name gathered mass in the 1990s due to his
constructive songs and died of HIV in 1997.
Sarah Birungi was a musical diva who died in 2002 due to HIV/AIDS. She was a band music singer
remembered for her song Okukula kweta.
Paul Job Kafeero died of AIDS IN 2007. He is a celebrated kandongokamu singer known for
illustrious musical career.
Martin Angume was a well-known musician for his single “switch”. He died in 2013 and it’s alleged
that he died of HIV/AIDS.
Harriet Kisakye was a band music singer who succumbed to death in 2015. It is alleged that the
musician died of HIV/AIDS.
As of 1998, UNAIDS estimates that 930,000 Ugandans are living with HIV infection or AIDS. In adults,
the infection rate is estimated to be 9.5%. It estimates that 1.8 million Ugandans have already died
of AIDS and there as many as 1.7 million children who have lost their mothers or both parents to
AIDS. In 1997, it is estimated that 160,000 Ugandans died of AIDS.
In 1986 the government of Uganda responded to the AIDS epidemic by becoming one of the first
countries in Africa to collaborate with the World Health Organization to create a national AIDS
control programme. The national AIDS programme includes 13 AIDS control programmes operating
out of 12 government ministries. The Uganda AIDS Commission is charged with coordinating the
overall programme which has carried out extensive education campaigns aimed at preventing
further spread of HIV.
Over the last three decades, there has been tremendous progress in curbing the HIV
epidemic in Uganda. HIV prevalence has declined from 18% in the 1990s to 6.2% in 2016
and 5.3% 2020 among 15-49 years old. Notwithstanding the high mortality rates among
patients with acquired immune deficiency syndrome (AIDS), the decline in the prevalence of
HIV is “partly” attributed to the use of HIV prevention services such as condom use, and
antiretroviral based prevention services, like in many other sub-Saharan countries.
The 95 95 95 Global goals aim to see people acquiring HIV reducing and increasing the
number on care and then [Link] control of diseases that are infectious where HIV is
one of them and a disease of a public health concern because it affects everyone,
government input in terms of human resource, drugs and in terms of equipment needed to
diagnose goes high so it’s a public health disease worth to be discussed because it puts a
constraint in terms of money and human resource. He puts emphasis on Mbarara city where
he is the focal person because there is a boundary geographically.
One of the current drivers of the HIV epidemic that threatens to undermine the success
story is the high incidence of HIV among high-risk groups or key population. Transport
workers like motorcycle taxi riders, truck drivers, and motor vehicle taxi drivers are among
the high-risk groups for acquiring HIV. HIV prevalence among transport workers varies
across countries “In Cambodia it ranged from 9.2 to 13.9% among truck driver”. The truck
drivers and motorcycle taxi riders in Mbale city in Eastern Uganda were 26% and 9.9%,
much higher than the national average of 12% and 5.4%, respectively.
The slum areas (hot spots) of Mbale city include Nabumali, Bugema, Kizungu, and Namatala.
The areas have many sex workers, motorcycle taxi riders, motor vehicle tax drivers (who are
residents of the area and its neighborhood), and stopover stations for truck drivers on
transit. According to the 2020 estimate, Mbale district has the fourth highest level of HIV
prevalence (13.1%) in Uganda when compared to the national average of 5.3%. among a
subset of transport workers in this case motorcycle riders (boda boda) in in Mbale city, a
previous study reported a 9.9% prevalence of HIV infections which was also above the
national average of 5.4%.
The 2024 report, health experts in Mbale city are raising alarms over an increasing trend of
people living with HIV dropping out of care, particularly women and girls. New HIV
infections are significantly higher among young women and girls aged 25 to 29 compared to
their male counterparts. “The high numbers of new infections are as a result of many young
girls engaging in unprotected commercial sex with men over 45 years old, for economic
reasons, which poses a challenge”.
In Mbale city, the number of new HIV cases between October last year and March this year
is notably higher among women than men, with 628 new cases in women compared to 408
in men. Young women are particularly affected, with 185 cases among those aged 20 to 24
and 150 cases among those aged 25 to 29. In contrast, there were only 34 cases among boys
aged 20 to 24 and 91 cases among those aged 25 to 29.
HIV/AIDS situation in Mbale city spans decades, the sentinel surveillance site in Mbale
hospital show persistent high levels of HIV infection among antenatal clients over the past
30 years.
Table: HIV/AIDS trends among antenatal attendees (1992-2002).
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
30.1 18.1 17.3 16.6 15.0 14.5 10.9 11.3 10.0 10.6 10.8
Source, District Health Office, Mbale District.
The rising HIV prevalence and dropout rates from ART programs underscore the urgent
need for targeted interventions sustained support to keep people in care and reduce new
infections.
In Uganda, since 2016, the test and treat strategy is employed for newly HIV diagnosed persons as
per the WHO recommendations. Viral Load (VL) testing is performed after 6 months following ART
(Antiretroviral therapy) initiation and every 6 months for those that have HIV VL suppression.
This progress is highly unequal, because non-suppression among adolescents. The very few papers
are available used data from the largely urbanized central region, ignoring rural areas or societies in
the East such as Mbale district. Non-suppressed adolescents are more prone to HIV related
morbidity and mortality that could be circumvented through IAC and support. IAC mitigates subpar
adherence that is common among adolescents and leads to drug-resistant HIV strains, which require
expensive second-line or third-line treatments.
The influence of various determinants of VL non-suppression varies among population, age groups,
and settings, requiring contextual data to inform remedial measures among adolescents. Therefore,
understanding the distinct determinants of VL non-suppression among adolescents will give all
stakeholders new insight into HIV infection among adolescents. It will further motivate adolescents
to adhere to medication, thus sustaining the relevance of affordable first-line treatments by
preventing drug resistance and also help attainment of the third UNAIDS 95-95-95 target. This is
aimed to describe factors associated with non-viral suppression among adolescents in Nyondo sub-
county, Mbale district.
Mbale district in Eastern Uganda boasts a population of 584,715 as of 2024. 51% are female, and
over 90% of the population is rural areas. Mbale district is a largely impoverished with a high HIV
prevalence. While the general prevalence of HIV in Mbale is 5.3% that of adolescents is 7%. Primary
care facilities in Uganda are organized by administrative division and include health center II (Parish),
health center III (sub-county), and healthy center IV (county). Mbale has numerous health facilities,
including special clinics, HCIII, HCIV and referral hospital providing HIV services, backed by the
government of Uganda and private funders. Mbale district has several health centers i.e., Bumbobi
health center IV, Naiku Health center II, Bunampongo Health center III, Lwakoli Health center IV,
Busiu Health center IV, Nyondo Health III among others, including Mbale referral hospital and
private hospitals like mt. Elgon. Mbale district, is a district in eastern Uganda, 245 km from the
capital city Kampala.
People living with HIV in Mbale city, called upon the government and other stakeholders to
address specific needs in the fight against HIV and recruit sign language experts at health
centers to assist the deaf.
The settings of the project are to investigate the influence of individual factors and
utilization of multiple HIV prevention services among transport workers, people dropping
out of and non-suppression among adolescents in Eastern Uganda. The findings of the study
will inform tailor-made interventions aimed at increasing access and utilization of HIV
prevention services among transport workers, people dropping out of care and non-
suppression among adolescents in Mbale city, Uganda and other similar sub-Saharan Africa
settings.
Problem statement.
The growing number of commercial sex workers in urban areas and transport workers like
motorcycle taxi riders, truck drivers, and motor vehicle taxi drivers are among the high-risk
groups for acquiring HIV. The truck drivers and motorcycle taxi riders in Mbale city in
Eastern Uganda were 26% and 9.9%, much higher than the national average of 12% and
5.4%, respectively. Due to the high number of the people coming in and out from boarders
of eastern Uganda like Malaba and Busia, which causes non-suppression among adolescents in
the region. The very few papers are available used data from the largely urbanized central region,
ignoring rural areas or societies in Mbale district leading to increased trend of people living with
HIV dropping out of care, particularly women and girls. New HIV infections are significantly
higher among young women and girls aged 25 to 29 compared to their male counterparts.
“The high numbers of new infections are as a result of many young girls engaging in
unprotected commercial sex with men over 45 years old for economic reasons, sexually
active youth between (15-35), school dropout, improper use of condoms, and use of
electronic media and ICT exposing young people to pornographic materials, which poses a
challenge”. In Mbale city, the number of new HIV cases between October last year and
March this year is notably higher among women than men, with 628 new cases in women
compared to 408 in men. Young women are particularly affected, with 185 cases among
those aged 20 to 24 and 150 cases among those aged 25 to 29. In contrast, there were only
34 cases among boys aged 20 to 24 and 91 cases among those aged 25 to 29, HIV/AIDS
situation in Mbale city spans decades, the sentinel surveillance site in Mbale hospitals, show
persistent high levels of HIV infection among antenatal clients over the past 30 years.
MAIN OBJECTIVE
To provide quality services for people living with HIV in Mbale city for sustainable progress
and development, reduce the prevalence of the disease by mitigating the impact on the
general population, and increase knowledge, skill and promote behavior change on
HIV/AIDS through appropriate communication channels.
SPECIFIC OBJECTIVE
To improve access to and utilization of ARVs among teenagers in Mbale city.
To provide knowledge and skill on HIV/AIDS prevention to the youths “especially young
women and girls”.
To strengthen and expand services for people who are sexually transmitted with infections.
To increase access and promote the correct and consistent use of condom in the general
population and among youths.
To prevent HIV/AIDS transmission by ensuring the availability of safe blood nationwide.
To strengthen and expand the national capacity to design, implement and evaluate
HIV/AIDS programmes in Mbale city.
To reduce HIV/AIDS transmission from parent to child through the provision of services for
the parent to child Transmission (PPTCT).
PROJECT JUSTIFICATION
SCOPE OF THE PROJECT
The project is going to be implemented in Nyondo sub-county, Mbale district IN Eastern
Uganda. Aiming at building up a health facility or referral hospital in Nyondo sub-county, to
extend community services like consoling, treatment and knowledge about prevention of
HIV/AIDS nearer to people in and around the area of Mbale district. It’s funded by Ministry
of Health, Government of Uganda, NGOs, WHO, UN and UNSAID.
CHAPTER TWO
This chapter relate to literature review of other authors who came up with an idea of
controlling the high prevalence of HIV/AIDS in Mbale city, Uganda and at global basis.
Literature Review.
The AIDS Healthcare Foundation Uganda cares is affiliated of Los Angeles in USA, the largest
global AIDS Organization which provides HIV/AIDS care and services including Anti-
Retroviral Treatment to more than 1.5million people in 45 countries. AHF opened the first
clinic in Masaka in 2002 in close partnership with the Uganda Ministry of Health, offering
the first opportunity for Anti-Retroviral Treatment outside the capital city of Kampala.
Today, AHF Uganda cares serves more than 100,000 clients making it one of country’s
largest provider of free HIV/AIDS services. AHF offers free and confidential rapid HIV and STI
services including, testing, care and treatment, counseling, and advice for all who need it.
THE AIDS INFORMATION CENTER (AIC) was established in February 1992 to provide
anonymous, voluntary and confidential HIV testing and selling services to the people of
Uganda. The center operates with understanding that knowledge of ones own HIV infection
status is an important intervention in controlling HIV infection. High public awareness of HIV
and increasing numbers of persons sick and dying with AIDS resulted in many Ugandans’
wanting to know their sero-status. Since 1990, AIC has served more than 370,000 clients in
Kampala and at branch offices in Jinja, Mbarara and Mbale. They offered services like HIV
testing and counseling, on-going psychosocial and medical support through the post test
club, counseling and treatment for sexually transmitted diseases and other medical
problems, condom distribution and community outreach programmes.
THE WORLD HEALTH ORGANIZATION (WHO) has been collecting countries stories from
around the world to showcase exemplars of IPC (Infection Prevention and Control)
implementation as they relate to the WHO core components. They always bring up
programmes like 95 95 95 in Mbarara city which helped experts to fight the high prevalence
of HIV and people dropping out of care as they came up with a solution and offered services
to the community like counseling, treatment and offering knowledge about HIV prevention
hence reducing the number of people living with AIDS.
AMICAALL (Alliance of Mayors Municipal Leaders On HIV/AIDS In Africa) Mbarara municipal
Council appreciated the importance of having in place a workplace policy on HIV/AIDS.
Mbarara municipality like other urban areas has a higher HIV prevalence compared to rural
areas.